Mg-Zr-Sr alloys as biodegradable implant materials

A comprehensive review on the role of strontium in biodegradable metals

Biodegradable metals, including magnesium, iron, and zinc alloys, have attracted extensive attention due to their good biodegradability and biocompatibility. However, the mechanical properties and corrosion rates of most biodegradable metallic materials have not yet reached the ideal level required for clinical applications. Strontium, as an element of Group IIA in the periodic table of elements, has similar chemical and biological properties to calcium. It can promote bone tissue development and increase bone strength. In addition, strontium can also promote angiogenesis and facilitate the repair of infarcted heart activity. Thus, strontium is commonly used as one of the most alloying elements to improve the in vitro and in vivo properties of biodegradable metals. Besides, strontium is also widely used in various bioactive coatings to improve the comprehensive properties of biodegradable metals. This paper outlines the role of strontium in the human body and summarizes recent research and applications of strontium-containing biodegradable metallic materials. Finally, this paper also provides an outlook on the challenges faced in applying and researching strontium in biodegradable metals.

Biodegradable Zn-2Cu-0.5Zr alloy promotes the bone repair of senile osteoporotic fractures via the immune-modulation of macrophages

Delayed bone-healing of senile osteoporotic fractures remains a clinical challenge due to the alterations caused by aging in bone and immune systems. The novel biomaterials that address the deficiencies in both skeletal cells and immune systems are required to effectively treat the bone injuries of older patients. Zinc (Zn) has shown promise as a biodegradable material for use in orthopedic implants. To address the bone-healing deficiencies in elderly patients with bone injuries, we developed a biodegradable Zn-based alloy (Zn-2Cu-0.5Zr) with enhanced mechanical properties, including a yield strength of 198.7 MPa and ultimate tensile strength of 217.6 MPa, surpassing those of pure Zn and Zn-2Cu alloys. Cytotoxicity tests conducted on bone marrow mesenchymal stem cells (BMSCs) and MC3T3-E1 cells demonstrated that the extracts from Zn-2Cu-0.5Zr alloy exhibited no observable cytotoxic effects. Furthermore, the extracts of Zn-2Cu-0.5Zr alloy exhibited significant anti-inflammatory effects through regulation of inflammation-related cytokine production and modulation of macrophage polarization. The improved immune-osteo microenvironment subsequently contributed to osteogenic differentiation of BMSCs. The potential therapeutic application of Zn-2Cu-0.5Zr in senile osteoporotic fracture was tested using a rat model of age-related osteoporosis. The Zn-2Cu-0.5Zr alloy met the requirements for load-bearing applications and accelerated the healing process in a tibial fracture in aged rats. The imaging and histological analyses showed that it could accelerate the bone-repair process and promote the fracture healing in senile osteoporotic rats. These findings suggest that the novel Zn-2Cu-0.5Zr alloy holds potential for influencing the immunomodulatory function of macrophages and facilitating bone repair in elderly individuals with osteoporosis.

Surface engineering of pure magnesium in medical implant applications

This review comprehensively surveys the latest advancements in surface modification of pure magnesium (Mg) in recent years, with a focus on various cost-effective procedures, comparative analyses, and assessments of outcomes, addressing the merits and drawbacks of pure Mg and its alloys. Diverse economically feasible methods for surface modification, such as hydrothermal processes and ultrasonic micro-arc oxidation (UMAO), are discussed, emphasizing their exceptional performance in enhancing surface properties. The attention is directed towards the biocompatibility and corrosion resistance of pure Mg, underscoring the remarkable efficacy of techniques such as Ca-deficientca-deficient hydroxyapatite (CDHA)/MgF2 bi-layer coating and UMAO coating in electrochemical processes. These methods open up novel avenues for the application of pure Mg in medical implants. Emphasis is placed on the significance of adhering to the principles of reinforcing the foundation and addressing the source. The advocacy is for a judicious approach to corrosion protection on high-purity Mg surfaces, aiming to optimize the overall mechanical performance. Lastly, a call is made for future in-depth investigations into areas such as composite coatings and the biodegradation mechanisms of pure Mg surfaces, aiming to propel the field towards more sustainable and innovative developments.

Synergistic Improvement of Antibacterial and Osteogenic Differentiation of Thermomechanically Processed Mg-Zr-Sr-Ce Alloy: Insights into the Role of Precipitate Evolution Supported by AIMD Simulation Study

In the present study, we have discussed the influence of forging temperature (623 K (FT623), 723 K (FT723) and 823 K (FT823)) on microstructure and texture evolution and its implication on mechanical behavior, in vitro-in vivo biocorrosion, antibacterial response, and cytocompatibility of microalloyed Mg-Zr-Sr-Ce alloy. Phase analysis, SEM, and TEM characterization confirm the presence of Mg12Ce precipitate, and its stability was further validated by performing ab initio molecular dynamic simulation study. FT723 exhibits strengthened basal texture, higher fraction of second phases, and particle-stimulated nucleation-assisted DRX grains compared to other two specimens, resulting in superior strength with comparable ductility. FT723 also exhibits superior corrosion resistance mainly due to the strengthened basal texture and lower dislocation density. All the specimens exhibit excellent antibacterial behavior with Gram-negative E. coli, Gram-positive Staphylococcus aureus, and Pseudomonas aeruginosa bacteria. 100% reduction of bacterial growth is observed within 24 h of culture of the specimens. Cytocompatibility was determined by challenging specimen extracts with the MC3T3-E1 cell lines. FT723 specimen exhibits the highest cell proliferation and alkaline phosphatase activity (ALP) because of its superior corrosion resistance. The ability of the specimens to be used in orthopedic implant application was evaluated by in vivo study in rabbit femur. Neither tissue-related infection nor the detrimental effect surrounding the implant was confirmed from histological analysis. Significant higher bone regeneration surrounding the FT723 specimen was observed in SEM analysis and fluorochrome labeling. After 60 days, the FT723 specimen exhibits the highest bone formation, suggesting it is a suitable candidate for orthopedic implant application.

Enhanced Mechanical Properties, Corrosion Resistance, Cytocompatibility, Osteogenesis, and Antibacterial Performance of Biodegradable Mg-2Zn-0.5Ca-0.5Sr/Zr Alloys for Bone-Implant Application

Magnesium (Mg) alloys are widely used in bone fixation and bone repair as biodegradable bone-implant materials. However, their clinical application is limited due to their fast corrosion rate and poor mechanical stability. Here, the development of Mg-2Zn-0.5Ca-0.5Sr (MZCS) and Mg-2Zn-0.5Ca-0.5Zr (MZCZ) alloys with improved mechanical properties, corrosion resistance, cytocompatibility, osteogenesis performance, and antibacterial capability is reported. The hot-extruded (HE) MZCZ sample exhibits the highest ultimate tensile strength of 255.8 ± 2.4 MPa and the highest yield strength of 208.4 ± 2.8 MPa and an elongation of 15.7 ± 0.5%. The HE MZCS sample shows the highest corrosion resistance, with the lowest corrosion current density of 0.2 ± 0.1 µA cm-2 and the lowest corrosion rate of 4 ± 2 µm per year obtained from electrochemical testing, and a degradation rate of 368 µm per year and hydrogen evolution rate of 0.83 ± 0.03 mL cm-2 per day obtained from immersion testing. The MZCZ sample shows the highest cell viability in relation to MC3T3-E1 cells among all alloy extracts, indicating good cytocompatibility except at 25% concentration. Furthermore, the MZCZ alloy shows good antibacterial capability against Staphylococcus aureus.

