Fatigue and biological properties of Ti-6Al-4V ELI cellular structures with variously arranged cubic cells made by selective laser melting

Bio-mechanical analysis of porous Ti-6Al-4V scaffold: a comprehensive review on unit cell structures in orthopaedic application

A scaffold is a three-dimensional porous structure that is used as a template to provide structural support for cell adhesion and the formation of new cells. Metallic cellular scaffolds are a good choice as a replacement for human bones in orthopaedic implants, which enhances the quality and longevity of human life. In contrast to conventional methods that produce irregular pore distributions, 3D printing, or additive manufacturing, is characterized by high precision and controlled manufacturing processes. AM processes can precisely control the scaffold's porosity, which makes it possible to produce patient specific implants and achieve regular pore distribution. This review paper explores the potential of Ti-6Al-4V scaffolds produced via the SLM method as a bone substitute. A state-of-the-art review on the effect of design parameters, material, and surface modification on biological and mechanical properties is presented. The desired features of the human tibia and femur bones are compared to bulk and porous Ti6Al4V scaffold. Furthermore, the properties of various porous scaffolds with varying unit cell structures and design parameters are compared to find out the designs that can mimic human bone properties. Porosity up to 65% and pore size of 600 μm was found to give optimum trade-off between mechanical and biological properties. Current manufacturing constraints, biocompatibility of Ti-6Al-4V material, influence of various factors on bio-mechanical properties, and complex interrelation between design parameters are discussed herein. Finally, the most appropriate combination of design parameters that offers a good trade-off between mechanical strength and cell ingrowth are summarized.

Heat Treatment's Vital Role: Elevating Orthodontic Mini-Implants for Superior Performance and Longevity-Pilot Study

Orthodontic mini-implants are devices used for anchorage in various orthodontic treatments. We conducted a pilot study which aimed to observe preliminary trends regarding the impact of heat treatment on the elastic modulus of Ti6Al4V alloy and stainless steel 316L mini-implants. The initial phase involved testing the impact of heat treatment on the mechanical properties of Ti6Al4V alloy and stainless steel 316L mini-implants.

MATERIAL AND METHODS

Ten self-drilling mini-implants sourced from two distinct manufacturers (Jeil Medical Corporation® and Leone®) with dimensions of 2.0 mm diameter and 10 mm length were tested. They were separated into two material groups: Ti6Al4V and 316L. Using the CETRUMT-2 microtribometer equipment, indentation testing was conducted employing a diamond-tipped Rockwell penetrator at a constant force of 4.5 N.

RESULTS

Slight differences were observed in the elastic modulus of the Ti6Al4V alloy (103.99 GPa) and stainless steel 316L (203.20 GPa) compared to natural bone. The higher elastic moduli of these materials indicate that they are stiffer, which could potentially lead to stress-shielding phenomena and bone resorption. Heat treatment resulted in significant changes in mechanical properties, including elastic modulus reductions of approximately 26.14% for Ti6Al4V and 24.82% for 316L, impacting their performance in orthodontic applications.

CONCLUSION

Understanding the effects of heat treatment on these alloys is crucial for optimizing their biomechanical compatibility and longevity in orthodontic treatment. To fully evaluate the effects of heat treatment on mini-implants and to refine their design and efficacy in clinical practice, further research is needed.

Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction

In recent years, the field of mandibular reconstruction has made great strides in terms of hardware innovations and their clinical applications. There has been considerable interest in using computer-aided design, finite element modelling, and additive manufacturing techniques to build patient-specific surgical implants. Moreover, lattice implants can mimic mandibular bone's mechanical and structural properties. This article reviews current approaches for mandibular reconstruction, their applications, and their drawbacks. Then, we discuss the potential of mandibular devices with lattice structures, their development and applications, and the challenges for their use in clinical settings.

Topology optimization on metamaterial cells for replacement possibility in non-pneumatic tire and the capability of 3D-printing

One of the applications of mechanical metamaterials is in car tires, as a non-pneumatic tire (NPT). Therefore, to find a suitable cell to replace the pneumatic part of the tire, three different solution methods were used, including topology optimization of the cubic unit cell, cylindrical unit cell, and fatigue testing cylindrical sample (FTCS). First, to find the mechanical properties, a tensile test was conducted for materials made of polylactic acid (PLA) and then, the optimization was done based on the weight and overhang control for the possibility of manufacturing with 3D printers, as constraints, besides, the objective of minimum compliance. In the optimization of the cubic unit cell, the sample with a minimum remaining weight of 35% was selected as the optimal sample. However, for the cylindrical unit cell, a sample with a weight limit of 20% was the most optimal state. In contrast, in the FTCS optimization, a specimen with lower remaining weight equal to 60% of the initial weight was selected. After obtaining the answer, five cells in the FTCS and two mentioned cells were evaluated under compressive testing. The samples were also subjected to bending fatigue loadings. The results demonstrated that cellular structures with 15% of lower weight than the optimized samples had the same fatigue lifetime. In the compressive test, the line slope of the specimens with cellular structures in the elastic region of the force-displacement diagram was reduced by 37%, compared to the completely solid samples. However, the weight of these samples decreased by 59%. Furthermore, the fracture surface was also investigated by field-emission scanning electron microscopy. It was observed that a weak connection between the layers was the cause of failure.

Fatigue life of 3D-printed porous titanium dental implants predicted by validated finite element simulations

Introduction: Porous dental implants represent a promising strategy to reduce failure rate by favoring osseointegration or delivering drugs locally. Incorporating porous features weakens the mechanical capacity of an implant, but sufficient fatigue strength must be ensured as regulated in the ISO 14801 standard. Experimental fatigue testing is a costly and time-intensive part of the implant development process that could be accelerated with validated computer simulations. This study aimed at developing, calibrating, and validating a numerical workflow to predict fatigue strength on six porous configurations of a simplified implant geometry. Methods: Mechanical testing was performed on 3D-printed titanium samples to establish a direct link between endurance limit (i.e., infinite fatigue life) and monotonic load to failure, and a finite element model was developed and calibrated to predict the latter. The tool was then validated by predicting the fatigue life of a given porous configuration. Results: The normalized endurance limit (10% of the ultimate load) was the same for all six porous designs, indicating that monotonic testing was a good surrogate for endurance limit. The geometry input of the simulations influenced greatly their accuracy. Utilizing the as-designed model resulted in the highest prediction error (23%) and low correlation between the estimated and experimental loads to failure (R2 = 0.65). The prediction error was smaller when utilizing specimen geometry based on micro computed tomography scans (14%) or design models adjusted to match the printed porosity (8%). Discussion: The validated numerical workflow presented in this study could therefore be used to quantitatively predict the fatigue life of a porous implant, provided that the effect of manufacturing on implant geometry is accounted for.

