Functional response of osteoblasts in functionally gradient titanium alloy mesh arrays processed by 3D additive manufacturing

Mechanical, bioactive, and long-lasting antibacterial properties of a Ti scaffold with gradient pores releasing iodine ions

The ideal bone implant would effectively prevent aseptic as well as septic loosening by minimizing stress shielding, maximizing bone ingrowth, and preventing implant-associated infections. Here, a novel gradient-pore-size titanium scaffold was designed and manufactured to address these requirements. The scaffold features a larger pore size (900 μm) on the top surface, gradually decreasing to small sizes (600 μm to 300 μm) towards the center, creating a gradient structure. To enhance its functionality, the additively manufactured scaffolds were biofunctionalized using simple chemical and heat treatments so as to incorporate calcium and iodine ions throughout the surface. This unique combination of varying pore sizes with a biofunctional surface provides highly desirable mechanical properties, bioactivity, and notably, long-lasting antibacterial activity. The target mechanical aspects, including low elastic modulus, high compression, compression-shear, and fatigue strength, were effectively achieved. Furthermore, the biofunctional surface exhibits remarkable in vitro bioactivity and potent antibacterial activity, even under conditions specifically altered to be favorable for bacterial growth. More importantly, the integration of small pores alongside larger ones ensures a sustained high release of iodine, resulting in antimicrobial activity that persisted for over three months, with full eradication of the bacteria. Taken together, this gradient structure exhibits obvious superiority in combining most of the desired properties, making it an ideal candidate for orthopedic and dental implant applications.

Construction of a layer-by-layer self-assembled rosemarinic acid delivery system on the surface of CFRPEEK implants for enhanced anti-inflammatory and osseointegration activities

Carbon fiber-reinforced polyether ether ketone (CFRPEEK) implants have attracted widespread attention in the field of clinical bone defect repair. However, the surface bioinertness confines the application of CFRPEEK implants. Inspired by the study of rosmarinic acid (RA)-promoted osteogenic differentiation, a self-assembly surface modification method based on electrostatic interactions, involving deposition of sodium carboxymethyl cellulose/chitosan and rosmarinic acid layer by layer on the surface of poly-L-lysine modified hydroxy CFRPEEK (SCPP/CC5@RA), is proposed to introduce RA on the surface of CFRPEEK for bioactivation. After layer-by-layer self-assembly (LBL), the surface of SCPP/CC5@RA exhibits weak electrophoresis (11.43 eV), suitable hydrophilicity, and bioactivity. The results of in vitro studies indicate that the RA release behavior of SCPP/CC5@RA effectively regulates the immune-inflammatory response and promotes the differentiation of osteoblasts. The rapid release of RA (0.17 μg mL-1) in the initial stage can downregulate the secretion of inflammation-related cytokines and significantly reduce oxidative stress levels; the sustained release of RA (0.06 μg mL-1) in the late stage can upregulate the expression of osteogenesis-related genes and induce mineralization of osteoblasts. Moreover, the rabbit tibia defect model demonstrates that the LBL technique can enhance the osseointegration of CFRPEEK implants. Compared with the control group, the bone trabecular thickness of the SCPP/CC5@RA group increases by 1.36 times, and the maximum pushing force increases by 2.67 times. In summary, this study provides a promising LBL based RA delivery system for the development of a dual-functional CFRPEEK implant in the field of bone implant biomaterials.

Process-structure-biofunctional paradigm in cellular structured implants: an overview and perspective on the synergy between additive manufacturing, bio-mechanical behaviour and biological functions

The overview describes the synergy between biological sciences and cellular structures processed by additive manufacturing to elucidate the significance of cellular structured implants in eliminating stress shielding and in meeting the bio-mechanical property requirements of elastic modulus, impact resistance, and fatigue strength in conjunction with the biological functionality. The convergence of additive manufacturing, computer-aided design, and structure-property relationships is envisaged to provide the solution to the current day challenges in the biomedical arena. The traditional methods of fabrication of biomedical devices including casting and mechanical forming have limitations because of the mismatch in micro/microstructure, mechanical, and physical properties with the host site. Additive manufacturing of cellular structured alloys via electron beam melting and laser powder bed fusion has benefits of fabricating patient-specific design that is obtained from the computed tomography scan of the defect site. The discussion in the overview consists of two aspects - the first one describes the underlying reason that motivated 3D printing of implants from the perspective of minimising stress shielding together with the mechanical property requirements, where the mechanical properties of cellular structured implants depend on the cellular architecture and percentage cellular porosity. The second aspect focuses on the biological response of cellular structured devices.

Preliminary exploration of the biomechanical properties of three novel cervical porous fusion cages using a finite element study

BACKGROUND

Porous cages are considered a promising alternative to high-density cages because their interconnectivity favours bony ingrowth and appropriate stiffness tuning reduces stress shielding and the risk of cage subsidence.

METHODS

This study proposes three approaches that combine macroscopic topology optimization and micropore design to establish three new types of porous cages by integrating lattices (gyroid, Schwarz, body-centred cubic) with the optimized cage frame. Using these three porous cages along with traditional high-density cages, four ACDF surgical models were developed to compare the mechanical properties of facet articular cartilage, discs, cortical bone, and cages under specific loads.

