Surface modification of magnesium alloys developed for bioabsorbable orthopedic implants: a general review

An overview of magnesium-based implants in orthopaedics and a prospect of its application in spine fusion

Due to matching biomechanical properties and significant biological activity, Mg-based implants present great potential in orthopedic applications. In recent years, the biocompatibility and therapeutic effect of magnesium-based implants have been widely investigated in trauma repair. In contrast, the R&D work of Mg-based implants in spinal fusion is still limited. This review firstly introduced the general background for Mg-based implants. Secondly, the mechanical properties and degradation behaviors of Mg and its traditional and novel alloys were reviewed. Then, different surface modification techniques of Mg-based implants were described. Thirdly, this review comprehensively summarized the biological pathways of Mg degradation to promote bone formation in neuro-musculoskeletal circuit, angiogenesis with H-type vessel formation, osteogenesis with osteoblasts activation and chondrocyte ossification as an integrated system. Fourthly, this review followed the translation process of Mg-based implants via updating the preclinical studies in fracture fixation, sports trauma repair and reconstruction, and bone distraction for large bone defect. Furthermore, the pilot clinical studies were involved to demonstrate the reliable clinical safety and satisfactory bioactive effects of Mg-based implants in bone formation. Finally, this review introduced the background of spine fusion surgeryand the challenges of biological matching cage development. At last, this review prospected the translation potential of a hybrid Mg-PEEK spine fusion cage design.

Application and Perspectives: Magnesium Materials in Bone Regeneration

The field of bone regeneration has always been a hot and difficult research area, and there is no perfect strategy at present. As a new type of biodegradable material, magnesium alloys have excellent mechanical properties and bone promoting ability. Compared with other inert metals, magnesium alloys have significant advantages and broad application prospects in the field of bone regeneration. By searching the official Web sites and databases of various funds, this paper summarizes the research status of magnesium composites in the field of bone regeneration and introduces the latest scientific research achievements and clinical transformations of scholars in various countries and regions, such as improving the corrosion resistance of magnesium alloys by adding coatings. Finally, this paper points out the current problems and challenges, aiming to provide ideas and help for the development of new strategies for the treatment of bone defects and fractures.

Long-Term Temporospatial Complementary Relationship between Degradation and Bone Regeneration of Mg-Al Alloy

The utilization of guided tissue regeneration membranes is a significant approach for enhancing bone tissue growth in areas with bone defects. Biodegradable magnesium alloys are increasingly being used as guided tissue regeneration membranes due to their outstanding osteogenic properties. However, the degradation rates of magnesium alloy bone implants documented in the literature tend to be rapid. Moreover, many studies focus only on the initial 3-month period post-implantation, limiting their applicability and impeding clinical adoption. Furthermore, scant attention has been given to the interplay between the degradation of magnesium alloy implants and the adjacent tissues. To address these gaps, this study employs a well-studied magnesium-aluminum (Mg-Al) alloy membrane with a slow degradation rate. This membrane is implanted into rat skull bone defects and monitored over an extended period of up to 48 weeks. Observations are conducted at various intervals (2, 4, 8, 12, 24, and 48 weeks) following the implantation. Assessment of degradation behavior and tissue regeneration response is carried out using histological sections, micro-CT scans, and scanning electron microscopy (SEM). The findings reveal that the magnesium alloy membranes demonstrate remarkable biocompatibility and osteogenic capability over the entire observation duration. Specifically, the Mg-Al alloy membranes sustain their structural integrity for 8 weeks. Notably, their osteogenic ability is further enhanced as a corrosion product layer forms during the later stages of implantation. Additionally, our in vitro experiments employing extracts from the magnesium alloy display a significant osteogenic effect, accompanied by a notable increase in the expression of osteogenic-related genes. Collectively, these results strongly indicate the substantial potential of Mg-Al alloy membranes in the context of guided tissue regeneration.

Bio-Resorption Control of Magnesium Alloy AZ31 Coated with High and Low Molecular Weight Polyethylene Oxide (PEO) Hydrogels

Magnesium AZ31 alloy has been chosen as bio-resorbable temporary prosthetic implants to investigate the degradation processes in a simulating body fluid (SBF) of the bare metal and the ones coated with low and high-molecular-weight PEO hydrogels. Hydrogel coatings are proposed to control the bioresorption rate of AZ31 alloy. The alloy was preliminary hydrothermally treated to form a magnesium hydroxide layer. 2 mm discs were used in bioresorption tests. Scanning electron microscopy was used to characterize the surface morphology of the hydrothermally treated and PEO-coated magnesium alloy surfaces. The variation of pH and the mass of Mg2+ ions present in the SBF corroding medium have been monitored for 15 days. Corrosion current densities (Icorr) and corrosion potentials (Ecorr) were evaluated from potentiodynamic polarisation tests on the samples exposed to the SBF solution. Kinetics of cumulative Mg ions mass released in the corroding solution have been evaluated regarding cations diffusion and mass transport parameters. The initial corrosion rates for the H- and L-Mw PEO-coated specimens were similar (0.95 ± 0.12 and 1.82 ± 0.52 mg/cm2day, respectively) and almost 4 to 5 times slower than that of the uncoated system (6.08 mg/cm2day). Results showed that the highly swollen PEO hydrogel coatings may extend into the bulk solution, protecting the coated metal and efficiently controlling the degradation rate of magnesium alloys. These findings focus more research effort on investigating such systems as tunable bioresorbable prosthetic materials providing idoneous environments to support cells and bone tissue repair.

In Vivo Safety of New Coating for Biodegradable Magnesium Implants

Biodegradable Magnesium (Mg) implants are promising alternatives to permanent metallic prosthesis. To improve the biocompatibility and with the aim of degradation control, we provided Plasma Electrolytic Oxidation (PEO) of pure Mg implant in silicate-based solution with NaOH (S1 250 V) and Ca(OH)2 (S2 300 V). Despite the well-structured surface, S1 250 V implants induced enormous innate immunity reaction with the prevalence of neutrophils (MPO+) and M1-macrophages (CD68+), causing secondary alteration and massive necrosis in the peri-implant area in a week. This reaction was also accompanied by systemic changes in visceral organs affecting animals' survival after seven days of the experiment. In contrast, S2 300 V implantation was associated with focal lymphohistiocytic infiltration and granulation tissue formation, defining a more favorable outcome. This reaction was associated with the prevalence of M2-macrophages (CD163+) and high density of αSMA+ myofibroblasts, implying a resolution of inflammation and effective tissue repair at the site of the implantation. At 30 days, no remnants of S2 300 V implants were found, suggesting complete resorption with minor histological changes in peri-implant tissues. In conclusion, Ca(OH)2-contained silicate-based solution allows generating biocompatible coating reducing toxicity and immunogenicity with appropriate degradation properties that make it a promising candidate for medical applications.

Controlling self-assembling co-polymer coatings of hydrophilic polysaccharide substrates via co-polymer block length ratio

HYPOTHESIS

The degree of polymerization of amphiphilic di-block co-polymers, which can be varied with ease in computer simulations, provides a means to control self-assembling di-block co-polymer coatings on hydrophilic substrates.