Wear and Thermal Behavior of TiAlN Thin Films onto Ti6Al4V Alloy Manufactured by Selective Laser Melting Method

In this study, it was targeted to enhance the tribological and thermal properties of Ti6Al4V alloys, which were manufactured with three different build orientations and hatch spacing by using the selective laser melting (SLM) method and a traditional method (casting). In addition, the surfaces of the samples produced by these two methods were coated with the TiAlN thin film by using the cathodic arc physical vapor deposition (CAPVD) method. After the experimental investigations, the lowest wear rate was obtained for the 60-90° sample, and the highest microhardness value was measured as ∼1070 HV0.1 for the 90-45° sample. It was specified that the wear rate rose as the hatch spacing increased among the same build orientation Ti6Al4V alloys produced by SLM method. According to thermal analysis results, among the same hatch spacing values, it was determined that as the build orientation value increased, the specific heat capacity and thermal conductivity values decreased. Among the coated samples, the highest thermal conductivity and specific heat capacity values were obtained for casting samples as 5.63 (W/m·K) and 560.4 (J/kg·K), respectively.

Nano-Mechanical Behavior of Ti6Al4V Alloy Manufactured Using Laser Powder Bed Fusion

The microstructure of Ti6Al4V alloy, manufactured using laser powder bed fusion (L-PBF), is affected by process parameters and heat treatment. However, their influence on the nano-mechanical behavior of this widely applicable alloy is still unknown and scarcely reported. This study aims to investigate the influence of the frequently used annealing heat treatment on mechanical properties, strain-rate sensitivity, and creep behavior of L-PBF Ti6Al4V alloy. Furthermore, the influence of different utilized L-PBF laser power-scanning speed combinations on mechanical properties of annealed specimens has been studied as well. It has been found that the effect of high laser power remains present in the microstructure even after annealing, resulting in increase in nano-hardness. Moreover, the linear relation between the Young's modulus and the nano-hardness after annealing has been established. Thorough creep analysis revealed dislocation motion as a dominant deformation mechanism, both for as-built and annealed conditions of the specimens. Although annealing heat treatment is beneficial and widely recommended, it reduces the creep resistance of Ti6Al4V alloy manufactured using L-PBF. The results presented within this research article contribute to the L-PBF process parameter selection, as well as to understanding the creep behavior of these novel and widely applicable materials.

Bone marrow stromal cells are sensitive to discrete surface alterations in build and post-build modifications of bioinspired Ti6Al4V 3D-printed in vitro testing constructs

Current standards in bone-facing implant fabrication by metal 3D (M3D) printing require post-manufacturing modifications to create distinct surface properties and create implant microenvironments that promote osseointegration. However, the biological consequences of build parameters and surface modifications are not well understood. This study evaluated the relative contributions of build parameters and post-manufacturing modification techniques to cell responses that impact osseointegration in vivo. Biomimetic testing constructs were created by using a M3D printer with standard titanium-aluminum-vanadium (Ti6Al4V) print parameters. These constructs were treated by either grit-blasting and acid-etching (GB + AE) or GB + AE followed by hot isostatic pressure (HIP) (GB + AE, HIP). Next, nine constructs were created by using a M3D printer with three build parameters: (1) standard, (2) increased hatch spacing, and (3) no infill, and additional contour trace. Each build type was further processed by either GB + AE, or HIP, or a combination of HIP treatment followed by GB + AE (GB + AE, HIP). Resulting constructs were assessed by SEM, micro-CT, optical profilometry, XPS, and mechanical compression. Cellular response was determined by culturing human bone marrow stromal cells (MSCs) for 7 days. Surface topography differed depending on processing method; HIP created micro-/nano-ridge like structures and GB + AE created micro-pits and nano-scale texture. Micro-CT showed decreases in closed pore number and closed porosity after HIP treatment in the third build parameter constructs. Compressive moduli were similar for all constructs. All constructs exhibited ability to differentiate MSCs into osteoblasts. MSCs responded best to micro-/nano-structures created by final post-processing by GB + AE, increasing OCN, OPG, VEGFA, latent TGFβ1, IL4, and IL10. Collectively these data demonstrate that M3D-printed constructs can be readily manufactured with distinct architectures based on the print parameters and post-build modifications. MSCs are sensitive to discrete surface topographical differences that may not show up in qualitative assessments of surface properties and respond by altering local factor production. These factors are vital for osseointegration after implant insertion, especially in patients with compromised bone qualities.

Finite element analysis of titanium anatomic plate and titanium reconstructive plate for treatment of extra-articular fractures of the scapula

BACKGROUND

Due to the lack of postoperative reporting outcomes and bio-mechanical studies, an optimal management of scapular fractures has not been well-established in clinical treatment, even though there are many options available. This study aimed to compare the stability of the new titanium anatomic and traditional titanium reconstructive plates for extra-articular scapular fractures through finite element analysis.

METHODS

Two models of scapular assembly were constructed, including one anatomic plate (AP model) and one reconstructive plate (RP model). After meshing, material parameter, and boundary condition settings, we applied four loading conditions to simulate forces acting on the scapula and osteosynthesis material. To evaluate the bio-mechanical properties, the equivalent von Mises stress, equivalent elastic strain, and total deformation were investigated.

RESULT

The stress and strain distribution of model AP has better performance than model RP, with more uniform and lower values. The maximum stress value of the scapula in model AP is smaller than that of the scapula in model RP (102.83 MPa vs. 166.71 MPa). The maximum stress of the anatomic plate is half that of the reconstructive plate (218.34 MPa vs. 416.01 MPa). The maximum strain of the scapula in model AP is smaller than that of the scapula in model RP (0.0071 vs. 0.0106). The maximum strain of the anatomic plate is half that of the reconstructive plate (0.0019 vs. 0.0037). The maximum displacement of each model is all at the acromion, with a similar value (2.2947 mm vs. 1.8308 mm).

CONCLUSIONS

With sufficient bio-mechanical stability, the anatomic plate to support scapular fracture fragments was superior to that of the reconstructive plate.

Multi-functional Ti6Al4V-CoCrMo implants fabricated by multi-material laser powder bed fusion technology: A disruptive material's design and manufacturing philosophy

A home-made 3D Multi-Material Laser Powder Bed Fusion (3DMMLPBF) technology was exploited to manufacture novel multi-material Ti6Al4V-CoCrMo parts. This multi-material concept aims to bring to life a new and disruptive material's design concept for the acetabular cup. Only using a layer-by-layer approach it is possible to manufacture an acetabular cup capable to combine CoCrMo alloy wear resistance and Ti6Al4V alloy bone-friendly nature, in a single component, fabricated at once. This system works with multiple powder deposition functions and vacuum cleaning procedures allowing to use two different powders (Ti6Al4V and CoCrMo) in each layer and thus, allowing to construct 3D Multi-Material transition between distinct materials, point-by-point and layer-by-layer. In this sense, the manufacturing strategies and the functional transition between Ti6Al4V and CoCrMo with a mechanical interlocking were analyzed and discussed both from mechanical and metallurgical point of view. A small diffusion area and no evidence of defects or cracks can be found in the transition's regions between the distinct materials which are strong evidences of a solid metallurgical bonding at the interfacial regions of Ti6Al4V and CoCrMo materials. A functional transition is also obtained through a design capable to provide a 3D mechanical interlocking with potential of assuring, simultaneously, tensile and compressive strength. This proof of concept might be a step-ahead in Laser Powder Bed Fusion in which the most desired intrinsic of individual materials can be combined in a single component targeting biomedical disruptive solutions.

