An investigation of the effects of hydroxyapatite coatings on the fixation strength of cortical screws

Electrophoretic Deposition of Nanocrystalline Calcium Phosphate Coating for Augmenting Bioactivity of Additively Manufactured Ti-6Al-4V

Additive manufacturing (AM) is being widely explored for engineering biomedical implants. The microstructure and surface finish of additively manufactured parts are typically different from wrought parts and exhibit limited bioactivity despite the other advantages of using AM for fabrication. The aim of this study was to enhance the bioactivity of selective laser melted Ti-6Al-4V alloy by electrophoretic deposition of nanohydroxyapatite (nanoHAp) coatings. The deposition parameters were systematically investigated after the coatings were deposited on the as-manufactured surface or after polishing the surface of the additively-manufactured sample. The surfaces were coated with nanoHAp suspended in either ethanol or butanol using different voltages (10, 30, or 50 V) for varied deposition times. The formation of the nanoHAp coating was confirmed by Fourier-transform infrared spectroscopy and X-ray diffraction. Microstructural analysis revealed that several conditions of the coating led to crack formation. The coated samples were subsequently heat-treated to improve the integrity of the coating. Heat treatment led to crack formation in several conditions due to thermal shrinkages. Coatings prepared using butanol were more uniform and had minimal cracks compared with the use of ethanol. Nanoindentation confirmed good stability and integrity of the nanoHAP coatings on the as-manufactured and polished surfaces. The coating on the as-manufactured sample exhibited higher hardness and lower elastic modulus as compared with the coating on the polished sample. In vitro study revealed that the nanoHAp coating markedly enhanced the attachment, proliferation, and differentiation of preosteoblasts on the alloy. These results provide a viable route to enhancing the bioactivity through deposition of nanoHAp with important implications for engineering additively manufactured orthopedic and dental implants suitable for better clinical performance.

Histopathological Evaluation of Orthopedic Medical Devices: The State-of-the-art in Animal Models, Imaging, and Histomorphometry Techniques

Orthopedic medical devices are continuously evolving for the latest clinical indications in craniomaxillofacial, spine, trauma, joint arthroplasty, sports medicine, and soft tissue regeneration fields, with a variety of materials from new metallic alloys and ceramics to composite polymers, bioresorbables, or surface-treated implants. There is great need for qualified medical device pathologists to evaluate these next generation biomaterials, with improved biocompatibility and bioactivity for orthopedic applications, and a broad range of knowledge is required to stay abreast of this ever-changing field. Orthopedic implants require specialized imaging and processing techniques to fully evaluate the bone-implant interface, and the pathologist plays an important role in determining the proper combination of histologic processing and staining for quality slide production based on research and development trials and validation. Additionally, histomorphometry is an essential part of the analysis to quantify tissue integration and residual biomaterials. In this article, an overview of orthopedic implants and animal models, as well as pertinent insights for tissue collection, imaging, processing, and slide generation will be provided with a special focus on histopathology and histomorphometry evaluation.

Simulation of mechanical behavior and optimization of simulated injection molding process for PLA based antibacterial composite and nanocomposite bone screws using central composite design

In this study, injection molding of three poly lactic acid (PLA) based bone screws was simulated and optimized through minimizing the shrinkage and warpage of the bone screws. The optimization was carried out by investigating the process factors such as coolant temperature, mold temperature, melt temperature, packing time, injection time, and packing pressure. A response surface methodology (RSM), based on the central composite design (CCD), was used to determine the effects of the process factors on the PLA based bone screws. Upon applying the method of maximizing the desirability function, optimization of the factors gave the lowest warpage and shrinkage for nanocomposite PLA bone screw (PLA9). Moreover, PLA9 has the greatest desirability among the selected materials for bone screw injection molding. Meanwhile, a finite element analysis (FE analysis) was also performed to determine the force values and concentration points which cause yielding of the screws under certain conditions. The Von-Mises stress distribution showed that PLA9 screw is more resistant against the highest loads as compared to the other ones. Finally, according to the results of injection molding simulations, the design of experiments (DOE) and structural analysis, PLA9 screw is recommended as the best candidate for the production of biomedical materials among all the three types of screws.

