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Periferakis A, Periferakis AT, Troumpata L, Dragosloveanu S, Timofticiuc IA, Georgatos-Garcia S, Scheau AE, Periferakis K, Caruntu A, Badarau IA, Scheau C, Caruntu C. Use of Biomaterials in 3D Printing as a Solution to Microbial Infections in Arthroplasty and Osseous Reconstruction. Biomimetics (Basel) 2024; 9:154. [PMID: 38534839 DOI: 10.3390/biomimetics9030154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
The incidence of microbial infections in orthopedic prosthetic surgeries is a perennial problem that increases morbidity and mortality, representing one of the major complications of such medical interventions. The emergence of novel technologies, especially 3D printing, represents a promising avenue of development for reducing the risk of such eventualities. There are already a host of biomaterials, suitable for 3D printing, that are being tested for antimicrobial properties when they are coated with bioactive compounds, such as antibiotics, or combined with hydrogels with antimicrobial and antioxidant properties, such as chitosan and metal nanoparticles, among others. The materials discussed in the context of this paper comprise beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), hydroxyapatite, lithium disilicate glass, polyetheretherketone (PEEK), poly(propylene fumarate) (PPF), poly(trimethylene carbonate) (PTMC), and zirconia. While the recent research results are promising, further development is required to address the increasing antibiotic resistance exhibited by several common pathogens, the potential for fungal infections, and the potential toxicity of some metal nanoparticles. Other solutions, like the incorporation of phytochemicals, should also be explored. Incorporating artificial intelligence (AI) in the development of certain orthopedic implants and the potential use of AI against bacterial infections might represent viable solutions to these problems. Finally, there are some legal considerations associated with the use of biomaterials and the widespread use of 3D printing, which must be taken into account.
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Affiliation(s)
- Argyrios Periferakis
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Akadimia of Ancient Greek and Traditional Chinese Medicine, 16675 Athens, Greece
- Elkyda, Research & Education Centre of Charismatheia, 17675 Athens, Greece
| | - Aristodemos-Theodoros Periferakis
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Elkyda, Research & Education Centre of Charismatheia, 17675 Athens, Greece
| | - Lamprini Troumpata
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Serban Dragosloveanu
- Department of Orthopaedics and Traumatology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Iosif-Aliodor Timofticiuc
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Spyrangelos Georgatos-Garcia
- Tilburg Institute for Law, Technology, and Society (TILT), Tilburg University, 5037 DE Tilburg, The Netherlands
- Corvers Greece IKE, 15124 Athens, Greece
| | - Andreea-Elena Scheau
- Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Konstantinos Periferakis
- Akadimia of Ancient Greek and Traditional Chinese Medicine, 16675 Athens, Greece
- Pan-Hellenic Organization of Educational Programs (P.O.E.P.), 17236 Athens, Greece
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, "Carol Davila" Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Ioana Anca Badarau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, "Prof. N.C. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
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Sanchez CV, Krag AE, Barnett S, Welch BG, Rozen SM. Polyetheretherketone Implant Cranioplasty for Large Cranial Defects: A Seven-Year Follow-Up. J Craniofac Surg 2024:00001665-990000000-01387. [PMID: 38421184 DOI: 10.1097/scs.0000000000010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Goals of a cranioplasty include protection of the brain, restoration of normal appearance, and neurological function improvement. Although choice of materials for cranial remodeling has changed through the years, computer-designed polyetheretherketone (PEEK) implant has gained traction as a preferred material used for cranioplasty. However, long-term outcomes and complications of PEEK implants remain limited. The goal of this study was to report long-term clinical outcomes after PEEK implant cranioplasty. METHODS A retrospective chart review was performed on patients undergoing PEEK cranioplasty between January 2007 and February 2023. Preoperative, intraoperative, and postoperative data were collected and analyzed. RESULTS Twenty-two patients were included in this study. Mean postoperative follow-up time was 83.45 months (range: 35.47-173.87). Before PEEK implant cranioplasty, patients with multiple cranial procedures had undergone a mean of 2.95 procedures. PEEK implant cranioplasty indications were prior implant infection (14) and secondary reconstruction of cranial defect (8). The mean implant size was 180.43 cm2 (range: 68.00-333.06). Four patients received a 2-piece implant. Postoperative complications included: perioperative subgaleal self-resolving fluid collection in 1 patient, hematoma in another, and 3 infections resulting in explantations with successful reinsertion in 2 patients. Four of 5 patients with preoperative history of seizures reported improved seizures and all 4 patients with preoperative syndrome of the trephined reported improved symptoms and neurological function. CONCLUSION At a mean follow-up of 7 years, most PEEK implants continued to provide protection to the brain and consistent symptom relief in patients suffering from prior postcraniectomy/craniotomy sequelae of seizures and syndrome of the trephined.
