Surface modification of stainless steel for biomedical applications: Revisiting a century-old material

Antibacterial metals and alloys for potential biomedical implants

Metals and alloys, including stainless steel, titanium and its alloys, cobalt alloys, and other metals and alloys have been widely used clinically as implant materials, but implant-related infection or inflammation is still one of the main causes of implantation failure. The bacterial infection or inflammation that seriously threatens human health has already become a worldwide complaint. Antibacterial metals and alloys recently have attracted wide attention for their long-term stable antibacterial ability, good mechanical properties and good biocompatibility in vitro and in vivo. In this review, common antibacterial alloying elements, antibacterial standards and testing methods were introduced. Recent developments in the design and manufacturing of antibacterial metal alloys containing various antibacterial agents were described in detail, including antibacterial stainless steel, antibacterial titanium alloy, antibacterial zinc and alloy, antibacterial magnesium and alloy, antibacterial cobalt alloy, and other antibacterial metals and alloys. Researches on the antibacterial properties, mechanical properties, corrosion resistance and biocompatibility of antibacterial metals and alloys have been summarized in detail for the first time. It is hoped that this review could help researchers understand the development of antibacterial alloys in a timely manner, thereby could promote the development of antibacterial metal alloys and the clinical application.

Mechanical Analysis of Explanted Telescopic Rods in the Management of Osteogenesis Imperfecta: A Multicenter Study

BACKGROUND

Telescopic rods in the management of osteogenesis imperfecta fail frequently. This could be attributed to technical errors, rod design, and rod structure. We aimed to analyze the mechanical properties and tribology of explanted male and female components to identify effects of in vivo telescoping that may relate to observed patterns of successful telescoping or failure.

METHODS

Recruitment took place at 3 of the 4 English centers for osteogenesis imperfecta. Twenty-five rods explanted for growth or failure during revision to a new rod were analyzed in terms of clinical indication and prerevision imaging to identify if there was a technical mode of failure. Laboratory analysis was performed using optical and scanning electrical microscopy, radiograph diffraction analysis, hardness test, bending test, and energy-dispersive x-ray spectroscopy.

RESULTS

All implants tested were of high-grade stainless steel. Female components had inferior strength [mean Vickers hardness property (HV0.3) at 0.3 to 313 kg] in comparison to male components (HV0.3 406) due to different techniques of manufacture. Female rods also had a higher wear coefficient (7.89×10-12 m3/N/m3) than the male rods (6.46×10-12 m3/N/m3). Abrasive wear, shear deformation, scratches, and wear debris were identified in all rods. Male and female components displayed corrosion contributing to adhesive wear. Intraoperatively cut rods, particularly the female components, had irregular ends leading to more wear.

CONCLUSIONS

Current manufacturing techniques result in inferior material strength in female components compared with males, which combined with wear patterns is likely to lead to implant failure. Intraoperative cutting of rods may increase risk of failure due to wear. Considering techniques to improve strength as well as design in new implants may lead to better outcomes.

LEVELS OF EVIDENCE

Level IV-cross-sectional study.

Polydopamine coated hypodermic needles as a microextraction device for the determination of tricyclic antidepressants in oral fluid by direct infusion MS/MS

In-needle microextraction consists of the confinement of the sorbent, by coating or packing, inside a metallic needle. The size of the needles reduces the eluent requirements providing an efficient preconcentration of the analytes. In this work, hypodermic needles coated with polydopamine (PDA) are presented as microextraction devices to isolate six tricyclic antidepressants from oral fluid samples. The coating consists of the in-surface polymerization of dopamine at pH 8.5 and mild conditions (room temperature and water as solvent). The PDA coating over the stainless-steel surface confers the needles with a high extraction ability towards the target analytes. After the extraction, the eluates were analyzed by direct infusion MS spectrometry, working in multiple reaction monitoring (MRM) mode, which provided a sample throughput of 30 samples per hour. The variables affecting the synthesis (number of coating cycles, the concentration of dopamine, and needle surface pre-treatment) and the extraction (sample salinity, sample loading cycles, and the number of elution strokes) were studied in depth. Under the optimum conditions, a matrix-matched calibration model was built. The limits of quantification are between 2 and 5 ng mL⁻¹ with linear ranges up to 1000 ng mL⁻¹ for all analytes. The precision, expressed as relative standard deviation (RSD), is better than 10% for all analytes. Accuracy was calculated as recovery, and the obtained values are between 84% and 107%. A single-blind assay was also performed to evaluate the suitability of the method for real application.