Improved corrosion resistance and mechanical properties of severely deformed ZM31 alloy

The hexagonal close-packed (HCP) crystal structure of Mg alloys lead to poor formability as well as other undesirable mechanical behaviors in an otherwise highly sought-after alloy for commercial use. This study investigates the evolution of microstructure, texture, corrosion and mechanical behaviors in Mg-Zn-Mn (ZM31) alloy after processing using Equal Channel Angular Pressing (ECAP). Dynamic recrystallization was evident in the ECAP-processed samples, correlated with a substantial fiber structure, and resulted in the attainment of notable grain refinement and high lattice strain. Average grain sizes of 2.2 and 2 μm were achieved via 2 and 4-Pass Bc processing, respectively. This significant refinement yielded lower corrosion rates through enhancement of the thickness, coherency, and stability of formed protective oxide layers. The corrosion rate in the NaCl medium was substantially enhanced by 99.5% after four passes via route Bc. The recrystallized fine structure was found to have contributed to yield strength, ultimate strength, and microhardness improvements. Deformation enhanced yield and ultimate strengths by 132% and 64%, respectively. The distinctive grain refinement mechanism exhibited through the current ECAP procedure has potential to pave the way for novel and impactful utilizations of ZM31 in industries that demand exceptional mechanical and corrosion performance.

The development of magnesium-based biomaterials in bone tissue engineering: A review

Bone regeneration is a vital clinical challenge in massive or complicated bone defects. Recently, bone tissue engineering has come to the fore to meet the demand for bone repair with various innovative materials. However, the reported materials usually cannot satisfy the requirements, such as ideal mechanical and osteogenic properties, as well as biocompatibility at the same time. Mg-based biomaterials have considerable potential in bone tissue engineering owing to their excellent mechanical strength and biosafety. Moreover, the biocompatibility and osteogenic activity of Mg-based biomaterials have been the research focuses in recent years. The main limitation faced in the applications of Mg-based biomaterials is rapid degradation, which can produce excessive Mg2+ and hydrogen, affecting the healing of the bone defect. In order to overcome the limitations, researchers have explored several ways to improve the properties of Mg-based biomaterials, including alloying, surface modification with coatings, and synthesizing other composite materials to control the degradation rate upon implantation. This article reviewed the osteogenic mechanism and requirement for appropriate degradation rate and focused on current progress in the biomedical use of Mg-based biomaterials to inspire more clinical applications of Mg in bone regeneration in the future.

Long-Term Temporospatial Complementary Relationship between Degradation and Bone Regeneration of Mg-Al Alloy

The utilization of guided tissue regeneration membranes is a significant approach for enhancing bone tissue growth in areas with bone defects. Biodegradable magnesium alloys are increasingly being used as guided tissue regeneration membranes due to their outstanding osteogenic properties. However, the degradation rates of magnesium alloy bone implants documented in the literature tend to be rapid. Moreover, many studies focus only on the initial 3-month period post-implantation, limiting their applicability and impeding clinical adoption. Furthermore, scant attention has been given to the interplay between the degradation of magnesium alloy implants and the adjacent tissues. To address these gaps, this study employs a well-studied magnesium-aluminum (Mg-Al) alloy membrane with a slow degradation rate. This membrane is implanted into rat skull bone defects and monitored over an extended period of up to 48 weeks. Observations are conducted at various intervals (2, 4, 8, 12, 24, and 48 weeks) following the implantation. Assessment of degradation behavior and tissue regeneration response is carried out using histological sections, micro-CT scans, and scanning electron microscopy (SEM). The findings reveal that the magnesium alloy membranes demonstrate remarkable biocompatibility and osteogenic capability over the entire observation duration. Specifically, the Mg-Al alloy membranes sustain their structural integrity for 8 weeks. Notably, their osteogenic ability is further enhanced as a corrosion product layer forms during the later stages of implantation. Additionally, our in vitro experiments employing extracts from the magnesium alloy display a significant osteogenic effect, accompanied by a notable increase in the expression of osteogenic-related genes. Collectively, these results strongly indicate the substantial potential of Mg-Al alloy membranes in the context of guided tissue regeneration.

In vitro and in vivo degradation behavior of Mg-0.45Zn-0.45Ca (ZX00) screws for orthopedic applications

Magnesium (Mg) alloys have become a potential material for orthopedic implants due to their unnecessary implant removal, biocompatibility, and mechanical integrity until fracture healing. This study examined the in vitro and in vivo degradation of an Mg fixation screw composed of Mg-0.45Zn-0.45Ca (ZX00, in wt.%). With ZX00 human-sized implants, in vitro immersion tests up to 28 days under physiological conditions, along with electrochemical measurements were performed for the first time. In addition, ZX00 screws were implanted in the diaphysis of sheep for 6, 12, and 24 weeks to assess the degradation and biocompatibility of the screws in vivo. Using scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX), micro-computed tomography (μCT), X-ray photoelectron spectroscopy (XPS), and histology, the surface and cross-sectional morphologies of the corrosion layers formed, as well as the bone-corrosion-layer-implant interfaces, were analyzed. Our findings from in vivo testing demonstrated that ZX00 alloy promotes bone healing and the formation of new bone in direct contact with the corrosion products. In addition, the same elemental composition of corrosion products was observed for in vitro and in vivo experiments; however, their elemental distribution and thicknesses differ depending on the implant location. Our findings suggest that the corrosion resistance was microstructure-dependent. The head zone was the least corrosion-resistant, indicating that the production procedure could impact the corrosion performance of the implant. In spite of this, the formation of new bone and no adverse effects on the surrounding tissues demonstrated that the ZX00 is a suitable Mg-based alloy for temporary bone implants.

The in vivo and in vitro corrosion behavior of MgO/Mg-Zn-Ca composite with different Zn/Ca ratio

The effect of Zn/Ca ratio on the corrosion behavior of Mg-3Zn-0.2Ca-1.0MgO (3ZX) and Mg-1Zn-0.2Ca-1.0MgO (ZX) was investigated on the as-extruded specimens. Microstructure observations revealed that the low Zn/Ca ratio led to the grain growth from 1.6 µm in 3ZX to 8.1 µm in ZX. At the same time, the low Zn/Ca ratio changed the nature of second phase from the existence of Mg-Zn and Ca₂Mg₆Zn₃ phases in 3ZX to the dominated Ca₂Mg₆Zn₃ phase in ZX. The local galvanic corrosion caused by the excessive potential difference was alleviated obviously due to the missing of MgZn phase in ZX. Besides, the in vivo experiment also showed that ZX composite exhibited a good corrosion performance and the bone tissue around the implant grew well.

Synergistic Effects of Cerium and Hot Forging on Biodegradation, Antibacterial Properties, and In Vivo Biocompatibility of Microalloyed Mg-Zr-Sr Alloys

Biodegradable magnesium (Mg)-based alloys are potential candidates for orthopedic applications. In the present study, we have discussed the effect of cerium (Ce) addition and hot forging on mechanical properties, in vitro-in vivo corrosion, antibacterial activity, and cytocompatibility of microalloyed Mg-0.2Zr-0.1Sr-xCe (x = 0 [MZS], 0.5 wt % [MZS-Ce]) alloys. Addition of 0.5 wt % Ce to forged MZS alloys leads to strengthening of the basal texture as well as formation of a higher fraction of dynamic recrystallized (DRX) grains. Hot forging and addition of cerium to the MZS alloy improve both the yield strength and ultimate tensile strength of the forged MZS-Ce alloy by 1.39 and 1.21 times, respectively, compared to those of the forged MZS alloy. The potentiodynamic polarization test in Hank's solution indicates that the corrosion resistance of the forged MZS alloy improves with addition of 0.5 wt % Ce. Uniform distribution of Mg₁₂Ce precipitates, a higher DRX fraction, strengthened texture, and formation of a compact CeO₂ passive layer result in 1.68 times reduction in the immersion corrosion rate of the forged MZS-Ce alloy compared to that of the forged MZS alloy. Addition of Ce to the MZS alloy shows excellent antibacterial activity. The forged MZS-Ce alloy exhibited the highest antibacterial efficacy (76.73%). All the alloys show favorable cytocompatibility and alkaline phosphatase (ALP) activity with MC3T3-E1 cells. The improved corrosion resistance of the forged MZS-Ce alloy (95%) leads to higher cell viability compared to that of the forged MZS alloy (85%). In vivo biodegradation and the ability to generate new bones were analyzed by implanting cylindrical samples in the rabbit femur. Histological analysis showed no adverse effects around the implants. Gradual degradation of the implants and higher new bone formation around the forged MZS-Ce sample were confirmed by micro-CT analysis. Bone regeneration around the implants (58.21%) was validated by flurochrome labeling. After 60 days, the forged MZS-Ce alloy showed controlled corrosion and better bone-implant integration, presenting it as a potential candidate for internal fracture fixation materials.

