Outcomes comparison between novel hydroxyapatite enhanced PEEK and titanium implants after anterior lumbar interbody fusion

BACKGROUND CONTEXT: Interbody implants have evolved to reduce the risk of nonunion with polyetheretherketone (PEEK) and titanium devices. Two novel ALIF implants, hydroxyapatite (HA) infused PEEK (HA PEEK) and titanium alloy with microtextured surface integrated with HA (TiHA) may mitigate this risk. PURPOSE: The primary objective of this study was to compare fusion rates between HA PEEK and TiHA implants. Secondarily, revision surgery rates and changes in Oswestry Disability Index (ODI) scores were compared between both implants. STUDY DESIGN/SETTING: Multicenter, retrospective cohort study of prospectively collected data. PATIENT SAMPLE: Circumferential lumbar fusion with ALIF ≤ 3 levels using novel HA PEEK or TiHA implants. OUTCOME MEASURES: Primary outcome includes rates of fusion at 6 months and 1 year; secondary outcomes include rates of revision surgery at 1 year and changes in ODI scores at 1 year. METHODS: Data was prospectively collected from 27 US centers of adult ALIFs ≤ 3 levels using HA PEEK or TiHA implants. Pre- and 1-year postoperative ODI scores were recorded. Fusion was analyzed by validated motion detection software and defined as < 2° of angular motion. Two sample proportion tests compared fusion and revision surgery rates, and two- way ANOVA compared changes in ODI. RESULTS: Analysis included 566 patients (78% HA PEEK, 22% TiHA) with mean age of 53.4 years and 1.5 levels of ALIF. There was no significant difference between fusion rates with respect to angular motion (88% HA PEEK, 95% TiHA, p=0.08) at 6 months or at 1 year (92% HA PEEK, 94% TiHA, p=0.8). There was no significant difference in revision surgery rates at 1 year (3.6% HA PEEK, 1.0% TiHA, p=0.2) or in ODI changes at 1 year (-22.7 HA PEEK, -19.7 TiHA, p=0.7). CONCLUSIONS: HA enhanced PEEK and titanium ALIF implants achieved similarly high rates of fusion, low rates of revision surgery, and improved ODI scores beyond established MCID at 6 months and 1 year. These findings suggest the historical nonunion risk with PEEK may be mitigated by the novel HA infused PEEK implant with titanium alloy face plate and screws for ALIF. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.

Duke Scholars

Author Peter Passias Orthopaedic Surgery