Hypodermic needles coated with polydopamine for the extraction of antidepressants.

Biodegradable magnesium-based biomaterials: An overview of challenges and opportunities

As promising biodegradable materials with nontoxic degradation products, magnesium (Mg) and its alloys have received more and more attention in the biomedical field very recently. Having excellent biocompatibility and unique mechanical properties, magnesium-based alloys currently cover a broad range of applications in the biomedical field. The use of Mg-based biomedical devices eliminates the need for biomaterial removal surgery after the healing process and reduces adverse effects induced by the implantation of permanent biomaterials. However, the high corrosion rate of Mg-based implants leads to unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. To overcome these limitations, alloying Mg with suitable alloying elements and surface treatment come highly recommended. In this area, open questions remain on the behavior of Mg-based biomaterials in the human body and the effects of different factors that have resulted in these challenges. In addition to that, many techniques are yet to be verified to turn these challenges into opportunities. Accordingly, this article aims to review major challenges and opportunities for Mg-based biomaterials to minimize the challenges for the development of novel biomaterials made of Mg and its alloys.

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

Bioactive Coatings with Ag-Camphorimine Complexes to Prevent Surface Colonization by the Pathogenic Yeast Candida albicans

Currently there is a gap between the rate of new antifungal development and the emergence of resistance among Candida clinical strains, particularly threatened by the extreme adhesiveness of C. albicans to indwelling medical devices. Two silver camphorimine complexes, [Ag(OH){OC₁₀H₁₄N(C₆H₄)₂NC₁₀H₁₄O}] (compound P) and [{Ag(OC₁₀H₁₄NC₆H₄CH₃-p)}₂(μ-O)] (compound Q), are herein demonstrated as having high inhibiting activity towards the growth of Candida albicans and Candida glabrata clinical strains resistant to azoles, the frontline antifungals used in clinical practice. Compounds P and Q were also explored as bioactive coatings to prevent colonization by C. albicans and colonize the surface of indwelling medical devices, resulting in persistent infections. Functionalization of stainless steel with polycaprolactone (PCL) matrix embedded with compounds P or Q was reported for the first time to inhibit the colonization of C. albicans by 82% and 75%, respectively. The coating of PCL loaded with Q or P did not cause cytotoxic effects in mammalian cells, demonstrating the biocompatibility of the explored approach. The identification and further exploration of new approaches for surface engineering based on new molecules that can sensitize resistant strains, as herein demonstrated for complexes P and Q, is a significant step forward to improve the successful treatment of candidiasis.

Biofunctionalization of Porous Ti Substrates Coated with Ag Nanoparticles for Potential Antibacterial Behavior

Ti prosthesis have shown better biological compatibility, mechanical performance, and resistance to corrosion in cases of bone replacements. Nevertheless, fully dense Ti in connection with bone-host tissues show stress-shielding phenomenon that, together with the development of frequent undesirable microbial infections, may lead to implant failures. To overcome these issues, the present study aimed at the development of a novel combination of a chemically functionalized porous Ti substrate with a potentially therapeutic AgNPs coating. Fully dense and porous Ti substrates (30 and 60 vol.%, 100–200 and 355–500 μm, as spacer particles) were studied. Ti surface was treated with acid or basic medium followed by silanization and deposition of AgNPs by “submerged” and “in situ” methods. In general, for similar porosity, mechanical resistance decreased as pore size increased. Acidic reagent and submerged methodology were the best combination for fully dense Ti substrates. Hence, they were also employed for porous Ti substrates. Depending on the porosity of the substrates, variations can be observed both in the size and degree of agglomeration of the deposited AgNPs, entailing differences in the antibacterial behavior of the samples.