Biomechanical evaluation and surface characterization of a nano-modified surface on PEEK implants: a study in the rabbit tibia

Polyether ether ketone (PEEK) is today frequently used as a biomaterial in different medical operations due to its excellent mechanical and chemical properties. However, the untreated surface of PEEK is bioinert and hydrophobic, and it does not osseointegrate in its pure form. The aim of this study was to evaluate a unique nano-modified surface of PEEK with respect to osseointegration. Forty-eight threaded, non-cutting PEEK implants were inserted bilaterally in the tibia of 24 rabbits. Half of the implants (n=24) were coated with nanocrystalline hydroxyapatite (test) and the remaining implants (n=24) were left uncoated (control). Half of the animals (n=12) were euthanized after 3 weeks of healing and the remaining (n=12) after 12 weeks. The implant retention was measured with a removal torque apparatus. Surface analysis was performed with interferometry, scanning electron microscopy, and X-ray photon spectroscopy to relate the removal torque to the applied surface. The test implants revealed a significantly higher retention after 3 weeks (P=0.05) and 12 weeks (P=0.028) compared to controls. The result of the present study proves that the addition of nanocrystalline hydroxyapatite coating to PEEK surfaces significantly increases its removal torque and biocompatibility.

Improved bonding of partially osteomyelitic bone to titanium pins owing to biomimetic coating of apatite

Increased fixation strength of the bone-pin interface is important for inhibiting pin loosening after external fixation. In a previous study, an apatite (Ap) layer was formed on anodically oxidized titanium (Ti) pins by immersing them in an infusion fluid-based supersaturated calcium phosphate solution at 37 °C for 48 h. In the present study, an Ap layer was also successfully formed using a one-step method at 25 °C for 24 h in an infusion fluid-based supersaturated calcium phosphate solution, which is clinically useful due to the immersion temperature [corrected]. After percutaneous implantation in a proximal tibial metaphysis for four weeks in rabbits (n = 20), the Ti pin coated with the Ap layer showed significantly increased extraction torque compared with that of an uncoated Ti screw even with partial osteomyelitis present, owing to dense bone formation on the Ap layer in the cortical and medullary cavity regions. When the infection status was changed from "no osteomyelitis" to "partial osteomyelitis," the extraction torque in the Ap group with "partial osteomyelitis" was almost identical to that for "no osteomyelitis" cases. These results suggest that the Ap layer formed by the room temperature process could effectively improve the fixation strength of the Ti pin for external fixation clinically even with partial osteomyelitis present.

Influence of micro- and nano-hydroxyapatite coatings on the osteointegration of metallic (Ti6Al4 V) and bioabsorbable interference screws: an in vivo study

The purpose of this study is to show and compare the fixation and osteointegration capability of metallic and bioabsorbable interference screws. For this, 8×20-mm interference screws were implanted into the bone tunnel in the proximal tibial metaphysis of sheep. The nano- (25 nm±0.8) and microscale (25 μm±0.5) hydroxyapatite were both dip-coated on Ti6Al4 V interference screws via an in vivo study. After the initial 12 weeks of postoperative, the pullout test, histopathology, X-ray diffraction and scanning electron microscopy examinations were performed. This multidisiplined work showed that the coated screws particularly those with nano-sized-HA coating and the bioabsorbable screws enhanced fixation and provided better stabilization, bone ingrowth and osteointegration than that of uncoated and microscale HA-coated screws. The bioabsorbable screws showed better histopathologic results.