SIMULATIONS

We examine self-assembly of linear amphiphilic di-block co-polymers on hydrophilic surface via dissipative particle dynamics simulations. The system models a glucose based polysaccharide surface on which random co-polymers of styrene and n-butyl acrylate, as the hydrophobic block, and starch, as the hydrophilic block, forms a film. Such setups are common in e.g. hygiene, pharmaceutical, and paper product applications.

FINDINGS

Variation of the block length ratio (35 monomers in total) reveals that all examined compositions readily coat the substrate. However, strongly asymmetric block co-polymers with short hydrophobic segments are best in wetting the surface, whereas approximately symmetric composition leads to most stable films with highest internal order and well-defined internal stratification. At intermediate asymmetries, isolated hydrophobic domains form. We map the sensitivity and stability of the assembly response for a large variety of interaction parameters. The reported response persists for a wide polymer mixing interactions range, providing general means to tune surface coating films and their internal structure, including compartmentalization.

A "built-up" composite film with synergistic functionalities on Mg-2Zn-1Mn bioresorbable stents improves corrosion control effects and biocompatibility

Control of premature corrosion of magnesium (Mg) alloy bioresorbable stents (BRS) is frequently achieved by the addition of rare earth elements. However, limited long-term experience with these elements causes concerns for clinical application and alternative methods of corrosion control are sought after. Herein, we report a "built-up" composite film consisting of a bottom layer of MgF₂ conversion coating, a sandwich layer of a poly (1, 3-trimethylene carbonate) (PTMC) and 3-aminopropyl triethoxysilane (APTES) co-spray coating (PA) and on top a layer of poly (lactic-co-glycolic acid) (PLGA) ultrasonic spray coating to decorate the rare earth element-free Mg-2Zn-1Mn (ZM21) BRS for tailoring both corrosion resistance and biological functions. The developed "built-up" composite film shows synergistic functionalities, allowing the compression and expansion of the coated ZM21 BRS on an angioplasty balloon without cracking or peeling. Of special importance is that the synergistic corrosion control effects of the "built-up" composite film allow for maintaining the mechanical integrity of stents for up to 3 months, where complete biodegradation and no foreign matter residue were observed about half a year after implantation in rabbit iliac arteries. Moreover, the functionalized ZM21 BRS accomplished re-endothelialization within one month.

Bioactive Synthetic Polymer-Based Polyelectrolyte LbL Coating Assembly on Surface Treated AZ31-Mg Alloys

Polyelectrolyte layer-by-layer (LbL) films on pretreated Mg containing 3 wt.% Al and 1 wt.% Zn (MgAZ31) alloy surfaces were prepared under physiological conditions offering improved bioresponse and corrosive protection. Pretreatments of the model MgAZ31 substrate surfaces were performed by alkaline and fluoride coating methods. The anti-corrosion and cytocompatibility behavior of pretreated substrates were evaluated. The LbL film assembly consisted of an initial layer of polyethyleneimine (PEI), followed by alternate layers of poly (lactic-co-glycolic acid) (PLGA) and poly (allylamine hydrochloride) (PAH), which self-arrange via electrostatic interactions on the pretreated MgAZ31 alloy substrate surface. The physicochemical characterization, surface morphologies, and microstructures of the LbL films were investigated using Fourier-transformed infrared spectroscopy (FTIR), atomic force microscopy (AFM), X-ray diffraction (XRD), and scanning electron microscopy (SEM). The in vitro stability studies related to the LbL coatings confirmed that the surface treatments are imperative to achieve the lasting stability of PLGA/PAH layers. Electrochemical impedance spectroscopy measurements demonstrated that pretreated and LbL multilayered coated substrates enhanced the corrosion resistance of the bare MgAZ31 alloy. Cytocompatibility studies using human mesenchymal stem cells seeded directly over the substrates showed that the pretreated and LbL-generated surfaces were more cytocompatible, displaying reduced cytotoxicity than the bare MgAZ31. The release of bovine serum albumin protein from the LbL films was also studied. The initial data presented cooperatively demonstrate the promise of creating LbL layers on Mg-related bioresorbable scaffolds to obtain improved surface bio-related activity.

A comprehensive review of properties of the biocompatible thin films on biodegradable Mg alloys

Magnesium (Mg) and its alloys have attracted attention as biodegradable materials for biomedical applications owing to their mechanical properties being comparable to that of bone. Mg is a vital trace element in many enzymes and thus forms one of the essential factors for human metabolism. However, before being used in biomedical applications, the early stage or fast degradation of Mg and its alloys in the physiological environment should be controlled. The degradation of Mg alloys is a critical criterion that can be controlled by a surface modification which is an effective process for conserving their desired properties. Different coating methods have been employed to modify Mg surfaces to provide good corrosion resistance and biocompatibility. This review aims to provide information on different coatings and discuss their physical and biological properties. Finally, the current withstanding challenges have been highlighted and discussed, followed by shedding some light on future perspectives.

Natural Coatings and Surface Modifications on Magnesium Alloys for Biomedical Applications

Magnesium (Mg) alloys have great potential in biomedical applications due to their incomparable properties regarding other metals, such as stainless steels, Co-Cr alloys, and titanium (Ti) alloys. However, when Mg engages with body fluids, its degradation rate increases, inhibiting the complete healing of bone tissue. For this reason, it has been necessary to implement protective coatings to control the rate of degradation. This review focuses on natural biopolymer coatings used on Mg alloys for resorbable biomedical applications, as well as some modification techniques implemented before applying natural polymer coatings to improve their performance. Issues such as improving the corrosion resistance, cell adhesion, proliferation, and biodegradability of natural biopolymers are discussed through their basic comparison with inorganic-type coatings. Emphasis is placed on the expected biological behavior of each natural polymer described, to provide basic information as a reference on this topic.

Optimized osteogenesis of biological hydroxyapatite-based bone grafting materials by ion doping and osteoimmunomodulation

BACKGROUND: Biological hydroxyapatite (BHA)-based bone grafting materials have been widely used for bone regeneration in implant surgery. Much effort has been made in the improvement of their osteogenic property as it remains unsatisfactory for clinical use. Osteoimmunomodulation plays a significant role in bone regeneration, which is highly related to active inorganic ions. Therefore, attempts have been made to obtain osteoimmunomodulatory BHA-based bone grafting materials with optimized osteogenic property by ion doping. OBJECTIVE: To summarize and discuss the active inorganic ions doped into BHA and their effects on BHA-based bone grafting materials. METHOD: A literature search was performed in databases including Google Scholar, Web of Science and PubMed, with the elementary keywords of “ion doped” and “biological hydroxyapatite”, as well as several supplementary keywords. All document types were included in this search. The searching period and language were not limited and kept updated to 2022. RESULTS: A total of 32 articles were finally included, of which 32 discussed the physiochemical properties of BHA-based biomaterials, while 12 investigated their biological features in vitro, and only three examined their biological performance in vivo. Various ions were doped into BHA, including fluoride, zinc, magnesium and lithium. Such ions improved the biological performance of BHA-based biomaterials, which was attributed to their osteoimmunomodulatory effect. CONCLUSION: The doping of active inorganic ions is a reliable strategy to endow BHA-based biomaterials with osteoimmunomodulatory property and promote bone regeneration. Further studies are still in need to explore more ions and their effects in the crosstalk between the skeletal and immune systems.