An osteogenic magnesium alloy with improved corrosion resistance, antibacterial, and mechanical properties for orthopedic applications

The aim of this study was to develop a novel biodegradable magnesium (Mg) alloy for bone implant applications. We used scandium (Sc; 2 wt %) and strontium (Sr; 2 wt %) as alloying elements due to their high biocompatibility, antibacterial efficacy, osteogenesis, and protective effects against corrosion. In the present work, we also examined the effect of a heat treatment process on the properties of the Mg-Sc-Sr alloy. Alloys were manufactured using a metal casting process followed by heat treatment. The microstructure, corrosion, mechanical properties, antibacterial activity, and osteogenic activity of the alloy were assessed in vitro. The results showed that the incorporation of Sc and Sr elements controlled the corrosion, reduced the hydrogen generation, and enhanced mechanical properties. Furthermore, alloying with Sc and Sr demonstrated a significantly enhanced antibacterial activity and decreased biofilm formation compared to control Mg. Also, culturing Mg-Sc-Sr alloy with human bone marrow-derived mesenchymal stromal cells showed a high degree of biocompatibility (>90% live cells) and a significant increase in osteoblastic differentiation in vitro shown by Alizarin red staining and alkaline phosphatase activity. Based on these results, the Mg-Sc-Sr alloy heat-treated at 400°C displayed optimal mechanical properties, corrosion rate, antibacterial efficacy, and osteoinductivity. These characteristics make the Mg-Sc-Sr alloy a promising candidate for biodegradable orthopedic implants in the fixation of bone fractures such as bone plate-screws or intramedullary nails.

Recent research advances on corrosion mechanism and protection, and novel coating materials of magnesium alloys: a review

Magnesium alloys have achieved a good balance between biocompatibility and mechanical properties, and have great potential for clinical application, and their performance as implant materials has been continuously improved in recent years. However, a high degradation rate of Mg alloys in a physiological environment remains a major limitation before clinical application. In this review, according to the human body's intake of elements, the current mainstream implanted magnesium alloy system is classified and discussed, and the corrosion mechanism of magnesium alloy in vivo and in vitro is described, including general corrosion, localized corrosion, pitting corrosion, and degradation of body fluid environment impact etc. The introduction of methods to improve the mechanical properties and biocorrosion resistance of magnesium alloys is divided into two parts: the alloying part mainly discusses the strengthening mechanisms of alloying elements, including grain refinement strengthening, solid solution strengthening, dislocation strengthening and precipitation strengthening etc.; the surface modification part introduces the ideas and applications of novel materials with excellent properties such as graphene and biomimetic materials in the development of functional coatings. Finally, the existing problems are summarized, and the future development direction is prospected.

Alkaline earth metals for osteogenic scaffolds: From mechanisms to applications

Regeneration of bone defects is a significant challenge today. As alternative approaches to the autologous bone, scaffold materials have remarkable features in treating bone defects; however, the various properties of current scaffold materials still fall short of expectations. Due to the osteogenic capability of alkaline earth metals, their application in scaffold materials has become an effective approach to improving their properties. Furthermore, numerous studies have shown that combining alkaline earth metals leads to better osteogenic properties than applying them alone. In this review, the physicochemical and physiological characteristics of alkaline earth metals are introduced, mainly focusing on their mechanisms and applications in osteogenesis, especially magnesium (Mg), calcium (Ca), strontium (Sr), and barium (Ba). Furthermore, this review highlights the possible cross-talk between pathways when alkaline earth metals are combined. Finally, some of the current drawbacks of scaffold materials are enumerated, such as the high corrosion rate of Mg scaffolds and defects in the mechanical properties of Ca scaffolds. Moreover, a brief perspective is also provided regarding future directions in this field. It is worth exploring that whether the levels of alkaline earth metals in newly regenerated bone differs from those in normal bone. The ideal ratio of each element in the bone tissue engineering scaffolds or the optimal concentration of each elemental ion in the created osteogenic environment still needs further exploration. The review not only summarizes the research developments in osteogenesis but also offers a direction for developing new scaffold materials.

Immune response differences in degradable and non-degradable alloy implants

Alloy based implants have made a great impact in the clinic and in preclinical research. Immune responses are one of the major causes of failure of these implants in the clinic. Although the immune responses toward non-degradable alloy implants are well documented, there is a poor understanding of the immune responses against degradable alloy implants. Recently, there have been several reports suggesting that degradable implants may develop substantial immune responses. This phenomenon needs to be further studied in detail to make the case for the degradable implants to be utilized in clinics. Herein, we review these new recent reports suggesting the role of innate and potentially adaptive immune cells in inducing immune responses against degradable implants. First, we discussed immune responses to allergen components of non-degradable implants to give a better overview on differences in the immune response between non-degradable and degradable implants. Furthermore, we also provide potential areas of research that can be undertaken that may shed light on the local and global immune responses that are generated in response to degradable implants.

SrFe12O19-doped nano-layered double hydroxide/chitosan layered scaffolds with a nacre-mimetic architecture guide in situ bone ingrowth and regulate bone homeostasis

Osteoporotic bone defects result from an imbalance in bone homeostasis, excessive osteoclast activity, and the weakening of osteogenic mineralization, resulting in impaired bone regeneration. Herein, inspired by the hierarchical structures of mollusk nacre, nacre exhibits outstanding high-strength mechanical properties, which are in part due to its delicate layered structure. SrFe₁₂O₁₉ nanoparticles and nano-layered double hydroxide (LDH) were incorporated into a bioactive chitosan (CS) matrix to form multifunctional layered nano-SrFe₁₂O₁₉-LDH/CS scaffolds. The compressive stress value of the internal ordered layer structure matches the trabecular bone (0.18 ​MPa). The as-released Mg²⁺ ions from the nano-LDH can inhibit bone resorption in osteoclasts by inhibiting the NFκB signaling pathway. At the same time, the as-released Sr²⁺ ions promote the high expression of osteoblast collagen 1 proteins and accelerate bone mineralization by activating the BMP-2/SMAD signaling pathway. In vivo, the Mg²⁺ ions released from the SrFe₁₂O₁₉-LDH/CS scaffolds inhibited the release of pro-inflammatory factors (IL-1β and TNF-α), while the as-released Sr²⁺ ions promoted osteoblastic proliferation and the mineralization of osteoblasts inside the layered SrFe₁₂O₁₉-LDH/CS scaffolds. Immunofluorescence for OPG, RANKL, and CD31, showed that stable vasculature could be formed inside the layered SrFe₁₂O₁₉-LDH/CS scaffolds. Hence, this study on multifunctional SrFe₁₂O₁₉-LDH/CS scaffolds clarifies the regulatory mechanism of osteoporotic bone regeneration and is expected to provide a theoretical basis for the research, development, and clinical application of this scaffold on osteoporotic bone defects.

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1, SrFe₁₂O₁₉ nanoparticles and LDH were incorporated into a bioactive CS matrix.

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2, SrFe₁₂O₁₉-LDH/CS scaffolds were prepared as a layered scaffold to increase mechanical strength.

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3, The slow release of Mg²⁺ and Sr²⁺ could maintain bone homeostasis.

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4, The scaffolds also promote the formation of new blood vessels.