RESULTS

The facet joints in the porous cage groups had lower contact forces than those in the high-density cage group. The intervertebral discs in all models experienced maximum stress at the C5/6 segment. The stress distribution on the cortical bone surface was more uniform in the porous cage groups, leading to increased average stress values. The gyroid, Schwarz, and BCC cage groups showed higher average stress on the C5 cortical bone. The average stress on the surface of porous cages was higher than that on the surface of high-density cages, with the greatest difference observed under the lateral bending condition. The BCC cage demonstrated favourable mechanical stability.

CONCLUSION

The new porous cervical cages satifies requirements of low rigidity and serve as a favourable biological scaffold for bone ingrowth. This study provides valuable insights for the development of next-generation orthopaedic medical devices.

Mechanical influence of tissue scaffolding design with different geometries using finite element study

The mechanical properties of tissue scaffolds are essential in providing stability for tissue repair and growth. Thus, the ability of scaffolds to withstand specific loads is crucial for scaffold design. Most research on scaffold pores focuses on grids with pore size and gradient structure, and many research models are based on scaffolding with vertically arranged holes. However, little attention is paid to the influence of the distribution of holes on the mechanical properties of the scaffold. To address this gap, this research investigates the effect of pore distribution on the mechanical properties of tissue scaffolds. The study involves four types of scaffold designs with regular and staggered pore arrangements and porosity ranging from 30% to 80%. Finite element analysis (FEA) was used to compare the mechanical properties of different scaffold designs, with von-Mises stress distribution maps generated for each scaffold. The results show that scaffolds with regular vertical holes exhibit a more uniform stress distribution and better mechanical performance than those with irregular holes. In contrast, the scaffold with a staggered arrangement of holes had a higher probability of stress concentration. The study emphasized the importance of balancing porosity and strength in scaffold design.

An overview of 3D printed metal implants in orthopedic applications: Present and future perspectives

With the ability to produce components with complex and precise structures, additive manufacturing or 3D printing techniques are now widely applied in both industry and consumer markets. The emergence of tissue engineering has facilitated the application of 3D printing in the field of biomedical implants. 3D printed implants with proper structural design can not only eliminate the stress shielding effect but also improve in vivo biocompatibility and functionality. By combining medical images derived from technologies such as X-ray scanning, CT, MRI, or ultrasonic scanning, 3D printing can be used to create patient-specific implants with almost the same anatomical structures as the injured tissues. Numerous clinical trials have already been conducted with customized implants. However, the limited availability of raw materials for printing and a lack of guidance from related regulations or laws may impede the development of 3D printing in medical implants. This review provides information on the current state of 3D printing techniques in orthopedic implant applications. The current challenges and future perspectives are also included.

Comparison of bone ingrowth between two porous titanium alloy rods with biogenic lamellar structures and diamond crystal lattice on femoral condyles in rabbits

PURPOSE

The comparison of bone ingrowth between two types of porous titanium alloy rods with different micro-architectures including diamond crystal lattice (Re-rod) and biogenic lamellar configurations (Bi-rod) on femoral condyles was investigated in this study.

METHODS

Twelve rabbits were used. Re-rod (Re-rod group) and Bi-rod (Bi-rod group) were implanted randomly in femoral condyles of each rabbits respectively. Bone ingrowth of these two rods were investigated and compared. 4 and 12 weeks after the operation, X-ray, micro-CT and histological examinations were performed.

RESULTS

No femoral condyle fracture and rod defluxion in the two groups was noted in the X-ray images during the observation period. Micro-CT images showed that all metal trabeculae in the Bi-rod group were covered by new bone at 4 and 12 weeks, whereas partial metal trabeculae in the Re-rod group were still uncovered at 12 weeks. Histological images showed that there was new bone growth in the centre and periphery of Bi-rods at 4 and 12 weeks, and there were several areas without new bone ingrowth at 4 and 12 weeks in the centre of Re-rods. In micro-CT analysis, the bone volume to total volume (BV/TV) of the volume of interest (VOI) of the Bi-rod group was higher than in the Re-rod group [(0.0794 ± 0.0021) % Vs (0.0521 ± 0.0032) % and (0.0875 ± 0.0039) % Vs (0.0702 ± 0.0028) % respectively, P < 0.05] at 4 weeks and 12 weeks. Whereas, the mean trabecular thickness (Tb.Th) values of VOI between the two groups were not significantly statistically different at 4 and 12 weeks. In histological analysis, the BV/TV of the VOI of the Bi-rod group was higher than in the Re-rod group [(0.0624 ± 0.0021) % Vs (0.0435 ± 0.0028) % and (0.0675 ± 0.0024) % Vs (0.0476 ± 0.0031) % respectively, P < 0.05] at 4 weeks and 12 weeks.

CONCLUSION

These results showed that Bi-rods got better bone ingrowth in femoral condyles of rabbits compared with Re-rods.