A review on current research status of the surface modification of Zn-based biodegradable metals

Recently, zinc and its alloys have been proposed as promising candidates for biodegradable metals (BMs), owning to their preferable corrosion behavior and acceptable biocompatibility in cardiovascular, bone and gastrointestinal environments, together with Mg-based and Fe-based BMs. However, there is the desire for surface treatment for Zn-based BMs to better control their biodegradation behavior. Firstly, the implantation of some Zn-based BMs in cardiovascular environment exhibited intimal activation with mild inflammation. Secondly, for orthopedic applications, the biodegradation rates of Zn-based BMs are relatively slow, resulting in a long-term retention after fulfilling their mission. Meanwhile, excessive Zn2+ release during degradation will cause in vitro cytotoxicity and in vivo delayed osseointegration. In this review, we firstly summarized the current surface modification methods of Zn-based alloys for the industrial applications. Then we comprehensively summarized the recent progress of biomedical bulk Zn-based BMs as well as the corresponding surface modification strategies. Last but not least, the future perspectives towards the design of surface bio-functionalized coatings on Zn-based BMs for orthopedic and cardiovascular applications were also briefly proposed.

Biocompatibility Analyses of HF-Passivated Magnesium Screws for Guided Bone Regeneration (GBR)

Background: Magnesium (Mg) is one of the most promising materials for human use in surgery due to material characteristics such as its elastic modulus as well as its resorbable and regenerative properties. In this study, HF-coated and uncoated novel bioresorbable magnesium fixation screws for maxillofacial and dental surgical applications were investigated in vitro and in vivo to evaluate the biocompatibility of the HF coating. Methods: Mg alloy screws that had either undergone a surface treatment with hydrofluoric-acid (HF) or left untreated were investigated. In vitro investigation included XTT, BrdU and LDH in accordance with the DIN ISO 10993-5/-12. In vivo, the screws were implanted into the tibia of rabbits. After 3 and 6 weeks, degradation, local tissue reactions and bony integration were analyzed histopathologically and histomorphometrically. Additionally, SEM/EDX analysis and synchrotron phase-contrast microtomography (µCT) measurements were conducted. The in vitro analyses revealed that the Mg screws are cytocompatible, with improved results when the surface had been passivated with HF. In vivo, the HF-treated Mg screws implanted showed a reduction in gas formation, slower biodegradation and a better bony integration in comparison to the untreated Mg screws. Histopathologically, the HF-passivated screws induced a layer of macrophages as part of its biodegradation process, whereas the untreated screws caused a slight fibrous tissue reaction. SEM/EDX analysis showed that both screws formed a similar layer of calcium phosphates on their surfaces and were surrounded by bone. Furthermore, the µCT revealed the presence of a metallic core of the screws, a faster absorbing corrosion front and a slow absorbing region of corroded magnesium. Conclusions: Overall, the HF-passivated Mg fixation screws showed significantly better biocompatibility in vitro and in vivo compared to the untreated screws.

Clinical translation and challenges of biodegradable magnesium-based interference screws in ACL reconstruction

As one of the most promising fixators developed for anterior cruciate ligament (ACL) reconstruction, biodegradable magnesium (Mg)-based interference screws have gained increasing attention attributed to their appropriate modulus and favorable biological properties during degradation after surgical insertion. However, its fast degradation and insufficient mechanical strength have also been recognized as one of the major causes to limit their further application clinically. This review focused on the following four parts. Firstly, the advantages of Mg or its alloys over their counterparts as orthopaedic implants in the fixation of tendon grafts in ACL reconstruction were discussed. Subsequently, the underlying mechanisms behind the contributions of Mg ions to the tendon-bone healing were introduced. Thirdly, the technical challenges of Mg-based interference screws towards clinical trials were discussed, which was followed by the introduction of currently used modification methods for gaining improved corrosion resistance and mechanical properties. Finally, novel strategies including development of Mg/Titanium (Ti) hybrid fixators and Mg-based screws with innovative structure for achieving clinically customized therapies were proposed. Collectively, the advancements in the basic and translational research on the Mg-based interference screws may lay the foundation for exploring a new era in the treatment of the tendon-bone insertion (TBI) and related disorders.

Modification of the surface nanotopography of implant devices: A translational perspective

There is an increasing need for the development of superior, safe, and more sophisticated implants, especially as our society historically has been moving towards an increasingly aging population. Currently, most research is being focused on the next generation of advanced medical implants, that are not only biocompatible but have modified surfaces that direct specific immunomodulation at cellular level. While there is a plethora of information on cell-surface interaction and how surfaces can be nanofabricated at research level, less is known about how the academic knowledge has been translated into clinical trials and commercial technologies. In this review, we provide a clinical translational perspective on the use of controlled physical surface modification of medical implants, presenting an analysis of data acquired from clinical trials and commercial products. We also evaluate the state-of-the-art of nanofabrication techniques that are being applied for implant surface modification at a clinical level. Finally, we identify some current challenges in the field, including the need of more advanced nanopatterning techniques, the comparatively small number of clinical trials and comment on future avenues to be explored for a successful clinical translation.

In vitro and in vivo degradation assessment and preventive measures of biodegradable Mg alloys for biomedical applications

Magnesium (Mg) and its alloys have been widely explored as a potential biodegradable implant material. However, the fast degradation of Mg-based alloys under physiological environment has hindered their widespread use for implant applications till date. The present review focuses on in vitro and in vivo degradation of biodegradable Mg alloys, and preventive measures for biomedical applications. Initially, the corrosion assessment approaches to predict the degradation behavior of Mg alloys are discussed along with the measures to control rapid corrosion. Furthermore, this review attempts to explore the correlation between in vitro and in vivo corrosion behavior of different Mg alloys. It was found that the corrosion depends on experimental conditions, materials and the results of different assessment procedures hardly matches with each other. It has been demonstrated the corrosion rate of magnesium can be tailored by alloying elements, surface treatments and heat treatments. Various researches also studied different biocompatible coatings such as dicalcium phosphate dihydrate (DCPD), β-tricalcium phosphate (β-TCP), hydroxyapatite (HA), polycaprolactone (PCL), polylactic acid (PLA), and so on, on Mg alloys to suppress rapid degradation and examine their influence on new bone regeneration as well. This review shows the need for a standard method of corrosion assessment to predict the in vivo corrosion rate based on in vitro data, and thus reducing the in vivo experimentation.

