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Sun M, Hu X, Tian L, Yang X, Min L. Auxetic Biomedical Metamaterials for Orthopedic Surgery Applications: A Comprehensive Review. Orthop Surg 2024; 16:1801-1815. [PMID: 38961661 PMCID: PMC11293933 DOI: 10.1111/os.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
Poisson's ratio in auxetic materials shifts from typically positive to negative, causing lateral expansion during axial tension. This scale-independent characteristic, originating from tailored architectures, exhibits specific physical properties, including energy adsorption, shear resistance, and fracture resistance. These metamaterials demonstrate exotic mechanical properties with potential applications in several engineering fields, but biomedical applications seem to be one of the most relevant, with an increasing number of articles published in recent years, which present opportunities ranging from cellular repair to organ reconstruction with outstanding mechanical performance, mechanical conduction, and biological activity compared with traditional biomedical metamaterials. Therefore, focusing on understanding the potential of these structures and promoting theoretical and experimental investigations into the benefits of their unique mechanical properties is necessary for achieving high-performance biomedical applications. Considering the demand for advanced biomaterial implants in surgical technology and the profound advancement of additive manufacturing technology that are particularly relevant to fabricating complex and customizable auxetic mechanical metamaterials, this review focuses on the fundamental geometric configuration and unique physical properties of negative Poisson's ratio materials, then categorizes and summarizes auxetic material applications across some surgical departments, revealing efficacy in joint surgery, spinal surgery, trauma surgery, and sports medicine contexts. Additionally, it emphasizes the substantial potential of auxetic materials as innovative biomedical solutions in orthopedics and demonstrates the significant potential for comprehensive surgical application in the future.
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Affiliation(s)
- Minghao Sun
- Department of Orthopedic Surgery and Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Leilei Tian
- Department of AnesthesiologyWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Xiao Yang
- National Engineering Research Center for BiomaterialsSichuan UniversityChengduChina
- Provincial Engineering Research Center for Biomaterials Genome of SichuanSichuan UniversityChengduChina
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
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2
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Gil B, Hall TAG, Freeman DME, Ming D, Kechagias S, Nabilla S, Cegla F, van Arkel RJ. Wireless implantable bioelectronics with a direct electron transfer lactate enzyme for detection of surgical site infection in orthopaedics. Biosens Bioelectron 2024; 263:116571. [PMID: 39047650 DOI: 10.1016/j.bios.2024.116571] [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: 01/31/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
Periprosthetic infection is one of the most devastating complications following orthopaedic surgery. Rapid detection of an infection can change the treatment pathway and improve outcomes for the patient. In here, we propose a miniaturized lactate biosensor developed on a flexible substrate and integrated on a small-form bone implant to detect infection. The methods for lactate biosensor fabrication and integration on a bone implant are fully described within this study. The system performance was comprehensively electrochemically characterised, including with L-lactate solutions prepared in phosphate-buffered saline and culture medium, and interferents such as acetaminophen and ascorbic acid. A proof-of-concept demonstration was then conducted with ex vivo ovine femoral heads incubated with and without exposure to Staphylococcus epidermidis. The sensitivity, current density and limit-of-detection levels achieved by the biosensor were 1.25 μA mM-1, 1.51 μA.M-1.mm-2 and 66 μM, respectively. The system was insensitive to acetaminophen, while sensitivity to ascorbic acid was half that of the sensitivity to L-lactate. In the ex vivo bone model, S. epidermidis infection was detected within 5 h of implantation, while the control sample led to no change in the sensor readings. This pioneering work demonstrates a pathway to improving orthopaedic outcomes by enabling early infection diagnosis.
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Affiliation(s)
- Bruno Gil
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Thomas A G Hall
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - David M E Freeman
- Centre for Antimicrobial Optimisation, Imperial College London, Room 7S5, Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK; Department of Infectious Disease, School of Medicine, St Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK
| | - Damien Ming
- Centre for Antimicrobial Optimisation, Imperial College London, Room 7S5, Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK; Department of Infectious Disease, School of Medicine, St Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK
| | - Stylianos Kechagias
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Sasza Nabilla
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Frederic Cegla
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
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Chen Z, Wang B, Yang C, Lv Z, Wei Y, Pan T, Xuan F, Zhou X, Chen H, Shen H, Wang L, Zhang Y. 3D Printed Pedicle Screws with Microarc Oxidation Ceramic Interfaces Enhance Osteointegration and Orthopedic Fixation Feasibility. ACS APPLIED MATERIALS & INTERFACES 2024; 16:31983-31996. [PMID: 38865688 DOI: 10.1021/acsami.4c03628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Effective osteointegration is of great importance for pedicle screws in spinal fusion surgeries. However, the lack of osteoinductive activity of current screws diminishes their feasibility for osteointegration and fixation, making screw loosening a common complication worldwide. In this study, Ti-6Al-4V pedicle screws with full through-hole design were fabricated via selective laser melting (SLM) 3D printing and then deposited with porous oxide coatings by microarc oxidation (MAO). The porous surface morphology of the oxide coating and the release of bioactive ions could effectively support cell adhesion, migration, vascularization, and osteogenesis in vitro. Furthermore, an in vivo goat model demonstrated the efficacy of modified screws in improving bone maturation and osseointegration, thus providing a promising method for feasible orthopedic internal fixation.
