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He X, Li Y, Zou D, Zu H, Li W, Zheng Y. An overview of magnesium-based implants in orthopaedics and a prospect of its application in spine fusion. Bioact Mater 2024; 39:456-478. [PMID: 38873086 PMCID: PMC11170442 DOI: 10.1016/j.bioactmat.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 06/15/2024] Open
Abstract
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.
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Affiliation(s)
- Xuan He
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Ye Li
- Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hong Kong SAR, PR China
| | - Da Zou
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Haiyue Zu
- Department of Orthopaedics, The First Affiliated Hospital of Suchow University, PR China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Comprehensive Scientific Research Building, Beijing, PR China
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2
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Wu YC, Hsieh MCW, Wang WT, Chang YH, Lee SS, Huang SH, Hou MF, Tseng CC, Kuo YR. A novel biodegradable magnesium skin staple: A safety and functional evaluation. Asian J Surg 2024; 47:3048-3055. [PMID: 38431472 DOI: 10.1016/j.asjsur.2024.02.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/21/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The potential of biodegradable magnesium (Mg) skin staple has recently garnered widespread attention due to their biodegradability and biocompatibility rather than traditional stainless steel staples, the most commonly used in current clinical practice. The aim of this study is to evaluate the safety and mechanical properties of a novel biodegradable Mg skin staple. METHODS A prototype of Mg skin staple was designed using a novel ZK60 Mg alloy. The mechanical properties of the staple were evaluated using a universal testing machine. The cytotoxicity of the staple was examined in vitro and the efficacy of the staple in wound closure was assessed in New Zealand rabbits for one and three weeks, respectively. RESULTS The tensile strength of this Mg alloy is 258.4 MPa with 6.9% elongation. The treatment of HaCaT and L929 cells with the staple extract resulted in over 95% cell viability, indicating no cytotoxicity. In vivo, no tissue irritation was observed. No difference was found in wound healing between the Mg skin staple and the stainless steel staple after one and three weeks in the cutting wound on the back of rabbits. Some Mg skin staples spontaneously dislodged from the skin within three weeks, while others were easily removed. CONCLUSION Our results confirm the safety, biocompatibility, and functionality of the novel Mg skin staple in wound closure. The efficacy of the staple in wound closure was demonstrated to be as effectively as conventional staples, with the added benefit of decreased long-term retention of skin staples in the wounds.
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Affiliation(s)
- Yi-Chia Wu
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; Department of Plastic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, 80145, Taiwan; Department of Surgery, School of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Meng-Chien Willie Hsieh
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; Department of Plastic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, 80145, Taiwan
| | - Wei-Ting Wang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Yen-Hao Chang
- Combination Medical Device Technology Division, Medical Devices and Opto-Electronics Equipment Department, Metal Industries Research & Development Centre, Kaohsiung, 82151, Taiwan
| | - Su-Shin Lee
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; Department of Surgery, School of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; Department of Surgery, School of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, 81267, Taiwan
| | - Ming-Feng Hou
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Chun-Chieh Tseng
- Combination Medical Device Technology Division, Medical Devices and Opto-Electronics Equipment Department, Metal Industries Research & Development Centre, Kaohsiung, 82151, Taiwan.
| | - Yur-Ren Kuo
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; Department of Surgery, School of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
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3
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Zheng L, Zhang R, Chen X, Luo Y, Du W, Zhu Y, Ruan YC, Xu J, Wang J, Qin L. Chronic kidney disease: a contraindication for using biodegradable magnesium or its alloys as potential orthopedic implants? Biomed Mater 2024; 19:045023. [PMID: 38815612 DOI: 10.1088/1748-605x/ad5241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/30/2024] [Indexed: 06/01/2024]
Abstract
Magnesium (Mg) has gained widespread recognition as a potential revolutionary orthopedic biomaterial. However, whether the biodegradation of the Mg-based orthopedic implants would pose a risk to patients with chronic kidney disease (CKD) remains undetermined as the kidney is a key organ regulating mineral homeostasis. A rat CKD model was established by a 5/6 subtotal nephrectomy approach, followed by intramedullary implantation of three types of pins: stainless steel, high pure Mg with high corrosion resistance, and the Mg-Sr-Zn alloy with a fast degradation rate. The long-term biosafety of the biodegradable Mg or its alloys as orthopedic implants were systematically evaluated. During an experimental period of 12 weeks, the implantation did not result in a substantial rise of Mg ion concentration in serum or major organs such as hearts, livers, spleens, lungs, or kidneys. No pathological changes were observed in organs using various histological techniques. No significantly increased iNOS-positive cells or apoptotic cells in these organs were identified. The biodegradable Mg or its alloys as orthopedic implants did not pose an extra health risk to CKD rats at long-term follow-up, suggesting that these biodegradable orthopedic devices might be suitable for most target populations, including patients with CKD.
