Evaluation of carbon nanotubes and graphene as reinforcements for UHMWPE-based composites in arthroplastic applications: A review

Nanostructured Medical Devices: Regulatory Perspective and Current Applications

Nanomaterials (NMs) are having a huge impact in several domains, including the fabrication of medical devices (MDs). Hence, nanostructured MDs are becoming quite common; nevertheless, the associated risks must be carefully considered in order to demonstrate safety prior to their immission on the market. The biological effect of NMs requires the consideration of methodological issues since already established methods for, e.g., cytotoxicity can be subject to a loss of accuracy in the presence of certain NMs. The need for oversight of MDs containing NMs is reflected by the European Regulation 2017/745 on MDs, which states that MDs incorporating or consisting of NMs are in class III, at highest risk, unless the NM is encapsulated or bound in such a manner that the potential for its internal exposure is low or negligible (Rule 19). This study addresses the role of NMs in medical devices, highlighting the current applications and considering the regulatory requirements of such products.

Nanotechnology development in surgical applications: recent trends and developments

This paper gives a detailed analysis of nanotechnology's rising involvement in numerous surgical fields. We investigate the use of nanotechnology in orthopedic surgery, neurosurgery, plastic surgery, surgical oncology, heart surgery, vascular surgery, ophthalmic surgery, thoracic surgery, and minimally invasive surgery. The paper details how nanotechnology helps with arthroplasty, chondrogenesis, tissue regeneration, wound healing, and more. It also discusses the employment of nanomaterials in implant surfaces, bone grafting, and breast implants, among other things. The article also explores various nanotechnology uses, including stem cell-incorporated nano scaffolds, nano-surgery, hemostasis, nerve healing, nanorobots, and diagnostic applications. The ethical and safety implications of using nanotechnology in surgery are also addressed. The future possibilities of nanotechnology are investigated, pointing to a possible route for improved patient outcomes. The essay finishes with a comment on nanotechnology's transformational influence in surgical applications and its promise for future breakthroughs.

Multi-Walled Carbon-Nanotube-Reinforced PMMA Nanocomposites: An Experimental Study of Their Friction and Wear Properties

This manuscript presents an experimental investigation of the friction and wear properties of poly (methyl methacrylate) (PMMA) nanocomposites reinforced with functionalized multi-walled carbon nanotubes (MWCNTs). The aim of this study is to evaluate the potential of MWCNTs as a reinforcement material for enhancing the tribological performance of PMMA. Three types of multi-walled carbon nanotubes, i.e., pristine, hydroxyl functionalized, and carboxyl functionalized, were utilized in this study. The nanocomposite samples were prepared by dispersing varying concentrations of MWCNTs (0.1 wt.%, 0.5 wt.%, and 1 wt.%) within the PMMA matrix via a 3D mixing approach, followed by injection molding/compression molding. The resulting nanocomposite films were characterized using scanning electron microscopy (SEM) to observe the dispersion of MWCNTs within the PMMA matrix. The friction and wear tests were conducted using a pin-on-disk tribometer under dry sliding conditions. The effects of functionalization and MWCNT content on the tribological behaviors of the nanocomposites were analyzed. The nanocomposites exhibited lower friction coefficients and reduced wear rates compared to pure PMMA. The lowest friction coefficient and wear rate were achieved at an optimum MWCNT loading of 0.5 wt.%. It was further revealed that the amount of MWCNT reinforcement, average load, and track diameter significantly affect the coefficient of friction (COF) and rate of wear. The COF and wear rate are best at a filler loading of 0.5 wt.%, a 20 Kg load, and 90 mm. The improved tribological performance of the MWCNT-reinforced PMMA nanocomposites can be attributed to the effective transfer of load between the MWCNTs and the PMMA matrix, as well as the reinforcement effect of the MWCNTs. The MWCNTs acted as reinforcing agents, enhancing the mechanical properties and wear resistance of the nanocomposites.

A mini-review on the emerging role of nanotechnology in revolutionizing orthopedic surgery: challenges and the road ahead

An emerging application of nanotechnology in medicine currently being developed involves employing nanoparticles to deliver drugs, heat, light, or other substances to specific types of cells (such as cancer cells). As most biological molecules exist and function at the nanoscale, engineering and manipulating matter at the molecular level has many advantages in the field of medicine (nanomedicine). Although encouraging, it remains unclear how much of this will ultimately result in improved patient care. In surgical specialties, clinically relevant nanotechnology applications include the creation of surgical instruments, suture materials, imaging, targeted drug therapy, visualization methods, and wound healing techniques. Burn lesion and scar management is an essential nanotechnology application. Prevention, diagnosis, and treatment of numerous orthopedic conditions are crucial technological aspects for patients' functional recovery. Orthopedic surgery is a specialty that deals with the diagnosis and treatment of musculoskeletal disorders. In recent years, the field of orthopedics has been revolutionized by the advent of nanotechnology. Using biomaterials comprised of nanoparticles and structures, it is possible to substantially enhance the efficacy of such interactions through nanoscale material modifications. This serves as the foundation for the majority of orthopedic nanotechnology applications. In orthopedic surgery, nanotechnology has been applied to improve surgical outcomes, enhance bone healing, and reduce complications associated with orthopedic procedures. This mini-review summarizes the present state of nanotechnology in orthopedic surgery, including its applications as well as possible future directions.

