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Treatment of osteochondral defects: chondrointegration of metal implants improves after hydroxyapatite coating

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



The treatment of osteochondral defects in joint cartilage remains challenging due to its limited repair capacity. This study presents a metallic osteochondral plug with hydroxyapatite (HA)-coated cap edges for improved implant-tissue contact. The hypothesis was that improved attachment prevents from synovial fluid-influx and thereby avoids osteolysis and resulting implant instability.


In total, 24 female, adult sheep were randomized into three groups. All animals received an Episealer®-implant in the medial condyle of the right knee. The implants were coated with two different HA versions or uncoated (control group). After 12 weeks, the implant-tissue connections were analysed radiologically and histologically.


In general, the groups with the coated cap edges showed a better quality of tissue connection to the implant. The occurrence of gaps between tissue and implant was more seldom, the binding of calcified and hyaline cartilage to the cap was significantly better than in the uncoated group. A histomorphometrically measured lower amount of void space in these groups compared to the group with the uncoated edges confirmed that.


The hypothesis of a tighter cartilage bone contact was confirmed. The HA coating of the implant’s cap edges resulted in better adherence of cartilage to the implant, which was not previously reported. In conclusion, this led to a better contact between implant and cartilage as well as neighbouring bone. In clinical routine, joint fluid is aggressive, penetrates through cartilage rifts, and promotes osteolysis and loosening of implants. The observed sealing effect will act to prevent joint fluid to get access to the implant–tissue interfaces. Joint fluid is aggressive, can cause osteolysis, and can, clinically cause pain. These effects are liable to decrease with these findings and will further the longevity of these osteochondral implants.

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This study was partially funded by the Bundesministeriums für Bildung und Forschung (BMBF: E! 7914 PIK, Eurostars Program), the BMBF Overload, and the European Commission, Horizon 2020 (MOZART). Implants and surgical tools for implantation were kindly provided by Episurf Medical.

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Correspondence to Katharina Schmidt-Bleek.

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Hanna Schell, Elisabeth Zimpfer, Katharina Schmidt-Bleek, Tobias Jung, and Georg N. Duda declare that they have no conflict of interest. Leif Ryd is board member and medical advisor of the Episurf Medical.

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All procedures performed in this study involving animals were in accordance with the ethical standards of the institution or practice at which the study was conducted.

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Schell, H., Zimpfer, E., Schmidt-Bleek, K. et al. Treatment of osteochondral defects: chondrointegration of metal implants improves after hydroxyapatite coating. Knee Surg Sports Traumatol Arthrosc 27, 3575–3582 (2019).

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