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Affiliation(s)
- Lizhen Zheng
- Centre for Regenerative Medicine and Health, Hong Kong Institute of Science & Innovation, Chinese Academy of Sciences, Hong Kong Special Administrative Region of China, People's Republic of China
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Ri Zhang
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Xin Chen
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Ying Luo
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wanting Du
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Yuwei Zhu
- Department of Chemistry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Ye Chun Ruan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Jiankun Xu
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, People's Republic of China
| | - Jiali Wang
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, People's Republic of China
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ling Qin
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, People's Republic of China
- Hong Kong-Shenzhen Innovation and Technology Institute (Futian), The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, People's Republic of China
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4
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Antoniac I, Manescu (Paltanea) V, Antoniac A, Paltanea G. Magnesium-based alloys with adapted interfaces for bone implants and tissue engineering. Regen Biomater 2023; 10:rbad095. [PMID: 38020233 PMCID: PMC10664085 DOI: 10.1093/rb/rbad095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Magnesium and its alloys are one of the most used materials for bone implants and tissue engineering. They are characterized by numerous advantages such as biodegradability, high biocompatibility and mechanical properties with values close to the human bone. Unfortunately, the implant surface must be adequately tuned, or Mg-based alloys must be alloyed with other chemical elements due to their increased corrosion effect in physiological media. This article reviews the clinical challenges related to bone repair and regeneration, classifying bone defects and presenting some of the most used and modern therapies for bone injuries, such as Ilizarov or Masquelet techniques or stem cell treatments. The implant interface challenges are related to new bone formation and fracture healing, implant degradation and hydrogen release. A detailed analysis of mechanical properties during implant degradation is extensively described based on different literature studies that included in vitro and in vivo tests correlated with material properties' characterization. Mg-based trauma implants such as plates and screws, intramedullary nails, Herbert screws, spine cages, rings for joint treatment and regenerative scaffolds are presented, taking into consideration their manufacturing technology, the implant geometrical dimensions and shape, the type of in vivo or in vitro studies and fracture localization. Modern technologies that modify or adapt the Mg-based implant interfaces are described by presenting the main surface microstructural modifications, physical deposition and chemical conversion coatings. The last part of the article provides some recommendations from a translational perspective, identifies the challenges associated with Mg-based implants and presents some future opportunities. This review outlines the available literature on trauma and regenerative bone implants and describes the main techniques used to control the alloy corrosion rate and the cellular environment of the implant.
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Affiliation(s)
- Iulian Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 050094 Bucharest, Romania
| | - Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
- Faculty of Electrical Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
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5
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Chen C, Huang B, Liu Y, Liu F, Lee IS. Functional engineering strategies of 3D printed implants for hard tissue replacement. Regen Biomater 2022; 10:rbac094. [PMID: 36683758 PMCID: PMC9845531 DOI: 10.1093/rb/rbac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
Three-dimensional printing technology with the rapid development of printing materials are widely recognized as a promising way to fabricate bioartificial bone tissues. In consideration of the disadvantages of bone substitutes, including poor mechanical properties, lack of vascularization and insufficient osteointegration, functional modification strategies can provide multiple functions and desired characteristics of printing materials, enhance their physicochemical and biological properties in bone tissue engineering. Thus, this review focuses on the advances of functional engineering strategies for 3D printed biomaterials in hard tissue replacement. It is structured as introducing 3D printing technologies, properties of printing materials (metals, ceramics and polymers) and typical functional engineering strategies utilized in the application of bone, cartilage and joint regeneration.