Bioresorption Control and Biological Response of Magnesium Alloy AZ31 Coated with Poly-β-Hydroxybutyrate

Magnesium and its alloys are not normally used as bioresorbable temporary implants due to their high and uncontrolled degradation rate in a physiological liquid environment. The improvement of corrosion resistance to simulated body fluids (SBF) of a magnesium alloy (AZ31) coated with poly-β-hydroxybutyrate (PHB) was investigated. Scanning electron microscopy, Fourier transform infrared spectrometer, and contact angle measurements were used to characterize surface morphology, material composition, and wettability, respectively. pH modification of the SBF corroding medium, mass of Mg2+ ions released, weight loss of the samples exposed to the SBF solution, and electrochemical experiments were used to describe the corrosion process and its kinetics. The material’s biocompatibility was described by evaluating the effect of corrosion by products collected in the SBF equilibrating solution on hemolysis ratio, cytotoxicity, nitric oxide (NO), and total antioxidant capacity (T-AOC). The results showed that the PHB coating can diffusively control the degradation rate of magnesium alloy, improving its biocompatibility: the hemolysis rate of materials was lower than 5%, while in vitro human umbilical vein endothelial cell (HUVEC) compatibility experiments showed that PHB-coated Mg alloy promoted cell proliferation and had no effect on the NO content and that the T-AOC was enhanced compared with the normal group and bare AZ31 alloy. PHB-coated AZ31 magnesium alloy extraction fluids have a less toxic behavior due to the lower concentration of corrosion byproducts deriving from the diffusion control exerted by the PHB coating films both from the metal surface to the solution and vice versa. These findings provide more reference value for the selection of such systems as tunable bioresorbable prosthetic materials.

Characterization and Corrosion Properties of Fluoride Conversion Coating Prepared on AZ31 Magnesium Alloy

Wrought AZ31 magnesium alloy was used as the experimental material for fluoride conversion coating preparation in Na[BF4] molten salt. Two coating temperatures, 430 °C and 450 °C, and three coating times, 0.5, 2, and 8 h, were used for the coating preparation. A scanning electron microscope and energy-dispersive X-ray spectroscopy were used for an investigation of the surface morphology and the cross-sections of the prepared coatings including chemical composition determination. The corrosion resistance of the prepared specimens was investigated in terms of the potentiodynamic tests, electrochemical impedance spectroscopy and immersion tests in the environment of simulated body fluids at 37 ± 2 °C. The increase in the coating temperature and coating time resulted in higher coatings thicknesses and better corrosion resistance. Higher coating temperature was accompanied by smaller defects uniformly distributed on the coating surface. The defects were most probably created due to the reaction of the AlxMny intermetallic phase with Na[BF4] molten salt and/or with the product of its decomposition, BF3 compound, resulting in the creation of soluble Na3[AlF6] and AlF3 compounds, which were removed from the coating during the removal of the secondary Na[MgF3] layer. The negative influence of the AlxMny intermetallic phase was correlated to the particle size and thus the size of created defects.

Bioresorbable Primary Battery Anodes Built on Core-Double-Shell Zinc Microparticle Networks

Bioresorbable implantable electronics require power sources that are also bioresorbable with controllable electrical output and lifetime. In this paper, we report a bioresorbable zinc primary battery anode filament based on a zinc microparticle (MP) network coated with chitosan and Al₂O₃ double shells. When discharged in 0.9% NaCl saline, a Zn MP filament with a 0.17 × 2 mm² cross-sectional area exhibited a stable voltage output of 0.55 V at a current of 0.01 mA. Covered by chitosan and Al₂O₃ double shells, the zinc MP filament exhibited a directional dissolution behavior with a tunable lifetime approximately linear to its length. A stable 200 h discharging time was achieved with a 15 mm Zn MP filament. The maximum output power was found to be 12 μW at 0.03 mA for one filament. The linearity relationship between the current output and the filament cross-sectional area suggested a facile strategy to raise the power output at constant discharging voltage. The filaments could also be connected in series and in parallel to boost its overall voltage and current output, demonstrating their excellent integration capability. This work presents a promising pathway toward bioresorbable transient batteries with controllable lifetime and power output, demonstrating a great potential for powering transient implantable biomedical devices.

Current interpretations on the in vivo response of bone to additively manufactured metallic porous scaffolds: A review

Recent advances in the field of metallic additive manufacturing have expanded production capabilities for bone implants to include porous lattice structures. While traditional models of de novo bone formation can be applied to fully dense implant materials, their applicability to the interior of porous materials has not been well-characterized. Unlike other reviews that focus on materials and mechanical properties of lattice structures, this review compiles biological performance from in vivo studies in pre-clinical models only. First, we introduce the most common lattice geometry designs employed in vivo and discuss some of their fabrication advantages and limitations. Then lattice geometry is correlated to quantitative (histomorphometric) and qualitative (histological) assessments of osseointegration. We group studies according to two common implant variables: pore size and percent porosity, and explore the extent of osseointegration using common measures, including bone-implant contact (BIC), bone area (BA), bone volume/total volume (BV/TV) and biomechanical stability, for various animal models and implantation times. Based on this, trends related to in vivo bone formation on the interior of lattice structures are presented. Common challenges with lattice structures are highlighted, including nonuniformity of bone growth through the entirety of the lattice structure due to occlusion effects and avascularity. This review paper identifies a lack of systematic in vivo studies on porous AM implants to target optimum geometric design, including pore shape, size, and percent porosity in controlled animal models and critical-sized defects. Further work focusing on surface modification strategies and systematic geometric studies to homogenize in vivo bone growth through the scaffold interior are recommended to increase implant stability in the early stages of osseointegration.

Toward Tailoring the Degradation Rate of Magnesium-Based Biomaterials for Various Medical Applications: Assessing Corrosion, Cytocompatibility and Immunological Effects

Magnesium (Mg)-based biomaterials hold considerable promise for applications in regenerative medicine. However, the degradation of Mg needs to be reduced to control toxicity caused by its rapid natural corrosion. In the process of developing new Mg alloys with various surface modifications, an efficient assessment of the relevant properties is essential. In the present study, a WE43 Mg alloy with a plasma electrolytic oxidation (PEO)-generated surface was investigated. Surface microstructure, hydrogen gas evolution in immersion tests and cytocompatibility were assessed. In addition, a novel in vitro immunological test using primary human lymphocytes was introduced. On PEO-treated WE43, a larger number of pores and microcracks, as well as increased roughness, were observed compared to untreated WE43. Hydrogen gas evolution after two weeks was reduced by 40.7% through PEO treatment, indicating a significantly reduced corrosion rate. In contrast to untreated WE43, PEO-treated WE43 exhibited excellent cytocompatibility. After incubation for three days, untreated WE43 killed over 90% of lymphocytes while more than 80% of the cells were still vital after incubation with the PEO-treated WE43. PEO-treated WE43 slightly stimulated the activation, proliferation and toxin (perforin and granzyme B) expression of CD8⁺ T cells. This study demonstrates that the combined assessment of corrosion, cytocompatibility and immunological effects on primary human lymphocytes provide a comprehensive and effective procedure for characterizing Mg variants with tailorable degradation and other features. PEO-treated WE43 is a promising candidate for further development as a degradable biomaterial.