Definition, measurement, and function of pore structure dimensions of bioengineered porous bone tissue materials based on additive manufacturing: A review

Bioengineered porous bone tissue materials based on additive manufacturing technology have gradually become a research hotspot in bone tissue-related bioengineering. Research on structural design, preparation and processing processes, and performance optimization has been carried out for this material, and further industrial translation and clinical applications have been implemented. However, based on previous studies, there is controversy in the academic community about characterizing the pore structure dimensions of porous materials, with problems in the definition logic and measurement method for specific parameters. In addition, there are significant differences in the specific morphological and functional concepts for the pore structure due to differences in defining the dimensional characterization parameters of the pore structure, leading to some conflicts in perceptions and discussions among researchers. To further clarify the definitions, measurements, and dimensional parameters of porous structures in bioengineered bone materials, this literature review analyzes different dimensional characterization parameters of pore structures of porous materials to provide a theoretical basis for unified definitions and the standardized use of parameters.

Evaluation of Compressive and Permeability Behaviors of Trabecular-Like Porous Structure with Mixed Porosity Based on Mechanical Topology

The mechanical properties and permeability properties of artificial bone implants have high-level requirements. A method for the design of trabecular-like porous structure (TLPS) with mixed porosity is proposed based on the study of the mechanical and permeability characteristics of natural bone. With this technique, the morphology and density of internal porous structures can be adjusted, depending on the implantation requirements, to meet the mechanical and permeability requirements of natural bone. The design parameters mainly include the seed points, topology optimization coefficient, load value, irregularity, and scaling factor. Characteristic parameters primarily include porosity and pore size distribution. Statistical methods are used to analyze the relationship between design parameters and characteristic parameters for precise TLPS design and thereby provide a theoretical basis and guidance. TLPS scaffolds were prepared by selective laser melting technology. First, TLPS under different design parameters were analyzed using the finite element method and permeability simulation. The results were then verified by quasistatic compression and cell experiments. The scaling factor and topology optimization coefficient were found to largely affect the mechanical and permeability properties of the TLPS. The corresponding compressive strength reached 270-580 MPa; the elastic modulus ranged between 6.43 and 9.716 GPa, and permeability was 0.6 × 10^-9-21 × 10^-9; these results were better than the mechanical properties and permeability of natural bone. Thus, TLPS can effectively improve the success rate of bone implantation, which provides an effective theory and application basis for bone implantation.

Optimisation of the additive manufacturing parameters of polylactic acid (PLA) cellular structures for biomedical applications

Fused deposition modelling (FDM) is an additive manufacturing technology used to create functional and complex geometries directly from computer-generated models. This technique can be utilised to generate cellular structures with controllable pore size, pore shape, and porosity. Cellular structures are fundamental in orthopaedics scaffolds because of its low elastic modulus, high compressive strength, and adequate cell accommodation spaces. This paper aims at investigating and optimising the FDM additive manufacturing process parameters of polylactic Acid (PLA) for two lattice structures namely Schoen Gyroid and Schwarz Primitive. The effect of additive manufacturing critical process parameters including layer height, flow rate, and print speed on the geometrical accuracy and compressive strength of the specimens were analysed. In addition, other parameters that have minimal effect on the geometrical accuracy of the printed parts were discussed. A Full Factorial Analysis (FFA) using Minitab software was undertaken to identify the perfect combination of printing parameters to provide the most geometrically accurate structure. In this study, samples of the Schoen Gyroid and the Schwarz Primitive lattices and a solid control cylinder were 3D printed using the ideal printing combination to assess the manufacturability, the geometrical accuracy, and the mechanical behaviour of both designs. It was found that the optimised FDM process parameters for the studied cellular structures were a layer height of 0.16 mm, a printing speed of 50 mm/s and a flow rate of 90%. As a result of using these parameters, the solid, Schoen Gyroid and Schwarz Primitive specimens demonstrated elastic moduli values of 951 MPa, 264 MPa, and 221 MPa, respectively. In addition, the Schoen Gyroid and the Schwarz Primitive have reached their stress limits at around 8.68 MPa and 7.06 MPa, respectively. It was noticed that the Schoen Gyroid structure exhibited ∼ 18% higher compressive strength and ∼ 16% higher elastic modulus compared to the Schwarz Primitive structure for the same volume fraction of porosity, overall dimensions, and the manufacturing process parameters. Although both structures revealed mechanical properties that fall within the range of the human trabecular bone, but Schoen Gyroid exhibited improved structural integrity performance that is evident by its post-yield behaviour.

