Effect of carbon fiber type on monotonic and fatigue properties of orthopedic grade PEEK

Strategies to improve the performance of polyetheretherketone (PEEK) as orthopedic implants: from surface modification to addition of bioactive materials

Polyetheretherketone (PEEK), as a high-performance polymer, is widely used for bone defect repair due to its homogeneous modulus of elasticity of human bone, good biocompatibility, excellent chemical stability and projectability. However, the highly hydrophobic surface of PEEK is biologically inert, which makes it difficult for cells and proteins to attach, and is accompanied by the development of infections that ultimately lead to failure of PEEK implants. In order to further enhance the potential of PEEK as an orthopedic implant, researchers have explored modification methods such as surface modification by physical and chemical means and the addition of bioactive substances to PEEK-based materials to enhance the mechanical properties, osteogenic activity and antimicrobial properties of PEEK. However, these current modification methods still have obvious shortcomings in terms of cost, maneuverability, stability and cytotoxicity, which still need to be explored by researchers. This paper reviews some of the modification methods that have been used to improve the performance of PEEK over the last three years in anticipation of the need for researchers to design PEEK orthopedic implants that better meet clinical needs.

Ultrasonic fatigue of unfilled and carbon nanotube (CNT) reinforced polyetheretherketone (PEEK)

Fatigue properties of polyetheretherketone (PEEK) and multiwall carbon nanotube (CNT) reinforced PEEK were investigated with the ultrasonic fatigue testing method. Lifetimes were measured in the high and very high cycle fatigue regime at resonance frequency 19 kHz and load ratio R = -1. Pulse-pause loading served to avoid specimen self-heating and led to effective cycling frequencies in the range from several hundred Hz to about two kHz. Stress amplitude for 50 % fracture probability at 109 cycles is 21.2 ± 4.3 MPa for unreinforced PEEK (22 % of its tensile strength) and 33.5 ± 3.5 MPa for CNT reinforced PEEK (33 % of its tensile strength). Servohydraulic fatigue tests at 22 Hz with CNT reinforced PEEK delivered fatigue lifetimes comparable to ultrasonic tests, i.e. no frequency effect and no influence of load versus displacement control was observed. Keeping specimen temperature far below the glass transition temperature, ultrasonic fatigue testing of a high temperature resistant plastic was successfully implemented.

Effect of carbon-fiber-reinforced polyetheretherketone on stress distribution in a redesigned tumor-type knee prosthesis: a finite element analysis

Background: Surgery for bone tumors around the knee often involves extensive resection, making the subsequent prosthetic reconstruction challenging. While carbon fiber-reinforced polyetheretherketone (CF-PEEK) has been widely used in orthopedic implants, its application in tumor-type prosthesis is limited. This study aims to evaluate the feasibility of using 30wt% and 60wt% carbon fiber-reinforced polyetheretherketone (CF30-PEEK and CF60-PEEK) as materials for a redesigned tumor-type knee prosthesis through numerical analysis. Methods: A knee joint model based on CT data was created, and the resection and prosthetic reconstruction were simulated. Three finite element models of the prostheses, representing the initial and updated designs with CoCrMo and CFR-PEEK components, were constructed. Loading conditions during standing and squatting were simulated with forces of 700 N and 2800 N, respectively. Finite element analysis was used to analyze the von Mises stress and stability of all components for each prosthesis type. Results: After improvements in both material and design, the new Type 3 prosthesis showed significantly lower overall stress with stress being evenly distributed. Compared with the initial design, the maximum von Mises stress in Type 3 was reduced by 53.9% during standing and 74.2% during squatting. In the standing position, the maximum stress in the CF30-PEEK femoral component decreased by 57.3% compared with the initial design which was composed of CoCrMo, while the stress in the CF60-PEEK cardan shaft remained consistent. In the squatting position, the maximum stress in the femoral component decreased by 81.9%, and the stress in the cardan shaft decreased by 46.5%. Conclusion: The incorporation of CF30-PEEK effectively transmits forces and reduces stress concentration on the femoral component, while CF60-PEEK in the redesigned cardan shaft significantly reduces stress while maintaining stiffness. The redesigned prosthesis effectively conducts loading force and demonstrates favorable biomechanical characteristics, indicating the promising potential of utilizing CF30-PEEK and CF60-PEEK materials for tumor-type knee prostheses. The findings of this study could provide novel insights for the design and development of tumor-type knee prostheses.

