The main reason for revision arthroplasty with an alumina-based prosthesis is aseptic loosening of the prosthesis. To prevent loosening of the prosthesis, endowing bioinert alumina with osteogenic ability is deemed an effective approach. Hence, we developed an alumina substrate with carbonate apatite and evaluated its effectiveness for early binding to the bone. Alumina substrates were coated with carbonate apatite using the following procedures: (1) etching the alumina substrate by alkaline hydrothermal treatment; (2) calcium carbonate coating of the etched alumina substrate; and (3) composition conversion of calcium carbonate coating into carbonate apatite by phosphatization. The tensile bond strength of carbonate apatite coating to alumina substrate was 17.6 MPa, which satisfied the criteria defined by the International Organization for Standardization. Contrary to the results of etched alumina substrates, the carbonate apatite-coated alumina substrates promoted the proliferation and osteogenic differentiation of mesenchymal stem cells and induced mineralization. Furthermore, the carbonate apatite-coated alumina substrates strongly adhered to the rabbit tibia 4 weeks after implantation compared to the etched alumina substrates. The contact area and adhesion strength of carbonate apatite-coated alumina substrates to bone were approximately 19- and 6-fold higher than those of etched alumina substrates, respectively. Thus, carbonate apatite coating may contribute to preventing the loosening of alumina prostheses.
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