Effect of the addition of low rare earth elements (lanthanum, neodymium, cerium) on the biodegradation and biocompatibility of magnesium

In vivo and in vitro evaluation of a biodegradable magnesium vascular stent designed by shape optimization strategy

The performance of biodegradable magnesium alloy stents (BMgS) requires special attention to non-uniform residual stress distribution and stress concentration, which can accelerate localized degradation after implantation. We now report on a novel concept in stent shape optimization using a finite element method (FEM) toolkit. A Mg-Nd-Zn-Zr alloy with uniform degradation behavior served as the basis of our BMgS. Comprehensive in vitro evaluations drove stent optimization, based on observed crimping and balloon inflation performance, measurement of radial strength, and stress condition validation via microarea-XRD. Moreover, a Rapamycin-eluting polymer coating was sprayed on the prototypical BMgS to improve the corrosion resistance and release anti-hyperplasia drugs. In vivo evaluation of the optimized coated BMgS was conducted in the iliac artery of New Zealand white rabbit with quantitative coronary angiography (QCA), optical coherence tomography (OCT) and micro-CT observation at 1, 3, 5-month follow-ups. Neither thrombus or early restenosis was observed, and the coated BMgS supported the vessel effectively prior to degradation and allowed for arterial healing thereafter. The proposed shape optimization framework based on FEM provides an novel concept in stent design and in-depth understanding of how deformation history affects the biomechanical performance of BMgS. Computational analysis tools can indeed promote the development of biodegradable magnesium stents.

In vitro and in vivo studies of Mg-30Sc alloys with different phase structure for potential usage within bone

Proper alloying magnesium with element scandium (Sc) could transform its microstructure from α phase with hexagonal closed-packed (hcp) structure into β phase with body-cubic centered (bcc) structure. In the present work, the Mg-30 wt% Sc alloy with single α phase, dual phases (α + β) or β phase microstructure were developed by altering the heat-treatment routines and their suitability for usage within bone was comprehensively investigated. The β phased Mg-30 wt% Sc alloy showed the best mechanical performance with ultimate compressive strength of 603 ± 39 MPa and compressive strain of 31 ± 3%. In vitro degradation test showed that element scandium could effectively incorporate into the surface corrosion product layer, form a double-layered structure, and further protect the alloy matrix. No cytotoxic effect was observed for both single α phased and β phased Mg-30 wt% Sc alloys on MC3T3 cell line. Moreover, the β phased Mg-30 wt%Sc alloy displayed acceptable corrosion resistance in vivo (0.06 mm y^-1) and maintained mechanical integrity up to 24 weeks. The degradation process did not significantly influence the hematology indexes of inflammation, hepatic or renal functions. The bone-implant contact ratio of 75 ± 10% after 24 weeks implied satisfactory integration between β phased Mg-30 wt%Sc alloy and the surrounding bone. These findings indicate a potential usage of the bcc-structured Mg-Sc alloy within bone and might provide a new strategy for future biomedical magnesium alloy design. STATEMENT OF SIGNIFICANCE: Scandium is the only rare earth element that can transform the matrix of magnesium alloy into bcc structure, and Mg-30 wt%Sc alloy had been recently reported to exhibit shape memory effect. The aim of the present work is to study the feasibility of Mg-30 wt%Sc alloy with different constitutional phases (single α phase, single β phase or dual phases (α + β)) as biodegradable orthopedic implant by in vitro and in vivo testings. Our findings showed that β phased Mg-30 wt%Sc alloy which is of bcc structure exhibited improved strength and superior in vivo degradation performance (0.06 mm y^-1). No cytotoxicity and systematic toxicity were shown for β phased Mg-30 wt%Sc alloy on MC3T3 cell model and rat organisms. Moreover, good osseointegration, limited hydrogen gas release and maintained mechanical integrity were observed after 24 weeks' implantation into the rat femur bone.

In Vivo Simulation of Magnesium Degradability Using a New Fluid Dynamic Bench Testing Approach

The degradation rate of magnesium (Mg) alloys is a key parameter to develop Mg-based biomaterials and ensure in vivo-mechanical stability as well as to minimize hydrogen gas production, which otherwise can lead to adverse effects in clinical applications. However, in vitro and in vivo results of the same material often differ largely. In the present study, a dynamic test bench with several single bioreactor cells was constructed to measure the volume of hydrogen gas which evolves during magnesium degradation to indicate the degradation rate in vivo. Degradation medium comparable with human blood plasma was used to simulate body fluids. The media was pumped through the different bioreactor cells under a constant flow rate and 37 °C to simulate physiological conditions. A total of three different Mg groups were successively tested: Mg WE43, and two different WE43 plasma electrolytically oxidized (PEO) variants. The results were compared with other methods to detect magnesium degradation (pH, potentiodynamic polarization (PDP), cytocompatibility, SEM (scanning electron microscopy)). The non-ceramized specimens showed the highest degradation rates and vast standard deviations. In contrast, the two PEO samples demonstrated reduced degradation rates with diminished standard deviation. The pH values showed above-average constant levels between 7.4–7.7, likely due to the constant exchange of the fluids. SEM revealed severe cracks on the surface of WE43 after degradation, whereas the ceramized surfaces showed significantly decreased signs of corrosion. PDP results confirmed the improved corrosion resistance of both PEO samples. While WE43 showed slight toxicity in vitro, satisfactory cytocompatibility was achieved for the PEO test samples. In summary, the dynamic test bench constructed in this study enables reliable and simple measurement of Mg degradation to simulate the in vivo environment. Furthermore, PEO treatment of magnesium is a promising method to adjust magnesium degradation.

