Mechanical and chemical bonding of artificial joints

Biomaterials which create chemical and mechanical bonds with tissue, i.e. (1) non-porous materials with or without a hydroxyapatite coating, (2) porous titanium alloy (beads) with or without a hydroxyapatite coating, (3) alpha-tricalcium phosphate bioactive bone cement and PMMA cement, and (4) interface bioactive bone cement made by interposing hydroxyapatite granules between polymethylmethacrylate cement and the bone, were used in animal experiments and clinical applications. The common problem with cementless fixation is that some patients complain of slight pain on weight-bearing, because a complete initial fixation is not obtained and micro-movement of the component may occur. Porous metal with hydroxyapatite coating is found to be better than that without coating for producing earlier and stronger fixation, and problems with fatigue and peeling of hydroxyapatite from the base metal are eliminated when the beads are coated with hydroxyapatite. As hydroxyapatite bonds chemically to the bone, pain on weight-bearing due to micromovement should never occur. In order to obtain long-term and stable fixation for severe bony atrophy, bioactive bone cement or interface bioactive bone cement (interposing hydroxyapatite at the bone interface) is desirable.