Mechanical and Tribological Performance of HDPE Matrix Reinforced by Hybrid Gr/TiO2 NPs for Hip Joint Replacement

Hip joint collapse is a very common health problem. Many cases need a joint replacement, so nano-polymeric composites are an ideal alternative solution. Due to its mechanical properties and wear resistance, HDPE might be considered a suitable alternative to frictional materials. The current research focuses on using hybrid nanofiller TiO2 NPs and nano-graphene with various loading compositions to evaluate the best loading amount. The compressive strength, modules of elasticity, and hardness were examined via experiments. The COF and wear resistance were evaluated via a pin-on-disk tribometer. The worn surfaces were analyzed based on 3D topography and SEM images. The HDPE samples with various compositions of 0.5%, 1.0%, 1.5%, and 2.0 wt.% filling content of TiO2 NPs and Gr (with a ratio of 1:1) were analyzed. Results revealed that hybrid nanofiller with a composition of 1.5 wt.% exhibits superior mechanical properties compared to other filling compositions. Moreover, the COF and wear rate decreased by 27.5% and 36.3%, respectively.

Contact stress and sliding wear damage tolerance of hydroxyapatite and carbon nanotube reinforced polyethylene cup liner against zirconia femoral head

A finite element modeling (FEM) approach is carried out to estimate the contact stresses such as von-Mises and shear stress on the acetabular cup liner, made up of ultra-high molecular weight polyethylene (UHMWPE)-hydroxyapatite (HAp)-carbon nanotubes (CNT) based composites. The highlights of this work include the effects of liners' material (UHMWPE-HAp-CNT composites), radial clearance (0.05 to 1 mm), and liners' wall thickness (3 to 8 mm) on contact stresses. The thick liner (thickness: 8 mm) with conformal geometry (radial clearance 0.05 mm) produced the lowest contact stresses (von-Mises: 13.8-17.5 MPa and shear stress: 2.3-3.3 MPa). In contrast, the thin liner (thickness: 3 mm) with higher radial clearance (1 mm) showed the highest von-Mises stress (78.6-131.0 MPa) and shear stress (17.0-23.3 MPa). According to ISO 7206-1, nearly 6-7 times reduced contact stresses were observed because of the wider articulating contact area provided by thick cup liner and its conformity with respect to the femoral head. The UHMWPE-2 wt % CNT composite (UC) showed low von-Mises stress (16.1 MPa) and lowest shear stress (2.3 MPa); thus, it is the most damage tolerant material (wear rate: 2.6 × 10-7 mm3/Nm). The excellent mechanical properties such as hardness (165 MPa), elastic modulus (2.28 GPa), and tensile strength (36.7 MPa) are reasoned to elicit an increased sliding-wear resistance of UC. Thus, CNT-based UHMWPE composite can be the potential acetabular cup liner with a thickness of 8 mm and clearance of 0.05 mm without plastic deformation.

Smart biomaterials and their potential applications in tissue engineering

Smart biomaterials have been rapidly advancing ever since the concept of tissue engineering was proposed. Interacting with human cells, smart biomaterials can play a key role in novel tissue morphogenesis. Various aspects of biomaterials utilized in or being sought for the goal of encouraging bone regeneration, skin graft engineering, and nerve conduits are discussed in this review. Beginning with bone, this study summarizes all the available bioceramics and materials along with their properties used singly or in conjunction with each other to create scaffolds for bone tissue engineering. A quick overview of the skin-based nanocomposite biomaterials possessing antibacterial properties for wound healing is outlined along with skin regeneration therapies using infrared radiation, electrospinning, and piezoelectricity, which aid in wound healing. Furthermore, a brief overview of bioengineered artificial skin grafts made of various natural and synthetic polymers has been presented. Finally, by examining the interactions between natural and synthetic-based biomaterials and the biological environment, their strengths and drawbacks for constructing peripheral nerve conduits are highlighted. The description of the preclinical outcome of nerve regeneration in injury healed with various natural-based conduits receives special attention. The organic and synthetic worlds collide at the interface of nanomaterials and biological systems, producing a new scientific field including nanomaterial design for tissue engineering.

A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture

BACKGROUND

Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at least of the prosthetic head. However, the root cause behind these rare events is not fully understood. This study evaluated head fracture occurrence in a sizeable cohort of patients with fourth-generation ceramic-on-ceramic implants and described the circumstances reported by patients in the rare cases of head fracture.

METHODS

The clinical survivorship of 29,495 hip prostheses, with fourth-generation ceramic bearings, was determined using data from a joint replacement registry. The average follow-up period was 5.2 years (range 0.1-15.6). Retrieval analysis was performed in one case for which the ceramic components were available.

RESULTS

Clinical outcomes confirmed the extremely low fracture rate of fourth-generation ceramic heads: only two out of 29,495 heads fractured. The two fractures, both involving 36 mm heads, occurred without a concurrent or previous remarkable trauma. Considering the feature of the fractured head, a multi-stage crack growth mechanism has been hypothesized to occur following damage at the head-neck taper interface.