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Affiliation(s)
- Zehao Chen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China
| | - Binghao Wang
- Guangxi Zhuang Autonomous Region Engineering Research Center for Biomaterials in Bone and Joint Degenerative Diseases, Guangxi Key Laboratory for Preclinical and Translational Research on Bone and Joint Degenerative Diseases, Affiliated Hospital of Youjiang Medical University, Baise, Guangxi 533000, China
- State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Chengliang Yang
- Guangxi Zhuang Autonomous Region Engineering Research Center for Biomaterials in Bone and Joint Degenerative Diseases, Guangxi Key Laboratory for Preclinical and Translational Research on Bone and Joint Degenerative Diseases, Affiliated Hospital of Youjiang Medical University, Baise, Guangxi 533000, China
| | - Zhendong Lv
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yu Wei
- Guangxi Zhuang Autonomous Region Engineering Research Center for Biomaterials in Bone and Joint Degenerative Diseases, Guangxi Key Laboratory for Preclinical and Translational Research on Bone and Joint Degenerative Diseases, Affiliated Hospital of Youjiang Medical University, Baise, Guangxi 533000, China
| | - Tianming Pan
- Danyang Hospital of Traditional Chinese Medicine, Jiangsu 212300, China
| | - Fuqing Xuan
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China
| | - Xingdie Zhou
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- School of Materials Science and Engineering, Shanghai University, Shanghai 200444, China
| | - Hao Chen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Hongxing Shen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Liqiang Wang
- State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yuhui Zhang
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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4
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Hall TAG, Theodoridis K, Kohli N, Cegla F, van Arkel RJ. Active osseointegration in an ex vivo porcine bone model. Front Bioeng Biotechnol 2024; 12:1360669. [PMID: 38585711 PMCID: PMC10995341 DOI: 10.3389/fbioe.2024.1360669] [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: 12/23/2023] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Achieving osseointegration is a fundamental requirement for many orthopaedic, oral, and craniofacial implants. Osseointegration typically takes three to 6 months, during which time implants are at risk of loosening. The aim of this study was to investigate whether osseointegration could be actively enhanced by delivering controllable electromechanical stimuli to the periprosthetic bone. First, the osteoconductivity of the implant surface was confirmed using an in vitro culture with murine preosteoblasts. The effects of active treatment on osseointegration were then investigated in a 21-day ex vivo model with freshly harvested cancellous bone cylinders (n = 24; Ø10 mm × 5 mm) from distal porcine femora, with comparisons to specimens treated by a distant ultrasound source and static controls. Cell viability, proliferation and distribution was evident throughout culture. Superior ongrowth of tissue onto the titanium discs during culture was observed in the actively stimulated specimens, with evidence of ten-times increased mineralisation after 7 and 14 days of culture (p < 0.05) and 2.5 times increased expression of osteopontin (p < 0.005), an adhesive protein, at 21 days. Moreover, histological analyses revealed increased bone remodelling at the implant-bone interface in the actively stimulated specimens compared to the passive controls. Active osseointegration is an exciting new approach for accelerating bone growth into and around implants.
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Affiliation(s)
- Thomas A G Hall
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Konstantinos Theodoridis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Nupur Kohli
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Frederic Cegla
- Non-Destructive Evaluation Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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Wang L, Huang H, Yuan H, Yao Y, Park JH, Liu J, Geng X, Zhang K, Hollister SJ, Fan Y. In vitro fatigue behavior and in vivo osseointegration of the auxetic porous bone screw. Acta Biomater 2023; 170:185-201. [PMID: 37634835 DOI: 10.1016/j.actbio.2023.08.040] [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: 03/27/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
The incidence of screw loosening, migration, and pullout caused by the insufficient screw-bone fixation stability is relatively high in clinical practice. To solve this issue, the auxetic unit-based porous bone screw (AS) has been put forward in our previous work. Its favorable auxetic effect can improve the primary screw-bone fixation stability after implantation. However, porous structure affected the fatigue behavior and in vivo longevity of bone screw. In this study, in vitro fatigue behaviors and in vivo osseointegration performance of the re-entrant unit-based titanium auxetic bone screw were studied. The tensile-tensile fatigue behaviors of AS and nonauxetic bone screw (NS) with the same porosity (51%) were compared via fatigue experiments, fracture analysis, and numerical simulation. The in vivo osseointegration of AS and NS were compared via animal experiment and biomechanical analysis. Additionally, the effects of in vivo dynamic tensile loading on the osseointegration of AS and NS were investigated and analyzed. The fatigue strength of AS was approximately 43% lower while its osseointegration performance was better than NS. Under in vivo dynamic tensile loading, the osseointegration of AS and NS both improved significantly, with the maximum increase of approximately 15%. Preferrable osseointegration of AS might compensate for the shortage of fatigue resistance, ensuring its long-term stability in vivo. Adequate auxetic effect and long-term stability of the AS was supposed to provide enough screw-bone fixation stability to overcome the shortages of the solid bone screw, developing the success of surgery and showing significant clinical application prospects in orthopedic surgery. STATEMENT OF SIGNIFICANCE: This research investigated the high-cycle fatigue behavior of re-entrant unit-based auxetic bone screw under tensile-tensile cyclic loading and its osseointegration performance, which has not been focused on in existing studies. The fatigue strength of auxetic bone screw was lower while the osseointegration was better than non-auxetic bone screw, especially under in vivo tensile loading. Favorable osseointegration of auxetic bone screw might compensate for the shortage of fatigue resistance, ensuring its long-term stability and longevity in vivo. This suggested that with adequate auxetic effect and long-term stability, the auxetic bone screw had significant application prospects in orthopedic surgery. Findings of this study will provide a theoretical guidance for design optimization and clinical application of the auxetic bone screw.
