gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Surface alterations and tissue reactions after implantation of a titanium internal fixator

Oberflächenveränderungen und Gewebereaktionen nach Implantation eines Fixateur interne

Meeting Abstract

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  • corresponding author C. Voss - Neurochirurgische Klinik, Leopoldina-Krankenhaus Schweinfurt
  • A.M. Gassel - Pathologisches Institut, Leopoldina-Krankenhaus Schweinfurt
  • U. Vieweg - Zentrum für Wirbelsäulenstabilisierungen, Leopoldina-Krankenhaus Schweinfurt

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 12.201

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Voss et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Implants made of titanium are preferred to implants made of stainless steel because of their superior corrosion resistance and better biocompatibility. It is known that titanium implants induce reactions in vivo, but there is a lack of literature describing such reactions after implantion of a titanium internal fixator. Surface examination of removed titanium internal fixatorrs as well as histological investigation of tissue samples taken from zones surrounding the implants were carried out in form of a prospective study.

Methods: 14 titanium (TiAlVa) internal fixators were removed and investigated. The mean length of implantation was 21 months. After removal, the surfaces of the implants were examined macro- and microscopically and alterations were documented using optical light microscopy. Besides tissue samples were taken from zones surrounding the implants and prepared for histological investigation. The slices were examined microscopically using optical light microscopy. Scarring, foreign body reactions and the presence of titanium particles were analyzed.

Results: In all cases surface alterations on the removed titanium internal fixators could be found macro- and microscopically. The alterations especially appeared in zones of the implants which were exposed to higher mechanical stress. Histological investigation always showed scarring which was not noticeable increased. In 71% (10 of the 14 cases) foreign body reactions and titanium particles could be detected as well. The titanium particles were found both intra- and extracellular.

Conclusions: As surface alterations especially appeared in zones of the implants which were exposed to higher mechanical stress, it is obvious that the superficial structure of the implants plays an important part for the occurence of surface alterations. The superficial structure however depends on the titanium alloy used and the surface preparation done during production of the implants.