A novel porous Ti6Al4V: Characterization and cell attachment

Biomimetic Porous Ti6Al4V Implants: A Novel Interbody Fusion Cage via Gel-Casting Technique to Promote Spine Fusion

An interbody fusion cage (Cage) is crucial in spinal decompression and fusion procedures for restoring normal vertebral curvature and rebuilding spinal stability. Currently, these Cages suffer from issues related to mismatched elastic modulus and insufficient bone integration capability. Therefore, a gel-casting technique is utilized to fabricate a biomimetic porous titanium alloy material from Ti6Al4V powder. The biomimetic porous Ti6Al4V is compared with polyetheretherketone (PEEK) and 3D-printed Ti6Al4V materials and their respective Cages. Systematic validation is performed through mechanical testing, in vitro cell, in vivo rabbit bone defect implantation, and ovine anterior cervical discectomy and fusion experiments to evaluate the mechanical and biological performance of the materials. Although all three materials demonstrate good biocompatibility and osseointegration properties, the biomimetic porous Ti6Al4V, with its excellent mechanical properties and a structure closely resembling bone trabecular tissue, exhibited superior bone ingrowth and osseointegration performance. Compared to the PEEK and 3D-printed Ti6Al4V Cages, the biomimetic porous Ti6Al4V Cage outperforms in terms of intervertebral fusion performance, achieving excellent intervertebral fusion without the need for bone grafting, thereby enhancing cervical vertebra stability. This biomimetic porous Ti6Al4V Cage offers cost-effectiveness, presenting significant potential for clinical applications in spinal surgery.

Design and Additive Manufacturing of Acetabular Implant with Continuously Graded Porosity

Porous structured metallic implants are preferable as bone graft substitutes due to their faster tissue integration mediated by bone in-growth and vascularization. The porous scaffolds/implants should also mimic the graded structure of natural bone to ensure a match of mechanical properties. This article presents a method for designing a graded porous structured acetabular implant and identifies suitable parameters for manufacturing the model through additive manufacturing. The design method is based on slice-wise modification to ensure continuity of gradation. Modification of the slices was achieved through the binary image processing route. A geodesic dome-type design was adopted for developing the acetabular cup model from the graded porous structure. The model had a solid shell with the target porosity and pore size gradually changing from 65% and 950 µm, respectively, in the inner side to 75% and 650 µm, respectively, towards the periphery. The required dimensions of the unit structures and the combinations of pore structure and strut diameter necessary to obtain the target porosity and pore size were determined analytically. Suitable process parameters were identified to manufacture the model by Direct Metal Laser Sintering (DMLS) using Ti6Al4V powder after carrying out a detailed experimental study to minimize the variation of surface roughness and warping over different build angles of the strut structures. Dual-contour scanning was implemented to simplify the scan strategy. The minimum diameter of struts that could be manufactured using the selected scanning strategy and scanning parameters was found to be 375 µm. Finally, the model was built and from the micro-CT data, the porosities and pore sizes were found to be closely conforming to the designed values. The stiffness of the structures, as found from compression testing, was also found to match with that of human trabecular bone well. Further, the structure exhibited compliant bending-dominated behaviour under compressive loading.

On-Growth and In-Growth Osseointegration Enhancement in PM Porous Ti-Scaffolds by Two Different Bioactivation Strategies: Alkali Thermochemical Treatment and RGD Peptide Coating

A lack of primary stability and osteointegration in metallic implants may result in implant loosening and failure. Adding porosity to metallic implants reduces the stress shielding effect and improves implant performance, allowing the surrounding bone tissue to grow into the scaffold. However, a bioactive surface is needed to stimulate implant osteointegration and improve mechanical stability. In this study, porous titanium implants were produced via powder sintering to create different porous diameters and open interconnectivity. Two strategies were used to generate a bioactive surface on the metallic foams: (1) an inorganic alkali thermochemical treatment, (2) grafting a cell adhesive tripeptide (RGD). RGD peptides exhibit an affinity for integrins expressed by osteoblasts, and have been reported to improve osteoblast adhesion, whereas the thermochemical treatment is known to improve titanium implant osseointegration upon implantation. Bioactivated scaffolds and control samples were implanted into the tibiae of rabbits to analyze the effect of these two strategies in vivo regarding bone tissue regeneration through interconnected porosity. Histomorphometric evaluation was performed at 4 and 12 weeks after implantation. Bone-to-implant contact (BIC) and bone in-growth and on-growth were evaluated in different regions of interest (ROIs) inside and outside the implant. The results of this study show that after a long-term postoperative period, the RGD-coated samples presented higher quantification values of quantified newly formed bone tissue in the implant's outer area. However, the total analyzed bone in-growth was observed to be slightly greater in the scaffolds treated with alkali thermochemical treatment. These results suggest that both strategies contribute to enhancing porous metallic implant stability and osteointegration, and a combination of both strategies might be worth pursuing.

3D-printed porous Ti6Al4V scaffolds for long bone repair in animal models: a systematic review

BACKGROUND

Titanium and its alloys have been widely employed for bone tissue repair and implant manufacturing. The rapid development of three-dimensional (3D) printing technology has allowed fabrication of porous titanium scaffolds with controllable microstructures, which is considered to be an effective method for promoting rapid bone formation and decreasing bone absorption. The purpose of this systematic review was to evaluate the osteogenic potential of 3D-printed porous Ti6Al4V (Ti64) scaffold for repairing long bone defects in animal models and to investigate the influential factors that might affect its osteogenic capacity.

METHODS

Electronic literature search was conducted in the following databases: PubMed, Web of Science, and Embase up to September 2021. The SYRCLE's tool and the modified CAMARADES list were used to assess the risk of bias and methodological quality, respectively. Due to heterogeneity of the selected studies in relation to protocol and outcomes evaluated, a meta-analysis could not be performed.

RESULTS

The initial search revealed 5858 studies. Only 46 animal studies were found to be eligible based on the inclusion criteria. Rabbit was the most commonly utilized animal model. A pore size of around 500-600 µm and porosity of 60-70% were found to be the most ideal parameters for designing the Ti64 scaffold, where both dodecahedron and diamond pores optimally promoted osteogenesis. Histological analysis of the scaffold in a rabbit model revealed that the maximum bone area fraction reached 59.3 ± 8.1% at weeks 8-10. Based on micro-CT assessment, the maximum bone volume fraction was found to be 34.0 ± 6.0% at weeks 12.

CONCLUSIONS

Ti64 scaffold might act as a promising medium for providing sufficient mechanical support and a stable environment for new bone formation in long bone defects. Trail registration The study protocol was registered in the PROSPERO database under the number CRD42020194100.