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Affiliation(s)
- Lizhen Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Huiwen Huang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Hao Yuan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Yan Yao
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Jeong Hun Park
- Wallace H. Coulter Department of Biomedical Engineering and Center for 3D Medical Fabrication, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, GA 30332, USA
| | - Jinglong Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Xuezheng Geng
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Kuo Zhang
- Laboratory Animal Science Center, Peking University Health Science Center, Beijing 100083, China
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering and Center for 3D Medical Fabrication, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, GA 30332, USA
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, China.
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6
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Lovera-Prado K, Vanaclocha V, Atienza CM, Vanaclocha A, Jordá-Gómez P, Saiz-Sapena N, Vanaclocha L. Barbed Dental Ti6Al4V Alloy Screw: Design and Bench Testing. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2228. [PMID: 36984107 PMCID: PMC10054258 DOI: 10.3390/ma16062228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND CONTEXT Dental implants are designed to replace a missing tooth. Implant stability is vital to achieving osseointegration and successful implantation. Although there are many implants available on the market, there is room for improvement. PURPOSE We describe a new dental implant with improved primary stability features. STUDY DESIGN Lab bench test studies. METHODS We evaluated the new implant using static and flexion-compression fatigue tests with compression loads, 35 Ncm tightening torque, displacement control, 0.01 mm/s actuator movement speed, and 9-10 Hz load application frequency, obtaining a cyclic load diagram. We applied variable cyclic loadings of predetermined amplitude and recorded the number of cycles until failure. The test ended with implant failure (breakage or permanent deformation) or reaching five million cycles for each load. RESULTS Mean stiffness was 1151.13 ± 133.62 SD N/mm, mean elastic limit force 463.94 ± 75.03 SD N, and displacement 0.52 ± 0.04 SD mm, at failure force 663.21 ± 54.23 SD N and displacement 1.56 ± 0.18 SD mm, fatigue load limit 132.6 ± 10.4 N, and maximum bending moment 729.3 ± 69.43 mm/N. CONCLUSIONS The implant fatigue limit is satisfactory for incisor and canine teeth and between the values for premolars and molars for healthy patients. The system exceeds five million cycles when subjected to a 132.60 N load, ensuring long-lasting life against loads below the fatigue limit.
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Affiliation(s)
- Keila Lovera-Prado
- CIRU-IMPLANT, S.L., Avenida Cornellà, 2-BJ, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Vicente Vanaclocha
- Department of Surgery, School of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Carlos M. Atienza
- Biomechanical Engineer, Biomechanics Institute of Valencia, Polytechnic University of Valencia, 46022 Valencia, Spain
| | - Amparo Vanaclocha
- Biomechanical Engineer, Biomechanics Institute of Valencia, Polytechnic University of Valencia, 46022 Valencia, Spain
| | - Pablo Jordá-Gómez
- Hospital General Universitario de Castellón, 12004 Castellón de la Plana, Spain
| | | | - Leyre Vanaclocha
- Medius Klinik, Ostfildern-Ruit Klinik für Urologie, Hedelfinger Strasse 166, 73760 Ostfildern, Germany
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Kohli N, Theodoridis K, Hall TAG, Sanz-Pena I, Gaboriau DCA, van Arkel RJ. Bioreactor analyses of tissue ingrowth, ongrowth and remodelling around implants: An alternative to live animal testing. Front Bioeng Biotechnol 2023; 11:1054391. [PMID: 36890911 PMCID: PMC9986429 DOI: 10.3389/fbioe.2023.1054391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction: Preclinical assessment of bone remodelling onto, into or around novel implant technologies is underpinned by a large live animal testing burden. The aim of this study was to explore whether a lab-based bioreactor model could provide similar insight. Method: Twelve ex vivo trabecular bone cylinders were extracted from porcine femora and were implanted with additively manufactured stochastic porous titanium implants. Half were cultured dynamically, in a bioreactor with continuous fluid flow and daily cyclic loading, and half in static well plates. Tissue ongrowth, ingrowth and remodelling around the implants were evaluated with imaging and mechanical testing. Results: For both culture conditions, scanning electron microscopy (SEM) revealed bone ongrowth; widefield, backscatter SEM, micro computed tomography scanning, and histology revealed mineralisation inside the implant pores; and histology revealed woven bone formation and bone resorption around the implant. The imaging evidence of this tissue ongrowth, ingrowth and remodelling around the implant was greater for the dynamically cultured samples, and the mechanical testing revealed that the dynamically cultured samples had approximately three times greater push-through fixation strength (p < 0.05). Discussion: Ex vivo bone models enable the analysis of tissue remodelling onto, into and around porous implants in the lab. While static culture conditions exhibited some characteristics of bony adaptation to implantation, simulating physiological conditions with a bioreactor led to an accelerated response.