Biocompatibility and osteogenic activity of guided bone regeneration membrane based on chitosan-coated magnesium alloy

Ideally, a guided bone regeneration membrane (GBRM) should possess high strength, as for titanium membranes, along with excellent biocompatibility and osteoconductivity, as for natural absorbable collagen membranes. Besides titanium, magnesium (Mg) is another metal widely used in the biomedical field, which also exhibits biodegradability. In this study, a composite chitosan‑magnesium (CS-Mg) membrane was fabricated by dip-coating Mg alloy into chitosan solution. In vitro and in vivo tests were performed to investigate whether this membrane could be used as biodegradable GBRM, and the test results were compared with those obtained for a commercial GBRM (Heal-All). The microstructure was analyzed by scanning electron microscopy-electron dispersive spectroscopy. The degradation behavior was investigated by immersing the membranes into Dulbecco's modified Eagle medium (DMEM). The in vitro biocompatibility was evaluated by cell adhesion, cytotoxicity and alkaline phosphatase (ALP) assays using MG63 cells. The cytotoxicity and ALP assays were performed with diluted extracts of Mg, CS-Mg and Heal-All. The results show that CS-Mg has a suitable degradation rate, as well as similar cell adhesion and cytocompatibility to Heal-All. However, the 10% CS-Mg extracts exhibited higher ALP activity at 3 and 5 days (p < 0.05) compared with the medium control and the Heal-All extracts, but no differences with 10% Mg extracts (p > 0.05). Rabbit calvarial defects were used for testing the osteogenic activity in vivo. Three groups of samples were examined: CS-Mg, Heal-All, and a blank control. Higher amounts of new bone were formed for the CS-Mg and Heal-All groups (p < 0.05) compared with the blank control, whereas no significant differences between the CS-Mg and Heal-All groups were observed (p > 0.1). In conclusion, the CS-Mg membrane shows great potential for application as a biodegradable metallic GBRM with excellent osteogenic activity.

The current trends of Mg alloys in biomedical applications-A review

Magnesium (Mg) has emerged as an ideal alternative to the permanent implant materials owing to its enhanced properties such as biodegradation, better mechanical strengths than polymeric biodegradable materials and biocompatibility. It has been under investigation as an implant material both in cardiovascular and orthopedic applications. The use of Mg as an implant material reduces the risk of long-term incompatible interaction of implant with tissues and eliminates the second surgical procedure to remove the implant, thus minimizes the complications. The hurdle in the extensive use of Mg implants is its fast degradation rate, which consequently reduces the mechanical strength to support the implant site. Alloy development, surface treatment, and design modification of implants are the routes that can lead to the improved corrosion resistance of Mg implants and extensive research is going on in all three directions. In this review, the recent trends in the alloying and surface treatment of Mg have been discussed in detail. Additionally, the recent progress in the use of computational models to analyze Mg bioimplants has been given special consideration. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1970-1996, 2019.

Lanthanum-Containing Magnesium Alloy with Antitumor Function Based on Increased Reactive Oxygen Species

Developing antitumor implants is of great significance to repair tumor-induced bone defects and simultaneously prevent bone tumor recurrence. The tumor cells, compared to normal cells, have a high reactive oxygen species level. They are vulnerable to oxidative insults under increased intrinsic oxidative stress. The lanthanum (La) ion with high phospholipid binding ability can open the mitochondrial permeability transition pore, which blocks the electron transport chain in the mitochondria, and consequently increases reactive oxygen species level. In this study, La was alloyed to Mg-6Zn-0.5Zr (ZK60) through selective laser melting technology. The results indicated that the mitochondrial membrane potential dropped whilst the reactive oxygen species increased as the La content increased. ZK60-1.0La revealed a high cell inhibition rate of 61.9% for bone tumor cell and high cell viability of 91.9% for normal cells, indicating that the alloy could induce bone tumor cell death, as well as exhibit good biocompatibility for normal cell. In addition, its degradation rate 1.23 mm/year was lower than that of ZK60 alloy 2.13 mm/year, which was mainly attributed to the grain refinement.

Deposition of Zinc⁻Cerium Coatings from Deep Eutectic Ionic Liquids

This work studies the electrodeposition of zinc and cerium species on carbon steel substrates from choline chloride-based ionic liquid bath in order to develop a protective coating with anti-corrosion, sacrificial, and self-repairing properties. Hull cell tests were used to study the influence of the current density on composition of the coatings and their morphology. Surface morphology, chemical composition and oxidation state of the obtained coatings were examined by scanning electron microscopy (SEM), Energy Dispersive X-ray spectroscopy (EDX), and X-ray photoelectron spectroscopy (XPS), respectively. Furthermore, electrochemical characterization and corrosion tests were performed in order to evaluate the corrosion properties of the electrodeposited Zn–Ce coatings. The cathodic deposition of Zn–Ce was achieved for the first time using the deep eutectic solvent choline chloride-urea as an electrolyte. Cerium was incorporated in the coating as oxide or mixed oxide within the Zn metal matrix. The composition and morphology of the electrodeposited coating were dependent on the applied current density. Electrochemical corrosion tests showed similar corrosion rates for all the coatings. Nevertheless on scratched tests with a ratio area of 15:1, for Zn–Ce coatings cerium oxide somehow migrates from the coating to the high pH cathodic areas developed on the surface of the bare steel substrate. Further study is still necessary to improve the corrosion protection of the Zn–Ce coating for carbon steel.