Structural, Electrical, and Mechanical Properties Investigation of Open-Cell Aluminum Foams Obtained by Spark Plasma Sintering and Replication on Polyurethane Template

The present paper illustrates a comparison of open-cell aluminum foams. The foams were fabricated by two different methods: spark plasma sintering and replication on a polyurethane template. The influence of pressure, temperature, and diameter of space holding material on foam obtained by the spark plasma sintering method was investigated. Additionally, the aluminum powder content in slurry and atmosphere during thermal processing of foam prepared by the replication technique were studied. The morphology and structure of obtained samples were analyzed by scanning electron microscopy and X-ray diffraction analysis. Supplementarily, mechanical properties and electrical conductivity were studied. The porosity of obtained samples was 83% for the SPS sample and 85% for the replication sample. The results of the studies carried out gave us an understanding that the SPS method is more promising for using the obtained foams as cathode current collectors in lithium-ion batteries due to excessive aluminum oxidation during sintering in the furnace.

3D porous Ti6Al4V-beta-tricalcium phosphate scaffolds directly fabricated by additive manufacturing

3D Ti6Al4V-beta-tricalcium phosphate (TCP) hybrid scaffolds with interconnected porous network and controllable porosity and pore size were successfully produced by three-dimensional fiber deposition (3DF). The macrostructure of scaffolds was determined by the 3D design, whereas the micro- and submicron structure were derived from the Ti6Al4V powder sintering and the crystalline TCP powder, respectively. Ti6Al4V-TCP slurry was developed for 3DF by optimizing the TCP powder size, Ti6Al4V-to-TCP powder ratio and Ti6Al4V-TCP powder content. Moreover, the air pressure and fiber deposition rate were optimized. A maximum achievable ceramic content in the Ti6Al4V-TCP slurry that enables 3DF manufacturing was 10 wt%. The chemical analysis showed that limited contamination occurred during sintering. The compressive strength and Young's modulus of the scaffolds exhibited values between those of cancellous and cortical bone. The 3D Ti6Al4V-TCP scaffolds with 10 wt% TCP allowed deposition of a calcium phosphate layer on the surface in a simulated body fluid. Cumulative release of calcium and phosphate ions from the scaffolds was observed in a simulated physiological solution, in contrast to a cell culture medium. A pilot in vivo study, in which the scaffolds were implanted intramuscularly in dogs showed ectopic bone formation in the Ti6Al4V-TCP scaffolds with 10 wt% TCP, showing their osteoinductive potential. The porous 3D Ti6Al4V-TCP scaffolds developed here combine the mechanical properties of the metal with the bioactivity of the ceramic and are therefore likely to yield more effective strategies to control the implant-bone interface and thereby improve long-term clinical results in orthopaedics and craniomaxillofacial surgery. STATEMENT OF SIGNIFICANCE: In this work, 3D porous hybrid scaffolds made of a titanium alloy and a beta-tricalcium phosphate ceramic (Ti6Al4V-TCP) were developed using the direct additive manufacturing technique 3D fiber deposition. Upon optimization of the powders and slurry, scaffolds with up to 10 wt.% TCP with good mechanical properties and controllable porous structure at different length scales were successfully manufactured. A preliminary in vivo study in an intramuscular model demonstrated that the addition of TCP to the metal alloy improved its bioactivity. The combination of the two materials and the use of a direct additive manufacturing technique resulted in scaffolds that may lead to more effective strategies to control the implant-bone interface and thereby improve long-term clinical results in orthopaedics and craniomaxillofacial surgery.

Microstructural, Mechanical, Corrosion and Cytotoxicity Characterization of Porous Ti-Si Alloys with Pore-Forming Agent

Titanium and its alloys belong to the group of materials used in implantology due to their biocompatibility, outstanding corrosion resistance and good mechanical properties. However, the value of Young’s modulus is too high in comparison with the human bone, which could result in the failure of implants. This problem can be overcome by creating pores in the materials, which, moreover, improves the osseointegration. Therefore, TiSi2 and TiSi2 with 20 wt.% of the pore-forming agent (PA) were prepared by reactive sintering and compared with pure titanium and titanium with the addition of various PA content in this study. For manufacturing implants (especially augmentation or spinal replacements), titanium with PA seemed to be more suitable than TiSi2 + 20 wt.% PA. In addition, titanium with 30 or 40 wt.% PA contained pores with a size allowing bone tissue ingrowth. Furthermore, Ti + 30 wt.% PA was more suitable material in terms of corrosion resistance; however, its Young’s modulus was higher than that of the human bone while Ti + 40 wt.% PA had a Young’s modulus close to the human bone.

Exploring Macroporosity of Additively Manufactured Titanium Metamaterials for Bone Regeneration with Quality by Design: A Systematic Literature Review

Additive manufacturing facilitates the design of porous metal implants with detailed internal architecture. A rationally designed porous structure can provide to biocompatible titanium alloys biomimetic mechanical and biological properties for bone regeneration. However, increased porosity results in decreased material strength. The porosity and pore sizes that are ideal for porous implants are still controversial in the literature, complicating the justification of a design decision. Recently, metallic porous biomaterials have been proposed for load-bearing applications beyond surface coatings. This recent science lacks standards, but the Quality by Design (QbD) system can assist the design process in a systematic way. This study used the QbD system to explore the Quality Target Product Profile and Ideal Quality Attributes of additively manufactured titanium porous scaffolds for bone regeneration with a biomimetic approach. For this purpose, a total of 807 experimental results extracted from 50 different studies were benchmarked against proposed target values based on bone properties, governmental regulations, and scientific research relevant to bone implants. The scaffold properties such as unit cell geometry, pore size, porosity, compressive strength, and fatigue strength were studied. The results of this study may help future research to effectively direct the design process under the QbD system.

Physical-Mechanical Characteristics and Microstructure of Ti6Al7Nb Lattice Structures Manufactured by Selective Laser Melting

The demand of lattice structures for medical applications is increasing due to their ability to accelerate the osseointegration process, to reduce the implant weight and the stiffness. Selective laser melting (SLM) process offers the possibility to manufacture directly complex lattice applications, but there are a few studies that have focused on biocompatible Ti6Al7Nb alloy. The purpose of this work was to investigate the physical-mechanical properties and the microstructure of three dissimilar lattice structures that were SLM-manufactured by using Ti6Al7Nb powder. In particular, the strut morphology, the fracture characterization, the metallographic structure, and the X-ray phase identification were analyzed. Additionally, the Gibson-Ashby prediction model was adapted for each lattice topology, indicating the theoretical compressive strength and Young modulus. The resulted porosity of these lattice structures was approximately 56%, and the pore size ranged from 0.40 to 0.91 mm. Under quasi-static compression test, three failure modes were recorded. Compared to fully solid specimens, the actual lattice structures reduce the elastic modulus from 104 to 6-28 GPa. The struts surfaces were covered by a large amount of partial melted grains. Some solidification defects were recorded in struts structure. The fractographs revealed a brittle rupture of struts, and their microstructure was mainly α' martensite with columnar grains. The results demonstrate the suitability of manufacturing lattice structures made of Ti6Al7Nb powder having unique physical-mechanical properties which could meet the medical requirements.