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Affiliation(s)
- Cen Chen
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, PR China
| | - Bo Huang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, PR China
| | - Yi Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang 110002, PR China
| | - Fan Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang 110002, PR China
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6
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Jing X, Ding Q, Wu Q, Su W, Yu K, Su Y, Ye B, Gao Q, Sun T, Guo X. Magnesium-based materials in orthopaedics: material properties and animal models. BIOMATERIALS TRANSLATIONAL 2021; 2:197-213. [PMID: 35836647 PMCID: PMC9255805 DOI: 10.12336/biomatertransl.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/16/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
As a new generation of medical metal materials, degradable magnesium-based materials have excellent mechanical properties and osteogenic promoting ability, making them promising materials for the treatment of refractory bone diseases. Animal models can be used to understand and evaluate the performance of materials in complex physiological environments, providing relevant data for preclinical evaluation of implants and laying the foundation for subsequent clinical studies. To date, many researchers have studied the biocompatibility, degradability and osteogenesis of magnesium-based materials, but there is a lack of review regarding the effects of magnesium-based materials in vivo. In view of the growing interest in these materials, this review briefly describes the properties of magnesium-based materials and focuses on the safety and efficacy of magnesium-based materials in vivo. Various animal models including rats, rabbits, dogs and pigs are covered to better understand and evaluate the progress and future of magnesium-based materials. This literature analysis reveals that the magnesium-based materials have good biocompatibility and osteogenic activity, thus causing no adverse reaction around the implants in vivo, and that they exhibit a beneficial effect in the process of bone repair. In addition, the degradation rate in vivo can also be improved by means of alloying and coating. These encouraging results show a promising future for the use of magnesium-based materials in musculoskeletal disorders.
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Affiliation(s)
- Xirui Jing
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qiuyue Ding
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qinxue Wu
- Department of Clinical Medicine, Hubei Enshi College, Enshi, Hubei Province, China
| | - Weijie Su
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Keda Yu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yanlin Su
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Bing Ye
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qing Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tingfang Sun
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China,Corresponding author: Xiaodong Guo,
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7
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Luo Y, Wang J, Ong MTY, Yung PSH, Wang J, Qin L. Update on the research and development of magnesium-based biodegradable implants and their clinical translation in orthopaedics. BIOMATERIALS TRANSLATIONAL 2021; 2:188-196. [PMID: 35836649 PMCID: PMC9255812 DOI: 10.12336/biomatertransl.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/20/2021] [Accepted: 08/12/2021] [Indexed: 11/06/2022]
Abstract
Biodegradable magnesium (Mg) or its alloys are desirable materials for development into new-generation internal fixation devices or implants with high biocompatibility, adequate mechanical modulus, and osteopromotive properties, which may overcome some of the drawbacks of the existing permanent orthopaedic implants with regard to stress-shielding of bone and beam-hardening effects on radiographic images. This review summarises the current research status of Mg-based orthopaedic implants in animals and clinical trials. First, detailed information of animal studies including bone fracture repair and anterior cruciate ligament reconstruction with the use of Mg-based orthopaedic devices is introduced. Second, the repair mechanisms of the Mg-based orthopaedic implants are also reviewed. Afterwards, reports of recent clinical cases treated using Mg-based implants in orthopaedics are summarised. Finally, the challenges and the strategies of the use of Mg-based orthopaedic implants are discussed. Taken together, the collected efforts in basic research, translational work, and clinical applications of Mg-based orthopaedic implants over the last decades greatly contribute to the development of a new generation of biodegradable metals used for the design of innovative implants for better treatment of orthopaedic conditions in patients with challenging skeletal disorders or injuries.
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Affiliation(s)
- Ying Luo
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jue Wang
- Hanglok-Tech Co., Ltd., Zhuhai, Guangdong Province, China
| | - Michael Tim Yun Ong
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and The Chinese University of Hong Kong Shenzhen-Hong Kong Innovation and Technology Institute (Futian), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Patrick Shu-hang Yung
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and The Chinese University of Hong Kong Shenzhen-Hong Kong Innovation and Technology Institute (Futian), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jiali Wang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, Guangdong Province, China,Corresponding authors: Jiali Wang, , Ling Qin,
| | - Ling Qin
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and The Chinese University of Hong Kong Shenzhen-Hong Kong Innovation and Technology Institute (Futian), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China,Corresponding authors: Jiali Wang, , Ling Qin,
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8
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Wang J, Xu J, Hopkins C, Chow DH, Qin L. Biodegradable Magnesium-Based Implants in Orthopedics-A General Review and Perspectives. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:1902443. [PMID: 32328412 PMCID: PMC7175270 DOI: 10.1002/advs.201902443] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/06/2020] [Indexed: 05/10/2023]
Abstract
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.