Antimicrobial Properties of MgO Nanostructures on Magnesium Substrates

Magnesium (Mg) and its alloys have attracted increasing attention in recent years as medical implants for repairing musculoskeletal injuries because of their promising mechanical and biological properties. However, rapid degradation of Mg and its alloys in physiological fluids limited their clinical translation because the accumulation of hydrogen (H2) gas and fast release of OH- ions could adversely affect the healing process. Moreover, infection is a major concern for internally implanted devices because it could lead to biofilm formation, prevent host cell attachment on the implants, and interfere osseointegration, resulting in implant failure or other complications. Fabricating nanostructured magnesium oxide (MgO) on magnesium (Mg) substrates is promising in addressing both problems because it could slow down the degradation process and improve the antimicrobial activity. In this study, nanostructured MgO layers were created on Mg substrates using two different surface treatment techniques, i.e., anodization and electrophoretic deposition (EPD), and cultured with Staphylococcus aureus in vitro to determine their antimicrobial properties. At the end of the 24-h bacterial culture, the nanostructured MgO layers on Mg prepared by anodization or EPD both showed significant bactericidal effect against S. aureus. Thus, nanostructured MgO layers on Mg are promising for reducing implant-related infections and complications and should be further explored for clinical translation toward antimicrobial biodegradable implants.

Bioabsorbable Osteofixation Materials for Maxillofacial Bone Surgery: A Review on Polymers and Magnesium-Based Materials

Clinical application of osteofixation materials is essential in performing maxillofacial surgeries requiring rigid fixation of bone such as trauma surgery, orthognathic surgery, and skeletal reconstruction. In addition to the use of titanium plates and screws, clinical applications and attempts using bioabsorbable materials for osteofixation surgery are increasing with demands to avoid secondary surgery for the removal of plates and screws. Synthetic polymeric plates and screws were developed, reaching satisfactory physical properties comparable to those made with titanium. Although these polymeric materials are actively used in clinical practice, there remain some limitations to be improved. Due to questionable physical strength and cumbersome molding procedures, interests in resorbable metal materials for osteofixation emerged. Magnesium (Mg) gained attention again in the last decade as a new metallic alternative, and numerous animal studies to evaluate the possibility of clinical application of Mg-based materials are being conducted. Thanks to these researches and studies, vascular application of Mg-based biomaterials was successful; however, further studies are required for the clinical application of Mg-based biomaterials for osteofixation, especially in the facial skeleton. The review provides an overview of bioabsorbable osteofixation materials in maxillofacial bone surgery from polymer to Mg.

Biodegradable Magnesium Alloy (ZK60) with a Poly(l-lactic)-Acid Polymer Coating for Maxillofacial Surgery

The purpose of this study was to evaluate the mechanical strength and biodegradation of a ZK60 plate coated with poly(l-lactic)-acid polymer (PLLA) in a LeFort I osteotomy canine model for maxillofacial applications. The PLLA-coated ZK60 plate and screw were evaluated using a LeFort I osteotomy canine model based on five beagles. The presence of wound dehiscence, plate exposure, gas formation, inflammation, pus formation, occlusion, food intake, and fistula formation were evaluated. After 12 weeks, these dogs were sacrificed, and an X-ray micro-computed tomography (µCT) was conducted. Plate exposure, gas formation, and external fistula were not observed, and the occlusion remained stable. Wound dehiscence did not heal for 12 weeks. CT images did not show plates in all the five dogs. A few screw bodies fixed in the bone remained, and screw heads were completely absorbed after 12 weeks. These findings may be attributed to the inability to optimize the absorption rate with PLLA coating. Rapid biodegradation of the PLLA-coated ZK60 occurred due to the formation of microcracks during the bending process. Further improvement to the plate system with PLLA-coated ZK60 is required using other surface coating methods or alternative Mg alloys.

Degradation, Bone Regeneration and Tissue Response of an Innovative Volume Stable Magnesium-Supported GBR/GTR Barrier Membrane

Introduction: Bioresorbable collagenous barrier membranes are used to prevent premature soft tissue ingrowth and to allow bone regeneration. For volume stable indications, only non-absorbable synthetic materials are available. This study investigates a new bioresorbable hydrofluoric acid (HF)-treated magnesium (Mg) mesh in a native collagen membrane for volume stable situations. Materials and Methods: HF-treated and untreated Mg were compared in direct and indirect cytocompatibility assays. In vivo, 18 New Zealand White Rabbits received each four 8 mm calvarial defects and were divided into four groups: (a) HF-treated Mg mesh/collagen membrane, (b) untreated Mg mesh/collagen membrane (c) collagen membrane and (d) sham operation. After 6, 12 and 18 weeks, Mg degradation and bone regeneration was measured using radiological and histological methods. Results: In vitro, HF-treated Mg showed higher cytocompatibility. Histopathologically, HF-Mg prevented gas cavities and was degraded by mononuclear cells via phagocytosis up to 12 weeks. Untreated Mg showed partially significant more gas cavities and a fibrous tissue reaction. Bone regeneration was not significantly different between all groups. Discussion and Conclusions: HF-Mg meshes embedded in native collagen membranes represent a volume stable and biocompatible alternative to the non-absorbable synthetic materials. HF-Mg shows less corrosion and is degraded by phagocytosis. However, the application of membranes did not result in higher bone regeneration.

Biodegradable Magnesium-Based Implants in Orthopedics-A General Review and Perspectives

Biodegradable Mg-based metals may be promising orthopedic implants for treating challenging bone diseases, attributed to their desirable mechanical and osteopromotive properties. This Review summarizes the current status and future research trends for Mg-based orthopedic implants. First, the properties between Mg-based implants and traditional orthopedic implants are compared on the following aspects: in vitro and in vivo degradation mechanisms of Mg-based implants, peri-implant bone responses, the fate of the degradation products, and the cellular and molecular mechanisms underlying the beneficial effects of Mg ions on osteogenesis. Then, the preclinical studies conducted at the low weight bearing sites of animals are introduced. The innovative strategies (for example, via designing Mg-containing hybrid systems) are discussed to address the limitations of Mg-based metals prior to their clinical applications at weight-bearing sites. Finally, the available clinical studies are summarized and the challenges and perspectives of Mg-based orthopedic implants are discussed. Taken together, the progress made on the development of Mg-based implants in basic, translational, and clinical research has laid down a foundation for developing a new era in the treatment of challenging and prevalent bone diseases.