Modulation of bone formation and resorption using a novel zoledronic acid loaded gelatin nanoparticles integrated porous titanium scaffold: an in vitro and in vivo study

Osteoporotic bone defects are a major challenge in clinics for bone regeneration. With the condition of osteoporosis, excessive bone absorption and impaired osteogenesis result in unexpectedly long healing procedures for defects. In order to simultaneously enhance bone formation and reduce bone resorption, a polydopamine-coated porous titanium scaffold was designed, to be integrated with anti-catabolic drug zoledronic acid nanoparticles (ZOL loaded gelatin NPs), which was able to achieve a local sustained release of ZOL as expected. The in vitro study demonstrated that extracts of the composite scaffolds would stimulate osteoblast differentiation; they also inhibited osteoclastogenesis at a ZOL loading concentration of 50 μmol l^-1. In the subsequent in vivo study, the composite scaffolds were implanted into ovariectomy-induced osteoporotic rabbits suffering from femoral condyles defects. The results indicated that the composite scaffolds without ZOL loaded gelatin NPs only induced callus formation, mainly at the interface margin between the implant and bone, whereas the composite scaffolds with ZOL loaded gelatin NPs were capable of further enhancing osteogenesis and bone growth into the scaffolds. Moreover, the research proved that the promoting effect was optimal at a ZOL loading concentration of 50 μmol l^-1. In summary, the present research indicated that a new type of porous titanium scaffold integrated with ZOL loaded gelatin NPs inherited a superior biocompatibility and bone regeneration capability. It would be an optimal alternative for the reconstruction of osteoporosis-related defects compared to a traditional porous titanium implant; in other words, the new type of scaffold offers a new effective and practical procedure option for patients suffering from osteoporotic bone defects.

The Effect of Ti-6Al-4V Alloy Surface Structure on the Adhesion and Morphology of Unidirectional Freeze-Coated Gelatin

The modification of a metal implant surface with a biomimetic coating of bone-like anisotropic and graded porosity structures to improve its biological anchorage with the surrounding bone tissue at implanting, is still a high challenge. In this paper, we present an innovative way of a gelatin (GEL) dip-coating on Ti-6Al-4V substrates of different square-net surface textures by the unidirectional deep-freezing process at simultaneous cross-linking using carbodiimide chemistry. Different concentrations of GEL solution were used to study the changes in morphology, density, and mechanical properties of the coatings. In addition, the surface free energy and polarity of Ti-6Al-4V substrate surfaces and GEL solutions have been evaluated to assess the wetting properties at the substrate interfaces, and to describe the adhesion of GEL macromolecules with their surfaces, being supported by mechanical pull-out testing. The results indicate that the coating’s morphology depends primarily on the Ti-6Al-4V substrate’s surface texture and second, on the concentration of GEL, which further influences their adhesion properties, orientation, morphological arrangement, as well as compression strength. The substrate with a 300 × 300 μm2 texture resulted in a highly adhered GEL coating with ≥80% porosity, interconnected and well-aligned pores of 75–200 μm, required to stimulate the bone ingrowth, mechanically and histologically.

Novel titanium-apatite hybrid scaffolds with spongy bone-like micro architecture intended for spinal application: In vitro and in vivo study

Titanium alloy scaffolds with novel interconnected and non-periodic porous bone-like micro architecture were 3D-printed and filled with hydroxyapatite bioactive matrix. These novel metallic-ceramic hybrid scaffolds were tested in vitro by direct-contact osteoblast cell cultures for cell adhesion, proliferation, morphology and gene expression of several key osteogenic markers. The scaffolds were also evaluated in vivo by implanting them on transverse and spinous processes of sheep's vertebras and subsequent histology study. The in vitro results showed that: (a) cell adhesion, proliferation and viability were not negatively affected with time by compositional factors (quantitative MTT-assay); (b) the osteoblastic cells were able to adhere and to attain normal morphology (fluorescence microscopy); (c) the studied samples had the ability to promote and sustain the osteogenic differentiation, matrix maturation and mineralization in vitro (real-time quantitative PCR and mineralized matrix production staining). Additionally, the in vivo results showed that the hybrid scaffolds had greater infiltration, with fully mineralized bone after 6 months, than the titanium scaffolds without bioactive matrix. In conclusion, these novel hybrid scaffolds could be an alternative to the actual spinal fusion devices, due to their proved osteogenic performance (i.e. osteoinductive and osteoconductive behaviour), if further dimensional and biomechanical optimization is performed.

Exploration of gum ghatti-modified porous scaffolds for bone tissue engineering applications

Taking advantage of the tissue engineering principles, the formed hydroxyl apatite-modified gum ghatti biomaterial with its porous nature, biocompatibility, and efficient mechanical properties can be potential for the bone repair and regeneration.

Open-Cell Aluminum Foams by the Sponge Replication Technique

Open-cell aluminum foams were manufactured by a sponge replication technique having a total porosity of ~90%. The influence of the thermal processing conditions such as atmosphere and temperature on the cellular structure, phase composition porosity, thermal conductivity, and compressive strength of the foams was studied. It was found that the thermal processing of aluminum foams in Ar at temperatures up to 800 °C led to aluminum foams with a reduced strut porosity, a lower amount of aluminum oxide, a higher thermal conductivity, and a higher compression strength, compared to foams thermally processed in air. These results were explained by the lower amount of aluminum oxide after thermal processing of the foams.

Biodegradable magnesium alloys as temporary orthopaedic implants: a review

The study of innovative biodegradable implant materials is one of the most interesting research topics at the forefront in the area of biomaterials. Biodegradable implant materials in the human body can be gradually dissolved, absorbed, consumed or excreted, so there is no need for the secondary surgery to remove implants after the surgery regions have healed. However, most of the biodegradable materials, usually polymers, do not have good mechanical properties to be reliable for bearing the load of the body. Magnesium and its alloys due to the excellent biodegradability and biocompatibility as well as the suitable mechanical compatibility with human bone are very promising candidates for the development of temporary, degradable implants in load-bearing applications. However, Mg alloys are corrosion susceptible in a biological environment. Besides, the high corrosion rate and the low bioactivity of magnesium implants are the challenging problems, which need to be resolved before employing them in clinical applications. This paper provides a review of state-of-the-art of magnesium alloy implants for orthopedic and tissue engineering applications and describes recent progress in the design of novel structure design Mg alloys and potential approaches to improve their biodegradation performance.

