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Along with biomechanically optimized implant designs and bioactive coatings for enhanced bone ingrowth, the indications have gradually been expanded to include even THAs in elderly patients with impaired bone quality and limited healing capacity (Keisu et al. 2001, Kelly et al. 2007, Meding et al. 2010, Mäkelä et al. 2010, Thillemann et al. 2010).
There was experimental evidence that HA was in fact well tolerated by the organism without leading to foreign body reactions (Nery et al. 1975), that HA coating enhanced bone ingrowth (Jarcho et al. 1977), and that implants coated with HA showed improved fixation to surrounding bone tissue (Ducheyne et al. 1980).
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The primary stability enhanced bone ingrowths which prevent micromotion, loosening, and concomitant failure.
These properties are essential for enhancing bone ingrowth in load-bearing applications.
In the case of porous implants, calcium orthophosphate coatings enhance bone ingrowth into the pores (Suchanek and Yoshimura 1998).
This indicates that 400 μm is not the maximum pore size to enhance bone ingrowth.
The superiority of our structures suggests that a large pore size and high porosity enhance bone ingrowth and support the importance of surface characteristics influencing bone ingrowth.
It was therefore hypothesized early on that coating of metallic implants with HA would enhance bone ingrowth and thus lead to better initial or even long-term stability.
Hydroxyapatite enhances bone ingrowth and provides for a durable and lasting construct.
The latter increases the surface area of Ti cathodes indicating potential applications for enhancing bone cell ingrowth in medical implants as well as lowering the bone-metal stiffness mismatch.
It is a well-known fact that bisphosphonates inhibit osteoclast-mediated bone resorption, play an important role in the healing of fractured bones, reduce osteoarthritis, prevent prosthetic migration or enhance bone allograft ingrowth [ 22– 25].
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