CONCLUSIONS

Surgeons must continue to pay attention to the assembly of the femoral head: achieving a proper head seating on a clean taper is a prerequisite to decrease the risk of occurrence of any damage process within head-neck junction, which may cause high stress concentration at the contact surface, promoting crack nucleation and propagation even in toughened ceramics.

Functional Ultra-High Molecular Weight Polyethylene Composites for Ligament Reconstructions and Their Targeted Applications in the Restoration of the Anterior Cruciate Ligament

The selection of biomaterials as biomedical implants is a significant challenge. Ultra-high molecular weight polyethylene (UHMWPE) and composites of such kind have been extensively used in medical implants, notably in the bearings of the hip, knee, and other joint prostheses, owing to its biocompatibility and high wear resistance. For the Anterior Cruciate Ligament (ACL) graft, synthetic UHMWPE is an ideal candidate due to its biocompatibility and extremely high tensile strength. However, significant problems are observed in UHMWPE based implants, such as wear debris and oxidative degradation. To resolve the issue of wear and to enhance the life of UHMWPE as an implant, in recent years, this field has witnessed numerous innovative methodologies such as biofunctionalization or high temperature melting of UHMWPE to enhance its toughness and strength. The surface functionalization/modification/treatment of UHMWPE is very challenging as it requires optimizing many variables, such as surface tension and wettability, active functional groups on the surface, irradiation, and protein immobilization to successfully improve the mechanical properties of UHMWPE and reduce or eliminate the wear or osteolysis of the UHMWPE implant. Despite these difficulties, several surface roughening, functionalization, and irradiation processing technologies have been developed and applied in the recent past. The basic research and direct industrial applications of such material improvement technology are very significant, as evidenced by the significant number of published papers and patents. However, the available literature on research methodology and techniques related to material property enhancement and protection from wear of UHMWPE is disseminated, and there is a lack of a comprehensive source for the research community to access information on the subject matter. Here we provide an overview of recent developments and core challenges in the surface modification/functionalization/irradiation of UHMWPE and apply these findings to the case study of UHMWPE for ACL repair.

Recent Advances and Perspective of Nanotechnology-Based Implants for Orthopedic Applications

Bioimplant engineering strives to provide biological replacements for regenerating, retaining, or modifying injured tissues and/or organ function. Modern advanced material technology breakthroughs have aided in diversifying ingredients used in orthopaedic implant applications. As such, nanoparticles may mimic the surface features of real tissues, particularly in terms of wettability, topography, chemistry, and energy. Additionally, the new features of nanoparticles support their usage in enhancing the development of various tissues. The current study establishes the groundwork for nanotechnology-driven biomaterials by elucidating key design issues that affect the success or failure of an orthopaedic implant, its antibacterial/antimicrobial activity, response to cell attachment propagation, and differentiation. The possible use of nanoparticles (in the form of nanosized surface or a usable nanocoating applied to the implant’s surface) can solve a number of problems (i.e., bacterial adhesion and corrosion resilience) associated with conventional metallic or non-metallic implants, particularly when implant techniques are optimised. Orthopaedic biomaterials’ prospects (i.e., pores architectures, 3D implants, and smart biomaterials) are intriguing in achieving desired implant characteristics and structure exhibiting stimuli-responsive attitude. The primary barriers to commercialization of nanotechnology-based composites are ultimately discussed, therefore assisting in overcoming the constraints in relation to certain pre-existing orthopaedic biomaterials, critical factors such as quality, implant life, treatment cost, and pain alleviation.

Probing lubricated sliding wear properties of HDPE/UHMWPE hybrid bionanocomposite

Ultra-high molecular weight polyethylene (UHMWPE) and its derivatives have been clinically used as an acetabular liner material in total hip joint replacement (THR) over last six decades. Despite significant efforts, the longevity of UHMWPE implants is still impaired due to their compromised tribological performance, leading to osteolysis and aseptic loosening. The present study aims to critically evaluate and analyze the tribological performance, of the next generation acetabular liner material, that is, a chemically modified graphene oxide (GO) reinforced HDPE/UHMWPE (HU) bionanocomposite (HUmGO), against stainless steel (SS 316L) counterface in lubricated conditions. This work also provides a performance comparative assessment of HUmGO with respect to medical grades, UHMWPE (UC) and crosslinked UHMWPE (XL-UC). Significant attempts have been made to correlate the tribological properties (frictional behavior, wear rate, wear debris shape and size, wear mechanism) with the physicomechanical conditions (contact stresses) at sliding contact and the variation in molecular architecture of different UHMWPE materials. Additionally, an emphasis is put forward to critically anlyze the nature of lubrication regime based on the bearing characterstic parameters. HUmGO exhibited a lower COF (0.07) and specific wear rate (2.86 × 10^-8 mm³/Nm) than UC and XL-UC under identical sliding conditions. The worn surfaces on HUmGO revealed the signatures of less abrasive wear and limited deformation. Based on the estimated lambda (λ) ratio and Sommerfield number, all the investigated sliding contacts exhibited boundary lubrication. Taken together, the modified GO reinforced HDPE/UHMWPE bionanocomposite can be considered as a new generation biomaterial for the fabrication of acetabular liner for hip-joint prosthesis.