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Affiliation(s)
- Cristina V Sanchez
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andreas E Krag
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sam Barnett
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Babu G Welch
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shai M Rozen
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Anderson B, Harris P, Mozaffari K, Foster CH, Johnson M, Jaco AA, Rosner MK. Comparison of Perioperative and Long-term Outcomes Following PEEK and Autologous Cranioplasty: A Single Institution Experience and Review of the Literature. World Neurosurg 2023; 180:e127-e134. [PMID: 37683922 DOI: 10.1016/j.wneu.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Three-dimensionally (3D) printed polyether-ether-ketone (PEEK) implants are a relatively novel option for cranioplasty that have recently gained popularity. However, there is ongoing debate with respect to material efficacy and safety compared to autologous bone grafts. The purpose of this study was to offer our institution's experience and add to the growing body of literature. METHODS A single-institution retrospective analysis of patients undergoing cranioplasties between 2016 and 2021. Patients were divided into PEEK and autologous cranioplasty cohorts. Parameters of interest included patient demographics as well as perioperative (<3 months postoperative) and long-term outcomes (>3 months postoperative). A P value < 0.05 was considered statistically significant. RESULTS A total of 31 patients met inclusion criteria (PEEK: 15, Autologous: 16). Mean age of total cohort was 48.9 years (range 19-82 years). Modified Frailty Index (mFI) revealed greater rate of comorbidities among the Autologous group (P = 0.073), which was accounted for in statistical analyses. Multiple logistic regression model revealed significantly higher rate of surgical site infection in the Autologous cohort (31.3% vs. 0%, P = 0.011). Minor complications were similar between groups, while the Autologous group experienced significantly more major postoperative complications (50%) versus PEEK (13.3%) (P = 0.0291). Otherwise perioperative and long term complication profiles were similar between groups. Additionally, generalized linear model demonstrated both cohorts had similar mean hospital length of stay (LoS) (Autologous: 16.1 vs. PEEK: 10.7 days). CONCLUSIONS PEEK cranioplasty implants may offer more favorable perioperative complication profiles with similar long-term complication rates and hospital LoS compared to autologous bone implants. Future studies are warranted to confirm our findings in larger series, and further examine the utility of PEEK in cranioplasty.
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Affiliation(s)
- Bradley Anderson
- Department of Neurological Surgery, The George Washington University Hospital, Washington DC, USA.
| | - Peter Harris
- Department of Neurological Surgery, The George Washington University Hospital, Washington DC, USA
| | - Khashayar Mozaffari
- Department of Neurological Surgery, The George Washington University Hospital, Washington DC, USA
| | - Chase H Foster
- Department of Neurological Surgery, The George Washington University Hospital, Washington DC, USA
| | - Michael Johnson
- Department of Neurological Surgery, The George Washington University Hospital, Washington DC, USA; Department of Physician Assistant Studies, The George Washington University, Washington DC, USA
| | - Alejandro A Jaco
- Department of Neurological Surgery, The George Washington University Hospital, Washington DC, USA
| | - Michael K Rosner
- Department of Neurological Surgery, The George Washington University Hospital, Washington DC, USA
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Li H, Xiao X, Liao W, Liu T, Li G. Numerical Simulation and Experimental Study Regarding the Cross-Sectional Morphology of PEEK Monofilament Deposition During FDM-Based 3D Printing. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2023; 39:13287-13295. [PMID: 37672721 DOI: 10.1021/acs.langmuir.3c01768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Polyether-ether-ketone (PEEK) is widely used in the field of biomedical engineering because of its excellent mechanical properties, chemical stability, and biocompatibility. Fused deposition modeling (FDM), which is a typical 3D printing process, can achieve low-cost and high-efficiency printing of complex PEEK structures. However, poor monofilament deposition quality leads to rough surfaces on macroscopic printed parts, low dimensional accuracy, and weak interlayer bonding, which are urgent problems to be solved. In this study, considering the shear thinning characteristic of PEEK, a numerical model for monofilament deposition was constructed by using the finite volume method. This model revealed the influences of process parameters on the monofilament cross-sectional profiles and achieved predictions of monofilament cross-sectional profiles during FDM-based 3D printing of PEEK. The average relative error of the monofilament cross-sectional area predictions was 7.68%. The average relative error of the monofilament cross-sectional aspect ratio predictions was 12.06%. It was also found that there are three typical deposited monofilament cross-sectional profile shapes, i.e., a capsule shape, a bread shape, and a circular shape. These three shapes occurred because of the combined effect of the layer thickness and the extrusion width during the extrusion and deposition of PEEK. These revealed monofilament cross-sectional profiles provide the basis for accurate nozzle motion trajectory planning, and they lay a foundation for surface roughness predictions and dimensional accuracy control during the FDM-based 3D printing of PEEK.