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Affiliation(s)
- Nupur Kohli
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Konstantinos Theodoridis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Thomas A G Hall
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Inigo Sanz-Pena
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - David C A Gaboriau
- FILM, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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Microstructure and electrochemical behavior of contemporary Ti6Al4V implant alloys. JOURNAL OF BIO- AND TRIBO-CORROSION 2022; 8:26. [PMID: 35911172 PMCID: PMC9328449 DOI: 10.1007/s40735-021-00623-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ti6Al4V is the most common titanium alloy within the biomaterial field. While material standards for different variations of this alloy exist, there are only minimal requirements with respect to its microstructure which is directly related to the alloy's properties. Thus, a better understanding of the Ti6Al4V microstructure of common contemporary implant components and its effect on the electrochemical behavior is needed; including additively manufactured (AM) devices. Therefore, this study aimed at characterizing the microstructures of conventional and AM total joint replacement components, and to identify the effect of microstructure on the electrochemical behavior. Thus, 22 components from conventional (surgically retrieved cast and wrought implants) and AM implants (not previously implanted) were analysed to characterize microstructure by means of electron backscatter diffraction (EBSD) and energy dispersive X-Ray spectroscopy (EDS), and tested to determine its electrochemical behavior (potentiodynamic polarization and EIS). The microstructure of the conventional implants varied broadly but could be categorized into four groups as to their grain size and shape: fine equiaxed, coarse equiaxed, bimodal, and lamellar. The AM components exhibited a fifth category: lath-type. The AM components had a network of β-phase along the α-phase grain boundaries, prior β-grains, and manufacturing voids. Finally, the electrochemical study showed that the equiaxed coarse grains and lath-type grains (AM components) had inferior electrochemical behavior, whereas cast alloys had superior electrochemical behaviour; fine-grained wrought alloys likely provide the best compromise between electrochemical and mechanical properties.
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9
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Agarwal R, Malhotra S, Gupta V, Jain V. The application of Three-dimensional printing on foot fractures and deformities: A mini-review. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Tan N, van Arkel RJ. Topology Optimisation for Compliant Hip Implant Design and Reduced Strain Shielding. MATERIALS (BASEL, SWITZERLAND) 2021; 14:7184. [PMID: 34885337 PMCID: PMC8658148 DOI: 10.3390/ma14237184] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 01/12/2023]
Abstract
Stiff total hip arthroplasty implants can lead to strain shielding, bone loss and complex revision surgery. The aim of this study was to develop topology optimisation techniques for more compliant hip implant design. The Solid Isotropic Material with Penalisation (SIMP) method was adapted, and two hip stems were designed and additive manufactured: (1) a stem based on a stochastic porous structure, and (2) a selectively hollowed approach. Finite element analyses and experimental measurements were conducted to measure stem stiffness and predict the reduction in stress shielding. The selectively hollowed implant increased peri-implanted femur surface strains by up to 25 percentage points compared to a solid implant without compromising predicted strength. Despite the stark differences in design, the experimentally measured stiffness results were near identical for the two optimised stems, with 39% and 40% reductions in the equivalent stiffness for the porous and selectively hollowed implants, respectively, compared to the solid implant. The selectively hollowed implant's internal structure had a striking resemblance to the trabecular bone structures found in the femur, hinting at intrinsic congruency between nature's design process and topology optimisation. The developed topology optimisation process enables compliant hip implant design for more natural load transfer, reduced strain shielding and improved implant survivorship.
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Affiliation(s)
| | - Richard J. van Arkel
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK;
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11
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The limit of tolerable micromotion for implant osseointegration: a systematic review. Sci Rep 2021; 11:10797. [PMID: 34031476 PMCID: PMC8144379 DOI: 10.1038/s41598-021-90142-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/04/2021] [Indexed: 02/04/2023] Open
Abstract
Much research effort is being invested into the development of porous biomaterials that enhance implant osseointegration. Large micromotions at the bone-implant interface impair this osseointegration process, resulting in fibrous capsule formation and implant loosening. This systematic review compiled all the in vivo evidence available to establish if there is a universal limit of tolerable micromotion for implant osseointegration. The protocol was registered with the International Prospective Register for Systematic Reviews (ID: CRD42020196686). Pubmed, Scopus and Web of Knowledge databases were searched for studies containing terms relating to micromotion and osseointegration. The mean value of micromotion for implants that osseointegrated was 32% of the mean value for those that did not (112 ± 176 µm versus 349 ± 231 µm, p < 0.001). However, there was a large overlap in the data ranges with no universal limit apparent. Rather, many factors were found to combine to affect the overall outcome including loading time, the type of implant and the material being used. The tables provided in this review summarise these factors and will aid investigators in identifying the most relevant micromotion values for their biomaterial and implant development research.