Recent Trends in Fascinating Applications of Nanotechnology in Allied Health Sciences

The increased advancement in nanosciences in recent times has led to fascinating innovations. It has potential applications for altering the structural, surface, and physicochemical properties of nano-ranged metamaterials. The adaptable optical, structural, and surface characteristics of the nanoscopic regimes enhance the quality of integrated nanodevices and sensors. These are further used in optoelectronics, biomedicines, and catalysis. The use of nanomaterials for constructing nano-biosensors and various other organic and inorganic functional nanomaterials is quite promising. They have excellent electronic and surface-to-volume reactivity. Their various applications include metal and metal-oxides-based nanoparticles, clusters, wires, and 2D nanosheets as carbon nanotubes. More recently, hybrid nanomaterials are being developed to regulate sensing functionalities in the field of nanomedicine and the pharmaceutical industry. They are used as nano-markers, templates, and targeted agents. Moreover, the mechanical strength, chemical stability, durability, and flexibility of the hybrid nanomaterials make them appropriate for developing a healthy life for humans. This consists of a variety of applications, such as drug delivery, antimicrobial impacts, nutrition, orthopedics, dentistry, and fluorescence fabrics. This review article caters to the essential importance of nanoscience for biomedical applications and information for health science and research. The fundamental characteristics and functionalities of nanomaterials for particular biomedical uses are specifically addressed here.

Tribological properties of organotin compound modified UHMWPE

A range of ultra-high molecular weight polyethylene (UHMWPE)/tetraphenyltin (Ph4Sn) nanocomposites were fabricated by hot-pressing. The surface hardness and crystallinity of composites were studied. It revealed that the surface hardness of the composites decreased slightly, and the changing trend of crystallinity was consistent with the hardness. The tribological properties of composites under seawater lubricating conditions were investigated. The experimental results showed that the friction coefficients of the composites almost keep the same but the wear reduced sharply. With the increases of Ph4Sn content, the wear of composites first decreases significantly and then increases, meanwhile the friction coefficient remains basically unchanged. The dominant wear mechanism has changed from adhesive wear to plastic deformation and finally to abrasive wear. The addition of Ph4Sn particles reduces the sensitivity of the Ph4Sn/UHMWPE composites to water and transfers the load to the UHMWPE network, resulting in the wear resistance improved.

High-Tribological-Performance Polymer Nanocomposites: An Approach Based on the Superlubricity State of the Graphene Oxide Agglomerates

Here, nanocomposites of high-molecular-weight polyethylene (HMWPE) and HMWPE-UHMWPE (80/20 wt.%) containing a low amount of multilayer graphene oxide (mGO) (≤0.1 wt.%) were produced via twin-screw extrusion to produce materials with a higher tribological performance than UHMWPE. Due to the high viscosity of both polymers, the nanocomposites presented a significant concentration of agglomerates. However, the mechanical (tensile) and tribological (volumetric loss) performances of the nanocomposites were superior to those of UHMWPE. The morphology of the nanocomposites was investigated using differential scanning calorimetry (DSC), microtomography, and transmission electron microscopy (TEM). The explanation for these results is based on the superlubricity phenomenon of mGO agglomerates. It was also shown that the well-exfoliated mGO also contained in the nanocomposite was of fundamental importance as a mechanical reinforcement for the polymer. Even with a high concentration of agglomerates, the nanocomposites displayed tribological properties superior to UHMWPE's (wear resistance up to 27% higher and friction coefficient up to 57% lower). Therefore, this manuscript brings a new exception to the rule, showing that agglomerates can act in a beneficial way to the mechanical properties of polymers, as long as the superlubricity phenomenon is present in the agglomerates contained in the polymer.

Preparation, characterization, and feasibility study of Sr/Zn-doped CPP/GNS/UHMWPE composites as an artificial joint component with enhanced hardness, impact strength, tribological and biological performance

In order to solve the problem of aseptic loosening of artificial joints resulting from the wear particles of artificial joint components in total joint replacement (TJR), we synthesized a new kind of metalo-organic particle (Sr/Zn-doped CPP/GNS) using spark plasma sintering (SPS) as a filler to enhance the comprehensive performance of UHMWPE. Sr/Zn-doped CPP/GNS was interfused evenly with UHMWPE particles and cured in a hot press instrument to prepare Sr/Zn-doped CPP/GNS/UHMWPE composites. FTIR and SEM were carried out to characterize Sr/Zn-doped CPP/GNS particles. EDS was carried out to characterize Sr/Zn-doped CPP/GNS/UHMWPE. The micro-structure, hardness, impact strength, tribology and bio-activities of Sr/Zn-doped CPP/GNS/UHMWPE composite materials were also investigated. The results confirmed the effectiveness of this method. The hardness, impact strength, and tribology of the composites were enhanced by adding homodispersed Sr/Zn-doped CPP/GNS particles into UHMWPE. In the meantime, Sr/Zn-doped CPP/GNS/UHMWPE composites could significantly promote the growth of osteoblasts due to the bio-activity of Sr/Zn-doped CPP/GNS. Furthermore, the addition of Sr/Zn-doped CPP/GNS particle-fillers into UHMWPE could promote the secretion of OPG from osteoblasts and inhibit the secretion of RANKL from osteoblasts, and thus increase the OPG/RANKL ratio. All the results above showed that Sr/Zn-doped CPP/GNS/UHMWPE composites with appropriate Sr/Zn-doped CPP/GNS content possessed superior physicochemical performances and bio-properties, and could be considered as promising materials to treat aseptic loosening in total joint replacement.

