Fixation of a double-coated titanium-hydroxyapatite focal knee resurfacing implant: a 12-month study in sheep

Osteoarthritis Cartilage. 2014 Jun;22(6):836-44. doi: 10.1016/j.joca.2014.03.019. Epub 2014 Apr 12.


Objective: Focal cartilage lesions according to International Cartilage Repair Society (ICRS) grade 3-4 in the medial femoral condyle may progress to osteoarthritis. When treating such focal lesions with metallic implants a sound fixation to the underlying bone is mandatory. We developed a monobloc unipolar cobalt-chrome (Co-Cr) implant with a double coating; first a layer of commercially pure titanium (c.p.Ti) on top of which a layer of hydroxyapatite (HA) was applied. We hypothesised that such a double coating would provide long-lasting and adequate osseointegration.

Design (materials and methods): Unilateral medial femoral condyles of 10 sheep were operated. The implants were inserted in the weight-bearing surface and immediate weight-bearing was allowed. Euthanasia was performed at 6 (three animals) or 12 months (six animals). Osseointegration was analysed with micro-computer tomography (CT), light microscopy and histomorphometric analyses using backscatter scanning electron microscopy (B-SEM) technique.

Results: At 6 months one specimen out of three showed small osteolytic areas at the hat and at 12 months two specimens out of six showed small osteolytic areas at the hat, no osteolytical areas were seen around the peg at any time point. At both time points, a high total bone-to-implant contact was measured with a mean (95% confidence interval - CI) of 90.6 (79-102) at 6 months and 92.3 (89-95) at 12 months, respectively.

Conclusions: A double coating (Ti + HA) of a focal knee resurfacing Co-Cr implant was presented in a sheep animal model. A firm and consistent bond to bone under weight-bearing conditions was shown up to 1 year.

Keywords: Focal cartilage lesion; Focal knee resurfacing; Metal implants; Osseointegration; Sheep animal model.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Biomechanical Phenomena
  • Cartilage, Articular / pathology
  • Cartilage, Articular / surgery*
  • Coated Materials, Biocompatible
  • Disease Models, Animal
  • Durapatite / pharmacology*
  • Female
  • Follow-Up Studies
  • Knee Joint / pathology
  • Knee Joint / surgery*
  • Knee Prosthesis*
  • Microscopy, Electron, Scanning
  • Osseointegration / physiology*
  • Prosthesis Design
  • Prosthesis Implantation
  • Random Allocation
  • Sheep
  • Sheep, Domestic
  • Time Factors
  • Titanium
  • Treatment Outcome
  • Weight-Bearing
  • X-Ray Microtomography


  • Coated Materials, Biocompatible
  • Durapatite
  • Titanium