Osseointegration of titanium implants in the tibia. Electron microscopy of biopsies from 4 patients

We studied the ultrastructure of bone tissue around implants of pure titanium inserted into the tibia in 4 patients with arthrosis or rheumatoid arthritis. Three main appearances of the interface were noted. First, a close contact between titanium and calcified bone with living osteocytes inside the newly-formed bone was observed in all samples. Secondly, a close contact was also seen between the implant and osteoid, the newly formed collagenous matrix being either uncalcified or calcifying. Thirdly, a loose extracellular matrix with fibrillar and nonfibrillar materials was sometimes observed between bone mineral and implant. There was no inflammatory reaction at the interface. We concluded that the titanium implants were osseointegrated, but the calcification of the bone tissue was not complete even after 20 months. However, mineralization of osteoid and living bone cells revealed the presence of an active tissue.