Manufacture and mechanical properties of knee implants using SWCNTs/UHMWPE composites

This article focuses on obtaining ultra high molecular weight polyethylene (UHMWPE) material reinforced with functionalized single-walled carbon nanotubes (f-SWCNTs) and the manufacturing of unicompartmental knee implants via Single-Point Incremental Forming process (SPIF). The physicochemical properties of the developed UHMWPE reinforced with 0.01 and 0.1 wt% concentrations of f-SWCNTs are investigated using Raman and Thermogravimetic Analysis (TGA). Tensile mechanical tests performed in the nanocomposite material samples reveal a 12% improvement in their Young's modulus when compare to that of the pure UHMWPE material samples. Furthermore, the surface biocompatibility of the UHMWPE reinforced with f-SWCNTs materials samples was evaluated with human osteoblast cells. Results show cell viability enhancement with good cell growth and differentiation after 14 incubation days, that validates the usefulness of the developed nanocomposite material in the production of hip and knee artificial implants, and other biomedical applications.

Recent Advances in UHMWPE/UHMWPE Nanocomposite/UHMWPE Hybrid Nanocomposite Polymer Coatings for Tribological Applications: A Comprehensive Review

In the recent past, polymer coatings have gained the attention of many researchers due to their low cost, their ability to be coated easily on different substrates, low friction and good anti-corrosion properties. Various polymers such as polytetrafluroethylene (PTFE), polyether ether ketone (PEEK), polymethylmethacrylate (PMMA), polyurethane (PU), polyamide (PA), epoxy and ultra-high molecular weight polytheylene (UHMWPE) have been used to develop these coatings to modify the surfaces of different components to protect them from wear and corrosion. However, among all these polymers, UHMWPE stands out as a tribologist’s polymer due to its low friction and high wear resistance. These coatings have found their way into applications ranging from microelectro mechanical systems (MEMS) to demanding tribological applications such as bearings and biomedical applications. Despite its excellent tribological properties, UHMWPE suffers from limitations such as low load bearing capacity and low thermal stability. To overcome these challenges researchers have developed various routes such as developing UHMWPE composite and hybrid composite coatings with several types of nano/micro fillers, developing composite films system and developing dual film systems. The present paper is an effort to summarize these various routes adopted by different researchers to improve the tribological performance of UHMWPE coatings.

Plastics in Total Knee Replacement: Processing to Performance

Polyethylene (PE) is the key component of total knee replacement (TKR). The wear of polyethylene, a common cause of revision surgeries, depends on multiple factors. The mechanical properties, wear characteristics, and oxidative resistance of PE can be manipulated by the techniques of processing, sterilization, and packaging methods. This article describes the making of conventional and cross-linked poly, packaging, sterilization, processing techniques, and a summary of commercially available plastics and their rationale in TKR including the latest advances.

CNT and rGO reinforced PMMA based bone cement for fixation of load bearing implants: Mechanical property and biological response

Polymethyl methacrylate (PMMA) bone cements (BCs) have some drawbacks, including limited bioactivity and bone formation, as well as inferior mechanical properties, which may result in failure of the BC. To deal with the mentioned issues, novel bioactive polymethyl methacrylate-hardystonite (PMMA-HT) bone cement (BC) reinforced with 0.25 and 0.5 wt% of carbon nanotube (CNT) and reduced graphene oxide (rGO) was synthesized. In this context, the obtained bone cements were evaluated in terms of their mechanical and biological characteristics. The rGO reinforced bone cement exhibited better mechanical properties to the extent that the addition of 0.5 wt% of rGO where its compressive and tensile strength of bioactive PMMA-HT/rGO cement escalated from 92.07 ± 0.72 MPa, and 40.02 ± 0.71 MPa to 187.48 ± 5.79 MPa and 64.92 ± 0.75 MPa, respectively. Besides, the mechanisms of toughening, apatite formation, and cell interaction in CNT and rGO encapsulated PMMA have been studied. Results showed that the existence of CNT and rGO in BCs led to increase of MG63 osteoblast viability, and proliferation. However, rGO reinforced bone cement was more successful in supporting MG63 cell attachment compared to the CNT counterpart due to its wrinkled surface, which made a suitable substrate for cell adhesion. Based on the results, PMMA-HT/rGO can be a proper bone cement for the fixation of load-bearing implants.