Special Biodegradable Fixation Device for Anterior Cruciate Ligament Reconstruction-Safety and Efficacy in a Beagle Model

This study aimed to evaluate the safety and efficacy of the special WE43 magnesium alloy stretch plates (SPs) used as fixation device for anterior cruciate ligament (ACL) reconstruction in a beagle model. Eleven beagle dogs underwent ACL reconstruction using WE43 SPs to fix the ligament grafts with the femoral ends, whereas titanium interferences were employed in the tibia ends. Load-to-failure tests were conducted to evaluate the mechanical properties. A comprehensive set of histological observations was performed to observe the local tissue response and assess the status of the attachment between the bone tissue and ligament grafts. Microcomputed tomography and scanning electron microscopy in conjunction with energy spectrum analysis were conducted to evaluate the degradation rate in vivo and investigate the morphology of the cross-section of the SPs and the element distribution in vivo. Immersion tests were employed to investigate the corrosion properties in vitro. The special WE43 SPs showed not only good mechanical strength but also a suitable degradation rate in vivo. The results indicated the special WE43 SP could be considered as a novel fixation device for ACL reconstruction.

Recovery of Cerium from Glass Polishing Waste: A Critical Review

Ceria is the main component in glass polishing powders due to its special physico-chemical properties. Glass polishing powder loses its polishing ability gradually during usage due to the accumulation of other compounds on the polishing powder or due to changes in the particle size distribution. The recovery of cerium from the glass polishing waste results in the efficient utilization of natural resources. This paper reviews processes for the recovery of rare earths from polishing waste. Glass polishing powder waste can be reused via physical, physico-chemical or chemical processes by removing silica and/or alumina. The removal of silica and/or alumina only improves the life span up to some extent. Therefore, removal of other elements by chemical processes is required to recover a cerium or cerium-rich product. However, cerium leaching from the polishing waste is challenging due to the difficulties associated with the dissolution of ceria. Therefore, high acid concentrations, high temperatures or costly reducing agents are required for cerium dissolution. After leaching, cerium can be extracted from the leach solution by solvent extraction or selective precipitation. The product can be used either in glass polishing again or other high value added applications.

The effect of tensile and fluid shear stress on the in vitro degradation of magnesium alloy for stent applications

Magnesium alloys have gained great attention as biodegradable materials for stent applications. Cardiovascular stents are continuously exposed to different types of mechanical loadings simultaneously during service, including tensile, compressive and fluid shear stress. In this study, the in vitro degradation of WE43 wires was investigated under combined effect of tensile loading and fluid shear stress and compared with that experienced an individual loading condition. For the individual mechanical loading treatment, the degradation of magnesium wires was more severely affected by tensile loading than fluid shear stress. Under tensile loading, magnesium wires showed faster increment of corrosion rates, loss of mechanical properties and localized corrosion morphology with the increasing tensile loadings. With the combined stress, smaller variation of the corrosion rates as well as the slower strength degeneration was shown with increasing stress levels, in comparison with the individual treatment of tensile loading. This study could help to understand the effect of complex stress condition on the corrosion of magnesium for the optimization of biodegradable magnesium stents.

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Tensile loading induced the localized corrosion and fast degeneration of mechanical properties of magnesium wires.

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Relatively homogeneous corrosion of magnesium wires was observed under fluid shear stress.

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Under combined stresses, smaller variation of the corrosion rates and the slower strength decay was shown with increasing stresses.

Investigation on the in vitro cytocompatibility of Mg-Zn-Y-Nd-Zr alloys as degradable orthopaedic implant materials

Mg-Zn-Y-Nd-Zr alloy has been developed as a new type of biodegradable orthopaedic implant material by the authors' research group with its excellent mechanical properties and controllable degradation rate. In this study, the cytocompatibility of Mg-Zn-Y-Nd-Zr alloy was systematically evaluated through in vitro cell culture method. MTT assay was applied to evaluate the cytotoxicity of Mg-Zn-Y-Nd-Zr alloy and no toxic effect was observed on L929 and MC3T3-E1 cells followed the protocol of ISO 10993 standard. Considering the potential ion accumulation in the bony environment, this study further investigated the cytotoxic effect of accumulated metallic ions during the alloy degradation by extending the extract preparation time. When the extract preparation time was prolonged to 1440 h, the accumulated metallic ions leaded to severe cell apoptosis, of which the combined ion concentration was determined as 39.5-65.8 µM of Mg²⁺, 3.5-5.9 µM of Zn²⁺, 0.44-0.74 µM of Y³⁺, 0.3-0.52 µM of Nd³⁺ and 0.11-0.18 µM of Zr⁴⁺ for L929, and 65.8-92.2 µM of Mg²⁺, 5.9-8.3 µM of Zn²⁺, 0.74-1.04 µM of Y³⁺, 0.52-0.73 µM of Nd³⁺ and 0.18-0.25 µM of Zr⁴⁺ for MC3T3-E1 cells. Besides the cell viability assessment, high expression of ALP activity and calcified nodules implied that metal elements in Mg-Zn-Y-Nd-Zr alloys can promote the osteogenic differentiation. Hence, excellent cytocompatibility has equipped Mg-Zn-Y-Nd-Zr alloy as a promising candidate for orthopaedic implant application, which can remarkably guide the magnesium-based alloy design and provide scientific evidence for clinical practice in future.

