1
|
Tong X, Miao D, Zhou R, Shen X, Luo P, Ma J, Li Y, Lin J, Wen C, Sun X. Mechanical properties, corrosion behavior, and in vitro and in vivo biocompatibility of hot-extruded Zn-5RE (RE = Y, Ho, and Er) alloys for biodegradable bone-fixation applications. Acta Biomater 2024:S1742-7061(24)00375-1. [PMID: 38997078 DOI: 10.1016/j.actbio.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/27/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024]
Abstract
Biodegradable Zn alloys have significant application potential for hard-tissue implantation devices owing to their suitable degradation behavior and favorable biocompatibility. Nonetheless, pure Zn and its alloys in the as-cast state are mechanically instable and low in strength, which restricts their clinical applicability. Here, we report the exceptional mechanical, corrosion, and biocompatibility properties of hot-extruded Zn-5RE (wt.%, RE = rare earth of Y; or Ho; or Er) alloys intended for use in biodegradable bone substitutes. The microstructural characteristics, mechanical behavior, corrosion resistance, cytocompatibility, osteogenic differentiation, and capacity of osteogenesis in vivo of the Zn-5RE alloys are comparatively investigated. The Zn-5Y alloy demonstrates the best tensile properties, encompassing a 138 MPa tensile yield strength, a 302 MPa ultimate tensile strength, and 63% elongation, while the Zn-5Ho alloy shows the highest compression yield strength of 260 MPa and Vickers hardness of 104 HV. The Zn-5Er alloy shows a 126 MPa tensile yield strength, a 279 MPa ultimate tensile strength, 52% elongation, a 196 MPa compression yield strength, and a 101 HV Vickers microhardness. Further, the Zn-5Er alloy has a 130 µm per year corrosion rate in electrochemical tests and a 26 µm per year degradation rate in immersion tests, which is the lowest among the tested alloys. It also has the best in vitro osteogenic differentiation ability and capacity for osteogenesis and osteointegration in vivo after implantation in rat femurs among the Zn-5RE alloys, indicating promising potential in load-bearing biodegradable internal bone-fixation applications. STATEMENT OF SIGNIFICANCE: This work reports the exceptional mechanical, corrosion, and biocompatibility properties of hot-extruded (HE) Zn-5 wt.%-rare earth (Zn-5RE) alloys using single yttrium (Y), holmium (Ho), and erbium (Er) alloying for biodegradable bone-implant applications. Our findings demonstrate that the HE Zn-5Er alloy showed σuts of 279 MPa, tensile yield strength of 126 MPa, elongation of 51.6%, compression yield strength of 196 MPa, and microhardness of 101.2 HV. Further, HE Zn-5Er showed the lowest electrochemical corrosion rate of 130 µm/y and lowest degradation rate of 26 µm/y, and the highest in vitro osteogenic differentiation ability, in vivo osteogenesis, and osteointegration ability after implantation in rat femurs among the Zn-5RE alloys, indicating promising potential in load-bearing biodegradable internal bone-fixation applications.
Collapse
Affiliation(s)
- Xian Tong
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China; School of Materials Science and Engineering, Xiangtan University, Xiangtan 411105, China
| | - Daoyi Miao
- Department of Orthopaedics, The Third Affiliated Hospital of Wenzhou Medical University (Ruian People's Hospital), Wenzhou 325016, China
| | - Runqi Zhou
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Higher Education and Stomatological Hospital, Chongqing Medical University, Chongqing 401174, China
| | - Xinkun Shen
- Department of Orthopaedics, The Third Affiliated Hospital of Wenzhou Medical University (Ruian People's Hospital), Wenzhou 325016, China
| | - Peng Luo
- Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| | - Jianfeng Ma
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Yuncang Li
- Centre for Additive Manufacturing, School of Engineering, RMIT University, Melbourne, Victoria 3001, Australia
| | - Jixing Lin
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China.
| | - Cuie Wen
- Centre for Additive Manufacturing, School of Engineering, RMIT University, Melbourne, Victoria 3001, Australia.