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12
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Teo AQA, Yan L, Chaudhari A, O’Neill GK. Post-Processing and Surface Characterization of Additively Manufactured Stainless Steel 316L Lattice: Implications for BioMedical Use. MATERIALS 2021; 14:ma14061376. [PMID: 33809197 PMCID: PMC8002108 DOI: 10.3390/ma14061376] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
Additive manufacturing of stainless steel is becoming increasingly accessible, allowing for the customisation of structure and surface characteristics; there is little guidance for the post-processing of these metals. We carried out this study to ascertain the effects of various combinations of post-processing methods on the surface of an additively manufactured stainless steel 316L lattice. We also characterized the nature of residual surface particles found after these processes via energy-dispersive X-ray spectroscopy. Finally, we measured the surface roughness of the post-processing lattices via digital microscopy. The native lattices had a predictably high surface roughness from partially molten particles. Sandblasting effectively removed this but damaged the surface, introducing a peel-off layer, as well as leaving surface residue from the glass beads used. The addition of either abrasive polishing or electropolishing removed the peel-off layer but introduced other surface deficiencies making it more susceptible to corrosion. Finally, when electropolishing was performed after the above processes, there was a significant reduction in residual surface particles. The constitution of the particulate debris as well as the lattice surface roughness following each post-processing method varied, with potential implications for clinical use. The work provides a good base for future development of post-processing methods for additively manufactured stainless steel.
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Affiliation(s)
- Alex Quok An Teo
- Department of Orthopaedic Surgery, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; (A.Q.A.T.), (G.K.O.)
| | - Lina Yan
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, #07-08 Block EA, Singapore 117575, Singapore
- Correspondence: (L.Y.); (A.C.)
| | - Akshay Chaudhari
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, #07-08 Block EA, Singapore 117575, Singapore
- Correspondence: (L.Y.); (A.C.)
| | - Gavin Kane O’Neill
- Department of Orthopaedic Surgery, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; (A.Q.A.T.), (G.K.O.)
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Doyle R, van Arkel RJ, Muirhead-Allwood S, Jeffers JRT. Impaction technique influences implant stability in low-density bone model. Bone Joint Res 2020; 9:386-393. [PMID: 32793333 PMCID: PMC7393184 DOI: 10.1302/2046-3758.97.bjr-2019-0303.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims Cementless acetabular components rely on press-fit fixation for initial stability. In certain cases, initial stability is more difficult to obtain (such as during revision). No current study evaluates how a surgeon’s impaction technique (mallet mass, mallet velocity, and number of strikes) may affect component fixation. This study seeks to answer the following research questions: 1) how does impaction technique affect a) bone strain generation and deterioration (and hence implant stability) and b) seating in different density bones?; and 2) can an impaction technique be recommended to minimize risk of implant loosening while ensuring seating of the acetabular component? Methods A custom drop tower was used to simulate surgical strikes seating acetabular components into synthetic bone. Strike velocity and drop mass were varied. Synthetic bone strain was measured using strain gauges and stability was assessed via push-out tests. Polar gap was measured using optical trackers. Results A phenomenon of strain deterioration was identified if an excessive number of strikes was used to seat a component. This effect was most pronounced in low-density bone at high strike velocities. Polar gap was reduced with increasing strike mass and velocity. Conclusion A high mallet mass with low strike velocity resulted in satisfactory implant stability and polar gap, while minimizing the risk of losing stability due to over-striking. Extreme caution not to over-strike must be exercised when using high velocity strikes in low-density bone for any mallet mass. Cite this article: Bone Joint Res 2020;9(7):386–393.
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Affiliation(s)
- Ruben Doyle
- Department of Mechanical Engineering, Imperial College London, London, UK
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Use of longer sized screws is a salvage method for broken pedicles in osteoporotic vertebrae. Sci Rep 2020; 10:10441. [PMID: 32591573 PMCID: PMC7320151 DOI: 10.1038/s41598-020-67489-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022] Open
Abstract
Screw loosening due to broken pedicles is a common complication resulting from the insertion of screws either with inadequate diameters or into an osteoporotic pedicle. In this novel in vitro study, we tried to clarify the contribution of the pedicle to screw fixation and subsequent salvage strategies using longer or larger-diameter screws in broken pedicles. Sixty L4 fresh-frozen lumbar vertebrae harvested from mature pigs were designed as the normal-density group (n = 30) and decalcified as the osteoporosis group (n = 30). Three modalities were randomly assigned as intact pedicle (n = 30), semi-pedicle (n = 15), and non-pedicle (n = 15) in each group. Three sizes of polyaxial screws (diameter × length of 6.0 mm × 45 mm, 6.0 mm × 50 mm, and 6.5 mm × 45 mm) over five trials were used in each modality. The associations between bone density, pedicle modality and screw pullout strength were analyzed. After decalcification for 4 weeks, the area bone mineral density decreased to approximately 56% (p < 0.05) of the normal-density group, which was assigned as the osteoporosis group. An appropriate screw trajectory and insertional depth were confirmed using X-ray imaging prior to pullout testing in both groups. The pullout forces of larger-diameter screws (6.5 mm × 45 mm) and longer screws (6.0 mm × 50 mm) were significantly higher (p < 0.05) in the semi- and non-pedicle modalities in the normal-density group, whereas only longer screws (6.0 mm × 50 mm) had a significantly higher (p < 0.05) pullout force in the non-pedicle modalities in the osteoporosis group. The pedicle plays an important role in both the normal bone density group and the osteoporosis group, as revealed by analyzing the pullout force percentage contributed by the pedicle. Use of a longer screw would be a way to salvage a broken pedicle of osteoporotic vertebra.