Research and Application of Medical Polyetheretherketone as Bone Repair Material

Polyetheretherketone (PEEK) can potentially be used for bone repair because its elastic modulus is similar to that of human natural bone and good biocompatibility and chemical stability. However, its hydrophobicity and biological inertness limit its application in the biomedical field. Inspired by the composition, structure, and function of bone tissue, many strategies are proposed to change the structure and functionality of the PEEK surface. In this review, the applications of PEEK in bone repair and the optimization strategy for PEEK's biological activity are reviewed, which provides a direction for the development of multifunctional bone repair materials in the future.

An overview of the tribological and mechanical properties of PEEK and CFR-PEEK for use in total joint replacements

Poly-ether-ether-ketone (PEEK) and PEEK composites are outstanding candidates for biomedical applications, such as orthopedic devices, where biocompatibility and modulus match with surrounding tissue are requisite for long-term success. The mechanical properties can be optimized by incorporating fillers such as continuous and chopped carbon fibers. While much is known about the mechanical and tribological behavior of PEEK composites, there are few articles that summarize the viability of using PEEK reinforced with carbon fibers in orthopedic implants. This paper reviews biocompatibility, tribological, and mechanical studies on PEEK and their composites with carbon fibers, notably PEEK reinforced with polyacrylonitrile (PAN)-based carbon fibers and PEEK reinforced with pitch-based carbon fibers, for application in orthopedics and total joint replacements (TJRs). The main objectives of this review are two-fold. Firstly, this paper aims to assist designers in making informed decisions on the suitability of using PEEK and PEEK composites in orthopedic applications; as it is not well understood how these materials perform on the whole in orthopedics and TJRs. Secondly, this paper aims to serve as a centralized paper in which researchers can gain information on the tribological and mechanical advancements of PEEK and PEEK composites.

Interfacial Design and Construction of Carbon Fiber Composites by Strongly Bound Hydroxyapatite Nanobelt-Carbon Nanotubes for Biological Applications

Carbon fiber composites are promising candidates for orthopedic implant applications, which calls for a combination of high mechanical strength and outstanding biotribological properties. In this work, hydroxyapatite nanobelts-carbon nanotubes (HN) were designed and constructed into carbon fiber-anhydrous dicalcium phosphate (DCPA)-epoxy composites (CDE) for simultaneously optimizing the mechanical and biotribological properties via the combined methods of pulse electrochemical deposition and injected chemical vapor deposition. HN provides more nucleation sites for the growth of DCPA and favors the infiltration of epoxy. In addition, HN optimizes the fiber/matrix interface by generating strong interfacial mechanical interlocking. Owing to the synergism of a strongly bound HN, the mechanical and biotribological properties of CDE have demonstrated significant improvement. The tensile strength and elastic modulus of HN-modified CDE (HN-CDE) increase by 52 and 170% compared with CDE, respectively. The wear rate and average friction coefficient of HN-CDE are decreased by 42% and increased by 45% compared with those of CDE, respectively. HN-CDE, with superior mechanical strength and biotribological properties, has high potential as a bone substitute and orthopedic implant.

Biocompatibility and osteoinductive ability of casein phosphopeptide modified polyetheretherketone

Polyetheretherketone (PEEK) is a potential implant material for dental application due to its excellent mechanical properties. However, its biological inertness and poor osteoinductive ability limited its clinical application. Based on a lay-by-layer self-assembly technique, here we incorporated casein phosphopeptide (CPP) onto PEEK surface by a simple two-step strategy to address the poor osteoinductive ability of PEEK implants. In this study, the PEEK specimens were positively charged by 3-ammoniumpropyltriethoxysilane (APTES) modification, then the CPP was adsorbed onto the positively charged PEEK surface electrostatically to obtain CPP-modified PEEK (PEEK-CPP) specimens. The surface characterization, layer degradation, biocompatibility and osteoinductive ability of the PEEK-CPP specimens were studied in vitro. After CPP modification, the PEEK-CPP specimens had a porous and hydrophilic surface and presented enhanced cell adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 cells. These findings indicated that CPP modification could significantly improve the biocompatibility and osteoinductive ability of PEEK-CPP implants in vitro. In a word, CPP modification is a promising strategy for the PEEK implants to achieve osseointegration.