Bone biomaterials and interactions with stem cells

Bone biomaterials play a vital role in bone repair by providing the necessary substrate for cell adhesion, proliferation, and differentiation and by modulating cell activity and function. In past decades, extensive efforts have been devoted to developing bone biomaterials with a focus on the following issues: (1) developing ideal biomaterials with a combination of suitable biological and mechanical properties; (2) constructing a cell microenvironment with pores ranging in size from nanoscale to submicro- and microscale; and (3) inducing the oriented differentiation of stem cells for artificial-to-biological transformation. Here we present a comprehensive review of the state of the art of bone biomaterials and their interactions with stem cells. Typical bone biomaterials that have been developed, including bioactive ceramics, biodegradable polymers, and biodegradable metals, are reviewed, with an emphasis on their characteristics and applications. The necessary porous structure of bone biomaterials for the cell microenvironment is discussed, along with the corresponding fabrication methods. Additionally, the promising seed stem cells for bone repair are summarized, and their interaction mechanisms with bone biomaterials are discussed in detail. Special attention has been paid to the signaling pathways involved in the focal adhesion and osteogenic differentiation of stem cells on bone biomaterials. Finally, achievements regarding bone biomaterials are summarized, and future research directions are proposed.

Novel high-strength, low-alloys Zn-Mg (<0.1wt% Mg) and their arterial biodegradation

It is still an open challenge to find a biodegradable metallic material exhibiting sufficient mechanical properties and degradation behavior to serve as an arterial stent. In this study, Zn-Mg alloys of 0.002 (Zn-002Mg), 0.005 (Zn-005Mg) and 0.08wt% Mg (Zn-08Mg) content were cast, extruded and drawn to 0.25mm diameter, and evaluated as potential biodegradable stent materials. Structural analysis confirmed formation of Mg₂Zn₁₁ intermetallic in all three alloys with the average grain size decreasing with increasing Mg content. Tensile testing, fractography analysis and micro hardness measurements showed the best integration of strength, ductility and hardness for the Zn-08Mg alloy. Yield strength, tensile strength, and elongation to failure values of >200-300MPa, >300-400MPa, and >30% respectively, were recorded for Zn-08Mg. This metal appears to be the first formulated biodegradable material that satisfies benchmark values desirable for endovascular stenting. Unfortunately, the alloy reveals signs of age hardening and strain rate sensitivity, which need to be addressed before using this metal for stenting. The explants of Zn-08Mg alloy residing in the abdominal aorta of adult male Sprague-Dawley rats for 1.5, 3, 4.5, 6 and 11months demonstrated similar, yet slightly elevated inflammation and neointimal activation for the alloy relative to what was recently reported for pure zinc.

Nd-induced honeycomb structure of intermetallic phase enhances the corrosion resistance of Mg alloys for bone implants

Mg-5.6Zn-0.5Zr alloy (ZK60) tends to degrade too rapid for orthopedic application, in spite of its natural degradation, suitable strength and good biocompatibility. In this study, Nd was alloyed with ZK60 via laser melting method to enhance its corrosion resistance. The microstructure features, mechanical properties and corrosion behaviors of ZK60-xNd (x = 0, 1.8, 3.6, 5.4 wt.%) were investigated. Results showed that laser melted ZK60-xNd were composed of fine ɑ-Mg grains and intermetallic phases along grain boundaries. And the precipitated intermetallic phases experienced successive changes: divorced island-like MgZn phase → honeycomb-like T phase → coarsened and agglomerated W phase with Nd increasing. It was worth noting that ZK60-3.6Nd with honeycomb-like T phase exhibited an optimal corrosion behavior with a corrosion rate of 1.56 mm year^-1. The improved corrosion behavior was ascribed to: (I) dense surface film caused by the formation of Nd₂O₃ hindered the invasion of immersion solution; (II) the three-dimensional honeycomb structure of intermetallic phases formed a tight barrier to restrain the propagation of corrosion. Moreover, ZK60-3.6Nd exhibited good biocompatibility. It was suggested that ZK60-3.6Nd was a preferable candidate for biodegradable bone implant.