3-dimensional printing for anterior cervical surgery: a review

Age-related degenerative changes and non-spondylotic pathologies of the cervical spine such as trauma and tumor can lead to compression of neurological structures and result in substantial alteration of the structural anatomy. The end-goal of surgical intervention is to decompress the neural structures which can be achieved via an anterior or a posterior approach, and stabilization of segments to restore stability and alignment. Three-dimensional printing (3DP or Additive Manufacturing) has been applied to the field of medicine, in particular orthopedics and neurosurgery. Coupled with advances of medical imaging such as computed tomography (CT) scans and magnetic resonance imaging (MRI), accurate 3D models of patient anatomy can be produced, and patient-specific implants (PSIs) for complex anatomical reconstruction have all been applied with positive outcomes. 3D printed implants have been applied in particular to the cervical spine predominantly due to the complex and relatively small osteological anatomy and the proximity of important neurovascular structures to the surgical sites. The purpose of this review is to evaluate the current application of 3DP for cervical spinal implants. This includes a review on the available literature on 3D printed PSIs and current available 3D printed "off-the-shelf" (OTS) implants (3D-OTS). Suitable materials for 3DP of spinal implants and the future prospect of cervical implants will be discussed. The review will be concluded with a suggested guide for carrying future studies to evaluate the efficacy and safety of 3DP for cervical spinal implants.

Two Different Strategies to Enhance Osseointegration in Porous Titanium: Inorganic Thermo-Chemical Treatment Versus Organic Coating by Peptide Adsorption

In this study, highly-interconnected porous titanium implants were produced by powder sintering with different porous diameters and open interconnectivity. The actual foams were produced using high cost technologies: Chemical Vapor Deposition (CVD), Physical Vapor Deposition (PVD), and spark plasma sintering, and the porosity and/or interconnection was not optimized. The aim was to generate a bioactive surface on foams using two different strategies, based on inorganic thermo-chemical treatment and organic coating by peptide adsorption, to enhance osseointegration. Porosity was produced using NaCl as a space holder and polyethyleneglicol as a binder phase. Static and fatigue tests were performed in order to determine mechanical behaviors. Surface bioactivation was performed using a thermo-chemical treatment or by chemical adsorption with peptides. Osteoblast-like cells were cultured and cytotoxicity was measured. Bioactivated scaffolds and a control were implanted in the tibiae of rabbits. Histomorphometric evaluation was performed at 4 weeks after implantation. Interconnected porosity was 53% with an average diameter of 210 µm and an elastic modulus of around 1 GPa with good mechanical properties. The samples presented cell survival values close to 100% of viability. Newly formed bone was observed inside macropores, through interconnected porosity, and on the implant surface. Successful bone colonization of inner structure (40%) suggested good osteoconductive capability of the implant. Bioactivated foams showed better results than non-treated ones, suggesting both bioactivation strategies induce osteointegration capability.

Biomimetic 3D-printed custom-made prosthesis for anterior column reconstruction in the thoracolumbar spine: a tailored option following en bloc resection for spinal tumors : Preliminary results on a case-series of 13 patients

PURPOSE

Various techniques for anterior column reconstruction have been described after en bloc resection of spinal tumors. Limited evidence exists regarding one being superior to another. The purpose of this study is to evaluate 3D-printed vertebral bodies for spinal reconstruction after en bloc resection in the thoracolumbar spine.

METHODS

Prospective observational study on custom-made 3D-printed titanium reconstruction of vertebral bodies after en bloc resection for spinal tumor was conducted between November 2015 and June 2017. 3D-printed vertebral bodies were monitored for mechanical complications such as (1) migration, (2) subsidence into the adjacent vertebral bodies, and/or (3) breakage. Complications and related details were recorded.

RESULTS

Thirteen patients (7 females and 6 males) were enrolled, and reconstruction of the anterior column was performed using custom-made 3D-printed titanium prosthesis after en bloc resection for spinal tumor (8 primary bone tumors and 5 solitary metastases). Subsidence into the adjacent vertebral bodies occurred in all patients at both proximal and distal bone-implant interfaces; however, it was clinically irrelevant (asymptomatic, and no consequences on posterior instrumentation), in 11 out of 12 patients (92%). In 1 patient (#4), severity of the subsidence led to revision of the construct. At an average 10-month follow-up (range 2-16), 1 implant was removed due to local recurrence of the disease and 1 was revisioned due to progressive distal junctional kyphosis.

CONCLUSION

Preliminary results from this series suggest that 3D printing can be effectively used to produce custom-made prosthesis for anterior column reconstruction. These slides can be retrieved under Electronic Supplementary Material.

Evaluation of an artificial vertebral body fabricated by a tantalum-coated porous titanium scaffold for lumbar vertebral defect repair in rabbits

Tantalum (Ta)-coated porous Ti-6A1-4V scaffolds have better bioactivity than Ti-6A1-4V scaffolds; however, their bioperformance as an artificial vertebral body (AVB) is unknown. In the present study, we combined a Ta-coated Ti-6A1-4V scaffold with rabbit bone marrow stromal cells (BMSCs) for tissue-engineered AVB (TEAVB) construction and evaluated the healing and fusion efficacy of this scaffold in lumbar vertebral defects after corpectomy in rabbits. The results showed that BMSCs on the surface of the Ta-coated Ti scaffolds proliferated better than BMSCs on Ti scaffolds. Histomorphometry showed better bone formation when using Ta-coated TEAVBs than that with Ti TEAVBs at both 8 and 12 weeks after implantation. In addition, the vertical and rotational stiffness results showed that, compared with uncoated TEAVBs, Ta-coated TEAVBs enhanced rabbit lumbar vertebral defect repair. Our findings demonstrate that Ta-coated TEAVBs have better healing and fusion efficacy than Ti TEAVBs in rabbit lumbar vertebral defects, which indicates their good prospects for clinical application.