Enhanced osteoinductivity and corrosion resistance of dopamine/gelatin/rhBMP-2-coated β-TCP/Mg-Zn orthopedic implants: An in vitro and in vivo study

Magnesium-based biomaterials are attracting increasingly more attention for orthopedic applications based on their appropriate mechanical properties, biodegradability, and favorable biocompatibility. However, the high corrosion rate of these materials remains to be addressed. In this study, porous β-Ca3(PO4)2/Mg-Zn (β-TCP/Mg-Zn) composites were fabricated via a powder metallurgy method. The β-TCP/Mg-Zn composites with 6% porosity exhibited optimal mechanical properties, and thus, they were selected for surface modification. A novel dopamine/gelatin/recombinant human bone morphogenetic protein-2 (rhBMP-2) coating with demonstrated stability was prepared to further improve the corrosion resistance of the composite and enhance early osteoinductivity. The homogeneously coated β-TCP/Mg-Zn composite showed significantly improved corrosion resistance according to electrochemical and immersion tests. In addition, extracts from the dopamine/gelatin/rhBMP-2-coated β-TCP/Mg-Zn composite not only facilitated cell proliferation but also significantly enhanced the osteogenic differentiation of Sprague-Dawley rat bone marrow-derived mesenchymal stem cells in vitro. Furthermore, in vivo experiments were performed to evaluate the biodegradation, histocompatibility, and osteoinductive potential of the coated composite. No obvious pathological changes in the vital visceral organs were observed after implantation, and radiography and hematoxylin-eosin staining showed strong promotion of new bone formation, matched composite degradation and bone regeneration rates, and complete absorption of the released hydrogen gas. Collectively, these results indicate that the dopamine/gelatin/rhBMP-2-coated β-TCP/Mg-Zn composite offers improved corrosion resistance, favorable biocompatibility, and enhanced osteoinductive potential for use in the fabrication of orthopedic implants.

An effective dual-factor modified 3D-printed PCL scaffold for bone defect repair

Numerous bioactive molecules produced in cells are involved in the process of bone formation. We consider that appropriate, simultaneous application of two types of bioactive molecules would accelerate the regeneration of tissues and organs. Therefore, we combined aspirin-loaded liposomes (Asp@Lipo) and bone forming peptide-1 (BFP-1) on three dimensional-printed polycaprolactone (PCL) scaffold and determined whether this system improved bone regeneration outcomes. in vitro experiments indicated that Asp@Lipo/BFP-1at a 3:7 ratio was the best option for enhancing the osteogenic efficiency of human mesenchymal stem cells (hMSCs). This was confirmed in an in vivo cranial defect animal model. In addition, RNA-Seq was applied for preliminarily exploration of the mechanism of action of this composite scaffold system, and the results suggested that it mainly improved bone regeneration via the PI3K/AKT signaling pathway. This approach will have potential for application in bone tissue engineering and regenerative medicine.

Enhanced corrosion resistance and bioactivity of Mg alloy modified by Zn-doped nanowhisker hydroxyapatite coatings

In this work, Zn is doped into a hydroxyapatite coating on the surface of ZK60 magnesium alloys using a one-pot hydrothermal method to obtain a corrosion-resistant implant with abilities of osteogenic differentiation and bacterial inhibition. With the addition of Zn, the morphology changes with a nanowhisker structure appearing on the coating. Electrochemical measurements show that the nanowhisker hydroxyapatite coating provides a high corrosion resistance. Compared with hydroxyapatite coating, the nanowhisker coating not only effectively inhibits bacteria, but also promotes the adhesion and differentiation of rat bone marrow mesenchymal stem cells at appropriate Zn concentrations. In conclusion, a novel nanowhisker structure prepared by a single variable Zn doping can significantly improve the corrosion resistance and biological activity of hydroxyapatite coatings.

Biofunctionalization of metallic implants by calcium phosphate coatings

Metallic materials have been extensively applied in clinical practice due to their unique mechanical properties and durability. Recent years have witnessed broad interests and advances on surface functionalization of metallic implants for high-performance biofunctions. Calcium phosphates (CaPs) are the major inorganic component of bone tissues, and thus owning inherent biocompatibility and osseointegration properties. As such, they have been widely used in clinical orthopedics and dentistry. The new emergence of surface functionalization on metallic implants with CaP coatings shows promise for a combination of mechanical properties from metals and various biofunctions from CaPs. This review provides a brief summary of state-of-art of surface biofunctionalization on implantable metals by CaP coatings. We first glance over different types of CaPs with their coating methods and in vitro and in vivo performances, and then give insight into the representative biofunctions, i.e. osteointegration, corrosion resistance and biodegradation control, and antibacterial property, provided by CaP coatings for metallic implant materials.

Magnesium Enhances Osteogenesis of BMSCs by Tuning Osteoimmunomodulation

In the process of bone tissue engineering, the osteoimmunomodulatory property of biomaterials is very important for osteogenic differentiation of stem cells, which determines the outcome of bone regeneration. Magnesium (Mg) is a biodegradable, biocompatible metal that has osteoconductive properties and has been regarded as a promising bone biomaterial. However, the high degradation rate of Mg leads to excessive inflammation, thereby restricting its application in bone tissue engineering. Importantly, different coatings or magnesium alloys have been utilized to lower the rate of degradation. In fact, a prior study proved that β-TCP coating of Mg scaffolds can modulate the osteoimmunomodulatory properties of Mg-based biomaterials and create a favorable immune microenvironment for osteogenesis. However, the osteoimmunomodulatory properties of Mg ions themselves have not been explored yet. In this study, the osteoimmunomodulatory properties of Mg ions with involvement of macrophages and bone marrow stem cells (BMSCs) were systematically investigated. Microscale Mg ions (100 mg/L) were found to possess osteoimmunomodulatory properties that favor bone formation. Specifically, microscale Mg ions induced M2 phenotype changes of macrophages and the release of anti-inflammatory cytokines by inhibiting the TLR-NF-κB signaling pathway. Microscale Mg ions also stimulated the expression of osteoinductive molecules in macrophages while Mg ions/macrophage-conditioned medium promoted osteogenesis of BMSCs through the BMP/SMAD signaling pathway. These findings indicate that manipulating Mg ion concentration can endow the Mg biomaterial with favorable osteoimmunomodulatory properties, thereby providing fundamental evidence for improving and modifying the effect of Mg-based bone biomaterials.

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

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

The Potential of Magnesium Based Materials in Mandibular Reconstruction

The future of biomaterial design will rely on development of bioresorbable implant materials that completely and safely degrade in vivo after the tissues grow, without generating harmful degradation products at the targeted anatomic site. Permanent biomaterials such as Ti6Al4V alloy, 316L stainless steel, and Co-based alloys currently used in mandibular reconstruction often result in stress shielding effects due to mismatch in the Young’s modulus values between the bone and the implant, resulting in implant loosening. Also, allergic responses due to metal ion releases necessitates revision surgery to prevent long term exposure of the body to toxic implant contents. Bioresorbable metals are perceived as revolutionary biomaterials that have transformed the nature of metallic biomaterials from bioinert to bioactive and multi-bio functional (anti-bacterial, anti-proliferation, and anti-cancer). In this aspect, magnesium (Mg)-based materials have recently been explored by the biomedical community as potential materials for mandibular reconstruction, as they exhibit favorable mechanical properties, adequate biocompatibility, and degradability. This article reviews the recent progress that has led to advances in developing Mg-based materials for mandibular reconstruction; correlating with the biomechanics of mandible and types of mandibular defects. Mg-based materials are discussed regarding their mechanical properties, corrosion characteristics, and in vivo performance. Finally, the paper summarizes findings from this review, together with a proposed scope for advancing the knowledge in Mg-based materials for mandibular reconstruction.

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.

The Effect of Surface Treatments on the Degradation of Biomedical Mg Alloys-A Review Paper

This report reviews the effects of chemical, physical, and mechanical surface treatments on the degradation behavior of Mg alloys via their influence on the roughness and surface morphology. Many studies have been focused on technically-used AZ alloys and a few investigations regarding the surface treatment of biodegradable and Al-free Mg alloys, especially under physiological conditions. These treatments tailor the surface roughness, homogenize the morphology, and decrease the degradation rate of the alloys. Conversely, there have also been reports which showed that rough surfaces lead to less pitting and good cell adherence. Besides roughness, there are many other parameters which are much more important than roughness when regarding the degradation behavior of an alloy. These studies, which indicate the relationship between surface treatments, roughness and degradation, require further elaboration, particularly for biomedical Mg alloy applications.

A new corrosion-inhibiting strategy for biodegradable magnesium: reduced nicotinamide adenine dinucleotide (NADH)

Utilization of biodegradable metals in biomedical fields is emerging because it avoids high-risk and uneconomic secondary surgeries for removing implantable devices. Mg and its alloys are considered optimum materials for biodegradable implantable devices because of their high biocompatibility; however, their excessive and uncontrollable biodegradation is a difficult challenge to overcome. Here, we present a novel method of inhibiting Mg biodegradation by utilizing reduced nicotinamide adenine dinucleotide (NADH), an endogenous cofactor present in all living cells. Incorporating NADH significantly increases Mg corrosion resistance by promoting the formation of thick and dense protective layers. The unique mechanism by which NADH enables corrosion inhibition was discovered by combined microscopic and spectroscopic analyses. NADH is initially self-adsorbed onto the surface of Mg oxide layers, preventing Cl⁻ ions from dissolving Mg oxides, and later recruits Ca²⁺ ions to form stable Ca-P protective layers. Furthermore, stability of NADH as a corrosion inhibitor of Mg under physiological conditions were confirmed using cell tests. Moreover, excellent cell adhesion and viability to Mg treated with NADH shows the feasibility of introduction of NADH to Mg-based implantable system. Our strategy using NADH suggests an interesting new way of delaying the degradation of Mg and demonstrates potential roles for biomolecules in the engineering the biodegradability of metals.

Layered double hydroxide/poly-dopamine composite coating with surface heparinization on Mg alloys: improved anticorrosion, endothelialization and hemocompatibility

Magnesium (Mg) and its alloys are promising cardiovascular stent materials due to their favourable physical properties and complete degradation in vivo. However, rapid degradation and poor cytocompatibility hinder their clinical applications. To enhance the corrosion resistance and endothelialization of the AZ31 alloy, a layered double hydroxide (LDH)/poly-dopamine (PDA) composite coating (LDH/PDA) was successfully fabricated. Polarization curves and the electrochemical impedance spectroscopy Nyquist spectrum test proved that the corrosion resistance of the LDH/PDA sample was significantly improved in vitro. The LDH/PDA sample greatly improved the adherence process and the proliferation rate of human umbilical vein endothelial cells (HUVECs). After culturing for 10 days, the number of living HUVECs on the LDH/PDA sample was comparable to that on the Ti sample whereas the cells barely survived on the AZ31 or LDH coating. Furthermore, heparin was immobilized on LDH/PDA via a covalent bond (LDH/PDA/HEP). The corrosion resistance and long-term proliferation of HUVECs after the introduction of heparin were mildly decreased compared with the L/P sample, but were still greatly improved compared with AZ31, the LDH coating and the PDA coating. Furthermore, the LDH/PDA/HEP sample greatly improved the HUVEC migration rate compared with the LDH/PDA sample, and inhibited platelet adhesion which was intense on the LDH/PDA sample. Both LDH/PDA and LDH/PDA/HEP samples had a low hemolysis rate (2.52% and 0.65%, respectively) in vitro and eliminated the adverse biocompatible effects of the direct PDA coating on the AZ31 substrate in vivo. Our results suggest that the LDH/PDA composite coating with further heparinization is a promising method to modify the surface of Mg alloys by significantly improving corrosion resistance, endothelialization and hemocompatibility.

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

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

Biodegradable Poly(l-lactic acid) (PLLA) Coatings Fabricated from Nonsolvent Induced Phase Separation for Improving Corrosion Resistance of Magnesium Rods in Biological Fluids

Magnesium (Mg)-based biometals are increasingly becoming a promising candidate of the next-generation implantable materials due to their unique properties, such as high biocompatibility, favorable mechanical strength, and good biodegradability in physiological conditions. However, the swift corrosion of Mg, resulting in early loss of structural support, has posed an enormous challenge in clinical application of Mg-based implants. To overcome these limitations, herein we developed a novel method, which combines the traditional dip-coating with nonsolvent induced phase separation (NIPS), to fabricate biodegradable PLLA coatings with controlled membrane morphology on pure Mg rods. Unlike the conventional dip-coating, where the polymer solution on the Mg substrates is left to evaporate directly under proper atmosphere, in NIPS, the polymer solution on the substrates is not left to dry but immersed in a nonsolvent of the PLLA, leading to the precipitation of polymer networks. Our results demonstrated that various polymer coatings with different morphologies and inner structures could be easily fabricated by a careful selection of nonsolvents. In comparison to dense PLLA coatings obtained from conventional solvent evaporation, PLLA coatings with a dense surface and porous inner structure were obtained when hexane and petroleum ether were used as the nonsolvents, while PLLA coatings with a completely porous structure were obtained when polar acetone and ethanol were chosen. The electrochemical corrosion tests and immersion tests further showed that all polymer coatings could significantly improve the corrosion resistance and suppress the corrosion rates of the substrates. However, PLLA films obtained via NIPS had much lower pH changes and slower Mg²⁺ release, implying better protective effects of the fabricated coatings. Based on results of all experiments, a new process for the corrosion mechanism of Mg implants during immersion has also been proposed in this work.

Plasma Electrolytic Oxidation of Titanium Implant Surfaces: Microgroove-Structures Improve Cellular Adhesion and Viability

BACKGROUND/AIM

Plasma electrolytic oxidation (PEO) is an established electrochemical treatment technique that can be used for surface modifications of metal implants. In this study we to treated titanium implants with PEO, to examine the resulting microstructure and to characterize adhesion and viability of cells on the treated surfaces. Our aim was to identify an optimal surface-modification for titanium implants in order to improve soft-tissue integration.

MATERIALS AND METHODS

Three surface-variants were generated on titanium alloy Ti6Al4V by PEO-treatment. The elemental composition and the microstructures of the surfaces were characterized using energy dispersive X-ray spectroscopy, scanning electron microscopy and profilometry. In vitro cytocompatibility of the surfaces was assessed by seeding L929 fibroblasts onto them and measuring the adhesion, viability and cytotoxicity of cells by means of live/dead staining, XTT assay and LDH assay.

RESULTS

Electron microscopy and profilometry revealed that the PEO-surface variants differed largely in microstructure/topography, porosity and roughness from the untreated control material as well as from one another. Roughness was generally increased after PEO-treatment. In vitro, PEO-treatment led to improved cellular adhesion and viability of cells accompanied by decreased cytotoxicity.

CONCLUSION

PEO-treatment provides a promising strategy to improve the integration of titanium implants with surrounding tissues.

Hybrid fracture fixation systems developed for orthopaedic applications: A general review

Orthopaedic implants are applied daily in our orthopaedic clinics for treatment of musculoskeletal injuries, especially for bone fracture fixation. To realise the multiple functions of orthopaedic implants, hybrid system that contains several different materials or parts have also been designed for application, such as prosthesis for total hip arthroplasty. Fixation of osteoporotic fracture is challenging as the current metal implants made of stainless steel or titanium that are rather rigid and bioinert, which are not favourable for enhancing fracture healing and subsequent remodelling. Magnesium (Mg) and its alloys are reported to possess good biocompatibility, biodegradability and osteopromotive effects during its in vivo degradation and now tested as a new generation of degradable metallic biomaterials. Several recent clinical studies reported the Mg-based screws for bone fixation, although the history of testing Mg as fixation implant was documented more than 100 years ago. Truthfully, Mg has its limitations as fixation implant, especially when applied at load-bearing sites because of rather rapid degradation. Currently developed Mg-based implants have only been designed for application at less or non-loading-bearing skeletal site(s). Therefore, after years research and development, the authors propose an innovative hybrid fixation system with parts composed of Mg and titanium or stainless steel to maximise the biological benefits of Mg; titanium or stainless steel in this hybrid system can provide enough mechanical support for fractures at load-bearing site(s) while Mg promotes the fracture healing through novel mechanisms during its degradation, especially in patients with osteoporosis and other metabolic disorders that are unfavourable conditions for fracture healing. This hybrid fixation strategy is designed to effectively enhance the osteoporotic fracture healing and may potentially also reduce the refracture rate. The translational potential of this article: This article systemically reviewed the combination utility of different metallic implants in orthopaedic applications. It will do great contribution to the further development of internal orthopaedic implants for fracture fixation. Meanwhile, it also introduced a titanium-magnesium hybrid fixation system as an alternative fixation strategy, especially for osteoporotic patients.

An innovative Mg/Ti hybrid fixation system developed for fracture fixation and healing enhancement at load-bearing skeletal site

Magnesium (Mg) is a potential biomaterial suitable for developing biodegradable orthopaedic implants, especially as internal fixators for fracture fixation at non-load bearing skeletal sites. However, Mg alone cannot provide sufficient mechanical support for stable fracture fixation at load bearing sites due to its rapid degradation in the early stage after implantation. In consideration of the strengths and weaknesses of Mg, we developed an innovative magnesium/titanium (Mg/Ti) hybrid fixation system for long bone fracture fixation and investigated the fixation efficacy. The finite element analysis (FEA) results indicated that the Mg/Ti hybrid fixation system provided sufficient mechanical support for fracture fixation at load-bearing skeletal site. As a proof-of-concept, we performed a "Z-shaped" open osteotomy at the mid-shaft of rabbit tibia. For comparison, the animals were divided into two groups: Mg/Ti group (fixated with Mg screws and Ti fixators) and Ti control group (fixated with Ti screws and Ti fixators). The radiographic, four-point bending mechanical test, histological and histomorphometric analysis were postoperatively performed in a temporal manner up to 12 weeks. Both X-ray and micro-CT images of the Mg/Ti group showed a larger callus (14.7% at 3rd week and 24.8% at 6th week, n = 5-7, p < 0.05) in the regions of interest (ROIs) over time, especially at the opposite cortex of the fixation plate. At the 12th week post-operation, the biomechanical test result indicated that the rabbit tibia in the Mg/Ti group healed better and the overall mechanical strength was approximately 3-fold higher (n = 8, p < 0.05) than that at 6th week. Furthermore, the FEA revealed that the Mg/Ti group had a higher mechanical strength (19.5% at week 6 and 31.5% at week 12) at the specified ROI and resulted in an earlier and faster endochondral ossification (68.0% at week 3 and 71.4% at week 6) with a higher expression of osteocalcin (54.0%) and collagen I (34.2%) than the Ti control group (n = 4, p < 0.05). Further evaluation suggested that a higher expression of calcitonin gene-related peptide (CGRP), a known osteogenic neuron peptide, in the fracture callus of the Mg/Ti group might be a major underlying mechanism of enhanced fracture healing attributed to the release of Mg ions during the degradation of Mg screws.

Mg-MOF-74/MgF₂ Composite Coating for Improving the Properties of Magnesium Alloy Implants: Hydrophilicity and Corrosion Resistance

Surface modification on Mg alloys is highly promising for their application in the field of bone repair. In this study, a new metal–organic framework/MgF₂ (Mg-MOF-74/MgF₂) composite coating was prepared on the surface of AZ31B Mg alloy via pre-treatment of hydrofluoric acid and in situ hydrothermal synthesis methods. The surface topography of the composite coating is compact and homogeneous, and Mg-MOF-74 has good crystallinity. The corrosion resistance of this composite coating was investigated through Tafel polarization test and immersion test in simulated body fluid at 37 °C. It was found that Mg-MOF-74/MgF₂ composite coating significantly slowed down the corrosion rate of Mg alloy. Additionally, Mg-MOF-74/MgF₂ composite coating expresses super-hydrophilicity with the water contact angle of nearly 0°. In conclusion, on the basis of MgF₂ anticorrosive coating, the introduction of Mg-MOF-74 further improves the biological property of Mg alloys. At last, we propose that the hydrophilicity of the composite coating is mainly owing to the large number of hydroxyl groups, the high specific surface area of Mg-MOF-74, and the rough coating produced by Mg-MOF-74 particles. Hence, Mg-MOF-74 has a great advantage in enhancing the hydrophilicity of Mg alloy surface.

Biodegradable Magnesium Alloys Developed as Bone Repair Materials: A Review

Bone repair materials are rapidly becoming a hot topic in the field of biomedical materials due to being an important means of repairing human bony deficiencies and replacing hard tissue. Magnesium (Mg) alloys are potentially biocompatible, osteoconductive, and biodegradable metallic materials that can be used in bone repair due to their in situ degradation in the body, mechanical properties similar to those of bones, and ability to positively stimulate the formation of new bones. However, rapid degradation of these materials in physiological environments may lead to gas cavities, hemolysis, and osteolysis and thus, hinder their clinical orthopedic applications. This paper reviews recent work on the use of Mg alloy implants in bone repair. Research to date on alloy design, surface modification, and biological performance of Mg alloys is comprehensively summarized. Future challenges for and developments in biomedical Mg alloys for use in bone repair are also discussed.