Resorption of hydroxyapatite and fluorapatite ceramic coatings on weight-bearing implants: A quantitative and morphological study in dogs

Resorption (defined as loss of ceramic coating because of cellular activity or dissolution) of ceramic coatings is a matter of concern for the long-term performance of ceramic-coated implants. A new fluorine-containing coating, fluorapatite (FA), has been shown to be more stable than hydroxyapatite (HA) in unloaded models. In a weight-bearing model in trabecular bone, we evaluated loss (defined as reduction of coating irrespective of type of mechanism) of HA and FA coatings during 25 weeks of implantation. Eight mature dogs had HA- or FA-coated implants inserted bilaterally into the weight-bearing region of the medial femoral condyle. Quantified loss of ceramic coating was estimated at the light microscopic level using stereological methods. The experiment showed significant loss of both types of coatings. However, no statistical difference in loss of ceramic coating was found regarding surface area, implant coverage, volume, and thickness (p = 0.77, p = 0.13, p = 0.56, p = 0.23, respectively). Completely resorbed HA coating was replaced by 36 ± 6.0% (range: 26-42) bone in direct contact with the implant surface compared with 29 ± 16.0% (range: 12-59) for FA (p = 0.40), suggesting that the implant was firmly fixed despite loss of the ceramic coating. Transmission electron microscopy in combination with electron energy spectroscopy and electron spectroscopic imaging showed that osteoclast-like cells, osteocytes, macrophage-like cells, and fibroblasts had phagocytosed calcium-containing fragments, indicating cell-mediated resorption of the ceramic coating.