A Novel Design Method of Gradient Porous Structure for Stabilized and Lightweight Mandibular Prosthesis

Compared to conventional prostheses with homogenous structures, a stress-optimized functionally gradient prosthesis will better adapt to the host bone due to its mechanical and biological advantages. Therefore, this study aimed to investigate the damage resistance of four regular lattice scaffolds and proposed a new gradient algorithm for stabilized and lightweight mandibular prostheses. Scaffolds with four configurations (regular hexahedron, regular octahedron, rhombic dodecahedron, and body-centered cubic) having different porosities underwent finite element analysis to select an optimal unit cell. Meanwhile, a homogenization algorithm was used to control the maximum stress and increase the porosity of the scaffold by adjusting the strut diameters, thereby avoiding fatigue failure and material wastage. Additionally, the effectiveness of the algorithm was verified by compression tests. The results showed that the load transmission capacity of the scaffold was strongly correlated with both configuration and porosity. Scaffolds with regular hexahedron unit cells can withstand stronger loads at the same porosity. The optimized gradient scaffold showed higher porosity and lower maximum stress than the target stress value, and the compression tests also confirmed the simulation results. A mandibular prosthesis was established using a regular hexahedron unit cell, and the strut diameters were gradually changed according to the proposed algorithm and the simulation results. Compared with the initial homogeneous prosthesis, the optimized gradient prosthesis reduced the maximum stress by 24.48% and increased the porosity by 6.82%, providing a better solution for mandibular reconstruction.

3D Printed Biomimetic Metamaterials with Graded Porosity and Tapering Topology for Improved Cell Seeding and Bone Regeneration

Biomimetic metallic biomaterials prepared for bone scaffolds have drawn more and more attention in recent years. However, the topological design of scaffolds is critical to cater to multi-physical requirements for efficient cell seeding and bone regeneration, yet remains a big scientific challenge owing to the coupling of mechanical and mass-transport properties in conventional scaffolds that lead to poor control towards favorable modulus and permeability combinations. Herein, inspired by the microstructure of natural sea urchin spines, biomimetic scaffolds constructed by pentamode metamaterials (PMs) with hierarchical structural tunability were additively manufactured via selective laser melting. The mechanical and mass-transport properties of scaffolds could be simultaneously tuned by the graded porosity (B/T ratio) and the tapering level (D/d ratio). Compared with traditional metallic biomaterials, our biomimetic PM scaffolds possess graded pore distribution, suitable strength, and significant improvements to cell seeding efficiency, permeability, and impact-tolerant capacity, and they also promote in vivo osteogenesis, indicating promising application for cell proliferation and bone regeneration using a structural innovation.

Progress in manufacturing and processing of degradable Fe-based implants: a review

Biodegradable metals have gained vast attention as befitting candidates for developing degradable metallic implants. Such implants are primarily employed for temporary applications and are expected to degrade or resorbed after the tissue is healed. Fe-based materials have generated considerable interest as one of the possible biodegradable metals. Like other biometals such as Mg and Zn, Fe exhibits good biocompatibility and biodegradability. The versatility in the mechanical behaviour of Fe-based materials makes them a better choice for load-bearing applications. However, the very low degradation rate of Fe in the physiological environment needs to be improved to make it compatible with tissue growth. Several studies on tailoring the degradation behaviour of Fe in the human body are already reported. Majority of these works include studies on the effect of manufacturing and processing techniques on biocompatibility and biodegradability. This article focuses on a comprehensive review and analysis of the various manufacturing and processing techniques so far reported for developing biodegradable iron-based orthopaedic implants. The current status of research in the field is neatly presented, and a summary of the works is included in the article for the benefit of researchers in the field to contextualise their research and effectively find the lacunae in the existing scholarship.

Compression properties and optimization design of SLM Ti6Al4V square pore tissue engineering scaffolds

The tissue engineering technology provides a new way to solve bone defect. Porous scaffolds supply support and adhesion space for cells. Design of pore structure of scaffolds is one of the key points in tissue engineering scaffolds, because the structure affects the performance of scaffolds directly. In this paper, mechanical properties of square porous Ti6Al4V scaffolds are studied. By finite element simulation, it can be found that the support structure in vertical direction assumes main force, so the structure can be optimized through relative density mapping (RDM) method. The modified arch structures can improve bearing effect of structure with the same porosity. The designed structures are obtained by selective laser melting. Results of compressive strength indicate that the compressive strength decreases with the increase of porosity. When the porosity is between 40% and 60%, the error of compressive strength calculated by Gibson-Ashby model is below 8%. Moreover, the optimized structure clears a better bearing effect, and the bearing capacity can be increased by 20%-30% under the same porosity.

Polymer Coated and Nanofiber Reinforced Functionally Graded Bioactive Glass Scaffolds Fabricated using Additive Manufacturing

In this study, carbon nanotube (CNT) reinforced functionally graded bioactive glass scaffolds have been fabricated using additive manufacturing technique. Sol-gel method was used for the synthesis of the bioactive glass. For ink preparation, Pluronic F-127 was used as an ink carrier. The CNT-reinforced scaffolds were coated with the polymer polycaprolactone (PCL) using dip-coating method to improve their properties further by sealing the micro cracks. The CNT-reinforcement and polymer coating resulted in an improvement in the compressive strength of the additively manufactured scaffolds by 98% in comparison to pure bioactive glass scaffolds. Further, the morphological analysis revealed interconnected pores and their size appropriate for osteogenesis and angiogenesis. Evaluation of the in vitro bioactivity of the scaffolds after immersion in simulated body fluid (SBF) confirmed the formation of hydroxyapatite (HA). Further, the cellular studies showed good cell viability and initiation of osteogensis. These results demonstrate the potential of these scaffolds for bone tissue engineering applications.