Initial adhesion suppression of biofilm-forming and copper-tolerant bacterium Variovorax sp. on laser microtextured copper surfaces

The growth of detrimental biofilms on metal surfaces affects their structural performance and lifespan. Microtopographic texturization has emerged as an approach to suppress biofilm growth by preventing the initial stages of bacterial adhesion. This work studies the effects of linear pattern copper texturization on the initial adhesion steps of the biofilm-forming and copper-resistant bacterium Variovorax sp. Linear patterns with 4.7, 6.8, 14, and 18 μm periodicity were produced by direct laser interference patterning (DLIP) on copper coupons. Surface features were characterized by microscopic and spectroscopic techniques, and bacterial adhesion behavior was characterized by epifluorescence microscopy and functionalization of atomic force microscopy tips. We found a periodicity of 4.7 μm as the most efficient pattern to suppress Variovorax sp. initial adhesion by 31.1 % with respect to the nontextured surface. Preferential settlement in hummocks over hollows was observed for patterns with 14 and 18 μm periodicity, with adhesion events showing higher frequency in these topographies than patterns with periodicities of 4.7 and 6.8 μm. Our results highlight an understanding of the initial bacteria-copper adhesion and settlement behavior, thus contributing to the potential development of innocuous strategies for controlling biofilm growth on copper-based materials.

Antibacterial and antibiofilm properties of graphene and its derivatives

Infections resulting from bacteria and biofilms have become a huge problem threatening human health. In recent years, the antibacterial and antibiofilm effects of graphene and its derivatives have been extensively studied. However, there continues to be some controversy over whether graphene and its derivatives can resist infection and biofilms. Moreover, the antibacterial mechanism and cytotoxicity of graphene and its derivatives are unclear. In the present review, antibacterial and antibiofilm abilities of graphene and its derivatives in solution, on the surface are reviewed, and their toxicity and possible mechanisms are also reviewed. Furthermore, we propose possible future development directions for graphene and its derivatives in antibacterial and antibiofilm applications.

Surface Modification of 316L SS Implants by Applying Bioglass/Gelatin/Polycaprolactone Composite Coatings for Biomedical Applications

In this study, various composites of bioglass/gelatin/polycaprolactone (BG/GE/PCL) were produced and coated on the surface of 316L stainless steel (SS) to improve its bioactivity. X-ray diffractometry (XRD), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) were utilized to characterize the specimens. The results showed that bioglass particles were distributed uniformly in the coating. By increasing the wt.% of bioglass in the nanocomposite coatings, the surface roughness and adhesion strength increased. The corrosion behavior of GE/PCL (PCL-10 wt.% gelatin coated on 316L SS) and 3BG/GE/PCL (GE/PCL including 3 wt.% bioglass coated on 316L SS) samples were studied in PBS solution. The results demonstrated that 3BG/GE/PCL sample improved the corrosion resistance drastically compared to the GE/PCL specimen. In vitro bioactivity of samples was examined after soaking the specimens for 7, 14 and 28 days in simulated body fluid (SBF). The results showed a significant apatite formation on the surface of 3BG/GE/PCL samples. The cell viability evaluation was performed using 3- (4, 5-dimethylthiazol-2-yl)-2,5 diphenyltetrazoliumbromide (MTT) tests which confirmed the enhanced cell viability on the surface of 3BG/GE/PCL samples. The in vivo behavior of specimens illustrated no toxicity and inflammatory response and was in a good agreement with the results obtained from the in vitro test.