Influence of processing conditions on microstructural, mechanical and tribological properties of graphene nanoplatelet reinforced UHMWPE

Ultra-high molecular weight polyethylene (UHMWPE) is a relevant thermoplastic in industry and a well-proven standard biomaterial in joint replacements. To enhance its tribological properties while preserving its bulk ones, composite coatings on a UHMWPE substrate were prepared using non-functionalised graphene nanoplatelet (GNP) at reinforcement concentration of 0.1-5 wt% and two mechanical mixing techniques (ball mill or blade mixer) with different consolidation temperatures of 175-240 °C. Changes in morphology and size of the UHMWPE particles before hot-pressing were observed in function of the mechanical mixing techniques applied. Wear rate was affected by graphene content, reaching a minimum at 0.5 wt% GNP, with a reduction of 20 and 15%, for ball milling and blade mixer, respectively. However, blade mixer increased the wear rate by around twice respect the ball milling results, for all the studied materials. The coefficient of friction decreased notably, by ~25%, below 3 wt% GNP content, and hardness increased by 24%, regardless of the mechanical mixing process used. Finally, consolidation temperature had a positive influence on wear rate at temperatures of around 195 °C, which could be related to the free radical scavenger effect of the GNP.

Multiwall Carbon Nanotube Composites as Artificial Joint Materials

Because ultrahigh-molecular-weight polyethylene (UHMWPE) is susceptible to frictional wear when used in sliding members of artificial joints, it is common practice to use cross-linked UHMWPE instead. However, cross-linked UHMWPE has low impact resistance; implant breakage has been reported in some cases. Hence, sliding members of artificial joints pose a major trade-off between wear resistance and impact resistance, which has not been resolved by any UHMWPE. On the other hand, multiwall carbon nanotubes (MWCNTs) are used in industrial products for reinforcement of polymeric materials but not used as biomaterials because of their unclear safety. In the present study, we attempted to solve this trade-off issue by complexing UHMWPE with MWCNTs. In addition, we assessed the safety of these composites for use in sliding members of artificial joints. The results showed the equivalence of MWCNT/UHMWPE composites to cross-linked UHMWPE in terms of wear resistance and to non-cross-linked UHMWPE in terms of impact resistance. In addition, all MWCNT/UHMWPE composites examined complied with the requirements of biosafety testing in accordance with the ISO10993-series specifications for implantable medical devices. Furthermore, because MWCNTs can occur alone in wear dust, MWCNTs in an amount of about 1.5 times that contained in the dust produced from 50 years of wear (in the worst case) were injected into rat knees, which were monitored for 26 weeks. Although mild inflammatory reactions occurred in the joints, the reactions soon became quiescent. In addition, the MWCNTs did not migrate to other organs. Furthermore, MWCNTs did not exhibit carcinogenicity when injected into the knees of mice genetically modified to spontaneously develop cancer. The MWCNT/UHMWPE composite is a new biomaterial expected to be safe for clinical applications in both total hip arthroplasty and total knee arthroplasty as the first sliding member of artificial joints to have both high wear resistance and high impact resistance.

Nanostructured Biomaterials for Bone Regeneration

This review article addresses the various aspects of nano-biomaterials used in or being pursued for the purpose of promoting bone regeneration. In the last decade, significant growth in the fields of polymer sciences, nanotechnology, and biotechnology has resulted in the development of new nano-biomaterials. These are extensively explored as drug delivery carriers and as implantable devices. At the interface of nanomaterials and biological systems, the organic and synthetic worlds have merged over the past two decades, forming a new scientific field incorporating nano-material design for biological applications. For this field to evolve, there is a need to understand the dynamic forces and molecular components that shape these interactions and influence function, while also considering safety. While there is still much to learn about the bio-physicochemical interactions at the interface, we are at a point where pockets of accumulated knowledge can provide a conceptual framework to guide further exploration and inform future product development. This review is intended as a resource for academics, scientists, and physicians working in the field of orthopedics and bone repair.

Wear Resistant Nanocomposites Based on Biomedical Grade UHMWPE Paraffin Oil and Carbon Nano-Filler: Preliminary Biocompatibility and Antibacterial Activity Investigation

In the present paper, we investigate the effectiveness of nanocomposites (composed of ultra-high molecular weight polyethylene (UHMWPE) mixed with carbon nano-filler (CNF) and medical grade paraffin oil (PO), from the biological point of view. Wear measurements were carried out without (air) and with lubricant (distilled water, natural, and artificial lubricant), and antibacterial activity and cytotoxicity were evaluated. The results highlighted that the presence of CNF is important in the nanocomposite formulation because it reduces the wear rate and prevents oxidative degradation during its processing. An amount of 1.0 wt % of CNF is best because it reaches the optimal distribution within the polymeric matrix, resulting in the best wear resistant, bio-active, and anti-bacterial nanocomposite among all investigated samples.