| | - Xuecheng Sun
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| |
Collapse
|
2
|
Huang Y, Zhai X, Ma T, Zhang M, Pan H, Weijia Lu W, Zhao X, Sun T, Li Y, Shen J, Yan C, Du Y. Rare earth-based materials for bone regeneration: Breakthroughs and advantages. Coord Chem Rev 2022. [DOI: 10.1016/j.ccr.2021.214236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
3
|
Calvert GC, VanBuren Huffmon G, Rambo WM, Smith MW, McEntire BJ, Bal BS. Clinical outcomes for lumbar fusion using silicon nitride versus other biomaterials. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:33-48. [PMID: 32309644 PMCID: PMC7154368 DOI: 10.21037/jss.2019.12.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND In lumbar fusion surgery, intervertebral spacer cages made of silicon nitride (Si3N4) ceramic are an available option among other biomaterials. While the surface chemistry of Si3N4 is known to favor bone fusion, large-scale clinical studies attesting to its efficacy are lacking. This multicenter retrospective study compared lumbar fusion outcomes for Si3N4 cages to previously reported data for other cage materials. METHODS Pre-operative patient demographics, comorbidities, changes in visual analog scale (ΔVAS) pain scores, complications, adverse events, and secondary surgical interventions (SSI) were compiled from the records of 450 patients who underwent Si3N4 lumbar spinal fusion at four separate U.S. surgical centers. For comparison, MEDLINE/PubMed and Google Scholar searches identified studies reporting similar outcomes for other biomaterials. A total of 1,025 patients from 26 cohorts reported in 14 publications met inclusion criteria for this control group. RESULTS Overall, the mean last-follow-up for all patients was 341±293 days (11.4±9.8 months), with the longest follow-up being 6.4 years. Patients with Si3N4 implants were similar in gender and age distribution to the control group but had higher BMI values (30.9±6.1 vs. 25.8±4.1, P<0.01) and lower tobacco use (15.8% vs. 30.0%, P<0.01). Both the Si3N4 and control groups showed significant improvements in VAS pain scores from preoperative to last follow-up. For the Si3N4 group, ΔVAS was 36.8±35.4 points compared to 37.6±22.5 points (P=0.63) for the metadata group. Complications and reoperations for the Si3N4 and the control groups were similar (i.e., 9.8% and 3.1% versus 12.4% and 2.9%, P=0.16 and P=0.84, respectively). CONCLUSIONS Lumbar fusion with Si3N4 spacers compared favorably with the improvements reported with other commonly used biomaterial cages.
Collapse
|
4
|
Calvert GC, Huffmon GV, Rambo WM, Smith MW, McEntire BJ, Bal BS. Clinical outcomes for anterior cervical discectomy and fusion with silicon nitride spine cages: a multicenter study. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:504-519. [PMID: 32043001 PMCID: PMC6989924 DOI: 10.21037/jss.2019.11.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/12/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intervertebral spacers made of silicon nitride (Si3N4) are currently used in cervical and thoracolumbar fusion. While basic science data demonstrate several advantages of Si3N4 over other biomaterials, large-scale clinical results on its safety and efficacy are lacking. This multicenter retrospective study examined outcomes for anterior cervical discectomy and fusion (ACDF) using Si3N4 cages. Results were compared to compiled metadata for other ACDF materials. METHODS Pre-operative patient demographics, comorbidities, changes in visual analog scale (VAS) pain scores, complications, adverse events, and secondary surgical interventions were collected from the medical records of 860 patients who underwent Si3N4 ACDF at four surgical centers. For comparison, MEDLINE/PubMed and Google Scholar searches were performed for ACDF using other cage or spacer materials. Nine studies with 13 cohorts and 736 patients met the inclusion criteria for this control group. RESULTS Overall, the mean last-follow-up for all patients was 319±325 days (10.6±10.8 months), with the longest follow-up being 6.5 years. In comparison to the metadata, patients from the Si3N4 groups were older (57.9±12.2 vs. 56.8±11.1 y, P=0.06) and had higher BMI values (30.0±6.3 vs. 28.1±6.5, P<0.01), but gender and smoking were not different. The Si3N4 patients reported significant improvements in VAS pain scores at last follow-up (i.e., pre-op of 71.0±22.1 vs. follow-up of 36.4±31.5, P<0.01). Although both preoperative and last-follow-up pain scores were higher for Si3N4 patients than the control, the overall change in scores (ΔVAS) was similar. From pre-op to last-follow up, ΔVAS values were 35.4±34.3 for patients receiving the Si3N4 implants versus 34.4±27.3 for patients from the meta-analysis (P=0.56). The complication and reoperation rate for the Si3N4 and the metadata were also comparable (i.e., 7.39% and 0.31% versus 9.79% and 0%, P=0.17 and 0.25, respectively). CONCLUSIONS ACDF outcomes using Si3N4 implants matched the clinical efficacy of other cage biomaterials.