The potential of isotopically enriched magnesium to study bone implant degradation in vivo

This pilot study highlights the substantial potential of using isotopically enriched (non-radioactive) metals to study the fate of biodegradable metal implants. It was possible to show that magnesium (Mg) release can be observed by combining isotopic mass spectrometry and isotopic pattern deconvolution for data reduction, even at low amounts of Mg released a from slowly degrading ²⁶Mg enriched (>99%) Mg metal. Following implantation into rats, structural in vivo changes were monitored by μCT. Results showed that the applied Mg had an average degradation rate of 16±5μmyear^-1, which corresponds with the degradation rate of pure Mg. Bone and tissue extraction was performed 4, 24, and 52weeks after implantation. Bone cross sections were analyzed by laser ablation inductively coupled plasma mass spectrometry (ICP-MS) to determine the lateral ²⁶Mg distribution. The ²⁶Mg/²⁴Mg ratios in digested tissue and excretion samples were analyzed by multi collector ICP-MS. Isotope pattern deconvolution in combination with ICP-MS enabled detection of Mg pin material in amounts as low as 200ppm in bone tissues and 20ppm in tissues up to two fold increased Mg levels with a contribution of pin-derived Mg of up to 75% (4weeks) and 30% (24weeks) were found adjacent to the implant. After complete degradation, no visual bone disturbance or residual pin-Mg could be detected in cortical bone. In organs, increased Δ²⁶Mg/²⁴Mg values up to 16‰ were determined compared to control samples. Increased Δ²⁶Mg/²⁴Mg values were detected in serum samples at a constant total Mg level. In contrast to urine, feces did not show a shift in the ²⁶Mg/²⁴Mg ratios. This investigation showed that the organism is capable of handling excess Mg well and that bones fully recover after degradation.

STATEMENT OF SIGNIFICANCE

Magnesium alloys as bone implants have faced increasing attention over the past years. In vivo degradation and metabolism studies of these implant materials have shown the promising application in orthopaedic trauma surgery. With advance in Mg research it has become increasingly important to monitor the fate of the implant material in the organism. For the first time, the indispensible potential of isotopically enriched materials is documented by applying ²⁶Mg enriched Mg implants in an animal model. Therefore, the spatial distribution of pin-Mg in bone and the pin-Mg migration and excretion in the organism could be monitored to better understand metal degradation as well as Mg turn over and excretion.

Macrophage phagocytosis of biomedical Mg alloy degradation products prepared by electrochemical method

Biomedical Mg alloy is promising for its widespread use clinically. In vitro and in vivo studies showed that the degradation products of biomedical Mg alloy were composed of O, P, Ca, Mg and other alloying elements. However, little is known about the metabolism of the degradation products. In this study, the in vitro macrophage phagocytosis of the degradation products of a biomedical Mg-Nd-Zn-Zr alloy was directly observed. This result affirms the necessity to investigate the long-term fate of Mg alloy degradation products in physiological environments. Besides, an electrochemical method was proposed to prepare enough amount of degradation products in vitro efficiently.

Development of a new biodegradable operative clip made of a magnesium alloy: Evaluation of its safety and tolerability for canine cholecystectomy

BACKGROUND

Operative clips used to ligate vessels in abdominal operation usually are made of titanium. They remain in the body permanently and form metallic artifacts in computed tomography images, which impair accurate diagnosis. Although biodegradable magnesium instruments have been developed in other fields, the physical properties necessary for operative clips differ from those of other instruments. We developed a biodegradable magnesium-zinc-calcium alloy clip with good biologic compatibility and enough clamping capability as an operative clip. In this study, we verified the safety and tolerability of this clip for use in canine cholecystectomy.

METHODS

Nine female beagles were used. We performed cholecystectomy and ligated the cystic duct by magnesium alloy or titanium clips. The chronologic change of clips and artifact formation were compared at 1, 4, 12, 18, and 24 weeks postoperative by computed tomography. The animals were killed at the end of the observation period, and the clips were removed to evaluate their biodegradability. We also evaluated their effect on the living body by blood biochemistry data.

RESULTS

The magnesium alloy clip formed much fewer artifacts than the titanium clip, and it was almost absorbed at 6 months postoperative. There were no postoperative complications and no elevation of constituent elements such as magnesium, calcium, and zinc during the observation period in both groups.

CONCLUSION

The novel magnesium alloy clip demonstrated sufficient sealing capability for the cystic duct and proper biodegradability in canine models. The magnesium alloy clip revealed much fewer metallic artifacts in CT than the conventional titanium clip.

Fabrication of biodegradable Zn-Al-Mg alloy: Mechanical properties, corrosion behavior, cytotoxicity and antibacterial activities

In this work, binary Zn-0.5Al and ternary Zn-0.5Al-xMg alloys with various Mg contents were investigated as biodegradable materials for implant applications. Compared with Zn-0.5Al (single phase), Zn-0.5Al-xMg alloys consisted of the α-Zn and Mg₂(Zn, Al)₁₁ with a fine lamellar structure. The results also revealed that ternary Zn-Al-Mg alloys presented higher micro-hardness value, tensile strength and corrosion resistance compared to the binary Zn-Al alloy. In addition, the tensile strength and corrosion resistance increased with increasing the Mg content in ternary alloys. The immersion tests also indicated that the corrosion rates in the following order Zn-0.5Al-0.5Mg<Zn-0.5Al-0.3Mg<Zn-0.5Al-0.1Mg<Zn-0.5Al. The cytotoxicity tests exhibited that the Zn-0.5Al-0.5Mg alloy presents higher viability of MC3T3-E1 cell compared to the Zn-0.5Al alloy, which suggested good biocompatibility. The antibacterial activity result of both Zn-0.5Al and Zn-0.5Al-Mg alloys against Escherichia coli presented some antibacterial activity, while the Zn-0.5Al-0.5Mg significantly prohibited the growth of Escherichia coli. Thus, Zn-0.5Al-0.5Mg alloy with appropriate mechanical properties, low corrosion rate, good biocompatibility and antibacterial activities was believed to be a good candidate as a biodegradable implant material.

