Calcium phosphate coating formed in infusion fluid mixture to enhance fixation strength of titanium screws

A novel technique was developed to coat a calcium phosphate (CaP) layer on titanium screws with a titanium oxide surface layer, using infusion fluids officially approved for clinical use. A calcium-containing solution, a phosphate-containing solution, and a sodium bicarbonate solution prepared from the infusion fluids were mixed at a Ca/P molar ratio of 2.0. Each screw was immersed in 10 mL of the resulting mixture at 37 degrees C for 2 days. A low-crystalline apatite layer (Ca/P molar ratio = 1.681 +/- 0.038) was formed on the screws. The layer consisted of a few 100 nm diameter particles fixed on the screw surface. In animal experiments, the screws were percutaneously implanted in both proximal tibial metaphyses of rabbits. The insertion torque was not significantly different between the CaP-coated screws (0.132 +/- 0.002 Nm, n = 10) and uncoated screws (0.140 +/- 0.002 Nm, n = 10) (p = 0.5785). After the insertion torque test, the apatite layer remained on the surface of the screws, which means that the apatite layer survived the friction of screw insertion. The extraction torque of the screws in the CaP-coated group (0.239 +/- 0.066 Nm, n = 19) was significantly higher (by 29.9%) than that in the uncoated group (0.184 +/- 0.062 Nm, n = 18) 4 weeks after the operations (p = 0.0132). Histologically, a larger amount of new bone formation was observed around the CaP-coated screws than that around the uncoated screws. Even after the removal of the screw, the CaP layer remained on the screw at the site where soft tissues were attached. The coating technique with the use of the infusion fluids is an effective method of improving bone-screw interface strength.