Mechanical performance of porous biomimetic intervertebral body fusion devices: an in vitro biomechanical study

BACKGROUND

Degenerative disc disease is one of the most common ailments severely affecting the quality of life in elderly population. Cervical intervertebral body fusion devices are utilized to provide stability after surgical intervention for cervical pathology. In this study, we design a biomimetic porous spinal cage, and perform mechanical simulations to study its performances following American Society for Testing and Materials International (ASTM) standards before manufacturing to improve design process and decrease cost and consumption of material.

METHODS

The biomimetic porous Ti-6Al-4 V interbody fusion devices were manufactured by selective laser melting (laser powder bed fusion: LPBF in ISO/ASTM 52900 standard) and subsequently post-processed by using hot isostatic pressing (HIP). Chemical composition, microstructure and the surface morphology were studied. Finite element analysis and in vitro biomechanical test were performed.

FINDINGS

The post heat treatment can optimize its mechanical properties, as the stiffness of the cage decreases to reduce the stress shielding effect between two instrumented bodies. After the HIP treatment, the ductility and the fatigue performance are substantially improved. The use of HIP post-processing can be a necessity to improve the physical properties of customized additive manufacturing processed implants.

INTERPRETATION

In conclusion, we have successfully designed a biomimetic porous intervertebral device. HIP post-treatment can improve the bulk material properties, optimize the device with reduced stiffness, decreased stress shielding effect, while still provide appropriate space for bone growth.

CLINICAL SIGNIFICANCE

The biomechanical performance of 3-D printed biomimetic porous intervertebral device can be optimized. The ductility and the fatigue performance were substantially improved, the simultaneously decreased stiffness reduces the stress shielding effect between two instrumented bodies; while the biomimetic porous structures provide appropriate space for bone growth, which is important in the patients with osteoporosis.

Definition, measurement, and function of pore structure dimensions of bioengineered porous bone tissue materials based on additive manufacturing: A review

Bioengineered porous bone tissue materials based on additive manufacturing technology have gradually become a research hotspot in bone tissue-related bioengineering. Research on structural design, preparation and processing processes, and performance optimization has been carried out for this material, and further industrial translation and clinical applications have been implemented. However, based on previous studies, there is controversy in the academic community about characterizing the pore structure dimensions of porous materials, with problems in the definition logic and measurement method for specific parameters. In addition, there are significant differences in the specific morphological and functional concepts for the pore structure due to differences in defining the dimensional characterization parameters of the pore structure, leading to some conflicts in perceptions and discussions among researchers. To further clarify the definitions, measurements, and dimensional parameters of porous structures in bioengineered bone materials, this literature review analyzes different dimensional characterization parameters of pore structures of porous materials to provide a theoretical basis for unified definitions and the standardized use of parameters.

Influence of the roughness of dental implants obtained by additive manufacturing on osteoblastic adhesion and proliferation: A systematic review

Objective

Critically analyzed the existing literature to answer the question "What is the influence of roughness of surfaces for dental implants obtained by additive manufacturing compared to machined on osteoblastic cell adhesion and proliferation?"

Design

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the Open Science Framework. The personalized search strategy was applied to Embase, Pub Med, Scopus, and Science Direct databases and Google Scholar and ProQuest grey literature. The selection process was carried out in two stages independently by two reviewers according to the eligibility criteria. The risk of bias was analyzed using a checklist of important parameters to be considered.

Results

When applying the search strategy on databases 223 articles were found, after removing the duplicates, 171 were analyzed by title and abstract of which 25 were selected for full reading, of these, 6 met the eligibility criteria. 2 studies were included from the reference list totaling 8 articles included in this systematic review and none were included from the Grey Literature. 7 had a low risk of bias and 1 moderate.

Conclusions

1) Roughness is a property that must be analyzed and correlated with the chemical composition, intrinsic to the alloy and resulting from the surface treatment; morphology of topographic peaks and valleys; printing technique and its parameters; 2) Need for more studies on the biomolecular level to elucidate the mechanism by which the roughness and the morphology of topographical peaks and valleys descriptive of roughness influence osteoblastic adhesion and proliferation.

Biomechanical analysis of printable functionally graded material (FGM) dental implants for different bone densities

The long-term success of a dental implant is related to the material and design of the implant, and bone density. Conventional implants cause stress-shielding due to a mismatch between the implant and bone stiffness. Functionally graded porous materials and designs are a great choice for the design of implants to control the local stiffness at a certain location to meet the biomechanical requirements. The purpose of this study is to analyze five designs of axial and radial functionally graded materials (FGM) implants besides the conventional implant and conical and cylindrical shapes that were simulated with five different bone densities. The results showed that strain in bone increased with a decrease in cancellous bone density. The shape of the implant did not play an important role in strain/stress distribution. Conventional implants showed optimal strain (1000-2240 με) in low-density (0.7-0.8 g/cm3) bone, however, FGM implants produced optimal strain (990-1280 με) in the high-density bone (0.9-1 g/cm3) as compared to conventional implants. The proposed designs of FGM implants have the potential to address the complications of conventional implants in high-density bone.

In vivo evaluation of osseointegration ability of sintered bionic trabecular porous titanium alloy as artificial hip prosthesis

Hydroxyapatite (HA) coatings have been widely used for improving the bone-implant interface (BII) bonding of the artificial joint prostheses. However, the incidence of prosthetic revisions due to aseptic loosening remains high. Porous materials, including three-dimensional (3D) printing, can reduce the elastic modulus and improve osseointegration at the BII. In our previous study, we identified a porous material with a sintered bionic trabecular structure with in vitro and in vivo bio-safety as well as in vivo mechanical safety. This study aimed to compare the difference in osseointegration ability of the different porous materials and HA-coated titanium alloy in the BII. We fabricated sintered bionic trabecular porous titanium acetabular cups, 3D-printed porous titanium acetabular cups, and HA-coated titanium alloy acetabular cups for producing a hip prosthesis suitable for beagle dogs. Subsequently, the imaging and histomorphological analysis of the three materials under mechanical loading in animals was performed (at months 1, 3, and 6). The results suggested that both sintered bionic porous titanium alloy and 3D-printed titanium alloy exhibited superior performances in promoting osseointegration at the BII than the HA-coated titanium alloy. In particular, the sintered bionic porous titanium alloy exhibited a favorable bone ingrowth performance at an early stage (month 1). A comparison of the two porous titanium alloys suggested that the sintered bionic porous titanium alloys exhibit superior bone in growth properties and osseointegration ability. Overall, our findings provide an experimental basis for the clinical application of sintered bionic trabecular porous titanium alloys.