Different models for simulation of mechanical behaviour of porous materials

Commercially pure Titanium (cpTi) and its alloys are the most successful metallic biomaterials for bone replacement, due to its excellent biomechanical and biofunctional balance. However, these materials have higher elastic modulus when compared with bone, leading to the stress-shielding phenomenon and promoting bone resorption. Development of porous implants with low elastic modulus, providing a good mechanical and functional balance (suitable mechanical strength and optimum osseointegration), is the focus of emergent research in advanced Ti-based alloy biomaterials. With the aim of understanding the mechanical behaviour of porous materials with relation to the porosity level and the porous morphology, a new improved model with three different versions have been developed in this work. The proposed FE model combines the simplicity of a 2D periodic geometry with the complex information of the pore morphology extracted from experimentation. The methodology to generate the 2D simulated microstructure is based on a series of nxn pores distributed in a square matrix. The different versions of the model differ in the way of building the porous geometry. In the first version of the model ("Basic-Pattern Model"), the pores are supposed to be circular and periodically distributed in the matrix, following a perfect pattern. The second version of the model ("Pattern Model") is similar to the previous one, but with elliptic pores with a morphology randomly generated, following statistical information from experiments. In the third version ("Semi-random Model"), a controlled random distribution of the pores is obtained by including a randomness factors in both directions. By making use of the proposed FE model with its different versions, five different porous titanium obtained by the space-holders technique (with porosities θ = 28%, 37%, 47%, 57% and 66%) have been modeled based on experimental information of the pore morphology, and its macroscopic mechanical behaviour has been simulated, showing relatively good agreement with experimental results.

Natural and Synthetic Biodegradable Polymers: Different Scaffolds for Cell Expansion and Tissue Formation

The formation of tissue produced by implanted cells is influenced greatly by the scaffold onto which they are seeded. In the long term it is often preferable to use a biodegradable material scaffold so that all the implanted materials will disappear, leaving behind only the generated tissue. Research in this area has identified several natural biodegradable materials. Among them, hydrogels are receiving increasing attention due to their ability to retain a great quantity of water, their good biocompatibility, their low interfacial tension, and the minimal mechanical and frictional irritation that they cause. Biocompatibility is not an intrinsic property of materials; rather it depends on the biological environment and the tolerability that exists with respect to specific polymer-tissue interactions. The most often utilized biodegradable synthetic polymers for 3D scaffolds in tissue engineering are saturated poly-a-hydroxy esters, including poly(lactic acid) (PLA) and poly(glycolic acid) (PGA), as well as poly(lactic-co-lycolide) (PLGA) copolymers. Hard materials provide compressive and torsional strength; hydrogels and other soft composites more effectively promote cell expansion and tissue formation. This review focuses on the future potential for understanding the characteristics of the biomaterials considered evaluated for clinical use in order to repair or to replace a sizable defect by only harvesting a small tissue sample.

Multilevel 3D Printing Implant for Reconstructing Cervical Spine With Metastatic Papillary Thyroid Carcinoma

MINI: A 3D printing technology is proposed for reconstructing multilevel cervical spine (C2-C4) after resection of metastatic papillary thyroid carcinoma. The personalized porous implant printed in Ti6AL4V provided excellent physicochemical properties and biological performance, including biocompatibility, osteogenic activity, and bone ingrowth effect.

STUDY DESIGN

A unique case report.

OBJECTIVE

A three-dimensional (3D) printing technology is proposed for reconstructing multilevel cervical spine (C2-C4) after resection of metastatic papillary thyroid carcinoma in a middle-age female patient.

SUMMARY OF BACKGROUND DATA

Papillary thyroid carcinoma is a malignant neoplasm with a relatively favorable prognosis. A metastatic lesion in multilevel cervical spine (C2-C4) destroys neurological functions and causes local instability. Radical excision of the metastasis and reconstruction of the cervical vertebrae sequence conforms with therapeutic principles, whereas the special-shaped multilevel upper-cervical spine requires personalized implants. 3D printing is an additive manufacturing technology that produces personalized products by accurately layering material under digital model control via a computer. Reporting of this recent technology for reconstructing multilevel cervical spine (C2-C4) is rare in the literature.

METHODS

Anterior-posterior surgery was performed in one stage. Radical resection of the metastatic lesion (C2-C4) and thyroid gland, along with insertion of a personalized implant manufactured by 3D printing technology, were performed to rebuild the cervical spine sequences. The porous implant was printed in Ti6AL4V with perfect physicochemical properties and biological performance, such as biocompatibility and osteogenic activity. Finally, lateral mass screw fixation was performed via a posterior approach.

RESULTS

Patient neurological function gradually improved after the surgery. The patient received 11/17 on the Japanese Orthopedic Association scale and ambulated with a personalized skull-neck-thorax orthosis on postoperative day 11. She received radioiodine I therapy. The plane x-rays and computed tomography revealed no implant displacement or subsidence at the 12-month follow-up mark.

CONCLUSION

The presented case substantiates the use of 3D printing technology, which enables the personalization of products to solve unconventional problems in spinal surgery.

LEVEL OF EVIDENCE

5.

Study on Topology Optimization Design, Manufacturability, and Performance Evaluation of Ti-6Al-4V Porous Structures Fabricated by Selective Laser Melting (SLM)

The combination of topology optimization (TOP) and selective laser melting (SLM) provides the possibility of fabricating the complex, lightweight and high performance geometries overcoming the traditional manufacturing "bottleneck". This paper evaluates the biomechanical properties of porous structures with porosity from 40% to 80% and unit cell size from 2 to 8 mm, which are designed by TOP and manufactured by SLM. During manufacturability exploration, three typical structures including spiral structure, arched bridge structure and structures with thin walls and small holes are abstracted and investigated, analyzing their manufacturing limits and forming reason. The property tests show that dynamic elastic modulus and compressive strength of porous structures decreases with increases of porosity (constant unit cell size) or unit cell size (constant porosity). Based on the Gibson-Ashby model, three failure models are proposed to describe their compressive behavior, and the structural parameter λ is used to evaluate the stability of the porous structure. Finally, a numerical model for the correlation between porous structural parameters (unit cell size and porosity) and elastic modulus is established, which provides a theoretical reference for matching the elastic modulus of human bones from different age, gender and skeletal sites during innovative medical implant design and manufacturing.

Sacral Reconstruction with a 3D-Printed Implant after Hemisacrectomy in a Patient with Sacral Osteosarcoma: 1-Year Follow-Up Result

Pelvic reconstruction after sacral resection is challenging in terms of anatomical complexity, excessive loadbearing, and wide defects. Nevertheless, the technological development of 3D-printed implants enables us to overcome these difficulties. Here, we present a case of sacral osteosarcoma surgically treated with hemisacrectomy and sacral reconstruction using a 3D-printed implant. The implant was printed as a customized titanium prosthesis from a 3D real-sized reconstruction of a patient's CT images. It consisted mostly of a porous mesh and incorporated a dense strut. After 3-months of neoadjuvant chemotherapy, the patient underwent hemisacretomy with preservation of contralateral sacral nerves. The implant was anatomically installed on the defect and fixed with a screw-rod system up to the level of L3. Postoperative pain was significantly low and the patient recovered sufficiently to walk as early as 2 weeks postoperatively. The patient showed left-side foot drop only, without loss of sphincter function. In 1-year follow-up CT, excellent bony fusion was noticed. To our knowledge, this is the first report of a case of hemisacral reconstruction using a custom-made 3D-printed implant. We believe that this technique can be applied to spinal reconstructions after a partial or complete spondylectomy in a wide variety of spinal diseases.