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Huang YM, Huang CC, Tsai PI, Yang KY, Huang SI, Shen HH, Lai HJ, Huang SW, Chen SY, Lin FH, Chen CY. Three-Dimensional Printed Porous Titanium Screw with Bioactive Surface Modification for Bone-Tendon Healing: A Rabbit Animal Model. Int J Mol Sci 2020; 21:ijms21103628. [PMID: 32455543 PMCID: PMC7279243 DOI: 10.3390/ijms21103628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
The interference screw fixation method is used to secure a graft in the tibial tunnel during anterior cruciate ligament reconstruction surgery. However, several complications have been reported, such as biodegradable screw breakage, inflammatory or foreign body reaction, tunnel enlargement, and delayed graft healing. Using additive manufacturing (AM) technology, we developed a titanium alloy (Ti6Al4V) interference screw with chemically calcium phosphate surface modification technology to improve bone integration in the tibial tunnel. After chemical and heat treatment, the titanium screw formed a dense apatite layer on the metal surface in simulated body fluid. Twenty-seven New Zealand white rabbits were randomly divided into control and additive manufactured (AMD) screw groups. The long digital extensor tendon was detached and translated into a tibial plateau tunnel (diameter: 2.0 mm) and transfixed with an interference screw while the paw was in dorsiflexion. Biomechanical analyses, histological analyses, and an imaging study were performed at 1, 3, and 6 months. The biomechanical test showed that the ultimate pull-out load failure was significantly higher in the AMD screw group in all tested periods. Micro-computed tomography analyses revealed early woven bone formation in the AMD screw group at 1 and 3 months. In conclusion, AMD screws with bioactive surface modification improved bone ingrowth and enhanced biomechanical performance in a rabbit model.
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Affiliation(s)
- Yu-Min Huang
- Department of Biomedical Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-M.H.); (S.-W.H.); (F.-H.L.)
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei 100, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 100, Taiwan
| | - Chih-Chieh Huang
- Department of Materials Science and Engineering, National Chiao-Tung University, Hsinchu 300, Taiwan; (C.-C.H.); (S.-Y.C.)
| | - Pei-I Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan; (P.-IT.); (K.-Y.Y.); (S.-IH.); (H.-H.S.)
| | - Kuo-Yi Yang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan; (P.-IT.); (K.-Y.Y.); (S.-IH.); (H.-H.S.)
| | - Shin-I Huang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan; (P.-IT.); (K.-Y.Y.); (S.-IH.); (H.-H.S.)
| | - Hsin-Hsin Shen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan; (P.-IT.); (K.-Y.Y.); (S.-IH.); (H.-H.S.)
| | - Hong-Jen Lai
- Material and Chemical Research Laboratories, Industrial Technology Research Institute, Hsinchu 310, Taiwan;
| | - Shu-Wei Huang
- Department of Biomedical Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-M.H.); (S.-W.H.); (F.-H.L.)
| | - San-Yuan Chen
- Department of Materials Science and Engineering, National Chiao-Tung University, Hsinchu 300, Taiwan; (C.-C.H.); (S.-Y.C.)
| | - Feng-Huei Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-M.H.); (S.-W.H.); (F.-H.L.)
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli County 360, Taiwan
| | - Chih-Yu Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei 100, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-970-747767
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Athwal KK, Lord BR, Milner PE, Gutteridge A, Williams A, Amis AA. Redesigning Metal Interference Screws Can Improve Ease of Insertion While Maintaining Fixation of Soft-Tissue Anterior Cruciate Ligament Reconstruction Grafts. Arthrosc Sports Med Rehabil 2020; 2:e137-e144. [PMID: 32368750 PMCID: PMC7190538 DOI: 10.1016/j.asmr.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/12/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose To compare the fixation strength and loads on insertion of a titanium alloy interference screw with a modified tip against a conventional titanium interference screw. Methods Slippage of bovine digital extensor tendons (as substitutes for human tendon grafts) under cyclic loading and interference fixation strength under a pullout test were recorded in 10 cadaveric knees, with 2 tunnels drilled in each femur and tibia to provide pair-wise comparisons between the modified-tip screw (MS) and conventional screw (CS). To analyze screw insertion, 10 surgeons blindly inserted pairs of the MS and CS into bone-substitute blocks (with polyester shoelaces as graft substitutes), with insertion loads measured using a force/torque sensor. Results No differences were found between the MS and CS either in graft slippage from the femur (P = .661) or tibia (P = .950) or in ultimate load to failure from the femur (P = .952) or tibia (P = .126). On insertion, the MS required less axial force application (78 ± 38 N, P = .001) and fewer attempted turns (2 ± 1, P < .001) to engage with the bone tunnel than the CS (99 ± 43 N and 4 ± 4, respectively). In 90% of the paired insertion tests, the screw identified by the surgeon as being easier to initially insert was the MS. Conclusions The MS was found to be easier to engage with the bone tunnel and initially insert than the CS while still achieving similar immediate postsurgical fixation strength. Clinical Relevance The study shows that screw designs can be improved to ease insertion into a bone tunnel, which should reduce any likelihood of ligament reconstruction graft damage.