Dual-Functional Polyetheretherketone Surface with an Enhanced Osteogenic Capability and an Antibacterial Adhesion Property In Vitro by Chitosan Modification

A chitosan layer was covalently bonded to a polyetheretherketone (PEEK) surface using a simple facile self-assembly method to address inadequate biological activity and infection around the implant. The surface characterization, layer degradation, biological activity, and antibacterial adhesion properties of chitosan-modified PEEK (PEEK-CS) were studied. Through chitosan grafting, the surface morphology changed, the surface roughness increased, and the contact angle decreased significantly. PEEK-CS boosted cell adhesion, proliferation, increased alkaline phosphate activity, extracellular matrix mineralization, and expression of osteogenic genes. PEEK-CS demonstrated less adhesion to Porphyromonas gingivalis as well as less bacterial adhesion to P. gingivalis and Streptococcus mutans. According to our findings, chitosan modification significantly improved the osteogenic ability and antibacterial adhesion of PEEK in vitro.

Fabrication and mechanical properties of different types of carbon fiber reinforced polyetheretherketone: A comparative study

OBJECTIVES

To find alternative non-metallic materials as dental implants for clinical application, different types of carbon fiber reinforced polyetheretherketone were fabricated and investigated.

METHODS

Continuous carbon fiber reinforced polyetheretherketone fabrics were fabricated with polyetheretherketone fibers and carbon fibers. Different kinds of carbon fiber reinforced polyetheretherketone were synthesized by setting specific experiment parameters of injection or hot press molding. Various mechanical tests were performed to determine the mechanical properties of different carbon fiber reinforced polyetheretherketone, pure polyetheretherketone and pure titanium.

RESULTS

Polyetheretherketone composites presented outstanding mechanical and thermal properties after incorporating carbon fiber. The bending and tensile strength of short carbon fiber reinforced polyetheretherketone were close to human bone, and the bending strength of continuous carbon fiber reinforced polyetheretherketone reached 644 MPa, even higher than that of pure titanium.

CONCLUSIONS

The mechanical properties of polyetheretherketone composites are more similar to bone tissue than titanium, and the stress shielding phenomenon may be inhibited. They may become promising materials as substitutions for titanium and prospective materials in bone tissue engineering.

Evaluation of PEEK and zirconia occlusal rest designs for removable partial dentures based on finite element analysis

Purpose We aimed to assess removable partial denture occlusal rests composed of polyether-ether-ketone (PEEK) and zirconia, using finite element analysis.Methods Three-dimensional PEEK and zirconia rest models, including the occlusal rest (1.5 mm thickness at the basal portion, 3.0 mm width) and minor connector (1.5 mm thickness, 6.0 mm height), and rest seat models with mechanical properties of enamel were constructed. The radius of transitional curvature between the rest and minor connector was 0.1-0.5 mm. The rest and rest seat model interfaces were set as frictional contacts (μ = 0.1), and the base of the rest seat model was restrained in all the directions. A 100 N downward load was applied perpendicular to the bottom surface of the minor connector. The maximum value of the first principal stress (Max-S1) was compared to the flexural and fatigue strengths of each material. Occlusal rests with 1.0-2.0 mm thickness, 2.0-3.5 mm width, and 0.5 mm radius of transitional curvature were analyzed.Results Max-S1 was observed at the transitional part and decreased with increasing radius of the transitional curvature, rest width, and thickness. PEEK rests with at least 1.5 mm thicknesses and 3.0 mm widths showed lower Max-S1 than the flexural strength. Max-S1 of all PEEK rests exceeded the PEEK fatigue strength, whereas Max-S1 of the zirconia rests was lower than the zirconia fatigue strength.Conclusions Zirconia occlusal rests with conventional metal rest designs have sufficient fatigue strength. PEEK occlusal rests have insufficient fatigue strength and may not withstand repeated mastication.