Early results using a biodegradable magnesium screw for modified chevron osteotomies

This is the first larger study analyzing the use of magnesium-based screws for fixation of modified Chevron osteotomies in hallux valgus surgery. Forty-four patients (45 feet) were included in this prospective study. A modified Chevron osteotomy was performed on every patient and a magnesium screw used for fixation. The mean clinical follow up was 21.4 weeks. The mean age of the patients was 45.5 years. Forty patients could be provided with the implant, in four patients the surgeon decided to change to a standard metallic implant. The AOFAS, FAAM and pain NRS-scale improved markedly. The hallux valgus angle, intermetatarsal angle and sesamoid position improved significantly. Seven patients showed dorsal subluxation, rotation or medial shifting of the metatarsal heads within the first 3 months. One of these patients was revised, in all others the findings were considered clinically not significant or the patients refused revision. This study shows the feasibility of using magnesium screws in hallux valgus-surgery. Surgeons starting with the use of these implants should be aware of the proper handling of these implants and should know about corrosion effects during healing and its radiographic appearance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2207-2214, 2016.

Current status on clinical applications of magnesium-based orthopaedic implants: A review from clinical translational perspective

As a new generation of medical metallic material, magnesium (Mg) and its alloys with or without surface coating have attracted a great deal of attention due to its biodegradability and potential for avoiding a removal operation after the implant has fulfilled its function for surgical fixation of injured musculoskeletal tissues. Although a few clinical cases on Mg-based orthopaedic implants were reported more than a century ago, it was not until recently that clinical trials using these implants with improved physicochemical properties were carried out in Germany, China and Korea for bone fracture fixation. The promising results so far suggest a bright future for biodegradable Mg-based orthopaedic implants and would warrant large scale phase II/III studies. Given the increasing interest on this emerging biomaterials and intense effort to improve its properties for various clinical applications, this review covers the evolution, current strategies, and future perspectives in the development of Mg-based orthopaedic implants. We also highlight a few clinical cases performed in China that may be unfamiliar to the general orthopaedic community.

Bio-Adaption between Magnesium Alloy Stent and the Blood Vessel: A Review

Biodegradable magnesium (Mg) alloy stents are the most promising next generation of bio-absorbable stents. In this article, we summarized the progresses on the in vitro studies, animal testing and clinical trials of biodegradable Mg alloy stents in the past decades. These exciting findings led us to propose the importance of the concept "bio-adaption" between the Mg alloy stent and the local tissue microenvironment after implantation. The healing responses of stented blood vessel can be generally described in three overlapping phases: inflammation, granulation and remodeling. The ideal bio-adaption of the Mg alloy stent, once implanted into the blood vessel, needs to be a reasonable function of the time and the space/dimension. First, a very slow degeneration of mechanical support is expected in the initial four months in order to provide sufficient mechanical support to the injured vessels. Although it is still arguable whether full mechanical support in stented lesions is mandatory during the first four months after implantation, it would certainly be a safety design parameter and a benchmark for regulatory evaluations based on the fact that there is insufficient human in vivo data available, especially the vessel wall mechanical properties during the healing/remodeling phase. Second, once the Mg alloy stent being degraded, the void space will be filled by the regenerated blood vessel tissues. The degradation of the Mg alloy stent should be 100% completed with no residues, and the degradation products (e.g., ions and hydrogen) will be helpful for the tissue reconstruction of the blood vessel. Toward this target, some future research perspectives are also discussed.

Effects of Corroded and Non-Corroded Biodegradable Mg and Mg Alloys on Viability, Morphology and Differentiation of MC3T3-E1 Cells Elicited by Direct Cell/Material Interaction

This study investigated the effect of biodegradable Mg and Mg alloys on selected properties of MC3T3-E1 cells elicited by direct cell/material interaction. The chemical composition and morphology of the surface of Mg and Mg based alloys (Mg2Ag and Mg10Gd) were analysed by scanning electron microscopy (SEM) and EDX, following corrosion in cell culture medium for 1, 2, 3 and 8 days. The most pronounced difference in surface morphology, namely crystal formation, was observed when Pure Mg and Mg2Ag were immersed in cell medium for 8 days, and was associated with an increase in atomic % of oxygen and a decrease of surface calcium and phosphorous. Crystal formation on the surface of Mg10Gd was, in contrast, negligible at all time points. Time-dependent changes in oxygen, calcium and phosphorous surface content were furthermore not observed for Mg10Gd. MC3T3-E1 cell viability was reduced by culture on the surfaces of corroded Mg, Mg2Ag and Mg10Gd in a corrosion time-independent manner. Cells did not survive when cultured on 3 day pre-corroded Pure Mg and Mg2Ag, indicating crystal formation to be particular detrimental in this regard. Cell viability was not affected when cells were cultured on non-corroded Mg and Mg alloys for up to 12 days. These results suggest that corrosion associated changes in surface morphology and chemical composition significantly hamper cell viability and, thus, that non-corroded surfaces are more conducive to cell survival. An analysis of the differentiation potential of MC3T3-E1 cells cultured on non-corroded samples based on measurement of Collagen I and Runx2 expression, revealed a down-regulation of these markers within the first 6 days following cell seeding on all samples, despite persistent survival and proliferation. Cells cultured on Mg10Gd, however, exhibited a pronounced upregulation of collagen I and Runx2 between days 8 and 12, indicating an enhancement of osteointegration by this alloy that could be valuable for in vivo orthopedic applications.

