N. Martinez-Carranza, H. E. Berg, A. -S. Lagerstedt, H. Nurmi-Sandh, P

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Fixation of a double-coated titanium-hydroxyapatite focal knee resurfacing implant N. Martinez-Carranza, H.E. Berg, A.-S. Lagerstedt, H. Nurmi-Sandh, P. Schupbach, L. Ryd Osteoarthritis and Cartilage Volume 22, Issue 6, Pages 836-844 (June 2014) DOI: 10.1016/j.joca.2014.03.019 Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Micro-CT scans of a 12-month specimen obtained directly below the hat (a), along the stem (b) and at the end of the stem (c). Note the osteolytic area below the hat (red arrow). Osteoarthritis and Cartilage 2014 22, 836-844DOI: (10.1016/j.joca.2014.03.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Ground sections of the three 6-month specimens. Note the perfect osseointegration of the stem in all specimens. Also note the osteolytic areas (red arrows) below the hat in one specimen (red arrows). Osteoarthritis and Cartilage 2014 22, 836-844DOI: (10.1016/j.joca.2014.03.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Ground sections of the 12-month specimens. Note the perfectly osseointegrated stem of all specimens. Also note the presence of osteolytic areas (red arrows) in two specimens, and a widened marrow chambers in one specimen (yellow arrow). Osteoarthritis and Cartilage 2014 22, 836-844DOI: (10.1016/j.joca.2014.03.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Ground sections of a 12-month specimen demonstrating the osseointegration at both, the side of the hat (a), below the hat (b) and around the stem (c). Note the intimate contact between bone and the HA coating and the integrity of the latter (d). Osteoarthritis and Cartilage 2014 22, 836-844DOI: (10.1016/j.joca.2014.03.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Ground sections of the same 12-month specimen demonstrating the disintegration of the HA layer when exposed to bone marrow (a). HA particles were found scattered in the bone marrow chambers next to the implant surface. The HA particles were engulfed by macrophages phagocytizing the particles. Note the absence of any inflammatory reaction in the marrow (b). Completely exposed titanium sprayed implant surface area (c). Ongoing new bone formation directly along the exposed titanium layer by contact osteogenesis (d). Osteoarthritis and Cartilage 2014 22, 836-844DOI: (10.1016/j.joca.2014.03.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 Ground section showing an osteolytic area at the side of the hat (a). The area is filled with an inflammatory free connective tissue (CT in b). Native trabecular bone (TB) framing the defect shows areas of new bone formation (c, red box), characterized by the presence of osteoblasts (OB) an osteoid (O). Newly formed woven bone (WB) can clearly be distinguished by its darker stain from native trabecular bone (d, higher magnification from area outlined in c). Osteoarthritis and Cartilage 2014 22, 836-844DOI: (10.1016/j.joca.2014.03.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 7 Ground sections demonstrating the cartilage and its interface towards the hat. The cleft in (a) is an artefact due to the ethanol dehydration of the specimens. Note the intact subchondral bone plate in (b) healthy cartilage in (c) and the intimate cartilage adherence to the hat in (d). Osteoarthritis and Cartilage 2014 22, 836-844DOI: (10.1016/j.joca.2014.03.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions