The effect of simulated inflammatory conditions and Fenton chemistry on the electrochemistry of CoCrMo alloy

In Vitro Inflammatory Cell-Induced Corrosion Using a Lymphocyte and Macrophage Coculture

BACKGROUND

Cobalt-chromium-molybdenum (CoCrMo) and titanium alloys have been used for orthopaedic implants for decades. However, recent evidence has shown that inflammatory cell-induced corrosion (ICIC) can damage these metal alloys. This study aimed to investigate the mechanisms of ICIC by coculturing macrophages with lymphocytes. We hypothesized that macrophages would be able to alter the surface oxide layer of CoCrMo and titanium alloy (Ti6Al4V) disks, with greater oxide layer damage occurring in groups with a coculture compared to a macrophage monoculture and in groups with inflammatory activators compared to nonactivated groups.

METHODS

Murine macrophages were cultured on American Society for Testing and Materials F1537 CoCrMo and F136 Ti6Al4V disks for 30 days and activated with interferon gamma and lipopolysaccharide. Interferon gamma and lipopolysaccharide were added to the culture medium to simulate local inflammation. Macrophages were either cultured alone or in a coculture with T helper lymphocytes. After the 30-day experiment, scanning electron microscopy was used to examine the disk surfaces, and oxide levels were found using energy dispersive x-ray spectroscopy.

RESULTS

Pitting features consistent with previous reports of ICIC were found on disks cultured with cells. Both CoCrMo and Ti6Al4V disks had significantly lower oxide levels in all groups with cells compared to control groups with no cells (P < .01). Additionally, CoCrMo disks had significantly lower oxide levels when cultured with activated macrophages and lymphocytes compared to nonactivated macrophages alone (P < .001), activated macrophages alone (P < .01), and nonactivated macrophages and lymphocytes (P < .05). No differences in the oxide levels were found among the Ti6Al4V groups.

CONCLUSIONS

This study demonstrates the ability of macrophages to alter the surface chemistry of commonly used orthopaedic alloys. We found that the addition of lymphocytes and a simulated local inflammatory response may contribute to the ICIC of CoCrMo implants.

Reactive oxygen species, electrode potential and pH affect CoCrMo alloy corrosion and semiconducting behavior in simulated inflammatory environments

Crevice corrosion in modular taper junctions of hip or knee replacements using cobalt-chrome-molybdenum (CoCrMo) alloys remains a clinical concern. Non-mechanically-driven corrosion has been less explored compared to mechanically assisted crevice corrosion. This study hypothesized that solution chemistry within crevices, inflammation, and cathodic electrode potential shifts during fretting result in low pH and generate reactive oxygen species (ROS), affecting oxide film behavior. This study investigated how resistance and capacitance of the CoCrMo oxide film (i.e., corrosion resistance) are modified in simulated in vivo crevice environments of modular taper junctions. Six solutions were evaluated (two pH levels: 1 and 7.4 and four hydrogen peroxide (H2O2) concentrations: 0, 0.001, 0.01 and 0.1 M). Rp versus voltage and Mott-Schottky plots were created from symmetry-based electrochemical impedance spectroscopy (sbEIS). At pH 1, the semiconductor transition to p-type occurs at more anodic potentials and higher flat band potentials were found. H2O2 decreased the flat band potential and slope in the Mott-Schottky plot. Higher H2O2 in pH 7.4 solution significantly modified the oxide film, leading to increased donor density (p = 0.0004) and a 150-fold reduction in Rp in the cathodic potential range at -1 V (p = 0.0005). The most unfavorable condition (0.1 M H2O2 pH 1) resulted in a 250-fold lower resistance compared to phosphate buffered saline (PBS) pH 7.4 at -1 V (p = 0.0013). This study highlights the corrosion susceptibility of CoCrMo under adverse chemical and potential conditions, identifying increased defects in the oxide film due to ROS, hydrogen ions and electrode potential. STATEMENT OF SIGNIFICANCE: Corrosion of cobalt chrome molybdenum alloy caused by direct chemical attack in the crevice region of hip replacements, such as modular taper junctions, remains a clinical concern. The junction environment contains adverse chemical compositions, including high acidity and reactive oxygen species (ROS) due to inflammatory responses against the corrosion products. We simulate inflammatory environments with different pH levels and hydrogen peroxide, representative of ROS. We employ electrochemical impedance spectroscopy and apply stepwise voltage over the range induced by tribocorrosion processes. We relate the effect of adverse chemical components on corrosion and semiconducting behavior of the oxide film using Mott-Schottky analysis. This study shows how pH and ROS concentration compromises the oxide film potentially leading to non-mechanically induced corrosion.

Influence of Proteins and Building Direction on the Corrosion and Tribocorrosion of CoCrMo Fabricated by Laser Powder Bed Fusion

Cobalt-chromium-molybdenum (CoCrMo) alloys are common wear-exposed biomedical alloys and are manufactured in multiple ways, increasingly using additive manufacturing processes such as laser powder bed fusion (LPBF). Here, we investigate the effect of proteins and the manufacturing process (wrought vs LPBF) and building orientation (LPBF-XY and XZ) on the corrosion, metal release, tribocorrosion, and surface oxide composition by means of electrochemical, mechanical, microscopic, diffractive, and spectroscopic methods. The study was conducted at pH 7.3 in 5 g/L NaCl and 5 mM 2-(N-morpholino) ethanesulfonic acid (MES) buffer, which was found to be necessary to avoid metal phosphate and metal-protein aggregate precipitation. The effect of 10 g/L bovine serum albumin (BSA) and 2.5 g/L fibrinogen (Fbn) was studied. BSA and Fbn strongly enhanced the release of Co, Cr, and Mo and slightly enhanced the corrosion (still in the passive domain) for all CoCrMo alloys and most for LPBF-XZ, followed by LPBF-XY and the wrought CoCrMo. BSA and Fbn, most pronounced when combined, significantly decreased the coefficient of friction due to lubrication, the wear track width and severity of the wear mechanism, and the tribocorrosion for all alloys, with no clear effect of the manufacturing type. The wear track area was significantly more oxidized than the area outside of the wear track. In the reference solution without proteins, a strong Mo oxidation in the wear track surface oxide was indicative of a pH decrease and cell separation of the anodic and cathodic areas. This effect was absent in the presence of the proteins.

Interaction pathways of implant metal localized corrosion and macrophage inflammatory reactions

Macrophages play a central role in immunological responses to metallic species associated with the localized corrosion of metallic implants, and mediating in peri-implant inflammations. Herein, the pathways of localized corrosion-macrophage interactions were systematically investigated on 316L stainless steel (SS) implant metals. Electrochemical monitoring under macrophage-mediated inflammatory conditions showed a decreased pitting corrosion resistance of 316L SSs in the presence of RAW264.7 cells as the cells would disrupt biomolecule adsorbed layer on the metal surface. The pitting potentials were furtherly decreased when the RAW264.7 cells were induced to the M1 pro-inflammatory phenotype by the addition of lipopolysaccharide (LPS), and pitting corrosion preferentially initiated at the peripheries of macrophages. The overproduction of aggressive ROS under inflammatory conditions would accelerate the localized corrosion of 316L SS around macrophages. Under pitting corrosion condition, the viability and pro-inflammatory polarization of RAW264.7 cells were region-dependent, lower viability and more remarkable morphology transformation of macrophages in the pitting corrosion region than the pitting-free region. The pitting corrosion of 316L SS induced high expression of CD86, TNF-α, IL-6 and high level of intracellular ROS in macrophages. Uneven release of metallic species (Fe2+, Cr3+, Ni2+, etc) and uneven distribution of surface overpotential stimulated macrophage inflammatory responses near the corrosion pits. A synergetic effect of localized corrosion and macrophages was revealed, which could furtherly promote localized corrosion of 316L SS and macrophage inflammatory reactions. Our results provided direct evidence of corrosion-macrophage interaction in metallic implants and disclosed the pathways of this mutual stimulation effect.

Revealing the composite fretting-corrosion mechanisms of Ti6Al4V alloy against zirconia-toughened alumina ceramic in simulated body fluid

The composite fretting-corrosion damage due to combinations of radial, tangential, rotational, and other fretting causes local adverse tissue reactions and failure of artificial joints. Previous studies have mainly focused on the single fretting mode, while ignoring the coupled effects of multimode fretting. The fretting-corrosion mechanisms between the components are not yet fully understood. In this study, the tangential-radial composite fretting was realized by applying a normal alternating load to the tangential fretting. The composite fretting corrosion behavior of zirconia toughened alumina ceramic/Ti6Al4V alloy used for the head-neck interface of an artificial hip joint under simulated body fluid was investigated. The effects of displacement and alternating load amplitude were considered. The alternating load amplitude was given by the maximum normal load and minimum normal load ratio R. The results showed that the composite fretting damage mechanisms of this pair were mainly abrasion and tribocorrosion. Cracking also existed under large displacement. The effect of alternating load on fretting corrosion was found to be mainly caused by changes in the contact area and instantaneous contact state. In addition, the alternating load during the composite fretting promoted the formation of the three-body layer in the contact area. A decrease in load ratio caused fretting to change from gross to partial slip. In the case of small displacement, the load ratio had little effect on the friction work or wear scar profile. The corrosion rate of materials and the concentration of metal ions released into the solution increased as load ratio decreased. In cases of large and medium displacement, load ratio reduction increased the friction work and expanded the wear scar. The reduction in load ratio also caused the corrosion rate of the material to increase and then decrease, and the metal ion concentration decreased.

A Review on Nano Ti-Based Oxides for Dark and Photocatalysis: From Photoinduced Processes to Bioimplant Applications

Catalysis on TiO₂ nanomaterials in the presence of H₂O and oxygen plays a crucial role in the advancement of many different fields, such as clean energy technologies, catalysis, disinfection, and bioimplants. Photocatalysis on TiO₂ nanomaterials is well-established and has advanced in the last decades in terms of the understanding of its underlying principles and improvement of its efficiency. Meanwhile, the increasing complexity of modern scientific challenges in disinfection and bioimplants requires a profound mechanistic understanding of both residual and dark catalysis. Here, an overview of the progress made in TiO₂ catalysis is given both in the presence and absence of light. It begins with the mechanisms involving reactive oxygen species (ROS) in TiO₂ photocatalysis. This is followed by improvements in their photocatalytic efficiency due to their nanomorphology and states by enhancing charge separation and increasing light harvesting. A subsection on black TiO₂ nanomaterials and their interesting properties and physics is also included. Progress in residual catalysis and dark catalysis on TiO₂ are then presented. Safety, microbicidal effect, and studies on Ti-oxides for bioimplants are also presented. Finally, conclusions and future perspectives in light of disinfection and bioimplant application are given.

Influence of FeCl3 and H2O2 in corrosion testing of modular taper connections in total hip arthroplasty: An in vitro study

Corrosion at the modular taper junctions in total hip arthroplasty is clinically relevant because wear particles and ions generated at this interface can lead to adverse local tissue reactions or even implant failure. In vitro tribo-corrosion tests are usually accomplished in saline solutions or calf serum (CS), but the addition of H₂O₂ and FeCl₃ have been suggested to mimic inflammatory conditions in the joint. Inflammatory conditions may aggravate corrosive processes and, therefore, should lead in vitro to a more severe and realistic tribo-corrosive material attack. Corrosion testing at 12/14 tapers comprising a CoCrMo head taper and a Ti6Al4V trunnion was accomplished in five electrolytes (Ringer's solution (RS), RS with 30 mM H₂O₂ and/or 0.7 mM FeCl₃ and CS) under dynamical loading for five million cycles. Resulting material loss was determined gravimetrically and by ion analysis. The tribo-corrosive material degradation was investigated by light and electron microscopy. FeCl₃ enhanced the material loss from taper connections while H₂O₂ did not lead to a significant alteration of total material loss. In comparison to pure RS, corrosion testing in CS decreased material loss at the head taper while it increased material loss at the trunnion. The combination of FeCl₃ and H₂O₂ led to an enhanced occurrence of micro cracks at the trunnion surface. Adding FeCl₃ and optionally also H₂O₂ aggravates material loss in in vitro corrosion testing of taper junctions and leads to harsher and probably more realistic testing conditions. STATEMENT OF SIGNIFICANCE: Tribo-corrosive processes at taper connections in hip implants are complex and can lead to major clinical implications. Joint inflammation is assumed to aggravate taper corrosion in vivo, why FeCl₃ and H₂O₂ have been proposed as additives to electrolytes to simulate inflammatory conditions in vitro. Often used fretting test setups, however, do not involve real taper geometries. Besides, testing is often accomplished in saline solutions or calf serum, which do not induce a clinically significant amount of corrosive material degradation. This study presents an approach to increase tribo-corrosive processes at realistic taper connections by adding FeCl₃ and/or H₂O₂. Unlike H₂O₂, FeCl₃ increased material loss from taper connections. The combination of both additives enhanced micro crack formation at the trunnion surfaces.

In Vitro Corrosion Assessment of the Essure® Medical Device in Saline, Simulated Inflammatory Solution and Neutral Buffered Formalin

The Essure® permanent contraceptive implant, comprised of four alloys (nickel-titanium, 316L stainless steel, platinum-iridium, and tin-silver solder) and Dacron (PET) fibers, has been approved for use in the US for about two decades. However, little has been published on this implant's biomaterials performance, and as this implant gains interest in terms of in vivo performance, methods of implant post-retrieval storage also need to be assessed. This study investigated the electrochemical properties and ion release profile of Essure® during storage in phosphate buffered saline (PBS), 10 mM H₂O₂/PBS, a simulated inflammatory solution, and 10% neutral buffered formalin (NBF) to investigate the corrosion behavior and metal ion release. First, a galvanic test method was used to measure the galvanic interactions between alloys within the device. Second, an ion-release study over 107 days was performed. Ions were measured using inductively-coupled plasma mass spectrometry and the implants were assessed using digital optical microscopy, scanning electron microscopy, and energy dispersive x-ray spectrometry. The tin-silver (SnAg) solder continuously corroded in PBS and H₂O₂/PBS. In the presence of H₂O₂, nickel and titanium ions were released from the nickel-titanium (NiTi) coil, whereas release of these ions was minimal in PBS alone. Overall, corrosion of the SnAg solder, which holds the NiTi and 316L SS together, was significant in both PBS and H₂O₂/PBS and may result in loss of connection of the NiTi and 316L stainless steel portions of the implant. Storage in NBF exhibited very low corrosion rates for all alloys and low levels of ion release were observed indicating that formalin storage minimally affects the implant's corrosion status. STATEMENT OF SIGNIFICANCE: The Essure® device is an FDA premarket-approved female permanent sterilization device containing four different metal alloys and poly(ethylene terephthalate) polymer fibers. Significant concerns related to this device have been raised by the FDA since its introduction in 2002. This study is the first published in vitro work to specifically assess the corrosion mechanisms in this multi-alloy device and the role of different solution environments, including formalin storage, inorganic physiological saline and a simulated inflammatory condition. Significant evidence of corrosion of the tin-silver solder is documented, the release of Ni and Ti under simulated inflammatory conditions, and the relative inertness of storage of these implants in neutral buffered saline is presented. The tin-silver corrosion corroborates recent clinical evidence of tin corrosion products in tissues adjacent to these devices in vivo.

Microstructure-dependent crevice corrosion damage of implant materials CoCr28Mo6, TiAl6V4 and REX 734 under severe inflammatory conditions

Fretting corrosion is associated with increased risk of premature implant failure. In this complex in vivo corrosion system, the contribution of static crevice corrosion of the joined metal alloys is still unknown. The aim of this study was to develop a methodology for testing crevice corrosion behavior that simulates the physiological conditions of modular taper junctions and to identify critical factors on corrosion susceptibility. Samples of medical grade CoCr28Mo6 cast and wrought alloy, TiAl6V4 wrought alloy and REX 734 stainless steel were prepared metallographically and the microstructure was investigated using scanning electron microscopy (SEM). Crevice formers that mimic typical geometries of taper junctions were developed. Crevice corrosion immersion tests were performed in different physiological fluids (bovine serum or phosphate buffered saline with additives of 30 mM H₂ O₂ at pH = 1) for 4 weeks at 37°C. SEM with energy dispersive X-ray spectroscopy as well as focused ion beam were used to characterize the surface morphology, investigate present damages and identify the chemical composition of residues. Macroscopic inspection showed increased crevice corrosion susceptibility of TiAl6V4 and REX 734 under severe simulated inflammatory conditions. CoCr28Mo6 cast alloy exhibited degraded areas next to Cr- and Mo-rich precipitations that were located within the opposed crevices. The results indicate that aggressive electrolyte composition and crevice heights of 50-500 μm are critical influencing factors on crevice corrosion of biomedical alloys. Furthermore, manufacturing-related microstructure of common implant alloys determines the deterioration of corrosion resistance. The developed method should be used to enhance the corrosion resistance of common implant biomaterials by an adapted microstructure.

Polyphenols from Grape Pomace: Functionalization of Chitosan-Coated Hydroxyapatite for Modulated Swelling and Release of Polyphenols

Chitosan is known for its specific antibacterial mechanism and biodegradability, while polyphenols are known for their antioxidant and anti-inflammatory properties: coupling these properties on a surface for bone contact, such as hydroxyapatite, is of great interest. The system developed here allows the combination of hydroxyapatite, chitosan, and polyphenol properties in the same multifunctional biomaterial in order to modulate the host response after implantation. Crosslinked chitosan is used in this research to create a stable coating on hydroxyapatite, and then it is functionalized for a smart release of the polyphenols. The release is higher in inflammatory conditions and lower in physiological conditions. The properties of the coated and functionalized samples are characterized on the as-prepared samples and after the samples are immersed (for 24 h) in solutions, which simulate the inflammatory and physiological conditions. Characterization is performed in order to confirm the presence of polyphenols grafted within the chitosan coating, the stability of grafting as a function of pH, the morphology of the coating and distribution of polyphenols on the surface, and the redox reactivity and radical scavenging activity of the functionalized coating. All the results are in line with previous results, which show a successful coating with chitosan and functionalization with polyphenols. Moreover, the polyphenols have a different release kinetics that is faster in a simulated inflammatory environment compared to that in the physiological environment. Even after the release tests, a fraction of polyphenols are still bound on the surface, maintaining the antioxidant and radical scavenging activity for a longer time. An electrostatic bond occurs between the negative-charged polar groups of polyphenols (carboxyls and/or phenols) and the positive amide groups of the chitosan coating, and the substitution of the crosslinker by the polyphenols occurs during the functionalization process.

Corrosion of titanium under simulated inflammation conditions: clinical context and in vitro investigations

Titanium and alloys thereof are widely utilized for biomedical applications in the fields of orthopedics and dentistry. The corrosion resistance and perceived biocompatibility of such materials are essentially related to the presence of a thin passive oxide layer on the surface. However, during inflammation phases, the immune system and its leukocytic cells generate highly aggressive molecules, such as hydrogen peroxide and radicals, that can significantly alter the passive film resulting in the degradation of the titanium implants. In combination with mechanical factors, this can lead to the release of metal ions, nanoparticles or microscaled debris in the surrounding tissues (which may sustain chronic inflammation), bring about relevant health issues and contribute to implant loss or failure. After briefly presenting the context of inflammation, this review article analyses the state-of-the-art knowledge of the in vitro corrosion of titanium, titanium alloys and coated titanium by reactive oxygen species and by living cells with an emphasis on electrochemical and microstructural aspects. STATEMENT OF SIGNIFICANCE: Inflammation involves the production of reactive oxygen species that are known to alter the passive layer protecting titanium implants against the aggressive environment of the human body. Inflammatory processes therefore contribute to the deterioration of biomedical devices. Although review articles on biomaterials for implant applications are regularly published in the literature, none has ever focused specifically on the topic of inflammation. After briefly recalling the clinical context, this review analyses the in vitro studies on titanium corrosion under simulated inflammation conditions from the pioneer works of the 80s and the 90s till the most recent investigations. It reports about the status of this research area for a multidisciplinary readership covering the fields of materials science, corrosion and implantology.

Fretting-corrosion of CoCr-alloys against TiAl6V4: The importance of molybdenum in oxidative biological environments

Periprosthetic fluids often contain reactive oxygen species, including H₂O₂, that are generated during inflammatory processes. Here, we investigated the fretting-corrosion behavior of CoCrX-alloys (X = Mo, Fe) in a complex protein-containing lubricant, with and without the addition of H₂O₂. Given the known protective role of molybdenum as an alloying element in metal degradation, we considered its effects by designing a two-way factorial experiment. The aim of the study was to investigate tribocorrosive mechanisms in modular joints of knee and hip prostheses. A previously described test-rig was used to run fretting corrosion tests of CoCrX-alloys with (X=Mo) and without (X=Fe) molybdenum against TiAl6V4 in bovine calf serum (BCS) with and without a physiological relevant H₂O₂ level (3 mM) in gross slip mode (4 Hz, ±50 μm, p_max=0.18 GPa, 37 °C, 50,000 cycles). Two CoCr-pins were pressed against a cylindrical TiAl6V4-rod, forming a line contact. Normal and frictional forces, the displacement, and the open circuit potential (OCP) were measured and recorded continuously. The dissipated frictional work was independent of alloy composition. The addition of H₂O₂ lowered the dissipated frictional work and increased wear, and this was significant in the absence of Mo. The mean OCP value was lower with Mo-containing than with Mo-free alloy in both pure BCS (p = .042), and BCS ± H₂O₂ (p < .0005). The wear scar was deeper for the Mo-free alloy, and this was significant (p = .013) in the presence of H₂O₂. These findings suggest a marked weakening of the passive film in the presence of H₂O₂, which is mitigated by the availability of Mo.

The effect of hypochlorous acid on the tribocorrosion of CoCrMo/Ti-6Al-4V bearing couples

Mechanically assisted corrosion (MAC) of metallic orthopedic alloys is a consequence of the use of modular devices where opposing metal surfaces are tightly mated and loaded at the taper junction. MAC processes are affected by material surface characteristics and local solution chemistry. During inflammation, active immune cells may generate reactive oxygen species (such as hypochlorous acid [HOCl]) adjacent to surfaces undergoing micromotion, which may affect the tribocorrosion behavior of an implanted device. This study investigated the fretting current response of CoCrMo/Ti-6Al-4 V couples in a pin-on-disk apparatus utilizing HOCl solutions as a proxy for a severe inflammatory environment. Testing in 1 and 5 mM HOCl solutions were shown to generate a threefold and fivefold increase (p < 0.01), respectively, in fretting currents over pH 7.4 phosphate-buffered saline control conditions. Fretting currents were shown to be dependent on the energy dissipated during fretting and the concentration of HOCl where the currents within a single HOCl concentration were linearly dependent of energy dissipated, but different HOCl levels shifted (increased and then decreased) fretting currents with concentration. Fretting currents, governed by regrowth of an abraded oxide film, were affected by the oxidative power of the solution, which caused positive shifts in open circuit potential and likely resulted in a thicker oxide for 1 mM and 5 mM and fell with 30 mM. Small amounts of HOCl release within a joint may result in increased release of tribocorrosion products such as oxide particles.

Impact of exogenous metal ions on peri-implant bone metabolism: a review

The development of effective methods to promote the osseointegration of dental implants by surface modification is an area of intense research in dental materials science. Exogenous metal ions present in the implant and surface modifications are closely related to the bone metabolism around the implant. In the complex oral microenvironment, the release of metal ions caused by continuous corrosion of dental implants has an unfavorable impact on the surrounding tissue, and then affects osseointegration, leading to bad results such as loosening and falling off in the late stage of the implant. Besides, these ions can even be distributed in distant tissues and organs. Currently, surface modification techniques are being developed that involve different processing technologies including the introduction of exogenous metal ions with different properties onto the surface of implants to improve performance. However, most metal elements have some level of biological toxicity and can only be used within a safe concentration range to exert the optimum biological effects on recipients. In this paper, we review the adverse effects of metal ions on osseointegration and highlight the emerging applications for metal elements in improving the performance of dental implants.

Taper corrosion: a complication of total hip arthroplasty

The focus on taper corrosion in modular hip arthroplasty increased around 2007 as a result of clinical problems with large-head metal-on-metal (MoM) bearings on standard stems. Corrosion problems with bi-modular primary hip stems focused attention on this issue even more.

Factors increasing the risk of taper corrosion were identified in laboratory and retrieval studies: stiffness of the stem neck, taper diameter and design, head diameter, offset, assembly force, head and stem material and loading.

The high variability of the occurrence of corrosion in the clinical application highlights its multi-factorial nature, identifying the implantation procedure and patient-related factors as important additional factors for taper corrosion.

Discontinuing the use of MoM has reduced the revisions due to metal-related pathologies dramatically from 49.7% (MoM > 32 mm), over 9.2% (MoM ⩽ 32 mm) to 0.8% (excluding all MoM).

Further reduction can be achieved by omitting less stiff Ti-alloys and large metal heads (36 mm and above) against polyethylene (PE).

Standardized taper assembly of smaller and ceramic heads will reduce the clinical occurrence of taper corrosion even further. If 36 mm heads are clinically indicated, only ceramic heads should be used.

Taper-related problems will not comprise a major clinical problem anymore if the mentioned factors are respected.

Cite this article: EFORT Open Rev 2020;5:776-784. DOI: 10.1302/2058-5241.5.200013

Reactive oxygen/nitrogen species (ROS/RNS) and oxidative stress in arthroplasty

The interplay between implant design, biomaterial characteristics, and the local microenvironment adjacent to the implant is of utmost importance for implant performance and success of the joint replacement surgery. Reactive oxygen and nitrogen species (ROS/RNS) are among the various factors affecting the host as well as the implant components. Excessive formation of ROS and RNS can lead to oxidative stress, a condition that is known to damage cells and tissues and also to affect signaling pathways. It may further compromise implant longevity by accelerating implant degradation, primarily through activation of inflammatory cells. In addition, wear products of metallic, ceramic, polyethylene, or bone cement origin may also generate oxidative stress themselves. This review outlines the generation of free radicals and oxidative stress in arthroplasty and provides a conceptual framework on its implications for soft tissue remodeling and bone resorption (osteolysis) as well as implant longevity. Key findings derived from cell culture studies, animal models, and patients' samples are presented. Strategies to control oxidative stress by implant design and antioxidants are explored and areas of controversy and challenges are highlighted. Finally, directions for future research are identified. A better understanding of the host-implant interplay and the role of free radicals and oxidative stress will help to evaluate therapeutic approaches and will ultimately improve implant performance in arthroplasty.

Effect of the coexistence of albumin and H2O2 on the corrosion of biomedical cobalt alloys in physiological saline

The corrosion of Co-28Cr-6Mo and Co-35Ni-20Cr-10Mo, as biomedical alloys, has been investigated for effects of typical species (albumin and H2O2) in physiological saline, with their coexistence explored for the first time. Electrochemical and long term immersion tests were carried out. It was found that Co alloys were not sensitive to the presence of albumin alone, which slightly promoted anodic dissolution of Co-35Ni-20Cr-10Mo without noticeably affecting Co-28Cr-6Mo and facilitated oxide film dissolution on both alloys. H2O2 led to a clear drop in corrosion resistance, favouring metal release and surface oxide formation and inducing much thicker but less compact oxide films for both alloys. The coexistence of both species resulted in the worst corrosion resistance and most metal release, while the amount and composition of surface oxide remained at a similar level as in the absence of both. The effect of H2O2 inducing low compactness of surface oxides should prevail on deciding the poor corrosion protection ability of passive film, while albumin simultaneously promoted dissolution or inhibited formation of oxides due to H2O2. Corrosion resistance was consistently lower for Co-35Ni-20Cr-10Mo under each condition, the only alloy where the synergistic effect of both species was clearly demonstrated. This work suggests that the complexity of the environment must be considered for corrosion resistance evaluation of biomedical alloys.

Fretting initiated crevice corrosion of 316LVM stainless steel in physiological phosphate buffered saline: Potential and cycles to initiation

Mechanically assisted crevice corrosion (MACC) has been associated with implant failure in vivo and is a serious concern in numerous metallic implant systems. Stainless steel medical devices may be subjected to fretting and crevice corrosion in the human body as are titanium and CoCrMo alloys due to the presence of a passive oxide film on their surface. One mechanism of MACC that has not been clearly identified and studied is fretting-initiated crevice corrosion (FICC) of stainless steel where an initial fretting event can initiate a rapid propagating crevice corrosion process even when fretting has ceased. FICC pin-on-disk experiments were performed at varying potential conditions and duration of fretting to explore the role of potential and fretting duration on the initiation of crevice corrosion. Triggering of a propagating crevice corrosion reaction on stainless steel at 250 mV vs Ag/AgCl/KCl (saturated) in PBS solution required only 2 s (2 cycles at 1 Hz) of fretting. Crevice corrosion continued to propagate under a 1.8 mm diameter pin with only 100 μm of direct contact, dissolving in both the depth and width dimension away from the fretting contact while the currents rose from 0.2 μA to 15 μA within 5 min. Three different potential-dependent FICC regions were identified that included unstable crevice corrosion (50 mV and above), metastable crevice corrosion (-100 mV to 0 mV) and stable fretting corrosion (between -500 mV and -150 mV). Crevice corrosion can be induced by fretting at potentials as low as -100 mV. Below -100 mV, there was no FICC, but rather fretting corrosion stopped immediately after fretting ceased and returned to a stable baseline current. Metastable FICC was shown at potentials between -100 mV and 0 mV, when the crevice corrosion current gradually decreased over several seconds or longer after fretting ceased. Self-sustained, unstable crevice corrosion started at 50 mV, where prior to fretting the currents were low, and after just a few cycles of fretting the crevice current rose rapidly and continued to increase after fretting stopped. Increase of potential increased the susceptibility of stainless steel to FICC. Scanning electron microscopy and digital optical microscopy revealed pitting and crevice corrosion on samples at -100 mV and higher potentials, where FICC was developing. By removing the oxide film, fretting motion significantly facilitates the critical crevice solution development, lowering the critical crevice potential and decreasing the initiation time for crevice corrosion. These results indicate that fretting initiated crevice corrosion may affect the performance of stainless steel in vivo. STATEMENT OF SIGNIFICANCE: AISI 316L stainless steel has been widely used as a metallic biomaterial for orthopaedic, spinal, dental and cardiovascular implants. Crevice corrosion has been a serious concern for stainless steel implants. For the first time we demonstrated and systematically studied the process of fretting-initiated crevice corrosion (FICC) in 316L stainless steel in simulated physiological solution of phosphate buffered saline. By removing the oxide film, fretting motion significantly facilitates the critical crevice solution development, lowering the critical crevice potential and decreasing the initiation time for crevice corrosion. Our findings indicate fundamental differences between the FICC mechanism and conventional crevice corrosion theory, showing that fretting can play a significant role in the initiation of crevice corrosion of stainless steel.

Enhanced corrosion resistance of zinc-containing nanowires-modified titanium surface under exposure to oxidizing microenvironment

Titanium (Ti) and its alloys as bio-implants have excellent biocompatibilities and osteogenic properties after modification of chemical composition and topography via various methods. The corrosion resistance of these modified materials is of great importance for changing oral system, while few researches have reported this point. Recently, oxidative corrosion induced by cellular metabolites has been well concerned. In this study, we explored the corrosion behaviors of four common materials (commercially pure Ti, cp-Ti; Sandblasting and acid etching-modified Ti, Ti-SLA; nanowires-modified Ti, Ti-NW; and zinc-containing nanowires-modified Ti, Ti-NW-Zn) with excellent biocompatibilities and osteogenic capacities under the macrophages induced-oxidizing microenvironment. The results showed that the materials immersed into a high oxidizing environment were more vulnerable to corrode. Meanwhile, different surfaces also showed various corrosion susceptibilities under oxidizing condition. Samples embed with zinc element exhibited more excellent corrosion resistance compared with other three surfaces exposure to excessive H₂O₂. Besides, we found that zinc-decorated Ti surfaces inhibited the adhesion and proliferation of macrophages on its surface and induced the M2 states of macrophages to better healing and tissue reconstruction. Most importantly, zinc-decorated Ti surfaces markedly increased the expressions of antioxidant enzyme relative genes in macrophages. It improved the oxidation microenvironment around the materials and further protected their properties. In summary, our results demonstrated that Ti-NW-Zn surfaces not only provided excellent corrosion resistance properties, but also inhibited the adhesion of macrophages. These aspects were necessary for maintaining osseointegration capacity and enhancing the corrosion resistance of Ti in numerous medical applications, particularly in dentistry.