Probing the Influence of γ-Sterilization on the Oxidation, Crystallization, Sliding Wear Resistance, and Cytocompatibility of Chemically Modified Graphene-Oxide-Reinforced HDPE/UHMWPE Nanocomposites and Wear Debris

Osteolysis and aseptic loosening due to wear at the articulating interfaces of prosthetic joints are considered to be the key concerns for implant failure in load-bearing orthopedic applications. In an effort to reduce the wear and processing difficulties of ultrahigh-molecular-weight polyethylene (UHMWPE), our research group recently developed high-density polyethylene (HDPE)/UHMWPE nanocomposites with chemically modified graphene oxide (mGO). Considering the importance of sterilization, this work explores the influence of γ-ray dosage of 25 kGy on the clinically relevant performance-limiting properties of these newly developed hybrid nanocomposites in vitro. Importantly, this work also probes into the cytotoxic effects of the wear debris of different compositions and sizes on MC3T3 murine osteoblasts and human mesenchymal stem cells (hMSCs). In particular, γ-ray-sterilized 1 wt % mGO-reinforced HDPE/UHMWPE nanocomposites exhibit an improvement in the oxidation index (16%), free energy of immersion (-12.1 mN/m), surface polarity (5.0%), and hardness (42%). Consequently, such enhancements result in better tribological properties, especially coefficient of friction (+13%) and wear resistance, when compared with UHMWPE. A spectrum of analyses using transmission electron microscopy (TEM) and in vitro cytocompatibility assessment demonstrate that phagocytosable (0.5-4.5 μm) sterilized 1 mGO wear particles, when present in culture media at 5 mg/mL concentration, induce neither significant reduction in MC3T3 murine osteoblast and hMSC growth nor cell morphology phenotype, during 24, 48, and 72 h of incubation. Taken together, this study suggests that γ-ray-sterilized HDPE/UHMWPE/mGO nanocomposites can be utilized as promising articulating surfaces for total joint replacements.

Ultra-High-Molecular-Weight-Polyethylene (UHMWPE) as a Promising Polymer Material for Biomedical Applications: A Concise Review

Ultra-High Molecular Weight Polyethylene (UHMWPE) is used in biomedical applications due to its high wear-resistance, ductility, and biocompatibility. A great deal of research in recent decades has focused on further improving its mechanical and tribological performances in order to provide durable implants in patients. Several methods, including irradiation, surface modifications, and reinforcements have been employed to improve the tribological and mechanical performance of UHMWPE. The effect of these modifications on tribological and mechanical performance was discussed in this review.

HDPE/UHMWPE hybrid nanocomposites with surface functionalized graphene oxide towards improved strength and cytocompatibility

High-density polyethylene (HDPE)-based and ultra-high molecular weight polyethylene (UHMWPE)-based composites with carbonaceous reinforcements are being widely investigated for biomedical applications. The enhancement of material properties critically depends on the nature, amount and compatibility of the reinforcement with the polymeric matrix. To this end, this study demonstrates the efficacy of a 'dual' hybrid approach of incorporating modified inorganic nanofiller into an optimized polyethylene blend. In particular, a unique synthesis strategy was adopted to design a covalently bonded maleated polyethylene (mPE) grafted modified graphene oxide (mGO) hybrid nanocomposite. In this scheme, polyethyleneimine (PEI) was initially attached onto GO to synthesize amine functionalized GO (GO-PEI). This is followed by mPE grafting, resulting in mGO. Melt-extrusion together with injection moulding of a polymer mix (60% HDPE-40% UHMWPE) with different proportions (less than or equal to 3 wt%) of surface functionalized GO was conducted to develop nanocomposites of different sizes and shapes. When compared with unreinforced PE blend, the nanocomposites with 1 wt% mGO exhibited an increase in ultimate tensile strength by 120% (up to 65 MPa) and elastic modulus by 40% (up to 908 MPa). The uniform dispersion of modified GO nanofillers, confirmed using X-ray micro-computed tomography and transmission electron microscopy, facilitated effective interfacial adhesion and compatibility with the hybrid polymer matrix. The variation in mechanical properties with GO/mGO addition to PE blend was critically discussed in reference to the structural modification of GO, crystallinity and nature of dispersion of fillers. Importantly, the nanocomposites support the attachment and proliferation of C2C12 murine myoblast cells over 3 days in culture in a statistically insignificant manner with respect to polymer blends without any nanofiller. Taken together, the experimental results suggest that HDPE/UHMWPE/mGO is a promising biomaterial for bone tissue engineering applications.

Tribological Behavior of Nanocomposites Based on UHMWPE Aged in Simulated Synovial Fluid

Ultra High molecular weight polyethylene (UHMWPE) suffers wear degradation in total joint replacements and it needs to be improved. Thus, we enhanced wear resistance of UHMWPE with carbon nanofiller and paraffin oil and studied its tribological behavior in Simulated Synovial Fluid (SSF) for 60 days at 37 °C to reproduce the conditions of a real joint. Ageing in biological fluid accelerates the wear action but nanocomposite exhibited a higher wear resistance compared to UHMWPE because of its higher structural homogeneity. Carbon nanofiller closes the porosity of UHMWPE hindering SSF to penetrate inside. Wear resistance of the nanocomposite with 1.0 wt.% of CNF improved of 65% (before ageing) and of 70% (after 60 days in SSF) with respect to pure UHMWPE.