Additively Manufactured Scaffolds for Bone Tissue Engineering and the Prediction of their Mechanical Behavior: A Review

Additive manufacturing (AM), nowadays commonly known as 3D printing, is a revolutionary materials processing technology, particularly suitable for the production of low-volume parts with high shape complexities and often with multiple functions. As such, it holds great promise for the fabrication of patient-specific implants. In recent years, remarkable progress has been made in implementing AM in the bio-fabrication field. This paper presents an overview on the state-of-the-art AM technology for bone tissue engineering (BTE) scaffolds, with a particular focus on the AM scaffolds made of metallic biomaterials. It starts with a brief description of architecture design strategies to meet the biological and mechanical property requirements of scaffolds. Then, it summarizes the working principles, advantages and limitations of each of AM methods suitable for creating porous structures and manufacturing scaffolds from powdered materials. It elaborates on the finite-element (FE) analysis applied to predict the mechanical behavior of AM scaffolds, as well as the effect of the architectural design of porous structure on its mechanical properties. The review ends up with the authors’ view on the current challenges and further research directions.

Microstructure and Characteristics of Calcium Phosphate Layers on Bioactive Oxide Surfaces of Air-Sintered Titanium Foams after Immersion in Simulated Body Fluid

We propose a simple and low-cost process for the preparation of porous Ti foams through a sponge replication method using single-step air sintering at various temperatures. In this study, the apatite-forming ability of air-sintered Ti samples after 21 days of immersion in simulated body fluid (SBF) was investigated. The microstructures of the prepared Ca-P deposits were examined by X-ray diffraction (XRD), field-emission scanning electron microscopy (FE-SEM), Fourier transform infrared (FTIR) spectroscopy, and cross-sectional transmission electron microscopy (TEM). In contrast to the control sample sintered in vacuum, which was found to have the simple hexagonal α-Ti phase, the air-sintered samples contained only the rutile phase. High intensities of XRD peaks for rutile TiO₂ were obtained with samples sintered at 1000 °C. Moreover, the air-sintered Ti samples had a greater apatite-forming ability than that of the Ti sample sintered in vacuum. Ti samples sintered at 900 and 1000 °C had large aggregated spheroidal particles on their surfaces after immersion in SBF for 21 days. Combined XRD, energy-dispersive X-ray spectroscopy, FTIR spectroscopy, and TEM results suggest that the calcium phosphate deposited on the rutile TiO₂ surfaces consist of carbonated calcium-deficient hydroxyapatite instead of octacalcium phosphate.

Hybrid Macro-Porous Titanium Ornamented by Degradable 3D Gel/nHA Micro-Scaffolds for Bone Tissue Regeneration

Porous titanium is a kind of promising material for bone substitution, while its bio-inert property results in demand of modifications to improve the osteointegration capacity. In this study, gelatin (Gel) and nano-hydroxyapatite (nHA) were used to construct 3D micro-scaffolds in the pores of porous titanium in the ratios of Gel:nHA = 1:0, Gel:nHA = 1:1, and Gel:nHA = 1:3, respectively. Cell attachment and proliferation, and gene and protein expression levels of osteogenic markers were evaluated in MC3T3-E1 cells, followed by bone regeneration assessment in a rabbit radius defect model. All hybrid scaffolds with different composition ratio were found to have significant promotional effects in cell adhesion, proliferation and differentiation, in which the group with Gel:nHA = 1:1 showed the best performance in vitro, as well as the most bone regeneration volume in vivo. This 3D micro-scaffolds modification may be an innovative method for porous titanium ornamentation and shows potential application values in clinic.

Reconstruction of the Upper Cervical Spine Using a Personalized 3D-Printed Vertebral Body in an Adolescent With Ewing Sarcoma

STUDY DESIGN

Case report.

OBJECTIVE

To describe a three-dimensional (3D) printed axial vertebral body used in upper cervical spine reconstruction after a C2 Ewing sarcoma resection in an adolescent boy.

SUMMARY OF BACKGROUND DATA

Ewing sarcoma is a malignant musculoskeletal neoplasm with a peak incidence in adolescents. Cervical spine as the primary site of the tumor has been related to a worse prognosis. Tumor resection is particularly challenging in the atlantoaxial region due to complexity of the anatomy, necessity for extensive resection according to oncological principles, and a lack of specialized implants for reconstruction. 3D printing refers to a process where 3D objects are created through successive layering of material under computer control. Although this technology potentially enables accurate fabrication of patient-specific orthopedic implants, literature on its utilization in this regard is rare.

METHODS

A 12-year-old boy with a C2 Ewing sarcoma underwent a staged spondylectomy. Wide resection of the posterior elements was first performed. Two weeks later, a high anterior retropharyngeal approach was taken to remove the remains of the C2 vertebra. A customized artificial vertebral body fabricated according to a computer model using titanium alloy powder was inserted to replace the defect between C1 and C3. The microstructure of the implant was optimized for better biomechanical stability and enhanced bone healing.

RESULTS

Patient had an uneventful recovery and began to ambulate on postoperative day 7. Adjuvant treatment commenced 3 weeks after the surgery. He was tumor-free at the 1-year follow-up. Computed tomography studies revealed evidence of implant osseointegration and no subsidence or displacement of the construct.

CONCLUSION

This is a case example on the concept of personalized precision medicine in a surgical setting and demonstrates how 3D-printed, patient-specific implants may bring individualized solutions to rare problems wherein restoration of the specific anatomy of each patient is a key prognostic factor.