Collapse
Affiliation(s)
| | | | | | - Micah W. Smith
- Ortho Northeast, 11130 Parkview Plaza Dr., Fort Wayne, IN, USA
| | | | | |
Collapse
|
5
|
Awad KR, Ahuja N, Shah A, Tran H, Aswath PB, Brotto M, Varanasi V. Silicon nitride enhances osteoprogenitor cell growth and differentiation via increased surface energy and formation of amide and nanocrystalline HA for craniofacial reconstruction. MEDICAL DEVICES & SENSORS 2019; 2:e10032. [PMID: 35781939 PMCID: PMC9248716 DOI: 10.1002/mds3.10032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
The bioactive silicon nitride (Si3N4) has been FDA cleared for use as spinal intervertebral arthrodesis devices. Because its surface properties promote bone ongrowth and ingrowth, it also has the potential to benefit craniofacial reconstruction. Thus, the aim of this work was to determine whether the surface properties of Si3N4 could enhance the osteoblast cell growth, differentiation and nucleation of hydroxyapatite (HA) crystals compared to conventional implant materials such as titanium (Ti) and polyether ether ketone (PEEK). X-ray absorbance near-edge structure analysis (XANES) indicated the presence of Si-Si, Si-O and Si-N bonding. Surface wettability studies confirmed that Si3N4 exhibits the lowest contact angle and highest surface energy. Cell culture studies showed that osteoblast growth was enhanced on Si3N4 after 1 day and up to 7 days. Si3N4 surface induced highest surface coverage and thickness of nanocrystalline HA (211) and (203) in cell-free in vitro studies after 7 days of culture. Raman spectroscopy analysis confirmed the presence of surface functional groups consisting of phosphate and carbonate species. Interestingly, Si3N4 surface showed amide and hydroxyproline groups, the precursors to collagen, which were not observed on Ti and PEEK surfaces. Furthermore, Si3N4 surface indicated high expression of RUNX2, enhanced cell differentiation and dense collagenous ECM after 30 days of the in vitro study. The present study concluded that Si3N4 surface enhances osteoprogenitor cell adhesion, growth, RUNX2 expression and ECM formation via the coupled effects of higher surface energy and the presence of amide and nanocrystalline HA functional groups.
Collapse
Affiliation(s)
- Kamal R. Awad
- Department of Material Science and Engineering, University of Texas at Arlington, Arlington, Texas
- Department of Refractories and Ceramics, National Research Centre, Giza, Egypt
| | - Neelam Ahuja
- College of Nursing & Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Ami Shah
- Department of Material Science and Engineering, University of Texas at Arlington, Arlington, Texas
| | - Henry Tran
- College of Nursing & Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Pranesh B. Aswath
- Department of Material Science and Engineering, University of Texas at Arlington, Arlington, Texas
| | - Marco Brotto
- College of Nursing & Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Venu Varanasi
- Department of Material Science and Engineering, University of Texas at Arlington, Arlington, Texas
- College of Nursing & Health Innovation, University of Texas at Arlington, Arlington, Texas
| |
Collapse
|
6
|
Kersten RFMR, Wu G, Pouran B, van der Veen AJ, Weinans HH, de Gast A, Öner FC, van Gaalen SM. Comparison of polyetheretherketone versus silicon nitride intervertebral spinal spacers in a caprine model. J Biomed Mater Res B Appl Biomater 2018; 107:688-699. [PMID: 30091515 DOI: 10.1002/jbm.b.34162] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/22/2018] [Accepted: 04/29/2018] [Indexed: 12/17/2022]
Abstract
Polyetheretherketone (PEEK) is commonly used as a spinal spacer for intervertebral fusion surgery. Unfortunately, PEEK is bioinert and does not effectively osseointegrate into living bone. In contrast, comparable spacers made of silicon nitride (Si3 N4 ) possess a surface nanostructure and chemistry that encourage appositional bone healing. This observational study was designed to compare the outcomes of these two biomaterials when implanted as spacers in an adult caprine model. Lumbar interbody fusion surgeries were performed at two adjacent levels in eight adult goats using implants of PEEK and Si3 N4 . At six-months after surgery, the operative and adjacent spinal segments were extracted and measured for bone fusion, bone volume, bone-implant contact (BIC) and soft-tissue implant contact (SIC) ratios, and biodynamic stability. The null hypothesis was that no differences in these parameters would be apparent between the two groups. Fusion was observed in seven of eight implants in each group with greater bone formation in the Si3 N4 group (52.6%) versus PEEK (27.9%; p = 0.2). There were no significant differences in BIC ratios between PEEK and Si3 N4 , and the biodynamic stability of the two groups was also comparable. The results suggest that Si3 N4 spacers are not inferior to PEEK and they may be more effective in promoting arthrodesis. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 00B: 000-000, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 688-699, 2019.