Design of single-phased magnesium alloys with typically high solubility rare earth elements for biomedical applications: Concept and proof

Rare earth elements (REEs) have been long applied in magnesium alloys, among which the mischmetal-containing WE43 alloy has already got the CE mark approval for clinical application. A considerable amount of REEs (7 wt%) is needed in that multi-phased alloy to achieve a good combination of mechanical strength and corrosion resistance. However, the high complex RE addition accompanied with multiple second phases may bring the concern of biological hazards. Single-phased Mg-RE alloys with simpler compositions were proposed to improve the overall performance, i.e., “Simpler alloy, better performance”. The single-phased microstructure can be successfully obtained with typical high-solubility REEs (Ho, Er or Lu) through traditional smelting, casting and extrusion in a wide compositional range. A good corrosion resistance with a macroscopically uniform corrosion mode was guaranteed by the homogeneously single-phased microstructure. The bimodal-grained structure with plenty of sub-grain microstructures allow us to minimize the RE addition to <1 wt%, without losing mechanical properties. The single-phased Mg-RE alloys show comparable mechanical properties to the clinically-proven Mg-based implants. They exhibited similar in-vitro and in-vivo performances (without local or systematic toxicity in SD-rats) compared to a high purity magnesium. In addition, metal elements in our single-phased alloys can be gradually excreted through the urinary system and digestive system, showing no consistent accumulation of RE in main organs, i.e., less burden on organs. The novel concept in this study focuses on the simplification of Mg-RE based alloys for biomedical purpose, and other biodegradable metals with single-phased microstructures are expected to be explored.

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A concept of developing single-phased biodegradable magnesium alloys was proposed.

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Single-phased magnesium alloys with bimodal-grained structures were obtained.

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Good strength and corrosion resistance synergy was achieved in the alloys.

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Significantly reduced rare earth addition is beneficial to the biocompatibility.

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Simpler alloy helps to lower the possible biological risks of Mg related implants.

In Vitro Degradation and In Vivo Biocompatibility of Strontium-Doped Magnesium Phosphate-Reinforced Magnesium Composites

Magnesium is projected for use as a degradable orthopedic biomaterial. However, its fast degradation in physiological media is considered as a significant challenge for its successful clinical applications. Bioactive reinforcements containing Mg-based composites constitute one of the promising approaches for developing degradable metallic implants because of their adjustable mechanical behaviors, corrosion resistance, and biological response. Strontium is a trace element known for its role in enhancing osteoblast activity. In this study, bioactive SrO-doped magnesium phosphate (MgP)-reinforced Mg composites containing 1, 3, and 5 wt % MgP were developed through the casting route. The influence of the SrO-doped MgP reinforcement on degradation behaviors of the composites along with its cell-material interactions and in vivo biocompatibility was investigated. The wt % and distribution of MgP particles significantly improved the mechanical properties of the composite. HBSS immersion study indicated the least corrosion rate (0.56 ± 0.038 mmpy) for the Mg-3MgP composite. The higher corrosion resistance of Mg-3MgP leads to a controlled release of Sr-containing bioactive reinforcement, which eventually enhanced the cytotoxicity as measured using MG-63 cell-material interactions. The in vivo biocompatibility of the composite was evaluated using the rabbit femur defect model. Micro-computed tomography (μ-CT) and histological analysis supported the fact that Mg-3MgP maintained its structural integrity and enhanced osteogenesis (50.36 ± 2.03%) after 2 months of implantation. The results indicated that the Mg-MgP composite could be used as a degradable internal fracture fixation device material.

Enhanced anti-corrosion and biocompatibility of a functionalized layer formed on ZK60 Mg alloy via hydroxyl (OH-) ion implantation

Magnesium and its alloys have piqued the interest of researchers due to their promising mechanical properties and biocompatibility. Moreover, the excessively fast corrosion rate of Mg alloys impedes their development in biomedical fields. Inspired by conventional ion implantation, a less-toxic functional group (hydroxyl) is used as the ion source to bombard the ZK60 Mg alloy surface to form a functionalized oxide layer. The surface characterization, corrosion resistance, and biocompatibility are systematically investigated before and after hydroxyl ion implantation. A smoother surface mainly constituted of hydroxide/oxide is formed for the treated samples. The formed functionalized layer significantly improves the corrosion resistance of the ZK60 Mg alloy substrate and the proliferation of MC3T3-E1 cells, as demonstrated by electrochemical, immersion, and in vitro cytocompatibility tests. In summary, less-toxic functional ion implantation can be an effective strategy for preventing corrosion of Mg alloy implants and promoting their biocompatibility.

A review on properties of magnesium-based alloys for biomedical applications

With changing lifestyles, the demand for bone implantation has been increasing day by day. The deficiency of nutritious elements within the human body results in certain diseases like osteoporosis, rickets, and other skeletal disorders; lack of physical activities; and the increasing number of accidents are the primary reasons for bone damage/fracture. Metallic implants made up of chrome steel, cobalt-based alloys, and titanium-based alloys are being majorly used worldwide owing to their high strength and high corrosion resistance which makes them permanent orthopedic bioimplant materials, however, they display a stress-shielding effect and it also requires an implant removal surgery. Thus, these problems can be addressed through the employment of biodegradable materials. Among the available biodegradable metallic materials, Mg alloys have been identified as a prospective orthopedic implant material. These alloys are biodegradable as well as biocompatible, however, they experience a relatively higher rate of degradation limiting their usability as implant material. This study attempts to comprehensively assess the effects of various alloying elements such as Ca, Zn, Sn, Mn, Sr and Rare earth elements (REEs) on the mechanical and degradation behavior (bothin vivoandin vitro) of Mg alloys. Since the microstructure, mechanical properties and degradation response of the Mg alloys are dependent on the processing route, hence detailed processing- property database of different Mg alloys is provided in this paper.

In vitro and in vivo assessment of the effect of biodegradable magnesium alloys on osteogenesis

Magnesium (Mg) and some of its alloys are considered promising biodegradable metallic biomaterials for bone implant applications. The osteogenesis effect of Mg alloys is widely reported; however, the underlying mechanisms are still not clear. In this study, pure Mg, Mg-3Zn, and Mg-2Zn-1Mn were prepared, and their degradation behavior, biocompatibility, and osteogenesis effect were systematically assessed both in vitro and in vivo. Primary rat bone marrow-derived mesenchymal stem cells (BMSCs) were used to evaluate the biocompatibility of the prepared Mg alloys, and a rat femur fracture model was used to assess the stimulating effect of these alloys on bone-tissue formation. Mg-2Zn-1Mn showed higher corrosion resistance and more stable degradation behavior than pure Mg and Mg-3Zn. Extracts of the three materials showed significant stimulating effects on osteogenic differentiation of BMSCs along with non-cytotoxicity. Implantation of Mg-2Zn-1Mn wires into the femur of rats demonstrated superior histocompatibility, stable degradation, and notable promotion of osteogenesis without systemic toxicity. Moreover, the results of both in vitro and in vivo assessments demonstrated that bone morphogenetic proteins and fibroblast growth factor receptors are involved in the stimulating effect of Mg alloys. STATEMENT OF SIGNIFICANCE: This work reports the degradation behavior, biocompatibility, and osteogenic effect of pure Mg and Mg-3Zn and Mg-2Zn-1Mn alloys in both in vitro and in vivo conditions. Mg-2Zn-1Mn showed higher corrosion resistance and more stable degradation behavior than pure Mg and Mg-3Zn. The extracts of the three materials showed a significant stimulating effect on osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells (BMSCs) along with non-cytotoxicity. Mg-2Zn-1Mn wires implanted into the femur of rats showed good histocompatibility, stable degradation, and notable promotion of osteogenesis without systemic toxicity. The results of the present study suggest that bone morphogenetic proteins (BMPs) and fibroblast growth factor receptors (FGFRs) are involved in the stimulating effect of Mg alloys on osteogenesis.

Magnesium-Based Alloys Used in Orthopedic Surgery

Magnesium (Mg)-based alloys have become an important category of materials that is attracting more and more attention due to their high potential use as orthopedic temporary implants. These alloys are a viable alternative to nondegradable metals implants in orthopedics. In this paper, a detailed overview covering alloy development and manufacturing techniques is described. Further, important attributes for Mg-based alloys involved in orthopedic implants fabrication, physiological and toxicological effects of each alloying element, mechanical properties, osteogenesis, and angiogenesis of Mg are presented. A section detailing the main biocompatible Mg-based alloys, with examples of mechanical properties, degradation behavior, and cytotoxicity tests related to in vitro experiments, is also provided. Special attention is given to animal testing, and the clinical translation is also reviewed, focusing on the main clinical cases that were conducted under human use approval.