Advancing of titanium medical implants by surface engineering: recent progress and challenges

Introduction:Titanium (Ti) and their alloys are used as main implant materials in orthopedics and dentistry for decades having superior mechanical properties, chemical stability and biocompatibility. Their rejections due lack of biointegration and bacterial infection are concerning with considerable healthcare costs and impacts on patients. To address these limitations, conventional Ti implants need improvements where the use of surface nanoengineering approaches and the development of a new generation of implants are recognized as promising strategies.Areas covered:This review presents an overview of recent progress on the application of surface engineering methods to advance Ti implants enable to address their key limitations. Several promising surface engineering strategies are presented and critically discussed to generate advanced surface properties and nano-topographies (tubular, porous, pillars) able not only to improve their biointegration, antibacterial performances, but also to provide multiple functions such as drug delivery, therapy, sensing, communication and health monitoring underpinning the development of new generation and smart medical implants.Expert opinion:Recent advances in cell biology, materials science, nanotechnology and additive manufacturing has progressively influencing improvements of conventional Ti implants toward the development of the next generation of implants with improved performances and multifunctionality. Current research and development are in early stage, but progressing with promising results and examples of moving into in-vivo studies an translation into real applications.

Additive manufacturing of Ti6Al4V alloy via electron beam melting for the development of implants for the biomedical industry

Additive Manufacturing (AM) or rapid prototyping technologies are presented as one of the best options to produce customized prostheses and implants with high-level requirements in terms of complex geometries, mechanical properties, and short production times. The AM method that has been more investigated to obtain metallic implants for medical and biomedical use is Electron Beam Melting (EBM), which is based on the powder bed fusion technique. One of the most common metals employed to manufacture medical implants is titanium. Although discovered in 1790, titanium and its alloys only started to be used as engineering materials for biomedical prostheses after the 1950s. In the biomedical field, these materials have been mainly employed to facilitate bone adhesion and fixation, as well as for joint replacement surgeries, thanks to their good chemical, mechanical, and biocompatibility properties. Therefore, this study aims to collect relevant and up-to-date information from an exhaustive literature review on EBM and its applications in the medical and biomedical fields. This AM method has become increasingly popular in the manufacturing sector due to its great versatility and geometry control.

Functional Gradient Metallic Biomaterials: Techniques, Current Scenery, and Future Prospects in the Biomedical Field

Functional gradient materials (FGMs), as a modern group of materials, can provide multiple functions and are able to well mimic the hierarchical and gradient structure of natural systems. Because biomedical implants usually substitute the bone tissues and bone is an organic, natural FGM material, it seems quite reasonable to use the FGM concept in these applications. These FGMs have numerous advantages, including the ability to tailor the desired mechanical and biological response by producing various gradations, such as composition, porosity, and size; mitigating some limitations, such as stress-shielding effects; improving osseointegration; and enhancing electrochemical behavior and wear resistance. Although these are beneficial aspects, there is still a notable lack of comprehensive guidelines and standards. This paper aims to comprehensively review the current scenery of FGM metallic materials in the biomedical field, specifically its dental and orthopedic applications. It also introduces various processing methods, especially additive manufacturing methods that have a substantial impact on FGM production, mentioning its prospects and how FGMs can change the direction of both industry and biomedicine. Any improvement in FGM knowledge and technology can lead to big steps toward its industrialization and most notably for much better implant designs with more biocompatibility and similarity to natural tissues that enhance the quality of life for human beings.

Additively manufactured functionally graded biodegradable porous zinc

Topological design provides additively manufactured (AM) biodegradable porous metallic biomaterials with a unique opportunity to adjust their biodegradation behavior and mechanical properties, thereby satisfying the requirements for ideal bone substitutes. However, no information is available yet concerning the effect of topological design on the performance of AM porous zinc (Zn) that outperforms Mg and Fe in biodegradation behavior. Here, we studied one functionally graded and two uniform AM porous Zn designs with diamond unit cell. Cylindrical specimens were fabricated from pure Zn powder by using a powder bed fusion technique, followed by a comprehensive study on their static and dynamic biodegradation behaviors, mechanical properties, permeability, and biocompatibility. Topological design, indeed, affected the biodegradation behavior of the specimens, as evidenced by 150% variations in biodegradation rate between the three different designs. After in vitro dynamic immersion for 28 days, the AM porous Zn had weight losses of 7-12%, relying on the topological design. The degradation rates satisfied the desired biodegradation time of 1-2 years for bone substitution. The mechanical properties of the biodegraded specimens of all the groups maintained within the range of those of cancellous bone. As opposed to the trends observed for other biodegradable porous metals, after 28 days of in vitro biodegradation, the yield strengths of the specimens of all the groups (σy = 7-14 MPa) increased consistently, as compared to those of the as-built specimens (σy = 4-11 MPa). Moreover, AM porous Zn showed excellent biocompatibility, given that the cellular activities in none of the groups differed from the Ti controls for up to 72 h. Using topological design of AM porous Zn for controlling its mechanical properties and degradation behavior is thus clearly promising, thereby rendering flexibility to the material to meet a variety of clinical requirements.