The Influence of Laser Power and Scan Speed on the Dimensional Accuracy of Ti6Al4V Thin-Walled Parts Manufactured by Selective Laser Melting

Laser Powder Bed Fusion (LPBF) technologies such as Selective Laser Melting (SLM) are being increasingly considered as viable production routes. This paradigm change demands an in-depth understanding of the fabrication process and variables, as previous studies have shown that energy density calculation alone is insufficient, because parts fabricated using similar energy density, but using different combinations of parameters, can display significantly different properties and dimensions. Thin-walled parts are particularly influenced by processing parameters; in this sense, this study explores the influence of laser power and scan speed on the dimensions of Ti6Al4V thin-walled tubes. Predictive models for manufacturing Ti6Al4V thin-walled tubes were developed using Response Surface Methodology (RSM), and the most influential (single and combined) factors were determined using Analysis of Variance (ANOVA). Three models were obtained: for the wall melt zone thickness, the total wall thickness, and the hole width.

3D-Printed Nanocomposite Denture-Base Resins: Effect of ZrO2 Nanoparticles on the Mechanical and Surface Properties In Vitro

Due to the low mechanical performances of 3D-printed denture base resins, ZrO2 nanoparticles (ZrO2NPs) were incorporated into different 3D-printed resins and their effects on the flexure strength, elastic modulus, impact strength, hardness, and surface roughness were evaluated. A total of 286 specimens were fabricated in dimensions per respective test and divided according to materials into three groups: heat-polymerized as a control group and two 3D-printed resins (NextDent and ASIGA) which were modified with 0.5 wt.%, 1 wt.%, 3 wt.%, and 5 wt.% ZrO2NPs. The flexure strength and elastic modulus, impact strength, hardness, and surface roughness (µm) were measured using the three-point bending test, Charpy’s impact test, Vickers hardness test, and a profilometer, respectively. The data were analyzed by ANOVA and Tukey’s post hoc test (α = 0.05). The results showed that, in comparison to heat-polymerized resin, the unmodified 3D-printed resins showed a significant decrease in all tested properties (p < 0.001) except surface roughness (p = 0.11). In between 3D-printed resins, the addition of ZrO2NPs to 3D-printed resins showed a significant increase in flexure strength, impact strength, and hardness (p < 0.05) while showing no significant differences in surface roughness and elastic modulus (p > 0.05). Our study demonstrated that the unmodified 3D-printed resins showed inferior mechanical behavior when compared with heat-polymerized acrylic resin while the addition of ZrO2NPs improved the properties of 3D-printed resins. Therefore, the introduced 3D-printable nanocomposite denture-base resins are suitable for clinical use.

Use of a new off-the-shelf 3D-printed trabecular titanium acetabular cup in Chinese patients undergoing hip revision surgery: Short- to mid-term clinical and radiological outcomes

Background

Revision total hip arthroplasty (THA) has been a challenge for surgeons. The purpose of this study was to explore the short-to mid-term clinical and radiological outcomes of Chinese patients who underwent revision THA using a new off-the-shelf three-dimensional (3D)-printed trabecular titanium (TT) acetabular cup by comparison with a conventional porous coated titanium acetabular cup, to provide a reference for the recommendation of this prostheses.

Methods

A retrospective analysis of 57 patients (57 hips) who received revision THA was performed from January 2016 to June 2019. A total of 23 patients received 3D-printed cups (observation group) and 34 patients received non-3D-printed cups (control group). Clinical scores including Visual Analogue Scale (VAS), Harris Hip Score (HHS) and Short Form 36 (SF-36), upward movement of the hip center of rotation(HCOR)and limb-length discrepancy (LLD), stabilization and bone ingrowth of cups were compared between two groups. The multivariate linear regression was used to determine the factors potentially influencing the HHS score. Postoperative complications in the two groups were also recorded.

Results

All 57 patients were routinely followed up. The average follow-up durations in the control and observation groups were 43.57 ± 13.68 (24–65) months and 41.82 ± 11.44 (24–64) months, respectively (p = 0.618). The postoperative clinical scores significantly improved in both groups compared to the preoperative scores (p < 0.001). The VAS score did not significantly differ between the groups at 3 (p = 0.946) or 12 (p = 0.681) months postoperatively, or at the last follow-up (p = 0.885). The HHS score did not significantly differ between the groups at 3 months (p = 0.378) postoperatively but differed at 12 months (p < 0.001) postoperatively and the last follow-up (p < 0.001). The SF-36 score did not significantly differ between the groups at 3 months (p = 0.289) postoperatively, but was significantly different at 12 months (p < 0.001) postoperatively and the last follow-up (p < 0.001). Compared with the control group, the postoperative recovery of HCOR and LLD was better in the observation group. All cups remained stable, with no loosening throughout the follow-up period. But the observation group had a significantly better rate of bone ingrowth compared to the control group (p = 0.037). Multivariate linear regression analysis showed that different cup types, upward movement of the HCOR, and LLD influenced the HHS score at the last follow-up (p < 0.001, p = 0.005, respectively). None of the patients exhibited severe postoperative complications.

Conclusion

The new off-the-shelf 3D-printed TT acetabular cup demonstrated encouraging short-to mid-term clinical outcomes in Chinese patients. It can effectively relieve pain, improve hip function, provide satisfactory biological fixation and high survival rate. But further follow up is necessary to assess its long-term outcomes.

Mechanical Properties of Ti6Al4V Fabricated by Laser Powder Bed Fusion: A Review Focused on the Processing and Microstructural Parameters Influence on the Final Properties

Ti6Al4V alloy is an ideal lightweight structural metal for a huge variety of engineering applications due to its distinguishing combination of high specific mechanical properties, excellent corrosion resistance and biocompatibility. In this review, the mechanical properties of selective laser-melted Ti6Al4V parts are addressed in detail, as well as the main processing and microstructural parameters that influence the final properties. Fundamental knowledge is provided by linking the microstructural features and the final mechanical properties of Ti6Al4V parts, including tensile strength, tensile strain, fatigue resistance, hardness and wear performance. A comparison between Laser Powder Bed Fusion and conventional processing routes is also addressed. The presence of defects in as-built Ti6Al4V parts and their influences on the mechanical performance are also critically discussed. The results available in the literature show that typical Laser Powder Bed–Fused Ti6Al4V tensile properties (>900 MPa yield strength and >1000 MPa tensile strength) are adequate when considering the minimum values of the standards for implants and for aerospace applications (e.g., ASTM F136–13; ASTM F1108–14; AMS4930; AMS6932).

