Influence of steel implant surface microtopography on soft and hard tissue integration

After implantation of an internal fracture fixation device, blood contacts the surface, followed by protein adsorption, resulting in either soft-tissue adhesion or matrix adhesion and mineralization. Without protein adsorption and cell adhesion under the presence of micro-motion, fibrous capsule formation can occur, often surrounding a liquid filled void at the implant-tissue interface. Clinically, fibrous capsule formation is more prevalent with electropolished stainless steel (EPSS) plates than with current commercially pure titanium (cpTi) plates. We hypothesize that this is due to lack of micro-discontinuities on the standard EPSS plates. To test our hypothesis, four EPSS experimental surfaces with varying microtopographies were produced and characterized for morphology using the scanning electron microscope, quantitative roughness analysis using laser profilometry and chemical analysis using X-ray photoelectron spectroscopy. Clinically used EPSS (smooth) and cpTi (microrough) were included as controls. Six plates of each type were randomly implanted, one on both the left and right intact tibia of 18 white New Zealand rabbits for 12 weeks, to allow for a surface interface study. The results demonstrate that the micro-discontinuities on the upper surface of internal steel fixation plates reduced the presence of liquid filled voids within soft-tissue capsules. The micro-discontinuities on the plate under-surface increased bony integration without the presence of fibrous tissue interface. These results support the hypothesis that the fibrous capsule and the liquid filled void formation occurs mainly due to lack of micro-discontinuities on the polished smooth steel plates and that bony integration is increased to surfaces with higher amounts of micro-discontinuities. (c) 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 705-715, 2018.