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Affiliation(s)
- Jia‐Li Wang
- School of Biomedical EngineeringSun Yat‐sen UniversityGuangzhou510006P. R. China
- Musculoskeletal Research LaboratoryDepartment of Orthopaedics & TraumatologyThe Chinese University of Hong KongHong Kong SARP. R. China
| | - Jian‐Kun Xu
- Musculoskeletal Research LaboratoryDepartment of Orthopaedics & TraumatologyThe Chinese University of Hong KongHong Kong SARP. R. China
- Innovative Orthopaedic Biomaterial and Drug Translational Research LaboratoryLi Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong SARP. R. China
| | - Chelsea Hopkins
- Musculoskeletal Research LaboratoryDepartment of Orthopaedics & TraumatologyThe Chinese University of Hong KongHong Kong SARP. R. China
| | - Dick Ho‐Kiu Chow
- Musculoskeletal Research LaboratoryDepartment of Orthopaedics & TraumatologyThe Chinese University of Hong KongHong Kong SARP. R. China
- Innovative Orthopaedic Biomaterial and Drug Translational Research LaboratoryLi Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong SARP. R. China
| | - Ling Qin
- Musculoskeletal Research LaboratoryDepartment of Orthopaedics & TraumatologyThe Chinese University of Hong KongHong Kong SARP. R. China
- Innovative Orthopaedic Biomaterial and Drug Translational Research LaboratoryLi Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong SARP. R. China
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9
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Sun Y, Wu H, Wang W, Zan R, Peng H, Zhang S, Zhang X. Translational status of biomedical Mg devices in China. Bioact Mater 2019; 4:358-365. [PMID: 31909297 PMCID: PMC6939060 DOI: 10.1016/j.bioactmat.2019.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
Magnesium (Mg) and its alloys as temporary medical implants with biodegradable and properly mechanical properties have been investigated for a long time. There are already three kinds of biodegradable Mg implants which are approved by Conformite Europeene (CE) or Korea Food and Drug Administration (KFDA), but not China Food and Drug Administration (CFDA, now it is National Medical Products Administration, NMPA). As we know, Chinese researchers, surgeons, and entrepreneurs have tried a lot to research and develop biodegradable Mg implants which might become other new approved implants for clinical applications. So in this review, we present the representative Mg implants of three categories, orthopedic implants, surgical implants, and intervention implants and provide an overview of current achievement in China from academic publications and Chinese patents. We would like to provide a systematic way to translate Mg and its alloy implants from experiment designs to clinical products.
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Affiliation(s)
- Yu Sun
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Hongliu Wu
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Wenhui Wang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Rui Zan
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Hongzhou Peng
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Shaoxiang Zhang
- Suzhou Origin Medical Technology Co. Ltd., Suzhou, 215513, China
| | - Xiaonong Zhang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
- Suzhou Origin Medical Technology Co. Ltd., Suzhou, 215513, China
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10
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Wang H, Kang H, Yao J, Cheng CK, Woo SLY. Evaluation of a magnesium ring device for mechanical augmentation of a ruptured ACL: Finite element analysis. Clin Biomech (Bristol, Avon) 2019; 68:122-127. [PMID: 31200296 DOI: 10.1016/j.clinbiomech.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/04/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recently, a ring device was used for mechanical augmentation to aid the healing of ACL. In-vivo study using goat showed improved joint stability after ring repair in comparison to using biological augmentation alone. Objective of this study was to quantify the load and stress levels in the ACL and its femoral insertion site following ring repair. METHODS A three dimensional finite element model of a goat stifle joint was developed to find the load and stress level in the ACL and at its femoral insertion site following ring repair. FINDINGS Ring repair led to approximately a 50% reduction in anterior-posterior tibial translation over the model with a deficient ACL: 5.2 mm vs 10.6 mm, 4.4 mm vs 9.0 mm, and 2.9 mm vs 5.2 mm at joint flexion angles of 37°, 60° and 90° respectively. After ring repair, the in situ force in the ACL was restored to be nearly 60% of the intact ACL. The maximum Von Mises stress at the femoral insertion site was up to 71% of those for the intact ACL. INTERPRETATION This study offers new knowledge on the function of a ring device to mechanically augment ACL repair in order to improve its healing. Quantitative data on loading levels in the repaired ACL and its insertion site that led to its healing could be used as basis for developing novel devices to mechanically augment the healing of ACL in humans.