Mechanical in vitro fatigue testing of implant materials and components using advanced characterization techniques

Implants of different material classes have been used for the reconstruction of damaged hard and soft tissue for decades. The aim is to increase and subsequently maintain the patient's quality of life through implantation. In service, most implants are subjected to cyclic loading, which must be taken particularly into consideration, since the fatigue strength is far below the yield and tensile strength. Inaccurate estimation of the structural strength of implants due to the consideration of yield or tensile strength leads to a miscalculation of the implant's fatigue strength and lifetime, and therefore, to its unexpected early fatigue failure. Thus, fatigue failure of an implant based on overestimated performance capability represents acute danger to human health. The determination of fatigue strength by corresponding tests investigating various stress amplitudes is time-consuming and cost-intensive. This study summarizes four investigation series on the fatigue behavior of different implant materials and components, following a standard and an in vitro short-time testing procedure, which evaluates the material reaction in one enhanced test set-up. The test set-up and the applied characterization methods were adapted to the respective application of the implant with the aim to simulate the surrounding of the human body with laboratory in vitro tests only. It could be shown that by using the short-time testing method the number of tests required to determine the fatigue strength can be drastically reduced. In future, therefore it will be possible to exclude unsuitable implant materials or components before further clinical investigations by using a time-efficient and application-oriented testing method.

Novel Design and Finite Element Analysis of Diamond-like Porous Implants with Low Stiffness

The purpose of this study was to design porous implants with low stiffness and evaluate their biomechanical behavior. Thus, two types of porous implants were designed (Type I: a combined structure of diamond-like porous scaffold and traditional tapered thread. Type II: a cylindrical porous scaffold filled by arrayed basic diamond-like pore units). Three implant-supported prosthesis models were constructed from Type I, Type II and commercial implants (control group) and were evaluated by finite element analysis (FEA). The stress distribution pattern of the porous implants were assessed and compared with the control group. In addition, the stiffness of the cylindrical specimens simplified from three types of implants was calculated. The Type I implant exhibited better stress distribution than the Type II implant. The maximum stress between the cortical bone–Type I implant interface was 12.9 and 19.0% lower than the other two groups. The peak stress at the cancellous bone–Type I implant interface was also reduced by 16.8 and 38.7%. Compared with the solid cylinder, the stiffness of diamond-like pore cylinders simplified from the two porous implants geometry was reduced by 61.5 to 76.1%. This construction method of porous implant can effectively lower its stiffness and optimize the stress distribution at the implant–bone interface.

Mechanical properties and in vitro cytocompatibility of dense and porous Ti-6Al-4V ELI manufactured by selective laser melting technology for biomedical applications

The Ti-6Al-4V alloy is the most common biomaterial used for bone replacements and reconstructions. Despite its advantages, the Ti-6Al-4V has a high stiffness that can cause stress-shielding. In this work, we demonstrated that the selective laser melting (SLM) technology could be used to fabricate porosity in Ti-6Al-4V extra low interstitial (ELI) to reduce its stiffness while improving cell adhesion and proliferation. With a porosity of 14.04%, the elastic modulus of the porous Ti-6Al-4V ELI was reduced to 80 GPa. The compressive stress and the 3-point-bending flexural tests revealed that the porous Ti-6Al-4V ELI possessed a brittle characteristic. The additional pores within the beams of the lattice structures of porous Ti-6Al-4V ELI increased its surface arithmetic average roughness, R_a = 3.94 μm. The in vitro cytocompatibility test showed that the SLM printing process and the post-processes did not cause any toxicity in the MC3T3-E1 cells. The in vitro cell proliferation test also showed that the porous Ti-6Al-4V ELI increased the proliferation rate of osteogenic induced MC3T3-E1 cells on Day 7. The findings from this study would provide engineers and researchers with both the mechanical information and biological understanding of SLM printed porous Ti-6Al-4V ELI, and SLM printed dense Ti-6Al-4V ELI towards biomedical applications.

Structural analysis of an endoprosthesis designed with graded density lattice structures

The most common causes of conducting a hip revision surgery after total hip replacement are aseptic loosening (aseptic instability) of the endoprosthesis, bone destruction as a result of contact with the endoprosthesis, and a periprosthetic fracture. These are the effects of load transfer to the bone tissue in arthroplasty resulting due to the difference in stiffness of the endoprosthesis and the bone. Titanium alloy is widely used in endoprostheses manufacturing because of its high biocompatibility, good wear properties, and corrosion resistance, but such endoprostheses are stiffer than the femur. These problems have raised interest in searching for the best materials and topology for a femoral implant. Nowadays additive technology is of great interest as it enables to create materials with graded density. These materials consist of multiple lattice structures with variable parameters and topology. By varying the parameters of lattice structures one can adjust the mechanical properties of the material as required. These materials find their application in hip endoprostheses manufacturing, allowing to adjust the parameters of the lattice structures, and deliver a product with femur-like mechanical properties. The porous structure also ensures bone tissue ingrowth into the prosthesis. The authors designed and simulated an endoprosthesis made of graded density lattice structures with femur-like mechanical properties. Using a numerical simulation software Ansys Mechanical authors determined the effect of the topology on the structural behavior of the femur and defined the endoprosthesis-femur combined performance under various load cases.

Design and properties of biomimetic irregular scaffolds for bone tissue engineering

The treatment of sizeable segmental bone defects remains a challenge encountered by surgeons. In addition to bone transplantation, porous scaffolds have become a common option. Although the mechanical and biological properties of porous scaffold have recently been the subject of intense research, pore irregularity as a critical characteristic has been poorly explored. Therefore, this study aimed to design an irregular biomimetic scaffold for use in bone tissue engineering applications. The irregular scaffold was based on the Voronoi tessellation method for similarity with the primary histomorphological indexes of bone (porosity, trabecular thickness, cortical bone thickness, and surface to volume ratio). Moreover, a new gradient method was adopted, in which porosity was maintained constant, and the strut diameter was changed to generate a gradient in the irregular scaffold. The permeability and stress concentration characteristics of the irregular scaffold were compared against three conventional scaffolds (the octet, body-centered cubic, pillar body-centered cubic). The results illustrated that the microstructure of the irregular scaffold could be controlled similarly to that of the cortical/cancellous bone unit. Simultaneously, a broad range of permeability was identified for the irregular scaffold, and gradient irregular scaffolds performed better in terms of both permeability and stress distribution than regular scaffolds. This study describes a novel method for the design of irregular scaffolds, which have good controllability and excellent permeability.