Carbon fibre reinforced PEEK versus traditional metallic implants for orthopaedic trauma surgery: A systematic review

INTRODUCTION

There is no literature review comparing outcomes of fixation using carbon-fibre-reinforced polyetheretherketone (CFR PEEK) compared to metal implants used in orthopaedic extremity trauma surgery. A systematic review was performed to compare CFR PEEK to metal implants for clinically-important fracture outcomes.

METHODS

A search of the online databases of PubMed/Medline, EMBASE and Cochrane Database was conducted. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analyses was performed for functional outcomes in proximal humerus fractures converting the score differences to standard mean difference units. GRADE approach was used to determine the level of certainty of the estimates.

RESULTS

Two prospective randomised controlled trials and seven comparative observational studies with a total of 431 patients were included. Of the nine studies included, four compared the use of CFR PEEK against metal plates in proximal humerus fractures. Aggregated functional scores across the proximal humerus studies, there was a small signal of better improvement with CFR PEEK (SMD 0.22, 95% CI -0.03 to 0.47, p = 0.08, low certainty). Greater odds of adverse events occurred in the metal group (OR 2.34, 95% CI 0.73 to 7.55, p = 0.15, low certainty).

CONCLUSIONS

Low to very low certainty evidence suggests a small improvement in functional recovery with CFR PEEK in proximal humerus fractures. This may be mediated through a small reduction in major adverse events related to fracture healing and stability. There is currently insufficient evidence to support the widespread use of CFR PEEK implants in fracture fixation.

LEVEL OF EVIDENCE

Level IV.

Evolution of materials for implants in metastatic spine disease till date - Have we found an ideal material?

"Metastatic Spine Disease" (MSD) often requires surgical intervention and instrumentation with spinal implants. Ti6Al4V is widely used in metastatic spine tumor surgery (MSTS) and is the current implant material of choice due to improved biocompatibility, mechanical properties, and compatibility with imaging modalities compared to stainless steel. However, it is still not the ideal implant material due to the following issues. Ti6Al4V implants cause stress-shielding as their Young's modulus (110 gigapascal [GPa]) is higher than cortical bone (17-21 GPa). Ti6Al4V also generates artifacts on CT and MRI, which interfere with the process of postoperative radiotherapy (RT), including treatment planning and delivery. Similarly, charged particle therapy is hindered in the presence of Ti6Al4V. In addition, artifacts on CT and MRI may result in delayed recognition of tumor recurrence and postoperative complications. In comparison, polyether-ether-ketone (PEEK) is a promising alternative. PEEK has a low Young's modulus (3.6 GPa), which results in optimal load-sharing and produces minimal artifacts on imaging with less hinderance on postoperative RT. However, PEEK is bioinert and unable to provide sufficient stability in the immediate postoperative period. This issue may possibly be mitigated by combining PEEK with other materials to form composites or through surface modification, although further research is required in these areas. With the increasing incidence of MSD, it is an opportune time for the development of spinal implants that possess all the ideal material properties for use in MSTS. Our review will explore whether there is a current ideal implant material, available alternatives and whether these require further investigation.

Analytical and Numerical Investigation of Free Vibration Behavior for Sandwich Plate with Functionally Graded Porous Metal Core

The current work presents a free vibration analysis of a simply supported rectangular functionally graded sandwich plate using a new analytical model. The core of the sandwich plate is made up of porous metal, and the top and bottom faces are made up of homogenous materials. The core metal properties are assumed to be porosity dependent and graded in the thickness direction according to a simple power-law distribution in terms of the volume fractions of the constituents. The contribution of this paper is to evaluate the performance of functionally graded porous materials (FGPMs) as it is used for many biomedical applications, particularly in tissue engineering. Theoretical formulations are based on the classical plate theory to find the free vibration characteristics of the imperfect FGM sandwich plate and include different parameters. Parameters included are graded distributions of porosity, power-law index, core metal type, and aspect ratios. A numerical investigation using finite element analysis (FEA) and the modal analysis was conducted with the assistance of the commercial ANSYS-2020-R2 software to validate the analytical solution. To detect the various parameters influencing the fundamental frequencies of sandwich plate comprehensive numerical results are presented in dimensionless tabular and graphical forms. The results reveal that the frequency parameter of the sandwich plate increases with the increase of the porosity parameter and number of the constraints in the boundary conditions. Furthermore, the increase in the number of layers leads to an increase in the accuracy of the results for the same FGM core thickness. An accepted agreement can be observed between the proposed analytical solution and numerical results with a maximum error discrepancy of 8%.