Magnesium inference screw supports early graft incorporation with inhibition of graft degradation in anterior cruciate ligament reconstruction

Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction.

A preliminary study for novel use of two Mg alloys (WE43 and Mg3Gd)

In this study, two types of magnesium alloys (WE43 and Mg3Gd) were compared with Heal-All membrane (a biodegradable membrane used in guided bone regeneration) in vitro to determine whether the alloys could be used as biodegradable membranes. Degradation behavior was assessed using immersion testing with simulated body fluid (SBF). Microstructural characteristics before and after immersion were evaluated through scanning electron microscopy, and degradation products were analyzed with energy dispersive spectrometry (EDS). To evaluate the biocompatibility of the three types of materials, we performed cytotoxicity, adhesion, and mineralization tests using human osteoblast-like MG63 cells. Immersion testing results showed no significant difference in degradation rate between WE43 and Mg3Gd alloys. However, both Mg alloys corroded faster than the Heal-All membrane, with pitting corrosion as the main corrosion mode for the alloys. Degradation products mainly included P- and Ca-containing apatites on the surface of WE43 and Mg3Gd, whereas these apatites were rarely detected on the surface of the Heal-All membrane. All three type of materials exhibited good biocompatibility. In the mineralization experiment, the alkaline phosphatase (ALP) activity of 10 % Mg3Gd extract was significantly higher than the extracts of the two other materials and the negative control. This study highlighted the potential of these Mg-REE alloys for uses in bone regeneration and further studies and refinements are obviously required.

Long-term clinical study and multiscale analysis of in vivo biodegradation mechanism of Mg alloy

There has been a tremendous amount of research in the past decade to optimize the mechanical properties and degradation behavior of the biodegradable Mg alloy for orthopedic implant. Despite the feasibility of degrading implant, the lack of fundamental understanding about biocompatibility and underlying bone formation mechanism is currently limiting the use in clinical applications. Herein, we report the result of long-term clinical study and systematic investigation of bone formation mechanism of the biodegradable Mg-5wt%Ca-1wt%Zn alloy implant through simultaneous observation of changes in element composition and crystallinity within degrading interface at hierarchical levels. Controlled degradation of Mg-5wt%Ca-1wt%Zn alloy results in the formation of biomimicking calcification matrix at the degrading interface to initiate the bone formation process. This process facilitates early bone healing and allows the complete replacement of biodegradable Mg implant by the new bone within 1 y of implantation, as demonstrated in 53 cases of successful long-term clinical study.

Fabrication of a magnesium alloy with excellent ductility for biodegradable clips

To develop a biodegradable clip, the equivalent plastic strain distribution during occlusion was evaluated by the finite element analysis (FEA) using the material data of pure Mg. Since the FEA suggested that a maximum plastic strain of 0.40 is required to allow the Mg clips, the alloying of magnesium with essential elements and the control of microstructure by hot extrusion and annealing were conducted. Mechanical characterization revealed that the Mg-Zn-Ca alloy obtained by double extrusion followed by annealing at 673K for 2h possessed a fracture strain over 0.40. The biocompatibility of the alloy was confirmed here by investigating its degradation behavior and the response of extraperitoneal tissue around the Mg-Zn-Ca alloy. Small gas cavity due to degradation was observed following implantation of the developed Mg-Zn-Ca clip by in vivo micro-CT. Histological analysis, minimal observed inflammation, and an only small decrease in the volume of the implanted Mg-Zn-Ca clip confirmed its excellent biocompatibility. FEA using the material data for ductile Mg-Zn-Ca also showed that the clip could occlude the simulated vessel without fracture. In addition, the Mg-Zn-Ca alloy clip successfully occluded the renal vein. Microstructural observations using electron backscattering diffraction confirmed that dynamic recovery occurred during the later stage of plastic deformation of the ductile Mg-Zn-Ca alloy. These results suggest that the developed Mg-Zn-Ca alloy is a suitable material for biodegradable clips.

STATEMENT OF SIGNIFICANCE

Since conventional magnesium alloys have not exhibited significant ductility for applying the occlusion of vessels, the alloying of magnesium with essential elements and the control of microstructure by hot extrusion and annealing were conducted. Mechanical characterization revealed that the Mg-Zn-Ca alloy obtained by double extrusion followed by annealing at 673K for 2h possessed a fracture strain over 0.40. The biocompatibility of the alloy was confirmed by investigating its degradation behavior and the response of extraperitoneal tissue around the Mg-Zn-Ca alloy. Finite element analysis using the material data for the ductile Mg-Zn-Ca alloy also showed that the clip could occlude the simulated vessel without fracture. In addition, the Mg-Zn-Ca alloy clip successfully occluded the renal vein. Microstructural observations using electron backscattering diffraction confirmed that dynamic recovery occurred during the later stage of plastic deformation of the ductile Mg-Zn-Ca alloy.