Biofilm Formation and Expression of Virulence Genes of Microorganisms Grown in Contact with a New Bioactive Glass

Bioactive glass F18 (BGF18), a glass containing SiO2-Na2O-K2O-MgO-CaO-P2O5, is highly effective as an osseointegration buster agent when applied as a coating in titanium implants. Biocompatibility tests using this biomaterial exhibited positive results; however, its antimicrobial activity is still under investigation. In this study we evaluated biofilm formation and expression of virulence-factor-related genes in Candida albicans, Staphylococcus epidermidis, and Pseudomonas aeruginosa grown on surfaces of titanium and titanium coated with BGF18. C. albicans, S. epidermidis, and P. aeruginosa biofilms were grown on specimens for 8, 24, and 48 h. After each interval, the pH was measured and the colony-forming units were counted for the biofilm recovery rates. In parallel, quantitative real-time polymerase chain reactions were carried out to verify the expression of virulence-factor-related genes. Our results showed that pH changes of the culture in contact with the bioactive glass were merely observed. Reduction in biofilm formation was not observed at any of the studied time. However, changes in the expression level of genes related to virulence factors were observed after 8 and 48 h of culture in BGF18. BGF18 coating did not have a clear inhibitory effect on biofilm growth but promoted the modulation of virulence factors.

Niobium-oxynitride coatings for biomedical applications: Its antibacterial effects and in-vitro cytotoxicity

316L Stainless Steel (SS) has been widely used in many medical applications, such as orthopedic prostheses and cardiovascular implants due to its good mechanical properties and resistance to corrosion. Despite its superior features, SS has bio-functionality problems. In this study, niobium oxynitride coatings were deposited onto 316L SS substrates to improve their biocompatibility using a reactive radio frequency (RF) magnetron sputtering technique. The nitrogen flow was fixed, and the nitrogen to oxygen flow ratio was set to 2, 5 and 10 to investigate the effect of oxygen concentration on biocompatibility and the antibacterial behavior of the oxynitride films. The microstructure, morphology and wettability properties of the coatings were analyzed by scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS) and an optical tensiometer. The antibacterial activities of coated and uncoated 316L substrates were tested against S. aureus and E. coli bacterial strains. The cytotoxic effects of NbO_xN_y-coated and uncoated substrates were evaluated on human fibroblast cells. The results showed that niobium oxynitride coatings were not cytotoxic and exhibited more antibacterial activity in comparison to the uncoated ones.

Surface Characteristics and Cell Adhesion Behaviors of the Anodized Biomedical Stainless Steel

In this study, an electrochemical anodizing method was applied as surface modification of the 316L biomedical stainless steel (BSS). The surface properties, microstructural characteristics, and biocompatibility responses of the anodized 316L BSS specimens were elucidated through scanning electron microscopy, X-ray photoelectron spectroscopy, X-ray diffractometry, transmission electron microscopy, and in vitro cell culture assay. Analytical results revealed that the oxide layer of dichromium trioxide (Cr2O3) was formed on the modified 316L BSS specimens after the different anodization modifications. Moreover, a dual porous (micro/nanoporous) topography can also be discovered on the surface of the modified 316L BSS specimens. The microstructure of the anodized oxide layer was composed of amorphous austenite phase and nano-Cr2O3. Furthermore, in vitro cell culture assay also demonstrated that the osteoblast-like cells (MG-63) on the anodized 316L BSS specimens were completely adhered and covered as compared with the unmodified 316L BSS specimen. As a result, the anodized 316L BSS with a dual porous (micro/nanoporous) oxide layer has great potential to induce cell adhesion and promote bone formation.

The Effectiveness of Nafion-Coated Stainless Steel Surfaces for Inhibiting Bacillus Subtilis Biofilm Formation

Stainless steel is one of most commonly used materials in the world; however, biofilms on the surfaces of stainless steel cause many serious problems. In order to find effective methods of reducing bacterial adhesion to stainless steel, and to investigate the role of electrostatic effects during the formation of biofilms, this study used a stainless steel surface that was negatively charged by being coated with Nafion which was terminated by sulfonic groups. The results showed that the roughness of stainless steel discs coated with 1% Nafion was similar to an uncoated surface; however the hydrophobicity increased, and the Nafion-coated surface reduced the adhesion of Bacillus subtilis by 75% compared with uncoated surfaces. Therefore, a facile way to acquire antibacterial stainless steel was found, and it is proved that electrostatic effects have a significant influence on the formation of biofilms.