3D Printing Technologies in Metallic Implants: A Thematic Review on the Techniques and Procedures

Additive manufacturing (AM) is among the most attractive methods to produce implants, the processes are very swift and it can be precisely controlled to meet patient’s requirement since they can be produced in exact shape, dimension, and even texture of different living tissues. Until now, lots of methods have emerged and used in this field with diverse characteristics. This review aims to comprehensively discuss 3D printing (3DP) technologies to manufacture metallic implants, especially on techniques and procedures. Various technologies based on their main properties are categorized, the effecting parameters are introduced, and the history of AM technology is briefly analyzed. Subsequently, the utilization of these AM-manufactured components in medicine along with their effectual variables is discussed, and special attention is paid on to the production of porous scaffolds, taking pore size, density, etc., into consideration. Finally, 3DP of the popular metallic systems in medical applications such as titanium, Ti6Al4V, cobalt-chromium alloys, and shape memory alloys are studied. In general, AM manufactured implants need to comply with important requirements such as biocompatibility, suitable mechanical properties (strength and elastic modulus), surface conditions, custom-built designs, fast production, etc. This review aims to introduce the AM technologies in implant applications and find new ways to design more sophisticated methods and compatible implants that mimic the desired tissue functions.

Additively manufactured biomedical Ti-Nb-Ta-Zr lattices with tunable Young's modulus: Mechanical property, biocompatibility, and proteomics analysis

Some β-Ti alloys, such as Ti-Nb-Ta-Zr (TNTZ) alloys, exhibit a low Young's modulus and excellent biocompatibility. These alloys are promising new generation biomedical implant materials. Selective laser melting (SLM) can further enable customer-specific manufacturing of β-Ti alloys to satisfy the ever-increasing need for enhanced biomedical products. In this study, we quantitatively determined the relationships between porosity, yield strength, and Young's modulus of SLM-prepared TNTZ lattices. The study constitutes a critical step toward understanding the behavior of the lattice and eventually enables tuning the Young's modulus to match that of human bones. Fatigue properties were also investigated on as-printed lattices in terms of the stress limit. The biocompatibility study included a routine evaluation of the relative cell growth rate and a proteomics analysis using a common mouse fibroblast cell line, L929. The results indicated that the as-printed TNTZ samples exhibited evidence of protein proliferation of the L929 cells, particularly P06733, and that those proteins are responsible for biological processes and molecular functions. They in turn may have promoted cell regeneration, cell motility, and protein binding, which at least partially explains the good biocompatibility of the as-printed TNTZ at the protein level. The study highlights the promising applications of additively manufactured TNTZ as a bone-replacing material from mechanical and biocompatibility perspectives.

Porous Scaffold Design for Additive Manufacturing in Orthopedics: A Review

With the increasing application of orthopedic scaffolds, a dramatically increasing number of requirements for scaffolds are precise. The porous structure has been a fundamental design in the bone tissue engineering or orthopedic clinics because of its low Young's modulus, high compressive strength, and abundant cell accommodation space. The porous structure manufactured by additive manufacturing (AM) technology has controllable pore size, pore shape, and porosity. The single unit can be designed and arrayed with AM, which brings controllable pore characteristics and mechanical properties. This paper presents the current status of porous designs in AM technology. The porous structures are stated from the cellular structure and the whole structure. In the aspect of the cellular structure, non-parametric design and parametric design are discussed here according to whether the algorithm generates the structure or not. The non-parametric design comprises the diamond, the body-centered cubic, and the polyhedral structure, etc. The Voronoi, the Triply Periodic Minimal Surface, and other parametric designs are mainly discussed in parametric design. In the discussion of cellular structures, we emphasize the design, and the resulting biomechanical and biological effects caused by designs. In the aspect of the whole structure, the recent experimental researches are reviewed on uniform design, layered gradient design, and layered gradient design based on topological optimization, etc. These parts are summarized because of the development of technology and the demand for mechanics or bone growth. Finally, the challenges faced by the porous designs and prospects of porous structure in orthopedics are proposed in this paper.

Application of biomaterials for the repair and treatment of osteonecrosis of the femoral head

Osteonecrosis of the femoral head (ONFH) is one of the most common causes of hip disability in young adults. However, its cause and pathogenesis remain unclear, and might be caused by a variety of factors. ONFH mainly occurs in young adults. If not treated, 70-80% of patients would progress into femoral head collapse in 3 years, and eventually require hip arthroplasty. Since these patients are younger and more physically active, multiple revision hip arthroplasty might be needed in their life. Repeated revision hip arthroplasty is difficult and risky, and has many complications, which inevitably affects the physical and mental health of patients. To delay the time of total hip arthroplasty for young adult patients with ONFH, biomaterials are used for its repair, which has a high clinical and social value for the retention of the patient's own hip function. At present, there are many types of biomaterials used in repairing the femoral head, there is no uniform standard of use and the clinical effects are different. In this review, the main biomaterials used in the repair of ONFH are summarized and analyzed, and the prospects are also described.