Construction of Multiple Switchable Sensors and Logic Gates Based on Carboxylated Multi-Walled Carbon Nanotubes/Poly(N,N-Diethylacrylamide)

In this work, binary hydrogel films based on carboxylated multi-walled carbon nanotubes/poly(N,N-diethylacrylamide) (c-MWCNTs/PDEA) were successfully polymerized and assembled on a glassy carbon (GC) electrode surface. The electroactive drug probes matrine and sophoridine in solution showed reversible thermal-, salt-, methanol- and pH-responsive switchable cyclic voltammetric (CV) behaviors at the film electrodes. The control experiments showed that the pH-responsive property of the system could be ascribed to the drug components of the solutions, whereas the thermal-, salt- and methanol-sensitive behaviors were attributed to the PDEA constituent of the films. The CV signals particularly, of matrine and sophoridine were significantly amplified by the electrocatalysis of c-MWCNTs in the films at 1.02 V and 0.91 V, respectively. Moreover, the addition of esterase, urease, ethyl butyrate, and urea to the solution also changed the pH of the system, and produced similar CV peaks as with dilution by HCl or NaOH. Based on these experiments, a 6-input/5-output logic gate system and 2-to-1 encoder were successfully constructed. The present system may lead to the development of novel types of molecular computing systems.

Nanotechnology in orthopedics: a clinically oriented review

The utility of nanotechnology in medicine, specifically within the field of orthopedics, is a topic of extensive research. Our review provides a unique comprehensive overview of the current and potential future uses of nanotechnology with respect to orthopedic sub-specialties. Nanotechnology offers an immense assortment of novel applications, most notably the use of nanomaterials as scaffolds to induce a more favorable interaction between orthopedic implants and native bone. Nanotechnology has the capability to revolutionize the diagnostics and treatment of orthopedic surgery, however the long-term health effects of nanomaterials are poorly understood and extensive research is needed regarding clinical safety.

Polyolefin/graphene nanocomposites: a review

The present article is mainly focused on literature studies centred on polyolefin (especially PE and PP) nanocomposites based on graphene and its derivatives.

Comprehensive Review on the Use of Graphene-Based Substrates for Regenerative Medicine and Biomedical Devices

Recent research suggests that graphene holds great potential in the biomedical field because of its extraordinary properties. Whereas initial attempts focused on the use of suspended graphene for drug delivery and bioimaging, more recent work has demonstrated its advantages for preparing substrates for tissue engineering and biomedical devices and products. Cells are known to interact with and respond to nanoparticles differently when presented in the form of a substrate than in the form of a suspension. In tissue engineering, a stable and supportive substrate or scaffold is needed to provide mechanical support, chemical stimuli, and biological signals to cells. This review compiles recent advances of the impact of both graphene and graphene-derived particles to prepare supporting substrates for tissue regeneration and devices as well as the associated cell response to multifunctional graphene substrates. We discuss the interaction of cells with pristine graphene, graphene oxide, functionalized graphene, and hybrid graphene particles in the form of coatings and composites. Such materials show excellent biological outcomes in vitro, in particular, for orthopedic and neural tissue engineering applications. Preliminary evaluation of these graphene-based materials in vivo reinforces their promise for tissue regeneration and implants. Although the reported findings of studies on graphene-based substrates are promising, several questions and concerns associated with their in vivo use persist. Possible strategies to examine these issues are presented.

Modulation of Protein Adsorption and Cell Proliferation on Polyethylene Immobilized Graphene Oxide Reinforced HDPE Bionanocomposites

The uniform dispersion of nanoparticles in a polymer matrix, together with an enhancement of interfacial adhesion is indispensable toward achieving better mechanical properties in the nanocomposites. In the context to biomedical applications, the type and amount of nanoparticles can potentially influence the biocompatibility. To address these issues, we prepared high-density polyethylene (HDPE) based composites reinforced with graphene oxide (GO) by melt mixing followed by compression molding. In an attempt to tailor the dispersion and to improve the interfacial adhesion, we immobilized polyethylene (PE) onto GO sheets by nucleophilic addition-elimination reaction. A good combination of yield strength (ca. 20 MPa), elastic modulus (ca. 600 MPa), and an outstanding elongation at failure (ca. 70%) were recorded with 3 wt % polyethylene grafted graphene oxide (PE-g-GO) reinforced HDPE composites. Considering the relevance of protein adsorption as a biophysical precursor to cell adhesion, the protein adsorption isotherms of bovine serum albumin (BSA) were determined to realize three times higher equilibrium constant (Keq) for PE-g-GO-reinforced HDPE composites as compared to GO-reinforced composites. To assess the cytocompatibility, we grew osteoblast cell line (MC3T3) and human mesenchymal stem cells (hMSCs) on HDPE/GO and HDPE/PE-g-GO composites, in vitro. The statistically significant increase in metabolically active cell over different time periods in culture for up to 6 days in MC3T3 and 7 days for hMSCs was observed, irrespective of the substrate composition. Such observation indicated that HDPE with GO or PE-g-GO addition (up to 3 wt %) can be used as cell growth substrate. The extensive proliferation of cells with oriented growth pattern also supported the fact that tailored GO addition can support cellular functionality in vitro. Taken together, the experimental results suggest that the PE-g-GO in HDPE can effectively be utilized to enhance both mechanical and cytocompatibility properties and can further be explored for potential biomedical applications.