Stainless steel wear debris of a scoliotic growth guidance system has little local and systemic effect in an animal model

Immunotoxicity of stainless-steel nanoparticles obtained after 3D printing

This study aims to investigate the in vitro effects of nanoparticles (NPs) produced during the selective laser melting (SLM) of 316 L stainless steel metal powder on the immune response in a human blood model. Experimental data did not reveal effect on viability of 316 L NPs for the tested doses. Functional immune assays showed a significant immunosuppressive effect of NPs. There was moderate stimulation (117%) of monocyte phagocytic activity without significant changes in phagocytic activity and respiratory burst of granulocytes. A significant dose-dependent increase in the levels of the pro-inflammatory cytokine TNF-a was found in blood cultures treated with NPs. On the contrary, IL-8 chemokine levels were significantly suppressed. The levels of the pro-inflammatory cytokine IL-6 were reduced by only a single concentration of NPs. These new findings can minimise potential health risks and indicate the need for more research in this area.

A comparison of the inflammatory host response to particulate debris adjacent to unlocked and locked screws of a growth guidance system for early onset scoliosis

PURPOSE

The SHILLA™ Growth Guidance system is a stainless-steel rod and screw system used for Early Onset Scoliosis which incorporates a unique flanged set screw designed to capture the rod, while allowing it to slide as the patient grows. Concomitant with this design is the potential for generation of wear debris and for an inflammatory host response. We hypothesized that the magnitude of the host response adjacent to the unlocked screws and rods would be greater than the host response to the locked rod/screws.

METHODS

Seven tissue samples adjacent to locked (3) and unlocked screws (4) from three SHILLA patients (mean implantation time of 19 post-operative months) with infantile idiopathic scoliosis were obtained as part of an explant analysis protocol during a PMDA-approved clinical trial in Japan. Gross appearance, high-resolution radiographs, and histology were assessed. ISO Standard 10993 Part 6 was used to assess the host response.

RESULTS

All three locked screw had no metallosis. In contrast, metallosis for unlocked screw tissue samples were rated as "ubiquitous" (2/4), "focal" (1/4), or "absent" (1/4). Microscopic metallic debris was found intracellularly and within interstices of fibrous connective tissues more frequently adjacent to unlocked screws compared to locked screws. Cell type and population scoring consistently showed a modestly larger inflammatory response (macrophages) in the unlocked tissue samples.

CONCLUSIONS

The peri-prosthetic tissue response to the unlocked rods/screws had a higher reactivity grade (slight reaction, Δ = 4.0) per ISO 10993 Part 6 compared to the locked screws in three patients with the SHILLA™ Growth Guidance scoliosis system.

QUANTITATIVE ASSESSMENTS OF FIRMNESS AND AUTOMATIC OPTIMIZATION METHODS OF TRAJECTORY FOR PEDICLE SCREWS

Pedicle screw placement is a common internal fixation technology used in spine surgery, with preoperative planning and assessment being one of the most important steps. Preoperative planning mainly refers to determining the path and parameters of screws, and preoperative assessment mainly refers to effects during and after operations (i.e., firmness, etc.). Technologies available at present lack effective quantitative assessments on the firmness of screws. Bone mineral density (BMD) is one of the most important influencing factors for firmness. To address the aforementioned problems, this study aimed to put forward quantitative assessments for the firmness of pedicle screws taking bone mass as the basis. In other words, quantitative assessments of the firmness of screw trajectories were made by computing the total mineral content of the bone supporting screws. Meanwhile, the quantitative assessment results of the firmness were used as the optimized objective functions to put forward and realize an automatic planning optimization method for screw trajectories. The findings of this study might provide more complete and simplified planning schemes for doctors, to enhance the postoperative firmness of screws effectively, prevent from issues such as the loosening of screws due to the low value of a patient’s bone mass, and promote the effects of operations.

Bio-Compatibility and Bio-Insulation of Implantable Electrode Prosthesis Ameliorated by A-174 Silane Primed Parylene-C Deposited Embedment

Microelectrodes for pain management, neural prosthesis or assistances have a huge medical demand, such as the application of pain management chip or retinal prosthesis addressed on age-related macular degeneration (AMD) and the retinitis pigmentosa (RP). Due to lifelong implanted in human body and direct adhesion of neural tissues, the electrodes and associated insulation materials should possess an ideal bio-compatibility, including non-cytotoxicity and no safety concern elicited by immune responses. Our goal intended to develop retinal prosthesis, an electrical circuit chip used for assisting neural electrons transmission on retina and ameliorating the retinal disability. Therefore, based on the ISO 10993 guidance for implantable medical devices, the electrode prosthesis with insulation material has to conduct bio-compatibility assessment including cytotoxicity, hemolysis, (skin) irritation and pathological implantation examinations. In this study, we manufactured inter-digitated electrode (IDE) chips mimic the electrode prosthesis through photolithography. The titanium and platinum composites were deposited onto a silicon wafer to prepare an electric circuit to mimic the electrode used in retinal prosthesis manufacture, which further be encapsulated to examine the bio-compatibility in compliance with ISO 10993 and ASTM guidance specifically for implantable medical devices. Parylene-C, polyimide and silicon carbide were selected as materials for electrode encapsulation in comparison. Our data revealed parylene-C coating showed a significant excellence on bio-insulation and bio-compatibility specifically addressed on implantable neuron stimulatory devices and provided an economic procedure to package the electrode prosthesis. Therefore, parylene C encapsulation should serve as a consideration for future application on retinal prosthesis manufacture and examination.