We compared the mechanical properties of carbon fibre composite bone plates with those of stainless steel and titanium. The composite plates have less stiffness with good fatigue properties. Tissue culture and small animal implantation confirmed the biocompatibility of the material. We also present a preliminary report on the use of the carbon fibre composite plates in 40 forearm fractures. All fractures united, 67% of them showing radiological remodelling within six months. There were no refractures or mechanical failures, but five fractures showed an unexpected reaction; this is discussed.

We investigated the possibility that the macrophages which are seen around implants may stimulate bone resorption and cause loosening. We found that macrophages release mediators that stimulate bone resorption, and that the amount of resorption increased by between 2.5 and 10 times when the macrophages adhered to a foreign surface. This bone resorption depended on the surface energy and roughness of the foreign surface, varying with these physical properties rather than with the chemical nature of the material. It is concluded that loosening of orthopaedic implants is likely to be influenced by the surface energy and roughness of the implant.

Some of the component metals of the alloys used for total joint prostheses are toxic and dissolve in the body fluids. It is important to establish how toxic these metals are and to assess the risk of localised tissue necrosis around the prostheses. This has been investigated by incubating primary monolayer cultures of human synovial fibroblasts with various preparations of metals for periods up to 18 days. Morphological changes were evident after exposure to cobalt chloride at a concentration of 50 nanomoles per millilitre and to nickel chloride at 200 nanomoles per millilitre. Chromic chloride, ammonium molybdate and ferric chloride produced no changes up to 500 nanomoles per millilitre. Cultures exposed to particulate pure metals were poisoned by cobalt and vanadium but were not affected under the same conditions by nickel, chromium, molybdenum, titanium or aluminium. Particulate cobalt and vanadium were probably toxic due to their relatively high solubility (four and one micromoles per millilitre respectively after seven days incubation). Particulate nickel also dissolved (three nanomoles per millilitre after seven days) but not in sufficient quantities to be toxic. It appears, therefore, that potentially the most harmful components are cobalt from cobalt-chromium alloy, nickel from stainless steel, and vanadium from titanium alloy. As far as can be estimated, the only combination of materials which is likely to give rise to toxic levels of metal under clinical conditions, is cobalt-chromium alloy articulating against itself to produce relatively high levels of cobalt.

This is part of a larger study designed to investigate the action of particulate metals of orthopaedic interest on tissues. Damaging effects were determined by cytological examination and the assay of two enzymes. Lactic dehydrogenase (LDH) if released into the supernatant indicates a damaged cell membrane; decreased intracellular levels of glucose-6-phosphate dehydrogenase (G6PD) indicates a lowered phagocytic capacity of the cells. Soluble and wear products around implanted prostheses could facilitate late infections by impairing local reactions to bacteria. Particulate cobalt, nickel and cobalt-chromium alloy were found to damage the cells and to cause LDH release. G6PD was found to have a lower activity in the cells exposed to these materials. In contrast, titanium, chromium and molybdenum were well tolerated by macrophages and had no effect on the distribution and activity of either enzyme. The solubility of these metals in the culture medium was also measured.