Collapse
Affiliation(s)
- Roel F M R Kersten
- Department of Orthopedic Surgery, Clinical Orthopedic Research Center midden-Nederland (CORCmN), Diakonessenhuis, Utrecht, The Netherlands.,Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU), Amsterdam, The Netherlands
| | - Behdad Pouran
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands
| | - Albert J van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Harrie H Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands
| | - Arthur de Gast
- Department of Orthopedic Surgery, Clinical Orthopedic Research Center midden-Nederland (CORCmN), Diakonessenhuis, Utrecht, The Netherlands
| | - F Cumhur Öner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven M van Gaalen
- Department of Orthopedic Surgery, Clinical Orthopedic Research Center midden-Nederland (CORCmN), Diakonessenhuis, Utrecht, The Netherlands
| |
Collapse
|
7
|
Smith MW, Romano DR, McEntire BJ, Bal BS. A single center retrospective clinical evaluation of anterior cervical discectomy and fusion comparing allograft spacers to silicon nitride cages. JOURNAL OF SPINE SURGERY (HONG KONG) 2018; 4:349-360. [PMID: 30069528 PMCID: PMC6046334 DOI: 10.21037/jss.2018.06.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 04/27/2023]
Abstract
BACKGROUND Iliac crest autograft or allograft spacers have been traditionally utilized in anterior cervical discectomy and fusion (ACDF) to provide vertebral stabilization and enhanced osteogenesis. However, abiotic cages have largely replaced these allogenic sources due to host-site morbidities and disease transmission risks, respectively. Although devices made of polyetheretherketone (PEEK) or titanium-alloys (Ti) have gained wide popularity, they lack osteoinductive or conductive capabilities. In contrast, silicon nitride (Si3N4) is a relatively new implant material that also provides structural stability and yet purportedly offers osteopromotive and antimicrobial behavior. This study compared radiographic outcomes at ≥12 months of follow-up for osseous integration, fusion rate, time to fusion, and subsidence in ACDF patients with differing intervertebral spacers. METHODS Fifty-eight ACDF patients (108 segments) implanted with Si3N4 cages were compared to thirty-four similar ACDF patients (61 segments) implanted with fibular allograft spacers. Lateral radiographs (normal, flexion, and extension) were obtained at 3, 6, 12, and 24 months to assess osseous integration, the presence of bridging bone, the absence of peri-implant radiolucencies, subsidence, and fusion using both interspinous distance (ISD) and Cobb angle methods. RESULTS In patients with ≥12 months of follow-up, fusion for the allograft spacers and Si3N4 cages was 86.84% and 96.83%, respectively (ISD method, P=0.10), and 67.65% and 84.13%, respectively (Cobb angle method P=0.07), while osseointegration was 76.32% and 93.65%, respectively (P=0.02). The time to fusion significantly favored the Si3N4 cages (4.08 vs. 8.64 months (ISD method, P=0.01), and 6.76 vs. 11.74 months (Cobb angle method, P=0.04). The assessed time for full osseointegration was 7.83 and 19.24 months for Si3N4 and allograft, respectively (P=0.00). Average subsidence at 1-year follow-up was 0.51 and 2.71 mm for the Si3N4 and allograft cohorts, respectively (P=0.00). CONCLUSIONS In comparison to fibular allograft spacers, Si3N4 cages showed earlier osseointegration and fusion, higher fusion rates, and less subsidence.
Collapse
Affiliation(s)
| | | | | | - B. Sonny Bal
- Amedica Corporation, Salt Lake City, UT, USA
- Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, MO, USA
| |
Collapse
|