Porous Tantalum and Titanium in Orthopedics: A Review

Porous metal is metal with special porous structures, which can offer high biocompatibility and low Young's modulus to satisfy the need for orthopedic applications. Titanium and tantalum are the most widely used porous metals in orthopedics due to their excellent biomechanical properties and biocompatibility. Porous titanium and tantalum have been studied and applied for a long history until now. Here in this review, various manufacturing methods of titanium and tantalum porous metals are introduced. Application of these porous metals in different parts of the body are summarized, and strengths and weaknesses of these porous metal implants in clinical practice are discussed frankly for future improvement from the viewpoint of orthopedic surgeons. Then according to the requirements from clinics, progress in research for clinical use is illustrated in four aspects. Various creative designs of microporous and functionally gradient structure, surface modification, and functional compound systems of porous metal are exhibited as reference for future research. Finally, the directions of orthopedic porous metal development were proposed from the clinical view based on the rapid progress of additive manufacturing. Controllable design of both macroscopic anatomical bionic shape and microscopic functional bionic gradient porous metal, which could meet the rigorous mechanical demand of bone reconstruction, should be developed as the focus. The modification of a porous metal surface and construction of a functional porous metal compound system, empowering stronger cell proliferation and antimicrobial and antineoplastic property to the porous metal implant, also should be taken into consideration.

Additively manufactured functionally graded biodegradable porous iron

Additively manufactured (AM) functionally graded porous metallic biomaterials offer unique opportunities to satisfy the contradictory design requirements of an ideal bone substitute. However, no functionally graded porous structures have ever been 3D-printed from biodegradable metals, even though biodegradability is crucial both for full tissue regeneration and for the prevention of implant-associated infections in the long term. Here, we present the first ever report on AM functionally graded biodegradable porous metallic biomaterials. We made use of a diamond unit cell for the topological design of four different types of porous structures including two functionally graded structures and two reference uniform structures. Specimens were then fabricated from pure iron powder using selective laser melting (SLM), followed by experimental and computational analyses of their permeability, dynamic biodegradation behavior, mechanical properties, and cytocompatibility. It was found that the topological design with functional gradients controlled the fluid flow, mass transport properties and biodegradation behavior of the AM porous iron specimens, as up to 4-fold variations in permeability and up to 3-fold variations in biodegradation rate were observed for the different experimental groups. After 4 weeks of in vitro biodegradation, the AM porous scaffolds lost 5-16% of their weight. This falls into the desired range of biodegradation rates for bone substitution and confirms our hypothesis that topological design could indeed accelerate the biodegradation of otherwise slowly degrading metals, like iron. Even after 4 weeks of biodegradation, the mechanical properties of the specimens (i.e., E = 0.5-2.1 GPa, σ_y = 8-48 MPa) remained within the range of the values reported for trabecular bone. Design-dependent cell viability did not differ from gold standard controls for up to 48 h. This study clearly shows the great potential of AM functionally graded porous iron as a bone substituting material. Moreover, we demonstrate that complex topological design permits the control of mechanical properties, degradation behavior of AM porous metallic biomaterials. STATEMENT OF SIGNIFICANCE: No functionally graded porous structures have ever been 3D-printed from biodegradable metals, even though biodegradability is crucial both for full tissue regeneration and for the prevention of implant-associated infections in the long term. Here, we present the first report on 3D-printed functionally graded biodegradable porous metallic biomaterials. Our results suggest that topological design in general, and functional gradients in particular can be used as an important tool for adjusting the biodegradation behavior of AM porous metallic biomaterials. The biodegradation rate and mass transport properties of AM porous iron can be increased while maintaining the bone-mimicking mechanical properties of these biomaterials. The observations reported here underline the importance of proper topological design in the development of AM porous biodegradable metals.

Topological design, permeability and mechanical behavior of additively manufactured functionally graded porous metallic biomaterials

Recent advances in additive manufacturing (AM) have enabled the fabrication of functionally graded porous biomaterials (FGPBs) for application as orthopedic implants and bone substitutes. Here, we present a step-wise topological design of FGPB based on diamond unit cells to mimic the structure of the femoral diaphysis. The FGPB was manufactured from Ti-6Al-4V powder using the selective laser melting (SLM) technique. The morphological parameters, permeability and mechanical properties of FGPB samples were measured and compared with those of the biomaterials with uniform porous structures based on the same type of the unit cell. The FGPB exhibited a low density (1.9 g/cm³), a moderate Young's modulus (10.44 GPa), a high yield stress (170.6 MPa), a high maximum stress (201 MPa) and favorable ductility, being superior to the biomaterials with uniform porous structures in comprehensive mechanical properties. In addition, digital image correlation (DIC) and finite element (FE) simulation were used to unravel the mechanisms governing the deformation and yielding behavior of these biomaterials particularly at the strut junctions. Both DIC and FE simulations confirmed that the deformation and yielding of the FGPB occurred largely in the load-bearing layers but not at the interfaces between layers. Defect-coupled FE models based on solid elements provided further insights into the mechanical responses of the FGPB to compressive loads at both macro- and micro-scales. With the defect-coupled representative volume element model for the FGPB, the Young's modulus and yield stress of the FGPBs were predicted with less than 2% deviations from the experimental data. The study clearly demonstrated the capabilities of combined experimental and computational methods to resolve the uncertainties of the mechanical behavior of FGPBs, which would open up the possibilities of applying various porosity variation strategies for the design of biomimetic AM porous biomaterials. STATEMENT OF SIGNIFICANCE: Functionally graded bone scaffolds significantly promote the recovery of segmental bone defect. In the present study, we present a step-wise topological design of functionally graded porous biomaterial (FGPB) to mimic the structure of the femoral diaphysis. The Ti-6Al-4V FGPB exhibited a superior combination of low density, moderate Young's modulus, high yield stress and maximum stress as well as favorable ductility. The biomechanical performance of FGPB was studied in both macro and micro perspectives. The defect-coupled model revealed the significant yielding in the load-bearing parts and the Young's modulus and yield stress of the FGPBs were predicted with less than 2% deviations from the experimental data. The superiority of combined experimental and computational methods has been confirmed.