A novel lean alloy of biodegradable Mg-2Zn with nanograins

Lean alloy (low alloyed) is beneficial for long-term sustainable development of metal materials. Creating a nanocrystalline microstructure is a desirable approach to improve biodegradability and mechanical properties of lean biomedical Mg alloy, but it is nearly impossible to realize. In the present study, the bulk nanocrystalline Mg alloy (average grain size: ~70 nm) was successfully obtained by hot rolling process of a lean Mg-2wt.%Zn (Z2) alloy and both high strength ((223 MPa (YS) and 260 MPa (UTS)) and good corrosion resistance (corrosion rate in vivo: 0.2 mm/year) could be achieved. The microstructure evolution during the rolling process was analyzed and discussed. Several factors including large strain, fine grains, strong basal texture, high temperature and Zn segregation conjointly provided the possibility for the activation of pyramidal slip to produce nanocrystals. This finding could provide a new development direction and field of application for lean biomedical Mg alloys.

Characterization and Corrosion Properties of Fluoride Conversion Coating Prepared on AZ31 Magnesium Alloy

Wrought AZ31 magnesium alloy was used as the experimental material for fluoride conversion coating preparation in Na[BF4] molten salt. Two coating temperatures, 430 °C and 450 °C, and three coating times, 0.5, 2, and 8 h, were used for the coating preparation. A scanning electron microscope and energy-dispersive X-ray spectroscopy were used for an investigation of the surface morphology and the cross-sections of the prepared coatings including chemical composition determination. The corrosion resistance of the prepared specimens was investigated in terms of the potentiodynamic tests, electrochemical impedance spectroscopy and immersion tests in the environment of simulated body fluids at 37 ± 2 °C. The increase in the coating temperature and coating time resulted in higher coatings thicknesses and better corrosion resistance. Higher coating temperature was accompanied by smaller defects uniformly distributed on the coating surface. The defects were most probably created due to the reaction of the AlxMny intermetallic phase with Na[BF4] molten salt and/or with the product of its decomposition, BF3 compound, resulting in the creation of soluble Na3[AlF6] and AlF3 compounds, which were removed from the coating during the removal of the secondary Na[MgF3] layer. The negative influence of the AlxMny intermetallic phase was correlated to the particle size and thus the size of created defects.

Recent research and progress of biodegradable zinc alloys and composites for biomedical applications: Biomechanical and biocorrosion perspectives

Biodegradable metals (BMs) gradually degrade in vivo by releasing corrosion products once exposed to the physiological environment in the body. Complete dissolution of biodegradable implants assists tissue healing, with no implant residues in the surrounding tissues. In recent years, three classes of BMs have been extensively investigated, including magnesium (Mg)-based, iron (Fe)-based, and zinc (Zn)-based BMs. Among these three BMs, Mg-based materials have undergone the most clinical trials. However, Mg-based BMs generally exhibit faster degradation rates, which may not match the healing periods for bone tissue, whereas Fe-based BMs exhibit slower and less complete in vivo degradation. Zn-based BMs are now considered a new class of BMs due to their intermediate degradation rates, which fall between those of Mg-based BMs and Fe-based BMs, thus requiring extensive research to validate their suitability for biomedical applications. In the present study, recent research and development on Zn-based BMs are reviewed in conjunction with discussion of their advantages and limitations in relation to existing BMs. The underlying roles of alloy composition, microstructure, and processing technique on the mechanical and corrosion properties of Zn-based BMs are also discussed.

Recent Developments in Magnesium Metal-Matrix Composites for Biomedical Applications: A Review

Recently, there is a growing interest in developing magnesium (Mg) based degradable biomaterial. Although corrosion is a concern for Mg, other physical properties, such as low density and Young's modulus, combined with good biocompatibility, lead to significant research and development in this area. To address the issues of corrosion and low yield strength of pure Mg, several approaches have been adopted, such as, composite preparation with suitable bioactive reinforcements, alloying, or surface modifications. This review specifically focuses on recent developments in Mg-based metal matrix composites (MMCs) for biomedical applications. Much effort has gone into finding suitable bioactive, bioresorbable reinforcements and processing techniques that can improve upon existing materials. In summary, this review provides a comprehensive overview of existing Mg-based composite preparation and their mechanical and corrosion properties and biological responses and future perspectives on the development of Mg-based composite biomaterials.

Corrosion Resistance of Mg72Zn24Ca4 and Zn87Mg9Ca4 Alloys for Application in Medicine

The aim of this work was to monitor the corrosion rate of the Mg72Zn24Ca4 and Zn87Mg9Ca4 alloys. The purity of the alloying elements was 99.9%. The melt process was carried out in an induction furnace. The melting process took place under the cover of an inert gas (argon). The copper form was flooded by liquid alloy. Then, in order to obtain ribbons, the cast alloy, in rod shape, was re-melted on the melt spinning machine. The corrosion resistance of both alloys has been determined on the basis of the following experiments: measurements of the evolution of OCP (open circuit potential), LSV (linear sweep voltamperometry) and EIS (electrochemical impedance spectroscopy). All corrosion tests were carried out in Ringer's solution at 37 °C and pH 7.2. The corrosion tests have revealed that the zinc alloy, Zn87Mg9Ca4, exhibits significantly higher corrosion resistance in the Ringer solution compared to the magnesium alloy, Mg72Zn24Ca4. Moreover, it has been shown that the cathodic reaction proceeds faster on the surface of ribbons. EIS measurements show that the dissolution of Mg alloy proceeds with two steps: transfer of Mg2+ ions to the Ringer solution and then the formation of the corrosion products, which are deposited on the surface of magnesium alloy. It has been revealed, too, that for both bulk materials, diffusion of chloride ions through the corrosion product's layer takes place.

Functions and applications of metallic and metallic oxide nanoparticles in orthopedic implants and scaffolds

Bone defects and diseases are devastating, and can lead to severe functional deficits or even permanent disability. Nevertheless, orthopedic implants and scaffolds can facilitate the growth of incipient bone and help us to treat bone defects and diseases. Currently, a wide range of biomaterials with distinct biocompatibility, biodegradability, porosity, and mechanical strength is used in bone-related research. However, most orthopedic implants and scaffolds have certain limitations and diverse complications, such as limited corrosion resistance, low cell proliferation, and bacterial adhesion. With recent advancements in materials science and nanotechnology, metallic and metallic oxide nanoparticles have become the subject of significant interest as they offer an ample variety of options to resolve the existing problems in the orthopedic industry. More importantly, these nanoparticles possess unique physicochemical and mechanical properties not found in conventional materials, and can be incorporated into orthopedic implants and scaffolds to enhance their antimicrobial ability, bioactive molecular delivery, mechanical strength, osteointegration, and cell labeling and imaging. However, many metallic and metallic oxide nanoparticles can also be toxic to nearby cells and tissues. This review article will discuss the applications and functions of metallic and metallic oxide nanoparticles in orthopedic implants and bone tissue engineering.

A Review of SLMed Magnesium Alloys: Processing, Properties, Alloying Elements and Postprocessing

Selective laser melting (SLM) is an additive manufacturing method with rapid solidification properties, which is conducive to the preparation of alloys with fine microstructures and uniform chemical compositions. Magnesium alloys are lightweight materials that are widely used in the aerospace, biomedical and other fields due to their low density, high specific strength, and good biocompatibility. However, the poor laser formability of magnesium alloy restricts its application. This paper discusses the current research status both related to the theoretical understanding and technology applications. There are problems such as limited processable materials, immature process conditions and metallurgical defects on SLM processing magnesium alloys. Some efforts have been made to solve the above problems, such as adding alloy elements and applying postprocessing. However, the breakthroughs in these two areas are rarely reviewed. Due to the paucity of publications on postprocessing and alloy design of SLMed magnesium alloy powders, we review the current state of research and progress. Moreover, traditional preparation techniques of magnesium alloys are evaluated and related to the SLM process with a view to gaining useful insights, especially with respect to the postprocessing and alloy design of magnesium alloys. The paper also reviews the influence of process parameters on formability, densification and mechanical behavior of magnesium. In addition, the progress of microstructure and metallurgical defects encountered in the SLM processed parts is described. Finally, this article summarizes the research results, and with respect to materials and metallurgy, the new challenges and prospects in the SLM processing of magnesium alloy powders are proposed with respect to alloy design, base material purification, inclusion control and theoretical calculation, and the role of intermetallic compounds.