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Affiliation(s)
- Kiron K Athwal
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, England
| | - Breck R Lord
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, England
| | - Piers E Milner
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, England
| | | | | | - Andrew A Amis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, England.,Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, Charing Cross Hospital, London, England
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Correlating in-situ process monitoring data with the reduction in load bearing capacity of selective laser melted Ti-6Al-4V porous biomaterials. J Mech Behav Biomed Mater 2020; 106:103723. [PMID: 32250941 DOI: 10.1016/j.jmbbm.2020.103723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 11/20/2022]
Abstract
Selective Laser Melting allows for the creation of intricate porous structures, that possess favourable biological properties. These structures are known as porous biomaterials. The focus of this paper is to evaluate the use of an in-line photodiode based process monitoring system, for the monitoring of the operational behaviour of the laser, and to correlate this with the resultant parts mechanical performance. In this study the production scale Renishaw 500M was used to produce porous structures, using Ti-6Al-4V feedstock powder. During the process, a co-axial process monitoring system was utilised to generate data relating to both the meltpool and the operational behaviour of the laser. An advanced scanning technique was used to produce the structures, whereby the laser parameters determine the strut dimensions. In this study, the laser input energy was reduced by 33%, 66% and 100%, at specific layers within the structures. Computer Tomography and Scanning Electron Microscopy was utilised to characterise the affected struts within the structures, while quasi-static compression testing was used to determine the structure's mechanical properties. It was demonstrated that as the level of input energy decreased and the number of affected layers increased, a corresponding decrease in the load bearing capacity of the structures occurred. With the structures experiencing a significant loss in strength also exhibiting a change in the failure mode during compression testing. Data generated during the processing of such structures was compared to the data generated during the processing of control structures, with the difference between the two been calculated on a layer-by-layer basis. A clear correlation was demonstrated between the total level of deviation between the two signal sets and a reduction in the load bearing capacity of the structures. This indicates that by comparing build data to a benchmark data set, valuable information relating to the structural integrity of the porous structures can be obtained.
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18
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Diaz MA, Garrigues GE, Ricchetti ET, Gutierrez S, Frankle MA. Relationship Between Insertion Torque and Compression Strength in the Reverse Total Shoulder Arthroplasty Baseplate. J Orthop Res 2020; 38:871-879. [PMID: 31692052 DOI: 10.1002/jor.24506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/14/2019] [Indexed: 02/04/2023]
Abstract
Reverse shoulder arthroplasty is a well-established procedure, however, there is limited data in the literature regarding adequate insertion torque and the resulting compression for glenoid baseplate fixation. In this biomechanical study, we evaluated the relationship between insertion torque and baseplate compression by simultaneously measuring the insertion torque and axial compressive forces generated by two reverse shoulder arthroplasty baseplates with central screw design. Three different bone surrogates were chosen to mimic clinical scenarios where differences in compression achieved during baseplate insertion may exist due to varying bone quality. Epoxy resin sheets were combined with the bone surrogates to simulate the glenoid vault. A digital torque gauge was used to measure insertion torque applied to the baseplate, while compression data were collected continuously from a load cell. A strong positive correlation was found between baseplate compression and insertion torque. Among the lower density bone surrogates, neither baseplate design reached maximum insertion torque (6.8 Nm) due to material strip-out. This phenomenon did not occur in denser bone surrogates. Both baseplate designs experienced a significant increase in mean baseplate compression as insertion torque increased and were found to behave similar in the denser bone surrogates. The results presented here suggest that larger compressive forces can be achieved with an increase in insertion torque in denser bone surrogates, but caution must be used when trying to achieve fixation in poor-quality bone. Clinically, this could be useful preoperatively to minimize baseplate failure, and in further studies regarding baseplate design for improved initial fixation and stability. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:871-879, 2020.
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Affiliation(s)
- Miguel A Diaz
- Foundation for Orthopaedic Research & Education, Tampa, Florida
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Mark A Frankle
- Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, Florida.,Florida Orthopaedic Institute, Tampa, Florida
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19
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Su CA, Knapik DM, Trivedi NN, Megerian MF, Salata MJ, Voos JE. Femoral Interference Screw Fixation in ACL Reconstruction Using Bone-Patellar Tendon-Bone Grafts. JBJS Rev 2020; 8:e0066. [PMID: 32105240 DOI: 10.2106/jbjs.rvw.19.00066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Anterior cruciate ligament (ACL) reconstruction is a commonly performed orthopaedic procedure with numerous reconstructive graft and fixation options. Interference screws have become one of the most commonly utilized methods of securing ACL grafts such as bone-patellar tendon-bone (BPTB) autografts.
» The composition of interference screws has undergone substantial evolution over the past several decades, and numerous advantages and disadvantages are associated with each design.
» The composition, geometry, and insertional torque of interference screws have important implications for screw biomechanics and may ultimately influence the strength, stability of graft fixation, and biologic healing in ACL reconstruction.
» This article reviews the development and biomechanical properties of interference screws while examining outcomes, complications, and gaps in knowledge that are associated with the use of femoral interference screws during BPTB ACL reconstruction.