Scaling up self-assembly: bottom-up approaches to macroscopic particle organization

This review presents an overview of recent work in the field of non-Brownian particle self-assembly. Compared to nanoparticles that naturally self-assemble due to Brownian motion, larger, non-Brownian particles (d > 6 μm) are less prone to autonomously organize into crystalline arrays. The tendency for particle systems to experience immobilization and kinetic arrest grows with particle radius. In order to overcome this kinetic limitation, some type of external driver must be applied to act as an artificial "thermalizing force" upon non-Brownian particles, inducing particle motion and subsequent crystallization. Many groups have explored the use of various agitation methods to overcome the natural barriers preventing self-assembly to which non-Brownian particles are susceptible. The ability to create materials from a bottom-up approach with these characteristics would allow for precise control over their pore structure (size and distribution) and surface properties (topography, functionalization and area), resulting in improved regulation of key characteristics such as mechanical strength, diffusive properties, and possibly even photonic properties. This review will highlight these approaches, as well as discuss the potential impact of bottom-up macroscale particle assembly. The applications of such technology range from customizable and autonomously self-assembled niche microenvironments for drug delivery and tissue engineering to new acoustic dampening, battery, and filtration materials, among others. Additionally, crystals made from non-Brownian particles resemble naturally derived materials such as opals, zeolites, and biological tissue (i.e. bone, cartilage and lung), due to their high surface area, pore distribution, and tunable (multilevel) hierarchy.

Microparticle entrapment for drug release from porous-surfaced bone implants

Metallic bone implants face interfacial concerns, such as infection and insufficient bone formation. Combination of drug-loaded microparticles with the implant surface is a promising approach to reducing the concerns. The present study reports a simple method for this purpose. Drug-loaded chitosan and alginate microparticles were separately prepared by emulsion methods. Dry microparticles were introduced into porous titanium (Ti) coatings on Ti discs, and induced to agglomerate in pores by wetting with water. Agglomerates were stably entrapped in the pores: 77-82% retained in the coating after immersion in a water bath for 7 d. Discs carrying drug-loaded microparticles showed a rapid release within 6 h and a subsequent slow release up to 1 d. After coculture with Staphylococcus epidermidis for 24 h, the discs formed inhibition zones, confirming antibacterial properties. These suggest that the microparticle entrapment-based method is a promising method for reducing some of the bone-implant interfacial concerns.

Direct metal laser sintering titanium dental implants: a review of the current literature

Statement of Problem. Direct metal laser sintering (DMLS) is a technology that allows fabrication of complex-shaped objects from powder-based materials, according to a three-dimensional (3D) computer model. With DMLS, it is possible to fabricate titanium dental implants with an inherently porous surface, a key property required of implantation devices. Objective. The aim of this review was to evaluate the evidence for the reliability of DMLS titanium dental implants and their clinical and histologic/histomorphometric outcomes, as well as their mechanical properties. Materials and Methods. Electronic database searches were performed. Inclusion criteria were clinical and radiographic studies, histologic/histomorphometric studies in humans and animals, mechanical evaluations, and in vitro cell culture studies on DMLS titanium implants. Meta-analysis could be performed only for randomized controlled trials (RCTs); to evaluate the methodological quality of observational human studies, the Newcastle-Ottawa scale (NOS) was used. Results. Twenty-seven studies were included in this review. No RCTs were found, and meta-analysis could not be performed. The outcomes of observational human studies were assessed using the NOS: these studies showed medium methodological quality. Conclusions. Several studies have demonstrated the potential for the use of DMLS titanium implants. However, further studies that demonstrate the benefits of DMLS implants over conventional implants are needed.

In vitro and in vivo performance of bioactive Ti6Al4V/TiC/HA implants fabricated by a rapid microwave sintering technique

Failure of the bone-implant interface in a joint prosthesis is a main cause of implant loosening. The introduction of a bioactive substance, hydroxyapatite (HA), to a metallic bone-implant may enhance its fixation on human bone by encouraging direct bone bonding. Ti6Al4V/TiC/HA composites with a reproducible porous structure (porosity of 27% and pore size of 6-89 μm) were successfully fabricated by a rapid microwave sintering technique. This method allows the biocomposites to be fabricated in a short period of time under ambient conditions. Ti6Al4V/TiC/HA composites exhibited a compressive strength of 93 MPa, compressive modulus of 2.9 GPa and microhardness of 556 HV which are close to those of the human cortical bone. The in vitro preosteoblast MC3T3-E1 cells cultured on the Ti6Al4V/TiC/HA composite showed that the composite surface could provide a biocompatible environment for cell adhesion, proliferation and differentiation without any cytotoxic effects. This is among the first attempts to study the in vivo performance of load-bearing Ti6Al4V/TiC and Ti6Al4V/TiC/HA composites in a live rabbit. The results indicated that the Ti6Al4V/TiC/HA composite had a better bone-implant interface compared with the Ti6Al4V/TiC implant. Based on the microstructural features, the mechanical properties, and the in vitro and in vivo test results from this study, the Ti6Al4V/TiC/HA composites have the potential to be employed in load-bearing orthopedic applications.

In vivo study of a self-stabilizing artificial vertebral body fabricated by electron beam melting

STUDY DESIGN

In vivo assessment of a novel artificial vertebral body fabricated by electron beam melting (EBM) for cervical vertebral body replacement in a sheep model.

OBJECTIVE

To investigate the feasibility of a novel artificial vertebral body: a "self-stabilizing artificial vertebral body" (SSAVB) fabricated by EBM in a sheep model.

SUMMARY OF BACKGROUND DATA

Artificial vertebral body is widely used for vertebral body replacement and spinal fusion, but research on an artificial vertebral body fabricated by EBM has not been reported.

METHODS

An SSAVB made of porous Ti6Al4V was implanted into a sheep cervical spine to replace the C4 vertebral body for 6 and 12 weeks. Bone ingrowth and implant stability were radiologically evaluated, and histological and biomechanical tests were performed.

RESULTS

No screw loosening, implant dislocation, or bone fractures occurred during the experimental period. A significant difference (P = 0.001) in bone ingrowth between the 6- and 12-week groups was noted. Comparison of the range of motion of C3-C5 segments between the in vivo group and the control groups (intact C2-C6 segment and fresh sheep cervical spines from C2 to C6 segments that underwent C4 subtotal corpectomy with the posterior vertebral wall retention by SSAVB implantation) suggests that the implant can stably replace this area of the cervical spine.

CONCLUSION

The open porous structure of Ti6Al4V fabricated by EBM facilitated bone ingrowth and the SSAVB can maintain cervical spine stability of the sheep. A porous metal implant can be used for load-bearing applications in a sheep model. It is hoped that these results will stimulate further study in human.

LEVEL OF EVIDENCE

4.