Biomimetic Design for a Dual Concentric Porous Titanium Scaffold with Appropriate Compressive Strength and Cells Affinity

In repairing or replacing damaged bones, a dual concentric porous titanium scaffold (P-Tix-y) has emerged as a promising bio-mimic design. Herein, various P-Tix-y were made and sintered with relatively dense (x = 10, 20, or 30% porosity) and loose (y = 45, 55, or 65 porosity) structures. Firstly, NaCl was used as the pore-forming additive and followed by a hydrothermal removal method. The compressive strength of the as-formed P-Tix_y and surface morphology, nanomechanical property, and cells' affinity on the cross-sectioned surface of P-Tix_y (CP-Tix_y) were then characterized. The results demonstrate that the compressive strength of P-Ti10_45, P-Ti20_45, or P-Ti20_55 exhibits a relatively mild decline (e.g., in the range of 181 and 97 MPa, higher than the required value of 70 MPa) and suitable porosities for the intended structure. Nano-hardness on the solid surface of CP-Tix_y shows roughly consistent with that of CP-Ti (i.e., ~8.78 GPa), thus, the porous structure of CP-Tix_y remains mostly unaffected by the addition of NaCl and subsequent sintering process. Most of the surfaces of CP-Tix_y exhibit high fibroblast (L929) cell affinity with low cell mortality. Notably, in the hFOB 1.19 cell adhesion and proliferation test, CP-Ti20_55 and CP-Ti20_65 reveal high cell viability, most probably relating with the assembly of dual porosities with interconnected pores. Overall, the sample P-Ti20_55 provides a relatively load-bearable design with high cell affinity and is thus promising as a three-dimensional bio-scaffold.

Prospects and strategies for magnesium alloys as biodegradable implants from crystalline to bulk metallic glasses and composites-A review

As a biodegradable metal (BM), alloys of magnesium (Mg) offer great potential as an alternative to the permanent metallic implants currently being used for fracture repairs and tissue-healing processes. These alloys exhibit superior biocompatibility and appropriate mechanical strength and dissolution behavior in the physiological environment, essential prerequisites for a BM. However, rapid and generally non-uniform corrosion has been the major drawback of Mg alloys. Abrupt deterioration in mechanical strength is experienced due to the inhomogeneous corrosion, which is also considered detrimental to the surface passivation process. This review has analyzed a variety of strategies that can be adopted to address the core challenges with Mg alloy biomaterials. In addition, the review provides fundamental understanding of the mechanisms associated with these challenging problems, including discussion of crystalline and bulk metallic glasses (BMGs) and composites. Comparison among the properties and mechanisms observed in other metal alloy systems, including zinc (Zn) and iron (Fe) alloys and prominent BMGs, are also presented for analysis in order to provide new approaches to resolving the critical issues of Mg alloys. STATEMENT OF SIGNIFICANCE: The effects of alloying elements, microstructure, heat treatment and deformation on the mechanical and corrosion properties of biodegradable metals such as Mg-based alloys and bulk metal glasses (BMGs) are identified. Theoretical models and experimental findings are comprehensively analyzed to corroborate the actual corrosion and deformation mechanisms observed in biodegradable metals (BMs). This work also provides an in-depth comparison of mechanical and corrosion properties among the prominent biodegradable metal alloy systems, illustrating a clear outlook on their potentials. The proposed strategies to address the current challenges in BMs are substantiated with fundamental theories and experimental evidence.

Mechanical, corrosion, and biocompatibility properties of Mg-Zr-Sr-Sc alloys for biodegradable implant applications

Magnesium (Mg) and its alloys are considered promising biodegradable implant materials because of their strength and natural degradation in the human body. However, the high corrosion rate of pure Mg in the physiological environment leads to rapid degradation before adequate bone healing. This mismatch between bone healing and the degradation of Mg implants supports the development of new Mg alloys with the addition of other suitable alloying elements in order to achieve simultaneously high corrosion resistance and desirable mechanical properties. This study systematically investigates the microstructure, mechanical properties, corrosion behavior, and biocompatibility of Mg-based alloys with the addition of different concentrations of scandium (Sc), i.e., Mg-0.6Zr-0.5Sr-xSc (x = 0.5, 1, 2, 3 wt.%). Results indicated that high concentration of Sc in strontium (Sr)-containing Mg alloys can alter their microstructures by suppressing the intermetallic phases along the grain boundaries and improve the corrosion resistance by forming chemically stable Sc oxide layers on the surfaces of the Mg alloys. Cytotoxicity assessment revealed that the Sc containing Mg alloys did not significantly alter the viability of human osteoblast-like SaOS2 cells. This study highlights the advantages of using Sc as an alloying element to simultaneously tune Mg alloys with higher strength and slower degradation. STATEMENT OF SIGNIFICANCE: Rare earth elements such as scandium (Sc) with both a high solid-solubility and strong affinity towards oxygen can improve the mechanical and corrosion properties of magnesium (Mg) alloys. However, the feasibility of Sc-containing Mg alloys as biodegradable implant materials is scarcely reported. This study investigates the effects of different Sc concentrations on the mechanical, corrosion, and biocompatibility properties of Mg-Zr-Sr-Sc alloys. Our findings indicated that the addition of Sc significantly improves the mechanical and corrosion properties of Mg-Zr-Sr alloys. Moreover, in vitro cytotoxicity assessment of the Mg-Zr-Sr-Sc alloys did not show any adverse effects on the viability of osteoblast-like cells.

The influence of ultrafine-grained structure on the mechanical properties and biocompatibility of austenitic stainless steels

In this study, equal-channel angular pressing (ECAP) of austenitic 316L and Cr-Ni-Ti stainless steels was carried out. Effect of ECAP at 400°C on the evolution of the microstructure, mechanical properties, and biocompatibility of these steels was investigated. The biocompatibility of samples with the ultrafine grain structure obtained in the ECAP process did not deteriorate in comparison with an austenitic 316L stainless steel in coarse-grained state. However, this treatment enhances the multipotent mesenchymal stromal/stem cell proliferation by 26% for 316L steel and by 17% for Cr-Ni-Ti stainless steel in comparison with coarse-grained counterparts. At the same time, ECAP contributes to a significant improvement in performance and weight reduction of medical devices, which is especially important for the creation of implanted prostheses for replacement of skeletal defects, due to significant increase in specific strength of steels. The strength properties of austenitic stainless steels were remarkably improved due to the grain refinement and deformation twinning resulted from ECAP at 400°C. After ECAP, the yield strength of 316L and Cr-Ni-Ti stainless steels increased by 4.2 and 2.9 times up to 950 and 900 MPa, and the fatigue limit by 2 and 1.7 times up to 500 and 475 MPa, respectively, comparing to coarse-grained counterparts.