Effect of lubricated sliding wear against CFRPEEK on the nanomechanical properties of Ag alloyed Cr/DLC thin film

Ag-doped Cr/DLC coatings were deposited on medical grade 316 LVM stainless steel using DC magnetron sputtering. Morphological study of the coating indicated the formation of island of Ag clusters owing to the inability of Ag to form carbides, which is also corroborated from the XRD analysis. The composite coating showcased elastic nature suggestive from the p-h curve obtained from the nanoindentation test. However, the coating possesses 33% ductility, which is an important virtue for stress relieving attributed to Ag in the carbon matrix. The coating registered improved adhesion due to Cr₃C₂ carbide formation in the interlayer. The composite coating was subjected to lubricated sliding in physiological fluid against carbon fiber reinforced PEEK (CFRPEEK) friction pair to realize a closer scenario to hip implant articulation. A lubricious film of Ag with scattered particles of PEEK was formed in the sliding interface resulting in a long run-in process during sliding. The composite coating suffered mild wear on the Ag-doped DLC top layer with few gullies of wear scar deep into the interlayer due to graphitization of carbon in the film. A statistically significant difference was observed in the hardness, H³/E², elastic work, and plastic work; however, there was no statistically significant difference in H/E attribute between the unworn and worn surface. What is more, Raman spectra of the worn (I_D/I_G = 1.9 ± 0.2) and unworn surface (I_D/I_G = 2.1 ± 0.1) were indicative of no significant loss in the structural integrity of the composite coating.

Fatigue Crack Growth and Fracture of Internal Fixation Materials in In Vivo Environments-A Review

The development of crack patterns is a serious problem affecting the durability of orthopedic implants and the prognosis of patients. This issue has gained considerable attention in the medical community in recent years. This literature focuses on the five primary aspects relevant to the evaluation of the surface cracking patterns, i.e., inappropriate use, design flaws, inconsistent elastic modulus, allergic reaction, poor compatibility, and anti-corrosiveness. The hope is that increased understanding will open doors to optimize fabrication for biomedical applications. The latest technological issues and potential capabilities of implants that combine absorbable materials and shape memory alloys are also discussed. This article will act as a roadmap to be employed in the realm of orthopedic. Fatigue crack growth and the challenges associated with materials must be recognized to help make new implant technologies viable for wider clinical adoption. This review presents a summary of recent findings on the fatigue mechanisms and fracture of implant in the initial period after surgery. We propose solutions to common problems. The recognition of essential complications and technical problems related to various approaches and material choices while satisfying clinical requirements is crucial. Additional investigation will be needed to surmount these challenges and reduce the likelihood of fatigue crack growth after implantation.

Polyetheretherketone and Its Composites for Bone Replacement and Regeneration

In this article, recent advances in the development, preparation, biocompatibility and mechanical properties of polyetheretherketone (PEEK) and its composites for hard and soft tissue engineering are reviewed. PEEK has been widely employed for fabricating spinal fusions due to its radiolucency, chemical stability and superior sterilization resistance at high temperatures. PEEK can also be tailored into patient-specific implants for treating orbital and craniofacial defects in combination with additive manufacturing process. However, PEEK is bioinert, lacking osseointegration after implantation. Accordingly, several approaches including surface roughening, thin film coating technology, and addition of bioactive hydroxyapatite (HA) micro-/nanofillers have been adopted to improve osseointegration performance. The elastic modulus of PEEK is 3.7-4.0 GPa, being considerably lower than that of human cortical bone ranging from 7-30 GPa. Thus, PEEK is not stiff enough to sustain applied stress in load-bearing orthopedic implants. Therefore, HA micro-/nanofillers, continuous and discontinuous carbon fibers are incorporated into PEEK for enhancing its stiffness for load-bearing applications. Among these, carbon fibers are more effective than HA micro-/nanofillers in providing additional stiffness and load-bearing capabilities. In particular, the tensile properties of PEEK composite with 30wt% short carbon fibers resemble those of cortical bone. Hydrophobic PEEK shows no degradation behavior, thus hampering its use for making porous bone scaffolds. PEEK can be blended with hydrophilic polymers such as polyglycolic acid and polyvinyl alcohol to produce biodegradable scaffolds for bone tissue engineering applications.