Materials for Orthopedic Bioimplants: Modulating Degradation and Surface Modification Using Integrated Nanomaterials

Significant research and development in the field of biomedical implants has evoked the scope to treat a broad range of orthopedic ailments that include fracture fixation, total bone replacement, joint arthrodesis, dental screws, and others. Importantly, the success of a bioimplant depends not only upon its bulk properties, but also on its surface properties that influence its interaction with the host tissue. Various approaches of surface modification such as coating of nanomaterial have been employed to enhance antibacterial activities of a bioimplant. The modified surface facilitates directed modulation of the host cellular behavior and grafting of cell-binding peptides, extracellular matrix (ECM) proteins, and growth factors to further improve host acceptance of a bioimplant. These strategies showed promising results in orthopedics, e.g., improved bone repair and regeneration. However, the choice of materials, especially considering their degradation behavior and surface properties, plays a key role in long-term reliability and performance of bioimplants. Metallic biomaterials have evolved largely in terms of their bulk and surface properties including nano-structuring with nanomaterials to meet the requirements of new generation orthopedic bioimplants. In this review, we have discussed metals and metal alloys commonly used for manufacturing different orthopedic bioimplants and the biotic as well as abiotic factors affecting the failure and degradation of those bioimplants. The review also highlights the currently available nanomaterial-based surface modification technologies to augment the function and performance of these metallic bioimplants in a clinical setting.

Tribological Characterization of Ni-Free Duplex Stainless Steel Alloys Using the Taguchi Methodology

Duplex stainless steels (DSSs) exhibit excellent corrosion resistance and are being used in a variety of industrial applications. Reducing/eliminating the amount of nickel in such alloys will contribute significantly to its economic viability. Moreover, a well-established wear behavior for these alloys is also an essential development in most of their applications. Hence, in this work, the Taguchi technique was effectively implemented to investigate the effect of operating factors such as sliding speed and applied load on the wear behavior of different compositions of nickel-free DSSs. It was observed that the composition had a higher contribution of 33.66% to the wear rate (WR) and the contribution of the sliding speed to the coefficient of friction (COF) was found to be 68.17%. With a good agreement, a regression model was also developed to predict the WR and COF within a certain range of factors. Wear tests have also shown that the developed nickel-free DSS is a promising candidate in terms of wear resistance as compared to austenitic stainless steels (ASS).

Bioactive glass coatings on metallic implants for biomedical applications

Metallic implant materials possess adequate mechanical properties such as strength, elastic modulus, and ductility for long term support and stability in vivo. Traditional metallic biomaterials, including stainless steels, cobalt-chromium alloys, and titanium and its alloys, have been the gold standards for load-bearing implant materials in hard tissue applications in the past decades. Biodegradable metals including iron, magnesium, and zinc have also emerged as novel biodegradable implant materials with different in vivo degradation rates. However, they do not possess good bioactivity and other biological functions. Bioactive glasses have been widely used as coating materials on the metallic implants to improve their integration with the host tissue and overall biological performances. The present review provides a detailed overview of the benefits and issues of metal alloys when used as biomedical implants and how they are improved by bioactive glass-based coatings for biomedical applications.

Encapsulation of a nanoporous simvastatin-chitosan composite to enhance osteointegration of hydroxyapatite-coated polyethylene terephthalate ligaments

PURPOSE

This study was designed to evaluate the in vitro and in vivo biocompatibility and osteointegration of plasma-sprayed hydroxyapatite (HA)-coated polyethylene terephthalate (PET) ligaments encapsulated with a simvastatin (SV)-chitosan (CS) composite.

METHODS

This study compared the in vitro and in vivo bone responses to three different PET ligaments: SV/CS/PET-HA, CS/PET-HA and PET-HA. A field emission scanning electron microscope was used to characterize the morphology, and the in vitro SV release profile was analyzed. MC3T3 cells were cocultured with SV/CS/PET-HA, CS/PET-HA and PET-HA to test their biocompatibility using CCK-8 tests. Osteogenic differentiation was investigated by the expression of marker genes using qPCR. Osteointegration was performed by implanting the PET ligaments into the proximal tibia bone tunnels of male Sprague-Dawley rats for 3 weeks and 6 weeks. The bone-implant interface was evaluated by micro-computed tomography (micro-CT) and histological analysis.