Strength Properties of a Porous Titanium Alloy Ti6Al4V with Diamond Structure Obtained by Laser Power Bed Fusion (LPBF)

This paper presents the results of experimental research on the strength properties of porous structures with different degrees of density manufactured of Ti6Al4V titanium alloy by Laser Power Bed Fusion. In the experiment, samples with diamond structure of porosity: 34%, 50%, 73% and 81% were used, as well as samples with near-zero porosity. Monotonic tensile tests were carried out to determine the effective values of axial modulus of elasticity, ultimate tensile strength, offset yield strength, ultimate elongation and Poisson ratio for titanium alloys with different porosities. The paper also proposes relationships that can be easily used to estimate the strength and rigidity of a porous material manufactured by 3D printing. They were obtained by the approximation of two quotients. The first one refers to the relationship between the tensile strength of a material with a defined porosity to the strength of full-filled material. The second similarly determines the change in the value of the axial modulus of elasticity. The analysis of microscopic observations of fracture surfaces and also microtomography visualization of the material structure are also presented.

Selective Laser Melting of Ti6Al4V sub-millimetric cellular structures: Prediction of dimensional deviations and mechanical performance

Ti6Al4V sub-millimetric cellular structures arise as promising solutions concerning the progress of conventional orthopedic implants due to its ability to address a combination of mechanical, physical and topological properties. Such ability can improve the interaction between implant materials and surrounding bone leading to long-term successful orthopedic implants. Selective Laser Melting (SLM) capability to produce high quality Ti6Al4V porous implants is in great demand towards orthopedic biomaterials. In this study, Ti6Al4V cellular structures were designed, modeled, SLM produced and characterized targeting orthopedic implants. For that purpose, a set of tools is proposed to overcome SLM limited accuracy to produce porous biomaterials with desired dimensions and mechanical properties. Morphological analyses were performed to evaluate the dimensional deviations noticed between the model CAD and the SLM produced structures. Tensile tests were carried out to estimate the elastic modulus of the Ti6Al4V cellular structures. The present work proposes a design methodology showing the linear correlations found for the dimensions, the porosity and the elastic modulus when comparing the model CAD designs with Ti6Al4V structures by SLM.

Relationship between the morphological, mechanical and permeability properties of porous bone scaffolds and the underlying microstructure

Bone scaffolds are widely used as one of the main bone substitute materials. However, many bone scaffold microstructure topologies exist and it is still unclear which topology to use when designing scaffold for a specific application. The aim of the present study was to reveal the mechanism of the microstructure-driven performance of bone scaffold and thus to provide guideline on scaffold design. Finite element (FE) models of five TPMS (Diamond, Gyroid, Schwarz P, Fischer-Koch S and F-RD) and three traditional (Cube, FD-Cube and Octa) scaffolds were generated. The effective compressive and shear moduli of scaffolds were calculated from the mechanical analysis using the FE unit cell models with the periodic boundary condition. The scaffold permeability was calculated from the computational fluid dynamics (CFD) analysis using the 4×4×4 FE models. It is revealed that the surface-to-volume ratio of the Fischer-Koch S-based scaffold is the highest among the scaffolds investigated. The mechanical analysis revealed that the bending deformation dominated structures (e.g., the Diamond, the Gyroid, the Schwarz P) have higher effective shear moduli. The stretching deformation dominated structures (e.g., the Schwarz P, the Cube) have higher effective compressive moduli. For all the scaffolds, when the same amount of change in scaffold porosity is made, the corresponding change in the scaffold relative shear modulus is larger than that in the relative compressive modulus. The CFD analysis revealed that the structures with the simple and straight pores (e.g., Cube) have higher permeability than the structures with the complex pores (e.g., Fischer-Koch S). The main contribution of the present study is that the relationship between scaffold properties and the underlying microstructure is systematically investigated and thus some guidelines on the design of bone scaffolds are provided, for example, in the scenario where a high surface-to-volume ratio is required, it is suggested to use the Fischer-Koch S based scaffold.

Porous Scaffold Design for Additive Manufacturing in Orthopedics: A Review

With the increasing application of orthopedic scaffolds, a dramatically increasing number of requirements for scaffolds are precise. The porous structure has been a fundamental design in the bone tissue engineering or orthopedic clinics because of its low Young's modulus, high compressive strength, and abundant cell accommodation space. The porous structure manufactured by additive manufacturing (AM) technology has controllable pore size, pore shape, and porosity. The single unit can be designed and arrayed with AM, which brings controllable pore characteristics and mechanical properties. This paper presents the current status of porous designs in AM technology. The porous structures are stated from the cellular structure and the whole structure. In the aspect of the cellular structure, non-parametric design and parametric design are discussed here according to whether the algorithm generates the structure or not. The non-parametric design comprises the diamond, the body-centered cubic, and the polyhedral structure, etc. The Voronoi, the Triply Periodic Minimal Surface, and other parametric designs are mainly discussed in parametric design. In the discussion of cellular structures, we emphasize the design, and the resulting biomechanical and biological effects caused by designs. In the aspect of the whole structure, the recent experimental researches are reviewed on uniform design, layered gradient design, and layered gradient design based on topological optimization, etc. These parts are summarized because of the development of technology and the demand for mechanics or bone growth. Finally, the challenges faced by the porous designs and prospects of porous structure in orthopedics are proposed in this paper.

Functionality-packed additively manufactured porous titanium implants

The holy grail of orthopedic implant design is to ward off both aseptic and septic loosening for long enough that the implant outlives the patient. Questing this holy grail is feasible only if orthopedic biomaterials possess a long list of functionalities that enable them to discharge the onerous task of permanently replacing the native bone tissue. Here, we present a rationally designed and additive manufacturing (AM) topologically ordered porous metallic biomaterial that is made from Ti-6Al-4V using selective laser melting and packs most (if not all) of the required functionalities into a single implant. In addition to presenting a fully interconnected porous structure and form-freedom that enables realization of patient-specific implants, the biomaterials developed here were biofunctionalized using plasma electrolytic oxidation to locally release both osteogenic (i.e. strontium) and antibacterial (i.e. silver ions) agents. The same single-step biofunctionalization process also incorporated hydroxyapatite into the surface of the implants. Our measurements verified the continued release of both types of active agents up to 28 days. Assessment of the antibacterial activity in vitro and in an ex vivo murine model demonstrated extraordinarily high levels of bactericidal effects against a highly virulent and multidrug-resistant Staphylococcus aureus strain (i.e. USA300) with total eradication of both planktonic and adherent bacteria. This strong antibacterial behavior was combined with a significantly enhanced osteogenic behavior, as evidenced by significantly higher levels of alkaline phosphatase (ALP) activity compared with non-biofunctionalized implants. Finally, we discovered synergistic antibacterial behavior between strontium and silver ions, meaning that 4-32 folds lower concentrations of silver ions were required to achieve growth inhibition and total killing of bacteria. The functionality-packed biomaterial presented here demonstrates a unique combination of functionalities that make it an advanced prototype of future orthopedic biomaterials where implants will outlive patients.