Highly porous drug-eluting structures: from wound dressings to stents and scaffolds for tissue regeneration

For many biomedical applications, there is need for porous implant materials. The current article focuses on a method for preparation of drug-eluting porous structures for various biomedical applications, based on freeze drying of inverted emulsions. This fabrication process enables the incorporation of any drug, to obtain an "active implant" that releases drugs to the surrounding tissue in a controlled desired manner. Examples for porous implants based on this technique are antibiotic-eluting mesh/matrix structures used for wound healing applications, antiproliferative drug-eluting composite fibers for stent applications and local cancer treatment, and protein-eluting films for tissue regeneration applications. In the current review we focus on these systems. We show that the release profiles of both types of drugs, water-soluble and water-insoluble, are affected by the emulsion's formulation parameters. The former's release profile is affected mainly through the emulsion stability and the resulting porous microstructure, whereas the latter's release mechanism occurs via water uptake and degradation of the host polymer. Hence, appropriate selection of the formulation parameters enables to obtain desired controllable release profile of any bioactive agent, water-soluble or water-insoluble, and also fit its physical properties to the application.

New Developments of Ti-Based Alloys for Biomedical Applications

Ti-based alloys are finding ever-increasing applications in biomaterials due to their excellent mechanical, physical and biological performance. Nowdays, low modulus β-type Ti-based alloys are still being developed. Meanwhile, porous Ti-based alloys are being developed as an alternative orthopedic implant material, as they can provide good biological fixation through bone tissue ingrowth into the porous network. This paper focuses on recent developments of biomedical Ti-based alloys. It can be divided into four main sections. The first section focuses on the fundamental requirements titanium biomaterial should fulfill and its market and application prospects. This section is followed by discussing basic phases, alloying elements and mechanical properties of low modulus β-type Ti-based alloys. Thermal treatment, grain size, texture and properties in Ti-based alloys and their limitations are dicussed in the third section. Finally, the fourth section reviews the influence of microstructural configurations on mechanical properties of porous Ti-based alloys and all known methods for fabricating porous Ti-based alloys. This section also reviews prospects and challenges of porous Ti-based alloys, emphasizing their current status, future opportunities and obstacles for expanded applications. Overall, efforts have been made to reveal the latest scenario of bulk and porous Ti-based materials for biomedical applications.

Preparation of porous PLGA/Ti biphasic scaffold and osteochondral defect repair

In this study, a porous PLGA/Ti biphasic scaffold was prepared and its potential to repair osteochondral defects was evaluated. The microstructure and mechanical properties of porous PLGA and porous Ti and their interface were characterized. The as-prepared biphasic scaffolds were implanted into rabbit knees for 1 and 3 months (PLGA/Ti group), and the porous PLGA (PLGA group) or empty defect (Untreated group) was also used. The results showed that both porous PLGA and porous Ti had an interconnected porous structure. The mechanical strength of porous PLGA and porous Ti was similar to that of cartilage and subchondral bone, respectively. The interface analysis revealed that the as-prepared biphasic scaffold had good overall integrity and interface stability. The gross observation and histological evaluation of specimens showed that hyaline-like cartilage filled the defects to a certain extent at 3 months for both PLGA/Ti and PLGA groups while the defects remained in an untreated group. In the PLGA/Ti group, better cartilage and subchondral bone repair was observed, and quantitative macroscopic and histological score evaluations confirmed this result, indicating that the porous biphasic PLGA/Ti scaffold had good biocompatibility and the best osteochondral defect repair ability in this study. The as-prepared porous biphasic scaffold showed the potential to be used in osteochondral tissue engineering for osteochondral defect repair.

Significance of nano- and microtopography for cell-surface interactions in orthopaedic implants

Cell-surface interactions play a crucial role for biomaterial application in orthopaedics. It is evident that not only the chemical composition of solid substances influence cellular adherence, migration, proliferation and differentiation but also the surface topography of a biomaterial. The progressive application of nanostructured surfaces in medicine has gained increasing interest to improve the cytocompatibility and osteointegration of orthopaedic implants. Therefore, the understanding of cell-surface interactions is of major interest for these substances. In this review, we elucidate the principle mechanisms of nano- and microscale cell-surface interactions in vitro for different cell types onto typical orthopaedic biomaterials such as titanium (Ti), cobalt-chrome-molybdenum (CoCrMo) alloys, stainless steel (SS), as well as synthetic polymers (UHMWPE, XLPE, PEEK, PLLA). In addition, effects of nano- and microscaled particles and their significance in orthopaedics were reviewed. The significance for the cytocompatibility of nanobiomaterials is discussed critically.

Porous titanium materials with entangled wire structure for load-bearing biomedical applications

A kind of porous metal-entangled titanium wire material has been investigated in terms of the pore structure (size and distribution), the strength, the elastic modulus, and the mechanical behavior under uniaxial tensile loading. Its functions and potentials for surgical application have been explained. In particular, its advantages over competitors (e.g., conventional porous titanium) have been reviewed. In the study, a group of entangled titanium wire materials with non-woven structure were fabricated by using 12-180 MPa forming pressure, which have porosity in a range of 48%-82%. The pores in the materials are irregular in shape, which have a nearly half-normal distribution in size range. The yield strength, ultimate tensile strength, and elastic modulus are 75 MPa, 108 MPa, and 1.05 GPa, respectively, when its porosity is 44.7%. The mechanical properties decrease significantly as the porosity increases. When the porosity is 57.9%, these values become 24 MPa, 47.5 MPa, and 0.33 GPa, respectively. The low elastic modulus is due to the structural flexibility of the entangled titanium wire materials. For practical reference, a group of detailed data of the porous structure and the mechanical properties are reported. This kind of material is very promising for implant applications because of their very good toughness, perfect flexibility, high strength, adequate elastic modulus, and low cost.

Stem Cells Grown in Osteogenic Medium on PLGA, PLGA/HA, and Titanium Scaffolds for Surgical Applications

Pluripotent adipose tissue-derived stem cells (hASCs) can differentiate into various mesodermal cell types such as osteoblasts, chondroblasts, and myoblasts. We isolated hASCs from subcutaneous adipose tissue during orthopaedic surgery and induced the osteogenic differentiation for 28 days on three different synthetic scaffolds such as polylactide-co-glycolide (PLGA), polylactide-co-glycolide/hydroxyapatite (PLGA/HA), and trabecular titanium scaffolds (Ti6Al4V). Pore size can influence certain criteria such as cell attachment, infiltration, and vascularization. The aim of this study was to investigate the performance of PLGA and PLGA/HA scaffolds with a higher porosity, ranging between 75% and 84%, with respect to Ti scaffolds but with smaller pore size, seeded with hASCs to develop a model that could be used in the treatment of bone defects and fractures. Osteogenesis was assessed by ELISA quantitation of extracellular matrix protein expression, von Kossa staining, X-ray microanalysis, and scanning electron microscopy. The higher amount of protein matrix on the Ti scaffold with respect to PLGA and PLGA/HA leads to the conclusion that not only the type of material but the structure significantly affects cell proliferation.