RESULTS

The characteristic nanoporous structures mainly formed on the surface of the plasma-sprayed HA particles in the SV/CS/PET-HA and CS/PET-HA groups. The SV release test showed that the sustained release of simvastatin lasted for 25 days in the SV/CS/PET-HA group. The in vitro studies demonstrated that the SV/CS/PET-HA ligaments induced osteogenic differentiation in the MC3T3 cells, with higher mRNA expression levels of collagen-1, bone morphogenetic protein-2, osteocalcin and alkaline phosphatase than those in the CS/PET-HA and PET-HA ligament groups. The in vivo tests showed that both micro-CT analysis (bone mineral density and bone volume per total volume) and histological analysis (bone implant contact and interface area) revealed significantly higher peri-implant bone formation and less interface area in the SV/CS/PET-HA group than in the other groups.

CONCLUSION

The SV-CS composite nanoporous structure was associated with the improved biocompatibility and osteogenic differentiation in vitro and enhanced osteointegration process in vivo of plasma-sprayed HA-coated PET ligaments.

Osteoblast Biocompatibility and Antibacterial Effects Using 2-Methacryloyloxyethyl Phosphocholine-Grafted Stainless-Steel Composite for Implant Applications

Poor osteogenesis and bacterial infections lead to an implant failure, so the enhanced osteogenic and antimicrobial activity of the implantable device is of great importance in orthopedic applications. In this study, 2-methacryloyloxyethyl phosphocholine (MPC) was grafted onto 316L stainless steel (SS) using a facile photo-induced radical graft polymerization method via a benzophenone (BP) photo initiator. Atomic force microscopy (AFM) was employed to determine the nanoscale morphological changes on the surface. The grafted BP-MPC layer was estimated to be tens of nanometers thick. The SS-BP-MPC composite was more hydrophilic and smoother than the untreated and BP-treated SS samples. Staphylococcus aureus (S. aureus) bacteria binding onto the SS-BP-MPC composite film surface was significantly reduced compared with the pristine SS and SS-BP samples. Mouse pre-osteoblast (MC3T3-E1) cells showed good adhesion on the MPC-modified samples and better proliferation and metabolic activity (73% higher) than the pristine SS sample. Biological studies revealed that grafting MPC onto the SS substrate enhanced the antibacterial efficiency and also retained osteoblast biocompatibility. This proposed procedure is promising for use with other implant materials.

Characterization of Sol-Gel Derived Calcium Hydroxyapatite Coatings Fabricated on Patterned Rough Stainless Steel Surface

Sol-gel derived calcium hydroxyapatite (Ca10(PO4)6(OH)2; CHA) thin films were deposited on stainless steel substrates with transverse and longitudinal patterned roughness employing a spin-coating technique. Each layer in the preparation of CHA multilayers was separately annealed at 850 °C in air. Fabricated CHA coatings were placed in simulated body fluid (SBF) for 2, 3, and 4 weeks and investigated after withdrawal. For the evaluation of obtained and treated with SBF coatings, diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS), X-ray diffraction (XRD) analysis, Raman spectroscopy, XPS spectroscopy, scanning electron microscopy (SEM) analysis, and contact angle measurements were used. The tribological properties of the CHA coatings were also investigated in this study.

Polydopamine-assisted surface modification for orthopaedic implants

Along with the massive use of implants in orthopaedic surgeries in recent few decades, there has been a tremendous demand for the surface modification of the implants to avoid surgery failure and improve their function. Polydopamine (PDA), being able to adhere to almost all kinds of substrates and possessing copious functional groups for covalently immobilizing biomolecules and anchoring metal ions, has been widely used for surface modification of materials since its discovery in the last decade. PDA and its derivatives can be used for the surface modification of orthopaedic implants to modulate cellular responses, including cell spreading, migration, proliferation, and differentiation, and may thereby enhance the function of existing implants. In addition, the osseointegration and antimicrobial properties of orthopaedic implants may also be improved by PDA-based coatings. The aim of this review is to provide a brief overview of current advances of surface modification technologies for orthopaedic implants using PDA and its derivatives as a medium. Given the versatility of PDA-based adhesion, such PDA-assisted surface modification technologies will certainly benefit the development of new orthopaedic implants.

THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE

Surface treatments of orthopaedic implants, which are normally inert materials, are essential for their performance in vivo. This review summarizes recent advances in the surface modification of orthopaedic implants using facile and highly versatile techniques based on the use of polydopamine (PDA) and its derivatives.

Biomedical Grade Stainless Steel Coating of Polycaffeic Acid via Combined Oxidative and Ultraviolet Light-Assisted Polymerization Process for Bioactive Implant Application

Stainless steel as a biomedical implant material has been studied in various fields and in various forms, such as vascular stents, bone plates, dental screws, and artificial hip and bone material. In this study, we used polycaffeic acid (PCA), a natural phenolic compound, to coat the surface of medical grade stainless steel to provide added potential medicinal effects by virtue of its inherent anti-inflammatory, antiviral, antifibrosis, antithrombosis, and antihypertensive characteristics. We did this via UV irradiation under an alkaline state to solve the cost and time problems of other existing coating methods. The physicochemical properties of the samples were investigated through field emission scanning electron microscopy (FESEM), atomic force microscopy (AFM), contact angle, FTIR, and X-ray photoelectron spectroscopy (XPS). Surface bioactivity using NIH-3T3 cell lines were observed in vitro. We expect that the proposed methodology may contribute to the field of study of implantable metallic devices.

Microporous Coatings of PEKK/SN Composites Integration with PEKK Exhibiting Antibacterial and Osteogenic Activity, and Promotion of Osseointegration for Bone Substitutes

To improve the antibacterial and osteogenic activities of poly(etherketoneketone) (PEKK), concentrated sulfuric acid (H₂SO₄) suspension with silicon nitride (SN) microparticle was utilized to modify PEKK surface. Through sulfonation reaction, microporous coatings of PEKK/SN composites were created on PEKK surface, which were integrated with PEKK substrate. The results showed that the content of SN in the microporous coatings increased with the increase of SN content in H₂SO₄ suspension (PKS without SN, PKSC5 and PKSC10 with 5 and 10 wt % SN content in H₂SO₄) and that the surface roughness and hydrophilicity of microporous coatings on PEKK were significantly improved with the SN content increasing. In addition, the microporous coating of PKSC10 with high SN content exhibited excellent antibacterial activity due to the synergistic action of the presence of amino (-NH₂) and sulfonic acid (-SO₃H) groups as well as the improvement of protein absorption. Moreover, the microporous coating of PKSC10 obviously stimulated adhesion, proliferation, and osteogenic differentiation of rat bone mesenchymal stem cells. Furthermore, histological and push-out load evaluation indicated that the microporous coating of PKSC10 significantly promoted osteogenesis and osseointegration in vivo. The results suggested that the microporous coating of PKSC10 with high SN content display good biocompatibility, antibacterial and osteogenic activities, and osseointegration ability, which would have great potential for bone substitutes.

Intraosseous metal implants in orthopedics: A review

Metal implants are biomaterials widely used in orthopedics. They are both used in osteosynthesis and arthroplasty. Their mechanical properties, biocompatibility and resistance to corrosion make them a widely used option in orthopedics. Alloys are the most commonly used metals in orthopedics. As far as physical traumas are concerned, implants such as screws, plates and/or nails are used for osteosynthesis as they ensure the stability of the fractured area and contribute to bone healing. Prostheses are used in arthroplasty to restore joint function for as long as possible. Contact between bone and the prosthesis induces bone remodeling at the interface between metal and bone even if the metal is recognized as biocompatible. Upon time, the interface between the metal implant and the bony tissue is continuously modified and adapted. Hip prosthesis is a typical example of intraosseous metal implant whose bone/implant interface has been extensively studied. Metal can be altered in vivo by different mechanisms including corrosion and fretting. An altered torque friction leads to wear debris that accumulate in the peri-prosthetic tissues causing metallosis.