Preparation, characterization and in vitro dissolution behavior of porous biphasic α/β-tricalcium phosphate bioceramics

The ideal bone tissue engineering scaffolds are long-cherished with the properties of interconnected macroporous structures, adjustable degradation and excellent biocompatibility. Here, a series of porous α/β-tricalcium phosphate (α/β-TCP) biphasic bioceramics with different phase ratios of α-TCP and β-TCP were successfully synthesized by heating an amorphous calcium phosphate precursor. The chemical and morphological characterization showed that α- and β-TCP phases co-existed in the α/β-TCP bioceramics and they had interconnected pore structures with size between 200 and 500μm. The in vitro dissolution behavior and bioactivity of the dual α/β-TCP were also probed in static and dynamic SBF for the first time. The results revealed that α/β-TCP scaffolds had good in vitro bioactivity, as the formation of bone-like apatite layers was induced on the scaffolds after mineralization in SBF. Moreover, dissolution rate of α/β-TCP bioceramics in dynamic environment was higher than that under static condition. Compared with monophasic TCP ceramics, these porous α/β-TCP bioceramics displayed a tailored dissolution rate proportionate to the TCP content (α and β) in the materials. Further, the degradation profile of porous α/β-TCP was well-described by Avrami equation. The porous dual α/β-TCP bioceramics with controllable degradation behavior hold great potential to be applied in bone tissue engineering as bone substitutes.

In vivo evaluation of a magnesium-based degradable intramedullary nailing system in a sheep model

The biocompatibility and the degradation behavior of the LAE442 magnesium-based intramedullary interlocked nailing system (IM-NS) was assessed in vivo in a comparative study (stainless austenitic steel 1.4441LA) for the first time. IM-NS was implanted into the right tibia (24-week investigation period; nails/screws diameter: 9 mm/3.5 mm, length: 130 mm/15-40 mm) of 10 adult sheep (LAE442, stainless steel, n=5 each group). Clinical and radiographic examinations, in vivo computed tomography (CT), ex vivo micro-computed tomography (μCT), mechanical and histological examinations and element analyses of alloying elements in inner organs were performed. The mechanical examinations (four-point bending) revealed a significant decrease of LAE442 implant stiffness, force at 0.2% offset yield point and maximum force. Periosteal (new bone formation) and endosteal (bone decline) located bone alterations occurred in both groups (LAE442 alloy more pronounced). Moderate gas formation was observed within the LAE442 alloy group. The CT-measured implant volume decreased slightly (not significant). Histologically a predominantly direct bone-to-implant interface existed within the LAE442 alloy group. Formation of a fibrous tissue capsule around the nail occurred in the steel group. Minor inflammatory infiltration was observed in the LAE442 alloy group. Significantly increased quantities of rare earth elements were detected in the LAE442 alloy group. μCT examination showed the beginning of corrosion in dependence of the surrounding tissue. After 24 weeks the local biocompatibility of LAE442 can be considered as suitable for a degradable implant material.

STATEMENT OF SIGNIFICANCE

An application oriented interlocked intramedullary nailing system in a comparative study (degradable magnesium-based LAE442 alloy vs. steel alloy) was examined in a sheep model for the first time. We focused in particular on the examination of implant degradation by means of (μ-)CT, mechanical properties (four-point bending), clinical compatibility, local bone reactions (X-ray and histology) and possible systemic toxicity (histology and element analyses of inner organs). A significant decrease of magnesium (LAE442 alloy) implant stiffness and maximum force occurred. Moderate not clinically relevant gas accumulation was determined. A predominantly direct bone-to-implant contact existed within the magnesium (LAE442 alloy) group compared to an indirect contact in the steel group. Rare earth element accumulation could be observed in inner organs but H&E staining was inconspicuous.

Comparison of Selective Laser Melted Titanium and Magnesium Implants Coated with PCL

Degradable implant material for bone remodeling that corresponds to the physiological stability of bone has still not been developed. Promising degradable materials with good mechanical properties are magnesium and magnesium alloys. However, excessive gas production due to corrosion can lower the biocompatibility. In the present study we used the polymer coating polycaprolactone (PCL), intended to lower the corrosion rate of magnesium. Additionally, improvement of implant geometry can increase bone remodeling. Porous structures are known to support vessel ingrowth and thus increase osseointegration. With the selective laser melting (SLM) process, defined open porous structures can be created. Recently, highly reactive magnesium has also been processed by SLM. We performed studies with a flat magnesium layer and with porous magnesium implants coated with polymers. The SLM produced magnesium was compared with the titanium alloy TiAl6V4, as titanium is already established for the SLM-process. For testing the biocompatibility, we used primary murine osteoblasts. Results showed a reduced corrosion rate and good biocompatibility of the SLM produced magnesium with PCL coating.