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Affiliation(s)
- Huizhi Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; Musculoskeletal Research Center, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Huijun Kang
- Musculoskeletal Research Center, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Jie Yao
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Cheng-Kung Cheng
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China.
| | - Savio L-Y Woo
- Musculoskeletal Research Center, University of Pittsburgh, Pittsburgh, PA 15219, USA.
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Nyland J, Gamble C, Franklin T, Caborn DNM. Permanent knee sensorimotor system changes following ACL injury and surgery. Knee Surg Sports Traumatol Arthrosc 2017; 25:1461-1474. [PMID: 28154888 DOI: 10.1007/s00167-017-4432-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/12/2017] [Indexed: 01/14/2023]
Abstract
The cruciate ligaments are components of the knee capsuloligamentous system providing vital neurosensory and biomechanical function. Since most historical primary ACL repair attempts were unsuccessful, reconstruction has become the preferred surgery. However, an increased understanding of the efficacy of lesion-site scaffolding, innovative suturing methods and materials, and evolving use of biological healing mediators such as platelet-rich plasma and stem cells has prompted reconsideration of what was once believed to be impossible. A growing number of in vivo animal studies and prospective clinical studies are providing increasing support for this intervention. The significance of ACL repair rather than reconstruction is that it more likely preserves the native neurosensory system, entheses, and ACL footprints. Tissue preservation combined with restored biomechanical function increases the likelihood for premorbid neuromuscular control system and dynamic knee stability recovery. This recovery should increase the potential for more patients to safely return to sports at their desired intensity and frequency. This current concepts paper revisits cruciate ligament neurosensory and neurovascular anatomy from the perspective of knee capsuloligamentous system function. Peripheral and central nerve pathways and central cortical representation mapping are also discussed. Surgical restoration of a more physiologically sound knee joint may be essential to solving the osteoarthritis dilemma. Innovative rehabilitative strategies and outcome measurement methodologies using more holistic and clinically relevant measurements that closely link biomechanical and neurosensory characteristics of physiological ACL function are discussed. Greater consideration of task-specific patient physical function and psychobehavioral links should better delineate the true efficacy of all ACL surgical and non-surgical interventions. Level of evidence IV.
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Affiliation(s)
- John Nyland
- Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203, USA.
| | - Collin Gamble
- School of Medicine, University of Louisville, 323 East Chestnut Street, Louisville, KY, 40202, USA
| | - Tiffany Franklin
- Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203, USA
| | - David N M Caborn
- Shea Orthopedic Group, KentuckyOne Health, 201 Abraham Flexner Way, Ste. 100, Louisville, KY, 40202, USA
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Biomechanical comparison of pure magnesium interference screw and polylactic acid polymer interference screw in anterior cruciate ligament reconstruction-A cadaveric experimental study. J Orthop Translat 2016; 8:32-39. [PMID: 30035092 PMCID: PMC5987054 DOI: 10.1016/j.jot.2016.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/23/2016] [Accepted: 09/09/2016] [Indexed: 01/13/2023] Open
Abstract
Background Polylactic acid polymer interference screws are commonly used in anterior cruciate ligament (ACL) reconstructions, especially in proximal tibia fixation. However, several concerns have been raised, including the acid products during its degradation in vivo. In recent years, biodegradable magnesium (Mg)-based implants have become attractive because of their favourable mechanical properties, which are more similar to those of natural bone when compared with other degradable materials, such as polymers, apart from their alkaline nature during degradation. Methods We developed a pure Mg interference screw for ACL reconstruction. In the present study, 24 fresh cadaver knees were used to compare the mechanical properties of pure Mg interference screws and polylactic acid polymer interference screws for ACL reconstruction via their application on the proximal tibia tested using specific robotics. Results Results showed that the pure Mg interference screw group showed similar mechanical stability to the polylactic acid polymer interference screw group, implying comparable postoperative fixation effects. Conclusion As there are no commercially available Mg-based interference screws for ACL reconstruction clinically and the in vivo degradation of pure Mg promotes bone formation, our cadaveric study supports its clinical tests for ACL reconstruction.
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