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Abstract
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Introduction
Bone growth is an important entity in the process of fracture healing and bone fusion. Spinal fusion is the major procedure in order to obtain stability in degenerative or traumatic conditions. The ideal material should be osteoinductive and osteoconductive leading to rapid bone growth. The aim of this study is to present the new porous trabecular titanium (PTT), 3D electron beam melting (EBM) designed, and the perspective of use in orthopedic and spine surgery.
Methodology
Description of the basic research on porous trabecular titanium and the different derived product already used. The porous trabecular titanium 3D EBM is nowadays used in cervical and lumbar cages (MT Ortho, Aci Sant'Antonio, Sicily, Italy). This material is actually under investigation in the form of titanium microspheres as cement replacement. The safety, biomechanical proprieties, risks and benefits of each products are analyzed.
Results
In vitro studies have shown that porous trabecular titanium 3D EBM are osteoinductive and osteoconductive. It was demonstrated in the cervical cages that the bone matrix could rapidly adhere and grow in the cage, leading to quick segmental stabilization. Preliminaries studies show a fusion rate in 83.3% of the patients and bony growth through the cage in 100% at 3 months. For the titanium microsphere, a preclinical study has shown good biomechanical stability. A first phase clinical study on 15 patients has confirmed the biomechanical stability and demonstrates less risk such as cement leak, temperature damage or pulmonary embolism.
Discussion
Porous trabecular titanium 3D electron beam melting is a promising material in bone growth stimulation. It can be used in a large variety of implants. In spine surgery, it allows rapid bone growth which is an imperative condition for fusion and segmental stability. The same material is also used in fractures as a cement replacement leading to greater stability and better bone healing with fewer complication risks. The osteoinductive and osteoconductive properties of the PTT 3D EBM can be exploited in orthopedic surgery, such as in important bony defects, avascular necrosis of bone or traumatic bone loss.
Conclusion
Porous trabecular titanium can be widely and safely used as a bone growth stimulator. The potential of product development based on porous trabecular titanium is encouraging for further therapeutic use in pathology needing a rapid bone growth.
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