Hot isostatic pressure treatment of 3D printed Ti6Al4V alters surface modifications and cellular response

Additive manufacturing can be used to create personalized orthopedic and dental implants with varying geometries and porosities meant to mimic morphological properties of bone. These qualities can alleviate stress shielding and increase osseointegration through bone ingrowth, but at the expense of reduced fatigue properties compared to machined implants, and potential for loose build particle erosion. Hot isostatic pressure (HIP) treatment is used to increase fatigue resistance; implant surface treatments like grit-blasting and acid-etching create microroughness and reduce the presence of loose particles. However, it is not known how HIP treatment affects surface treatments and osseointegration of the implant to bone. We manufactured two titanium-aluminum-vanadium constructs, one with simple through-and-through porosity and one possessing complex trabecular bone-like porosity. We observed HIP treatment varied in effect and was dependent on architecture. Micro/meso/nano surface properties generated by grit-blasting and acid-etching were altered on biomimetic HIP-treated constructs. Human mesenchymal stem cells (MSCs) were cultured on constructs fabricated +/- HIP and subsequently surface-treated. MSCs were sensitive to 3D-architecture, exhibiting greater osteogenic differentiation on constructs with complex trabecular bone-like porosity. HIP-treatment did not alter the osteogenic response of MSCs to these constructs. Thus, HIP may provide mechanical and biological advantages during implant osseointegration and function.

Correlating in-situ process monitoring data with the reduction in load bearing capacity of selective laser melted Ti-6Al-4V porous biomaterials

Selective Laser Melting allows for the creation of intricate porous structures, that possess favourable biological properties. These structures are known as porous biomaterials. The focus of this paper is to evaluate the use of an in-line photodiode based process monitoring system, for the monitoring of the operational behaviour of the laser, and to correlate this with the resultant parts mechanical performance. In this study the production scale Renishaw 500M was used to produce porous structures, using Ti-6Al-4V feedstock powder. During the process, a co-axial process monitoring system was utilised to generate data relating to both the meltpool and the operational behaviour of the laser. An advanced scanning technique was used to produce the structures, whereby the laser parameters determine the strut dimensions. In this study, the laser input energy was reduced by 33%, 66% and 100%, at specific layers within the structures. Computer Tomography and Scanning Electron Microscopy was utilised to characterise the affected struts within the structures, while quasi-static compression testing was used to determine the structure's mechanical properties. It was demonstrated that as the level of input energy decreased and the number of affected layers increased, a corresponding decrease in the load bearing capacity of the structures occurred. With the structures experiencing a significant loss in strength also exhibiting a change in the failure mode during compression testing. Data generated during the processing of such structures was compared to the data generated during the processing of control structures, with the difference between the two been calculated on a layer-by-layer basis. A clear correlation was demonstrated between the total level of deviation between the two signal sets and a reduction in the load bearing capacity of the structures. This indicates that by comparing build data to a benchmark data set, valuable information relating to the structural integrity of the porous structures can be obtained.

Meta-biomaterials

Meta-biomaterials are designer biomaterials with unusual and even unprecedented properties that primarily originate from their geometrical designs at different (usually smaller) length scales.

Bioactive Glass and Silicate-Based Ceramic Coatings on Metallic Implants: Open Challenge or Outdated Topic?

The overall success and long-term life of the medical implants are decisively based on the convenient osseointegration at the hosting tissue-implant interface. Therefore, various surface modifications and different coating approaches have been utilized to the implants to enhance the bone formation and speed up the interaction with the surrounding hosting tissues, thereby enabling the successful fixation of implants. In this review, we will briefly present the main metallic implants and discuss their biocompatibility and osseointegration ability depending on their chemical and mechanical properties. In addition, as the main goal of this review, we explore the main properties of bioactive glasses and silica-based ceramics that are used as coating materials for both orthopedic and dental implants. The current review provides an overview of these bioactive coatings, with a particular emphasis on deposition methods, coating adhesion to the substrates and apatite formation ability tested by immersion in Simulated Body Fluid (SBF). In vitro and in vivo performances in terms of biocompatibility, biodegradability and improved osseointegration are examined as well.

Corrosion and Corrosion Fatigue Properties of Additively Manufactured Magnesium Alloy WE43 in Comparison to Titanium Alloy Ti-6Al-4V in Physiological Environment

Laser powder bed fusion (L-PBF) of metals enables the manufacturing of highly complex geometries which opens new application fields in the medical sector, especially with regard to personalized implants. In comparison to conventional manufacturing techniques, L-PBF causes different microstructures, and thus, new challenges arise. The main objective of this work is to investigate the influence of different manufacturing parameters of the L-PBF process on the microstructure, process-induced porosity, as well as corrosion fatigue properties of the magnesium alloy WE43 and as a reference on the titanium alloy Ti-6Al-4V. In particular, the investigated magnesium alloy WE43 showed a strong process parameter dependence in terms of porosity (size and distribution), microstructure, corrosion rates, and corrosion fatigue properties. Cyclic tests with increased test duration caused an especially high decrease in fatigue strength for magnesium alloy WE43. It can be demonstrated that, due to high process-induced surface roughness, which supports locally intensified corrosion, multiple crack initiation sites are present, which is one of the main reasons for the drastic decrease in fatigue strength.

Design of porous titanium scaffold for complete mandibular reconstruction: The influence of pore architecture parameters

Patients having a medical history of oral cancer, infectious diseases or trauma are often advised surgical intervention with customized complete mandibular constructs (CMC) made of Titanium (Ti) scaffolds. A numerical framework based on a homogenization technique was developed to investigate the influence of pore architecture parameters on homogenized orthotropic material properties of the scaffolds. A comparative 3D Finite Element (FE) analysis of six CMC models, having homogenized orthotropic material properties, under a mastication cycle, was undertaken to pre-clinically determine the optimal CMC for a patient. Orthotropic material properties of Ti-scaffolds decreased with an increase in the inter-strut distance. Stress and strain distributions of CMC models during right molar bite were investigated. Despite small differences in stress distributions in the 'body' region of CMC models, the overall stress distribution (tensile and compressive) of CMC models (30-32 MPa) were well comparable to that of an intact mandible (34.54 MPa). Higher magnitudes of tensile strains were observed for models with 0.2 mm (9884μɛ) and 0.4 mm strut diameter (SD), both having 0.5 mm inter-strut distance (ID), at articular condyle area, body and symphysis equivalent part of the constructs. The maximum principal tensile strains were higher in the CMC models with 0.5 mm ID as compared to those having 0.3 mm ID. Comparatively, the scaffolds with lesser ID (0.3 mm) resulted in higher stiffness, thereby evoking less principal strains in the CMC models. Moreover, considering the weight of the scaffolds, the CMC models having 0.3 mm ID with 0.2 mm SD and 0.5 mm ID with 0.6 mm SD seemed most appropriate for a patient.

