Purpose of the study: Biphasic macroporous phosphocalcium ceramics are used in routine surgery to fill bone defects. This type of material presents the characteristics of an ideal substitute: free of the adverse effects of grafts, biocompatibility, bioactivity, osteoconduction, osteointegration, reproducibility, availability in sufficient quantity. The purpose of our work was to evaluate the role of osteointegration on the resistance of two macroporous biphasic phosphocalcium ceramics routinely proposed on the French market. These two macroprous materials have a similar chemical composition but vary by the presence or not of interpores.
Material and methods: The experimental model involved the implantation of ceramic cylinders in a femoral cortical site in sheep, via the intermediary of conduction chambers with specific cortical entrances. The resistance to compression of the implanted samples an non implanted controls was measured using the same ISO norms.
Results: After two months implantation in a cortical site in the sheep, Eurocer200plus® exhibited a significant 38% increase in resistance to compression while in the same conditions, Triosite® exhibited a 41% decline in resistance. For ceramics with open porosity, the interpores acted like tunnels enabling rapid colonization for osteoforming cells and early formation of new bone reaching the centre of the substitute, and leading to increased material resistance. Cell colonization of a ceramic with closed porosity is, on the contrary, slowed by the partitions, while its dissolution by biological fluids within the micropores occurs in all materials; there results an imbalance between absorption and synthesis, leading to loss of mechanical resistance as a first phase of osteointegration.
Discussion: Open macroposity enables an improvement in the mechanical properties of a biphasic ceramic substitute due to more rapid osteointegration. In the future, material associated with osteoinduction cells or proteins should play an important role, together with changes in the architecture of the ceramic skeleton which should play a determining role in terms of physical and biological properties.