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Affiliation(s)
- Haozhen Li
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, China
| | - Xingzhi Xiao
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, China
| | - Wenhe Liao
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, China
| | - Tingting Liu
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, China
| | - Gang Li
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, China
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Chen L, Li J, Huang S, Ma J, Zhou L. Perioperative management and prevention of postoperative complications in patients undergoing cranioplasty with polyetheretherketone. J Plast Reconstr Aesthet Surg 2023; 84:71-78. [PMID: 37327735 DOI: 10.1016/j.bjps.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE This study aimed to compare the incidence of postoperative complications in patients undergoing cranioplasty with polyetheretherketone (PEEK) materials under different perioperative management schemes and summarize and describe a perioperative bundle to reduce patients' postoperative complications and improve patient outcomes. METHOD We retrospectively analyzed the clinical data of 69 patients who had undergone craniotomy with PEEK materials in the neurosurgery department of our hospital between June 2017 and June 2021. Patients who had received conventional treatment were defined as the conventional group (29 cases), and those who had received the improved scheme were defined as the improved group (40 cases). The early complications of the two groups were compared, and the long-term effects were observed. RESULTS The early total complication rates of the conventional and the improved groups were 55.2% and 32.5%, respectively, without any significant difference (P = 0.06), and the long-term complication rates were 24.1% and 7.5%, respectively, with no significant difference (P = 0.112). The incidence of epidural effusion in the improved group was significantly lower than that in the conventional group, with no significant difference in the incidence of complications, such as intracranial pneumatosis, epidural hemorrhage, new seizures and intracerebral hemorrhage. There was no difference in long-term complications, such as seizures, incision infections, and implant exposure. CONCLUSION Epidural effusion after cranioplasty with PEEK materials is common. This study's improved perioperative bundle can effectively reduce the occurrence of epidural effusion after skull repair.
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Affiliation(s)
- Lin Chen
- Department of Neurosurgery, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Jun Li
- Department of Neurosurgery, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Shan Huang
- Department of Neurosurgery, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Junfeng Ma
- Department of Neurosurgery, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Liang Zhou
- Department of Neurosurgery, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China.
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Wei Z, Zhang Z, Zhu W, Weng X. Polyetheretherketone development in bone tissue engineering and orthopedic surgery. Front Bioeng Biotechnol 2023; 11:1207277. [PMID: 37456732 PMCID: PMC10345210 DOI: 10.3389/fbioe.2023.1207277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.
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Affiliation(s)
- Zhanqi Wei
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Ze Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Wei Zhu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Zheng Z, Liu P, Zhang X, Jingguo xin, Yongjie wang, Zou X, Mei X, Zhang S, Zhang S. Strategies to improve bioactive and antibacterial properties of polyetheretherketone (PEEK) for use as orthopedic implants. Mater Today Bio 2022; 16:100402. [PMID: 36105676 PMCID: PMC9466655 DOI: 10.1016/j.mtbio.2022.100402] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 12/26/2022] Open
Abstract
Polyetheretherketone (PEEK) has gradually become the mainstream material for preparing orthopedic implants due to its similar elastic modulus to human bone, high strength, excellent wear resistance, radiolucency, and biocompatibility. Since the 1990s, PEEK has increasingly been used in orthopedics. Yet, the widespread application of PEEK is limited by its bio-inertness, hydrophobicity, and susceptibility to microbial infections. Further enhancing the osteogenic properties of PEEK-based implants remains a difficult task. This article reviews some modification methods of PEEK in the last five years, including surface modification of PEEK or incorporating materials into the PEEK matrix. For surface modification, PEEK can be modified by chemical treatment, physical treatment, or surface coating with bioactive substances. For PEEK composite material, adding bioactive filler into PEEK through the melting blending method or 3D printing technology can increase the biological activity of PEEK. In addition, some modification methods such as sulfonation treatment of PEEK or grafting antibacterial substances on PEEK can enhance the antibacterial performance of PEEK. These strategies aim to improve the bioactive and antibacterial properties of the modified PEEK. The researchers believe that these modifications could provide valuable guidance on the future design of PEEK orthopedic implants.
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