Combining Surface Modification and Bioactive Cues to Enhance Medpor® Implant Integration In Vivo.

BACKGROUND: Achieving stable and functional integration of synthetic implants with host tissue remains a key challenge in tissue engineering. Medpor®, a porous high-density polyethylene (HDPE) implant widely used in craniofacial reconstruction, provides excellent mechanical strength but lacks bioactivity, limiting early cell adhesion, vascularization, and extracellular matrix (ECM) deposition. METHODS: To enhance Medpor® biointegration, we employed a multi-faceted modification strategy combining plasma treatment with biologically active components. Treated implants were coated with collagen and fibrin hydrogels and further supplemented with a platelet-derived Purified Exosome Product (PEP). Modified and control implants were evaluated in a subcutaneous mouse model to assess host tissue response, vascularization, and implant integration. RESULTS: Tissue ingrowth was observed in the pores of all Medpor® implants. Plasma treatment significantly increased the surface hydrophilicity of Medpor®, promoting host cell adhesion and tissue infiltration. Implants modified with both hydrogels and PEP exhibited enhanced ECM deposition, greater vascular density, and improved tissue integration compared to untreated Medpor®. The combination of physicochemical surface treatment and biochemical cues led to a synergistic effect, supporting tissue ingrowth and angiogenesis under a controlled host immune response. CONCLUSION: This study demonstrates that integrating plasma surface modification with bioactive hydrogels and PEP can effectively enhance the biointegration of Medpor® implants in vivo. The combined approach significantly enhances implant vascularization and ECM development, offering a promising translational strategy for improving synthetic implant performance in regenerative and reconstructive biomaterial applications.