Mechanical performance of additively manufactured meta-biomaterials

Additive manufacturing (AM) (=3D printing) and rational design techniques have enabled development of meta-biomaterials with unprecedented combinations of mechanical, mass transport, and biological properties. Such meta-biomaterials are usually topologically ordered and are designed by repeating a number of regular unit cells in different directions to create a lattice structure. Establishing accurate topology-property relationships is of critical importance for these materials. In this paper, we specifically focus on AM metallic meta-biomaterials aimed for application as bone substitutes and orthopaedic implants and review the currently available evidence regarding their mechanical performance under quasi-static and cyclic loading conditions. The topology-property relationships are reviewed for regular beam-based lattice structures, sheet-based lattice structures including those based on triply periodic minimal surface, and graded designs. The predictive models used for establishing the topology-property relationships including analytical and computational models are covered as well. Moreover, we present an overview of the effects of the AM processes, material type, tissue regeneration, biodegradation, surface bio-functionalization, post-manufacturing (heat) treatments, and loading profiles on the quasi-static mechanical properties and fatigue behavior of AM meta-biomaterials. AM meta-biomaterials exhibiting unusual mechanical properties such as negative Poisson's ratios (auxetic meta-biomaterials), shape memory behavior, and superelasitcity as well as the potential applications of such unusual behaviors (e.g. deployable implants) are presented too. The paper concludes with some suggestions for future research. STATEMENT OF SIGNIFICANCE: Additive manufacturing enables fabrication of meta-biomaterials with rare combinations of topological, mechanical, and mass transport properties. Given that the micro-scale topological design determines the macro-scale properties of meta-biomaterials, establishing topology-property relationships is the central research question when rationally designing meta-biomaterials. The interest in understanding the relationship between the topological design and material type on the one hand and the mechanical properties and fatigue behavior of meta-biomaterials on the other hand is currently booming. This paper presents and critically evaluates the most important trends and findings in this area with a special focus on the metallic biomaterials used for skeletal applications to enable researchers better understand the current state-of-the-art and to guide the design of future research projects.

Additively manufactured porous metallic biomaterials

Additively manufactured (AM, =3D printed) porous metallic biomaterials with topologically ordered unit cells have created a lot of excitement and are currently receiving a lot of attention given their great potential for improving bone tissue regeneration and preventing implant-associated infections.

Trabecular Titanium acetabular cups in hip revision surgery: mid-term clinical and radiological outcomes

INTRODUCTION:

Severe acetabular bone loss during revision hip arthroplasty can be restored with different surgical techniques. Best results have been observed using porous tantalum cementless cups. Trabecular Titanium (TT) cups were designed to reproduce the structure, mechanical and biological characteristics of trabecular bone. Few clinical studies have been published with these cups. The aim of this study is to evaluate the clinical and radiological outcome of patients with large acetabular defects (Paprosky IIb or higher) revised using TT cups.

MATERIALS AND METHODS:

64 consecutive patients who underwent revision for total hip arthroplasty (THA) between 2011 and 2015 at our institution were enrolled. All were classified as Paprosky IIb, IIc, IIIa and IIIb. Periprosthetic joint infections and fractures were not included in this study. Radiographic and clinical (Harris Hip Score (HHS)) outcomes were evaluated. Kaplan-Meyer survivorship curve was performed.

RESULTS:

Complete data of 58 patients (mean follow-up 48.3 months) were analysed. 6 patients underwent a further revision (10.3%). Causes of re-revision were instability (5.2%), infection (3.4%) and aseptic loosening (1.7%). No radiolucent lines or signs of migration were observed. Survivorship was 94.8%. HHS Improved from a mean of 36.5-83.7.

DISCUSSION:

TT cups demonstrated encouraging results at mid-term follow-up. Cup modularity represented a helpful tool to restore hip rotation centre and to reduce the risk of dislocation. The capacity of trabecular titanium to induce bone growth and the versatility of modularity, make the Delta TT System a very useful aid for surgeons who are more frequently faced with complex revision.

Current Trends in Metallic Orthopedic Biomaterials: From Additive Manufacturing to Bio-Functionalization, Infection Prevention, and Beyond

There has been a growing interest in metallic biomaterials during the last five years, as recent developments in additive manufacturing (=3D printing), surface bio-functionalization techniques, infection prevention strategies, biodegradable metallic biomaterials, and composite biomaterials have provided many possibilities to develop biomaterials and medical devices with unprecedented combinations of favorable properties and advanced functionalities. Moreover, development of biomaterials is no longer separated from the other branches of biomedical engineering, particularly tissue biomechanics, musculoskeletal dynamics, and image processing aspects of skeletal radiology. In this editorial, I will discuss all the above-mentioned topics, as they constitute some of the most important trends of research on metallic biomaterials. This editorial will, therefore, serve as a foreword to the papers appearing in a special issue covering the current trends in metallic biomaterials.

Frontiers of Additively Manufactured Metallic Materials

Additive manufacturing (AM) (=3D printing) has emerged during the last few years as a powerful technological platform for fabrication of functional parts with unique complex geometries and superior functionalities that are next to impossible to achieve using conventional manufacturing techniques. Due to their importance in industrial applications and the maturity of the applicable AM techniques, metallic materials are at the forefront of the developments in AM. In this editorial, which has been written as a preamble to the special issue “Perspectives on Additively Manufactured Metallic Materials”, I will highlight some of the frontiers of research on AM of metallic materials to help readers better understand the cutting edge of research in this area. Some of these topics are addressed in the articles appearing in this special issue, while others constitute worthy avenues for future research.

Stress Concentration and Mechanical Strength of Cubic Lattice Architectures

The continuous design of cubic lattice architecture materials provides a wide range of mechanical properties. It makes possible to control the stress magnitude and the local maxima in the structure. This study reveals some architectures specifically designed to reach a good compromise between mass reduction and mechanical strength. Decreased local stress concentration prevents the early occurrence of localized plasticity or damage, and promotes the fatigue resistance. The high performance of cubic architectures is reported extensively, and structures with the best damage resistance are identified. The fatigue resistance and S⁻N curves (stress magnitude versus lifetime curves) can be estimated successfully, based on the investigation of the stress concentration. The output data are represented in two-dimensional (2D) color maps to help mechanical engineers in selecting the suitable architecture with the desired stress concentration factor, and eventually with the correct fatigue lifetime.