Can Polyether Ether Ketone Dethrone Titanium as the Choice Implant Material for Metastatic Spine Tumor Surgery?

Kumar, Naresh; Ramakrishnan, Sridharan Alathur; Lopez, Keith Gerard; Madhu, Sirisha; Ramos, Miguel Rafael D; Fuh, Jerry Ying Hsi; Hallinan, James; Nolan, Colum P; Benneker, Lorin M.; Vellayappan, Balamurugan A (2021). Can Polyether Ether Ketone Dethrone Titanium as the Choice Implant Material for Metastatic Spine Tumor Surgery? World neurosurgery, 148, pp. 94-109. Elsevier 10.1016/j.wneu.2021.01.059

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Instrumentation during metastatic spine tumor surgery (MSTS) provides stability to the spinal column in patients with pathologic fracture or iatrogenic instability produced while undergoing extensive decompression. Titanium is the current implant material of choice in MSTS. However, it hinders radiotherapy planning and generates artifacts, with magnetic resonance imaging and computed tomography scans used for postoperative evaluation of tumor recurrence and/or complications. The high modulus of elasticity of titanium (110 GPa) results in stress shielding, which may lead to construct failure at the bone-implant interface. Polyether ether ketone (PEEK), a thermoplastic polymer, is an emerging alternative to titanium for use in MSTS. The modulus of elasticity of PEEK (3.6 GPa) is close to that of cortical bone (17-21 GPa), resulting in minimal stress shielding. Its radiolucent and nonmetallic properties cause minimal interference with magnetic resonance imaging and computed tomography scans. PEEK also causes low-dose perturbation for radiotherapy planning. However, PEEK has reduced bioactivity with bone and lacks sufficient rigidity to be used as rods in MSTS. The reduced bioactivity of PEEK may be addressed by 1) surface modification (introducing porosity or bioactive coating with hydroxyapatite [HA] or titanium) and 2) forming composites with HA/titanium. The mechanical properties of PEEK may be improved by forming composites with HA or carbon fiber. Despite these modifications, all PEEK and PEEK-based implants are difficult to handle and contour intraoperatively. Our review provides a comprehensive overview of PEEK and modified PEEK implants, with a description of their properties and limitations, potentially serving as a basis for their future development and use in MSTS.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Benneker, Lorin Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1878-8750

Publisher:

Elsevier

Language:

English

Submitter:

Kathrin Aeschlimann

Date Deposited:

03 Feb 2022 14:46

Last Modified:

05 Dec 2022 16:02

Publisher DOI:

10.1016/j.wneu.2021.01.059

PubMed ID:

33508491

Uncontrolled Keywords:

Carbon fiber Implants Neoplasm metastasis Polyether ether ketone Spine Surgery Titanium alloy

BORIS DOI:

10.48350/164080

URI:

https://boris.unibe.ch/id/eprint/164080

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