Magnesium matrix nanocomposites for orthopedic applications: A review from mechanical, corrosion, and biological perspectives

Magnesium (Mg) and some of its alloys have attracted extensive interests for biomedical applications as they exhibit biodegradability and low elastic modulus that is closer to natural bones than the currently used metallic implant materials such as titanium (Ti) and its alloys, stainless steels, and cobalt-chromium (Co-Cr) alloys. However, the rapid degradation of Mg alloys and loss of their mechanical integrity before sufficient bone healing impede their clinical application. Our literature review shows that magnesium matrix nanocomposites (MMNCs) reinforced with nanoparticles possess enhanced strength, high corrosion resistance, and good biocompatibility. This article provides a detailed analysis of the effects of nanoparticle reinforcements on the mechanical properties, corrosion behavior, and biocompatibility of MMNCs as promising biodegradable implant materials. The governing equations to quantitatively predict the mechanical properties and underlying synergistic strengthening mechanisms in MMNCs are elucidated. The potential, recent advances, challenges and future research directions in relation to nanoparticles reinforced MMNCs are highlighted. STATEMENT OF SIGNIFICANCE: Critically reviewing magnesium metal matrix nanocomposites (MMNCs) for the biomedical application. Clear definitions of strengthening mechanisms using reinforcement particle in the magnesium matrix, as there were controversial in governing equations of strengthening parameters. Providing better understanding of the effect of particle size, volume fraction, interfacial bonding, and uniform dispersion of reinforcement particles on MMNCs.

Effect of Gallium Content and Heat Treatment on the Microstructure and Corrosion Rate of Magnesium Binary Alloys

The microstructure and corrosion rate of as-cast and heat-treated binary Mg-Ga alloys with gallium content ranging from 0.375 to 1.5 wt. % were investigated. The corrosion rate was determined by the weight loss method using a simulated body fluid (SBF). The microstructure of the as-cast alloys showed an α-Mg matrix of dendritic morphology with intermetallic compounds Mg5Ga2 located mainly at the interdendritic regions. The fraction and size of the Mg5Ga2 particles increased with the amount of Ga in the alloy. The grain size decreased as the Ga content was increased. The products formed on the surface of the Mg-Ga alloys after immersion in SBF were MgO, Mg(OH)2, and calcium phosphates. The corrosion rate of the as-cast alloys was dependent on the Ga content. At concentrations lower than 1 wt. % the corrosion rate was similar to that of pure Mg (0.65 mm/year). However, Ga additions higher than 1 wt. % worsened the corrosion resistance. After heat treatment, the corrosion rate of Mg-Ga alloys decreased, and in the case of the alloys with Ga concentrations lower than 1 wt. %, corrosion rate was lower than that of pure Mg. Corrosion of these alloys after heat treatment was uniform.

Development of magnesium implants by application of conjoint-based quality function deployment

Biodegradable magnesium-based implants are the subject of a great deal of research for different orthopedic and vascular applications. The targeted design and properties depend on the specific medical function and location in the body. Development of the biomaterial requires a comprehensive understanding of the biological interaction between the implant and the host tissue, as well as of the behavior in the physiological environment in vivo. Research into and the development of innovative magnesium implants entails interdisciplinary research efforts and communication between materials science, bioscience, and medical experts. The present study provides a transparent planning and communication tool for market-oriented implant development processes. The objective was to identify medical needs at an early stage of the development process and to quantify the importance of the engineering characteristics of different research fields that cater to specific implant requirements. The method is demonstrated by the performance of a survey-based conjoint analysis, which was integrated into a quality function deployment approach. Twenty-seven medical professionals and 29 biomaterial scientists assessed the importance of identified medical requirements, whereby the control of mechanical integrity and degradation along with nontoxicity and nonimmunogenicity showed the highest number of preferences. The evaluation of implant options by 31 experts indicated that the engineering characteristic with the highest importance was the condition and sterilization of the surface. These values can be used to set priorities in strategic decisions. Research trials can be aligned to medical preferences, ensuring high product quality and an effective development process. This is the first paper to report on the application of conjoint-based quality function deployment in biomaterial research.

Novel porous Ti35Zr28Nb scaffolds fabricated by powder metallurgy with excellent osteointegration ability for bone-tissue engineering applications

Titanium (Ti) based porous alloys have been widely used as orthopedic implants. However, the successful applications of these porous Ti alloys need to have the ability to mimic the mechanical properties of natural bone. Novel porous Ti35Zr28Nb scaffolds were fabricated via powder metallurgy (PM), and the fabricated scaffold with 61.1% porosity exhibited favorable mechanical properties with a compression yield strength of 132.5 ± 3.5 MPa and an elastic modulus of 2.9 ± 0.4 GPa, which are desired mechanical properties for bone implant material applications. The extracts of the porous Ti35Zr28Nb scaffolds showed no toxic effect on cell proliferation in vitro and their cytotoxicity grade was at level 0, similar to that of as-cast pure Ti and Ti-6Al-4 V alloy. Additionally, the extracellular alkaline phosphatase (ALP) level of MC3T3-E1 indicated that the bone matrix synthesis on the porous Ti35Zr28Nb scaffolds was slightly higher than that of as-cast Ti-6Al-4 V and pure Ti alloys. After implantation in rat distal femurs for 8 weeks, the porous Ti35Zr28Nb scaffolds were surrounded by new bone tissue, and the numbers of red blood cells, white blood cells, immunocyte cells, and neutrophil cells returned to the normal levels, which indicate that the porous Ti35Zr28Nb scaffolds possess good in vivo osteointegration ability and hemocompatibility. It hence can be concluded that the PM-fabricated Ti35Zr28Nb scaffolds, which have desired mechanical properties and excellent biocompatibility and osteointegration, are a promising candidate alloy for bone-tissue engineering applications in orthopedics.

Improving in vitro and in vivo antibacterial functionality of Mg alloys through micro-alloying with Sr and Ga

Despite of technical advancements in design and development of new biomaterials, device-related infections continue to occur and can be life-threatening. Differing from existing research work pertaining to introducing antibacterial function upon device surface, this study attempts to address such germ-infection issues through controlled release of antibacterial species from bulk gallium (Ga) and strontium (Sr) containing magnesium (Mg) alloys. To validate such a conceptual framework, Mg alloys containing micro-level concentrations of Ga and/or Sr (0.1 wt%) are employed as model materials, along with commercially pure Mg and titanium (Ti) as control groups. Biodegradation progress of such metal specimens is examined through pH and mass loss measurements, and inductively coupled plasma - atomic emission spectrometry (ICP-AES) as a function of immersion time in Trypticase Soy Broth (TSB) solution under physiological conditions. In vitro biocompatibility and antibacterial performance are characterised through MTT proliferation assay with human mesenchymal stem cells (hMSCs) and the spread plate method with three representative bacterial strains, i.e. S. aureus (ATCC 43300), E. coli (ATCC 25922), and S. epidermidis (ATCC 35984). Animal tests are performed through implanting target metal rods into femurs of Sprague Dawley rats, accompanied with injection of S. aureus to build a model of osteomyelitis. Results demonstrate that such lean additions of Ga and/or Sr reduce the degradation kinetics of Mg matrix, and the release of Ga³⁺ ions plays a crucial role in disabling the viability of all selected bacterial strains. The histological tests confirm that the growth of fibrous tissue has been accelerated in the vicinity of Mg-based implants, in comparison to that of blank and c.p. Ti controls. It is also striking that the smallest number density of S. aureus bacteria on the surface of the retrieved Ga-containing Mg rod implants. Such a proof-of-concept study provides a new and feasible strategy to address the notorious device-infection issues associated with biomedical implants for bone fracture management.

Influence of surface modifications on the degradation of standard-sized magnesium plates and healing of mandibular osteotomies in miniature pigs

Biodegradable magnesium alloys are suitable osteosynthesis materials. Despite the alloy composition, surface modifications appear to have an influence on the degradation process and biocompatibility. The aim of this study was to investigate the impact of hydrogenation and fluoridation of the surface in a mandibular osteotomy model. Standard-sized plates and screws were implanted in an osteotomy at the mandibular angle in nine miniature pigs. The plates and screws were harvested together with the adjacent tissues at 8 weeks after surgery and were investigated by micro-computed tomography and histological analysis. The bone healing of the osteotomy was undisturbed, independent of the surface properties. The adjacent bone tissue showed new bone formation at the implant surface; however, formation of some lacunae could be observed. The corrosion was between 9.8% and 11.6% (fluoridated<hydrogenated<non-modified) in histological specimens, while radiologically neither the volume nor the density of the osteosynthesis material was reduced in any treatment group. The soft tissues exhibited full biocompatibility with every surface property. In summary, surface modification by hydrogenation and fluoridation did not significantly influence bone healing, biocompatibility, or corrosion kinetics of the magnesium osteosynthesis at the mandibular angle.

