Biocompatibility of clinically applied hydroxylapatite ceramic.

The biocompatibility of 11 porous canal wall prostheses and 4 dense incus prostheses, both types made of hydroxylapatite, was studied by light microscopy, scanning electron microscopy, transmission electron microscopy, and x-ray microanalysis. The duration of implantation varied between 4 and 40 months, and the 15 retrieved implants constitute 4% of the 375 clinically applied hydroxylapatite prostheses involved in this study. With respect to integration characteristics, coverage by epithelium and fibrous tissue, and biodegradation, the performance of clinically applied hydroxylapatite generally resembled that seen in animal experiments. However, the reactions during chronic infection in the human ear were more severe than those in experimentally induced acute infections in the rat middle ear. One of the canal wall prostheses showed trace element accumulation in the cytoplasm of phagocytes.