Heat treatment effect on the mechanical properties, roughness and bone ingrowth capacity of 3D printing porous titanium alloy

The weak mechanical strength and biological inertia of Ti-6Al-4V porous titanium alloy limit its clinical application in the field of orthopedics. The present study investigated the influence of different solution temperatures (e.g. 800 °C, 950 °C and 1000 °C) on the mechanical properties, roughness and bone ingrowth capacity of Ti-6Al-4V porous titanium alloy prepared by Electron Beam Melting. It was found that the compressive and shear strength were promoted with the increase of solution temperature because of the transformed crystallinity of Ti-6Al-4V titanium alloy and phase changes from TiAl to TiAl + TiV. In addition, the topological morphology, surface roughness and wettability of the porous titanium alloy scaffolds were improved after heat treatment, and in turn, the adhesion rate and cell proliferation of bone marrow mesenchymal stem cells were enhanced. Compared with the scaffolds before and after heat treatment at 800 °C, the scaffolds heat-treated at 950 °C and 1000 °C achieved better bone ingrowth, extracellular matrix deposition and osseointegration. These findings indicate the great potential of heat treatment in possessing Ti-6Al-4V porous titanium alloy for orthopedic implant.

Surface nanotopography-induced favorable modulation of bioactivity and osteoconductive potential of anodized 3D printed Ti-6Al-4V alloy mesh structure

The objective of the study described here is to fundamentally elucidate the biological response of 3D printed Ti-6Al-4V alloy mesh structures that were surface modified to introduce titania nanotubes with an average pore size of ∼80 nm via an electrochemical anodization process from the perspective of enhancing bioactivity. The bioactivity of the mesh structures were analyzed through immersion test in simulated body fluid, which confirmed the nucleation and growth of fine globular nanoscale apatite on the nanoporous titania-modified (anodized) mesh structure surface, and agglomerated apatite with fine flakes of apatite crystals on as-fabricated mesh structure surface, that were rich in calcium and phosphorous. The cellular activity of bioactive anodized mesh structure was explored in terms of cell–material interactions involving adhesion, proliferation, synthesis of extracellular and intracellular proteins, differentiation, and mineralization. Cells adhered with a sheet-like morphology on as-fabricated mesh structure, whereas, on anodized mesh structure, numerous filopodia-like cellular extensions interacting with nanotube pores were observed. The formation of a bioactive nanoscale apatite, cell–nanotube interactions as imaged via electron microscopy, higher expression of proteins (actin, vinculin, fibronectin, and alkaline phosphatase (ALP)), and calcium content points toward the determining role of anodized mesh structure in modulating osteoblasts functions. The unique combination of nanoporous bioactive titania and interconnected porous architecture of anodized titanium alloy mesh structure provided a multimodal roughness surface ranging from nano to micro to macroscale, which helps in attaining strong primary and secondary fixation of the implant device along with the pathway for supply of nutrients and oxygen to cells and tissue.

Additively Manufactured Scaffolds for Bone Tissue Engineering and the Prediction of their Mechanical Behavior: A Review

Additive manufacturing (AM), nowadays commonly known as 3D printing, is a revolutionary materials processing technology, particularly suitable for the production of low-volume parts with high shape complexities and often with multiple functions. As such, it holds great promise for the fabrication of patient-specific implants. In recent years, remarkable progress has been made in implementing AM in the bio-fabrication field. This paper presents an overview on the state-of-the-art AM technology for bone tissue engineering (BTE) scaffolds, with a particular focus on the AM scaffolds made of metallic biomaterials. It starts with a brief description of architecture design strategies to meet the biological and mechanical property requirements of scaffolds. Then, it summarizes the working principles, advantages and limitations of each of AM methods suitable for creating porous structures and manufacturing scaffolds from powdered materials. It elaborates on the finite-element (FE) analysis applied to predict the mechanical behavior of AM scaffolds, as well as the effect of the architectural design of porous structure on its mechanical properties. The review ends up with the authors’ view on the current challenges and further research directions.