Nanomechanical analysis of medical grade PEEK and carbon fiber-reinforced PEEK composites

Polyether ether ketone (PEEK) and PEEK composites are viable candidates for orthopedic implants owing to their ability for modulus match of surrounding bone tissue. The structural properties of these systems for load-bearing application in the body can be tailored by incorporating carbon fibers; to this end, polyacrylonitrile (PAN) and pitch fibers are commonly incorporated in the PEEK matrix. Mechanical property optimization for a given medical application requires consideration of carbon fiber type and volume fraction, as well as processing conditions for the composite systems. While much is known about the bulk mechanical properties of PEEK and PEEK composites, little is known about the nanomechanical properties of these systems. Insight into nanoscale behavior can offer valuable information about fiber-matrix interactions that may influence long-term integrity of these biomaterials when used in load bearing medical device applications. In this study, we utilize nanoindentation as a method to characterize mechanical behavior of clinical grade PEEK and PEEK composites. We examine PEEK formulations with pitch and PAN fibers and evaluate a range of thermal treatments known to influence polymer microstructure. We use a conospherical tip of 1.5 μm in radius and a conospherical tip of 20 μm radius to determine indentation modulus over different length scales. We correlate these findings with previous characterization on these same PEEK systems using microindentation. A novelty of this work is that we combine nanoindentation with k-means clustering to quantitatively discern the influence of heat treatment and carbon fiber type on the mechanical behavior of PEEK composites and their constituents. We demonstrate that nanoindentation is an effective characterization tool for discerning fiber-matrix interactions and measuring the mechanical behavior in response to thermal treatment and carbon fiber type in PEEK composites. Nanoindentation is shown to be a viable tool for characterizing complex biomaterials and can serve as an effective technique to guide optimization of microstructures for long-term structural applications in the body.

Contouring Plates in Fracture Surgery: Indications and Pitfalls

Effective fracture surgery requires contouring orthopaedic implants in multiple planes. The amount of force required for contouring is dependent on the amount and type of material contained within the plane to be altered. The type of contouring used depends on the desired plate function; for example, buttress mode often requires some degree of undercontouring, whereas compression plating may require prebending. Other reasons to contour a plate include matching patient anatomy either to maximize fixation options or to reduce implant prominence. Precontoured plates can be convenient and help to facilitate soft-tissue friendly techniques but have the potential to introduce malreduction if the plate position and fit are not carefully monitored.

Biaxial fatigue crack propagation behavior of ultrahigh molecular weight polyethylene reinforced by carbon nanofibers and hydroxyapatite

Ultrahigh molecular weight polyethylene (UHMWPE) artificial joint has remained the preferred polymer component in total joint replacement surgery. However, more and more concerns have been raised about the failure of UHMWPE components due to the initiation and propagation of cracks at the notches with fixed functions. For this reason, biaxial fatigue crack growth (FCG) experiments of UHMWPE reinforced by carbon nanofibers (CNF) and hydroxyapatite (HA) were carried out using elastic-plastic fracture mechanics theory. The FCG resistance of UHMWPE, UHMWPE/CNF, and UHMWPE/HA was compared, and the effects of stress ratio (R) value and phase difference on FCG rate were investigated. At the same time, the influence of loading path was considered, and the corresponding crack path was analyzed. Results suggest that UHMWPE/CNF has better FCG resistance and the FCG rate increases with the increase of R value and the existence of 180° phase difference. In addition, crack bifurcation behavior is not observed under nonproportional loading conditions. The findings in this study will provide experimental validation and data support for better clinical application of UHMWPE-modified materials.