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Affiliation(s)
- Charles A Su
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nikunj N Trivedi
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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20
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Doyle R, van Arkel RJ, Jeffers JRT. Effect of impaction energy on dynamic bone strains, fixation strength, and seating of cementless acetabular cups. J Orthop Res 2019; 37:2367-2375. [PMID: 31317554 PMCID: PMC6851739 DOI: 10.1002/jor.24418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
Abstract
Seating a cementless acetabular cup via impaction is a balancing act; good cup fixation must be obtained to ensure adequate bone in-growth and cup apposition, while acetabular fracture must be avoided. Good impaction technique is essential to the success of hip arthroplasty. Yet little guidance exists in the literature to inform surgeons on "how hard" to hit. A drop rig and synthetic bone model were used to vary the energy of impaction strikes in low and high-density synthetic bone, while key parameters such as dynamic strain (quantifying fracture risk), implant fixation, and polar gap were measured. For high energy impaction (15 J) in low-density synthetic bone, a peak tensile strain was observed during impaction that was up to 3.4× as large as post-strike strain, indicating a high fracture risk. Diminishing returns were observed for pushout fixation with increasing energy. Eighty-five percent of the pushout fixation achieved using a 15 J impaction strike was attained by using a 7.5 J strike energy. Similarly, polar gap was only minimally reduced at high impaction energies. Therefore it is suggested that higher energy strikes increase fracture risk, but do not offer large improvements to fixation or implant-bone apposition. It may difficult be for surgeons to accurately deliver specific impaction energies, suggesting there is scope for operative tools to manage implant seating. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2367-2375, 2019.
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Affiliation(s)
- Ruben Doyle
- Department of Mechanical EngineeringImperial College LondonLondonSW7 2AZUnited Kingdom
| | - Richard J. van Arkel
- Department of Mechanical EngineeringImperial College LondonLondonSW7 2AZUnited Kingdom
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Singh M, Nanda HS, O'Rorke RD, Jakus AE, Shah AH, Shah RN, Webster RD, Steele TWJ. Voltaglue Bioadhesives Energized with Interdigitated 3D-Graphene Electrodes. Adv Healthc Mater 2018; 7:e1800538. [PMID: 30253081 DOI: 10.1002/adhm.201800538] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/25/2018] [Indexed: 01/08/2023]
Abstract
Soft tissue fixation of implant and bioelectrodes relies on mechanical means (e.g., sutures, staples, and screws), with associated complications of tissue perforation, scarring, and interfacial stress concentrations. Adhesive bioelectrodes address these shortcomings with voltage cured carbene-based bioadhesives, locally energized through graphene interdigitated electrodes. Electrorheometry and adhesion structure activity relationships are explored with respect to voltage and electrolyte on bioelectrodes synthesized from graphene 3D-printed onto resorbable polyester substrates. Adhesive leachates effects on in vitro metabolism and human-derived platelet-rich plasma response serves to qualitatively assess biological response. The voltage activated bioadhesives are found to have gelation times of 60 s or less with maximum shear storage modulus (G') of 3 kPa. Shear modulus mimics reported values for human soft tissues (0.1-10 kPa). The maximum adhesion strength achieved for the ≈50 mg bioelectrode films is 170 g cm-2 (17 kPa), which exceeds the force required for tethering of electrodes on dynamic soft tissues. The method provides the groundwork for implantable bio/electrodes that may be permanently incorporated into soft tissues, vis-à-vis graphene backscattering wireless electronics since all components are bioresorbable.
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Affiliation(s)
- Manisha Singh
- NTU‐Northwestern Institute for Nanomedicine Interdisciplinary Graduate School Nanyang Technological University 50 Nanyang Drive Singapore 637553 Singapore
- School of Materials Science and Engineering (MSE) Division of Materials Technology Nanyang Technological University (NTU) Singapore 639798 Singapore
| | - Himansu Sekhar Nanda
- School of Materials Science and Engineering (MSE) Division of Materials Technology Nanyang Technological University (NTU) Singapore 639798 Singapore
- Department of Mechanical Engineering PDPM‐Indian Institute of Information Technology Design and Manufacturing (IIITDM)‐Jabalpur Dumna Airport Road Jabalpur ‐482005 MP India
| | - Richard D. O'Rorke
- Singapore University of Technology and Design 8 Somapah Road Singapore 487372 Singapore
| | - Adam E. Jakus
- Department of Materials Science and Engineering Northwestern University 2220 Campus Drive Evanston IL 60208 USA
- Simpson Querrey Institute for BioNanotechnology Northwestern University 303 E Superior St. Chicago IL 60611 USA
- Department of Biomedical Engineering Northwestern University 2145 Sheridan Rd. Evanston IL 60611 USA
- Division of Organ Transplantation Comprehensive Transplant Center Department of Surgery Northwestern University 251 E Huron St. Chicago IL 60611 USA
| | - Ankur Harish Shah
- School of Materials Science and Engineering (MSE) Division of Materials Technology Nanyang Technological University (NTU) Singapore 639798 Singapore
| | - Ramille N. Shah
- Department of Materials Science and Engineering Northwestern University 2220 Campus Drive Evanston IL 60208 USA
- Simpson Querrey Institute for BioNanotechnology Northwestern University 303 E Superior St. Chicago IL 60611 USA
- Department of Biomedical Engineering Northwestern University 2145 Sheridan Rd. Evanston IL 60611 USA
- Division of Organ Transplantation Comprehensive Transplant Center Department of Surgery Northwestern University 251 E Huron St. Chicago IL 60611 USA
| | - Richard D. Webster
- Division of Chemistry and Biological Chemistry School of Physical and Mathematical Sciences Nanyang Technological University Singapore 637371 Singapore
| | - Terry W. J. Steele
- NTU‐Northwestern Institute for Nanomedicine Interdisciplinary Graduate School Nanyang Technological University 50 Nanyang Drive Singapore 637553 Singapore
- School of Materials Science and Engineering (MSE) Division of Materials Technology Nanyang Technological University (NTU) Singapore 639798 Singapore
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