Degradable magnesium-based alloys for biomedical applications: The role of critical alloying elements

Magnesium-based alloys exhibit biodegradable, biocompatible and excellent mechanical properties which enable them to serve as ideal candidate biomedical materials. In particular, their biodegradable ability helps patients to avoid a second surgery. The corrosion rate, however, is too rapid to sustain the healing process. Alloying is an effective method to slow down the corrosion rate. However, currently magnesium alloys used as biomaterials are mostly commercial alloys without considering cytotoxicity from the perspective of biosafety. This article comprehensively reviews the status of various existing and newly developed degradable magnesium-based alloys specially designed for biomedical application. The effects of critical alloying elements, compositions, heat treatment and processing technology on the microstructure, mechanical properties and corrosion resistance of magnesium alloys are discussed in detail. This article covers Mg-Ca based, Mg-Zn based, Mg-Sr based, Mg-RE based and Mg-Cu-based alloy systems. The novel methods of fabricating Mg-based biomaterials and surface treatment on Mg based alloys for potential biomedical applications are summarized.

Carbon Nanotubes and Graphene as Nanoreinforcements in Metallic Biomaterials: a Review

Current challenges in existing metallic biomaterials encourage undertaking research in the development of novel materials for biomedical applications. This paper critically reviews the potential of carbon nanotubes (CNT) and graphene as nanoreinforcements in metallic biomaterials for bone tissue engineering. Unique and remarkable mechanical, electrical, and biological properties of these carbon nanomaterials allow their use as secondary-phase reinforcements in monolithic biomaterials. The nanoscale dimensions and extraordinarily large surface areas of CNT and graphene make them suitable materials for purposeful reaction with living organisms. However, the cytocompatibility of CNT and graphene is still a controversial issue that impedes advances in utilizing these promising materials in clinical orthopedic applications. The interaction of CNT and graphene with biological systems including proteins, nucleic acids, and human cells is critically reviewed to assess their cytocompatibity in vitro and in vivo. It is revealed that composites reinforced with CNT and graphene show enhanced adhesion of osteoblast cells, which subsequently promotes bone tissue formation in vivo. This potential is expected to pave the way for developing ground-breaking technologies in regenerative medicine and bone tissue engineering. In addition, current progress and future research directions are highlighted for the development of CNT and graphene reinforced implants for bone tissue engineering.

Endovascular Metal Devices for the Treatment of Cerebrovascular Diseases

Cerebrovascular disease involves various medical disorders that obstruct brain blood vessels or deteriorate cerebral circulation, resulting in ischemic or hemorrhagic stroke. Nowadays, platinum coils with or without biological modification have become routine embolization devices to reduce the risk of cerebral aneurysm bleeding. Additionally, many intracranial stents, flow diverters, and stent retrievers have been invented with uniquely designed structures. To accelerate the translation of these devices into clinical usage, an in-depth understanding of the mechanical and material performance of these metal-based devices is critical. However, considering the more distal location and tortuous anatomic characteristics of cerebral arteries, present devices still risk failing to arrive at target lesions. Consequently, more flexible endovascular devices and novel designs are under urgent demand to overcome the deficiencies of existing devices. Herein, the pros and cons of the current structural designs are discussed when these devices are applied to the treatment of diseases ranging broadly from hemorrhages to ischemic strokes, in order to encourage further development of such kind of devices and investigation of their use in the clinic. Moreover, novel biodegradable materials and drug elution techniques, and the design, safety, and efficacy of personalized devices for further clinical applications in cerebral vasculature are discussed.

The current trends of Mg alloys in biomedical applications-A review

Magnesium (Mg) has emerged as an ideal alternative to the permanent implant materials owing to its enhanced properties such as biodegradation, better mechanical strengths than polymeric biodegradable materials and biocompatibility. It has been under investigation as an implant material both in cardiovascular and orthopedic applications. The use of Mg as an implant material reduces the risk of long-term incompatible interaction of implant with tissues and eliminates the second surgical procedure to remove the implant, thus minimizes the complications. The hurdle in the extensive use of Mg implants is its fast degradation rate, which consequently reduces the mechanical strength to support the implant site. Alloy development, surface treatment, and design modification of implants are the routes that can lead to the improved corrosion resistance of Mg implants and extensive research is going on in all three directions. In this review, the recent trends in the alloying and surface treatment of Mg have been discussed in detail. Additionally, the recent progress in the use of computational models to analyze Mg bioimplants has been given special consideration. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1970-1996, 2019.

Mineralized collagen/Mg-Ca alloy combined scaffolds with improved biocompatibility for enhanced bone response following tooth extraction

Mineralized collagen has been used clinically as a bone grafting material in oral applications. We have developed a mineralized collagen/Mg-Ca alloy combined scaffold to overcome the mechanical limitations of mineralized collagen. This study discusses the cytocompatibility of the mineralized collage/Mg-Ca alloy combined scaffold in vitro and the bone regeneration following tooth extraction in vivo. Using an indirect proliferation assay adapted from ISO 10993-5, it was found that mineralized collagen/Mg-Ca alloy combined scaffold enhanced cell proliferation and migration in addition to MC3T3-E1 cells not showing a cytotoxicity response in vitro. Finally, the ability of the combined scaffold to enhance osteogenesis was assessed in a canine socket preservation model. Cone beam CT, x-ray microscopes and biomechanical analysis showed the mineralized collagen/Mg-Ca alloy combined scaffold to be more effective at reducing the absorption of alveolar ridge and preserving the socket site than mineralized collagen alone. The combined scaffolds can promote bone regeneration with good biocompatibility, providing a new concept of the combined application of mineralized collagen and magnesium alloy.

Biocompatible hydrophilic brushite coatings on AZX310 and AM50 alloys for orthopaedic implants

Dicalcium phosphate dihydrate (DCPD) brushite coating with flake like crystal structure for the protection of AZX310 and AM50 magnesium (Mg) alloys was prepared through chemical deposition treatment. Chemical deposition treatment was employed using Ca(NO₃)₂·4H₂O and KH₂PO₄ along with subsequent heat treatment. The morphological results revealed that the brushite coating with dense and uniform structures was successfully deposited on the surface of AZX310 and AM50 alloys. The X-ray diffraction (XRD) patterns and Attenuated total reflectance infrared (ATR-IR) spectrum also revealed the confirmation of DCPD layer formation. Hydrophilic nature of the DCPD coatings was confirmed by Contact angle (CA) measurements. Moreover, electrochemical immersion and in vitro studies were evaluated to measure the corrosion performance and biocompatibility performance. The deposition of DCPD coating for HTI AM50 enables a tenfold increase in the corrosion resistance compared with AZX310. Hence the ability to offer such significant improvement in corrosion resistance for HTI AM50 was coupled with more bioactive nature of the DCPD coating is a viable approach for the development of Mg-based degradable implant materials.

Effects of Sr on the microstructure, mechanical properties and corrosion behavior of Mg-2Zn-xSr alloys

The effects of the addition of Sr on the microstructures, mechanical properties and bio-corrosion properties of Mg-2Zn alloys were investigated. Examination of the microstructures indicates that Sr addition promoted grain refinement and the formation of secondary phases. The results for the mechanical and corrosion property analyses show that the Mg-2Zn-0.2Sr alloy exhibited the best mechanical properties and bio-corrosion resistance. Notably, fine grain structure can promote strength and ductility, while the excessive secondary phases Mg₁₇Sr₂ resulted in the degradation of mechanical performance. Moreover, corrosion resistance could be improved by reducing the impurity concentrations and forming a denser corrosion product layer, while the secondary phases accelerated the corrosion process by forming micro-galvanic couples with the Mg matrix. It is considered that the addition of Sr (0.2%) represents the main contributing factor to these improved properties. The Mg-2Zn-0.2Sr alloy provides excellent strength and corrosion resistance for biomedical applications.