Preparation and Characterization of Biphasic Calcium Phosphate Coatings on 316L Stainless Steel Fabricated by Electrophoretic Deposition

Biphasic calcium phosphate (BCP) ceramic is a synthetic biomaterial exhibiting a chemical composition similar to that of tooth mineral. Therefore, it is viably used in coating metallic implants manufactured from metals and alloys, such as titanium and stainless steel. In the present study, electrophoretic deposition (EPD) has been attempted for depositing BCP coatings on 316L Stainless Steel substrate followed by vacuum sintering at 800 °C for 1 h. The surface morphology, thickness, compositions and microstructure of the BCP coated 316L SS was investigated by scanning electron microscope (SEM), energy dispersive spectrometer (EDS), X-ray diffraction (XRD) and the bond strength of the coating was measured.

Compositionally graded hydroxyapatite/tricalcium phosphate coating on Ti by laser and induction plasma

In this study we report the fabrication of compositionally graded hydroxyapatite (HA) coatings on Ti by combining laser engineering net shaping (LENS) and radio frequency induction plasma spraying processes. Initially, HA powder was embedded in the Ti substrates using LENS, forming a Ti-HA composite layer. Later, RF induction plasma spraying was used to deposit HA on these Ti substrates with a Ti-HA composite layer on top. Phase analysis by X-ray diffraction indicated phase transformation of HA to β-tricalcium phosphate in the laser processed coating. Laser processed coatings showed the formation of a metallurgically sound and diffused substrate-coating interface, which significantly increased the coating hardness to 922 ± 183 Hv from that of the base metal hardness of 189 ± 22 Hv. In the laser processed multilayer coating a compositionally graded nature was successfully achieved, however, with severe cracking and a consequent decrease in the flexural strength of the coating. To obtain a structurally stable coating with a composition gradient across the coating thickness a phase pure HA layer was sprayed on top of the laser processed single layer coatings using induction plasma spray. The plasma sprayed HA coatings were strongly adherent to the LENS-TCP coatings, with adhesive bond strength of 21 MPa. In vitro biocompatibility of these coatings, using human fetal osteoblast cells, showed a clear improvement in cellular activity from uncoated Ti compared with LENS-TCP-coated Ti and reached a maximum in the plasma sprayed HA coating.

Electrophoretic deposition of biomaterials

Electrophoretic deposition (EPD) is attracting increasing attention as an effective technique for the processing of biomaterials, specifically bioactive coatings and biomedical nanostructures. The well-known advantages of EPD for the production of a wide range of microstructures and nanostructures as well as unique and complex material combinations are being exploited, starting from well-dispersed suspensions of biomaterials in particulate form (microsized and nanoscale particles, nanotubes, nanoplatelets). EPD of biological entities such as enzymes, bacteria and cells is also being investigated. The review presents a comprehensive summary and discussion of relevant recent work on EPD describing the specific application of the technique in the processing of several biomaterials, focusing on (i) conventional bioactive (inorganic) coatings, e.g. hydroxyapatite or bioactive glass coatings on orthopaedic implants, and (ii) biomedical nanostructures, including biopolymer-ceramic nanocomposites, carbon nanotube coatings, tissue engineering scaffolds, deposition of proteins and other biological entities for sensors and advanced functional coatings. It is the intention to inform the reader on how EPD has become an important tool in advanced biomaterials processing, as a convenient alternative to conventional methods, and to present the potential of the technique to manipulate and control the deposition of a range of nanomaterials of interest in the biomedical and biotechnology fields.

In vitro characterization of bioactive titanium dioxide/hydroxyapatite surfaces functionalized with BMP-2

Poor implant fixation and bone resorption are two of the major challenges in modern orthopedics and are caused by poor bone/implant integration. In this work, bioactive crystalline titanium dioxide (TiO(2))/hydroxyapatite (HA) surfaces, functionalized with bone morphogenetic protein 2 (BMP-2), were evaluated as potential implant coatings for improved osseointegration. The outer layer consisted of HA, which is known to be osteoconductive, and may promote improved initial bone attachment when functionalized with active molecules such as BMP-2 in a soaking process. The inner layer of crystalline TiO(2) is bioactive and ensures long-term fixation of the implant, once the hydroxyapatite has been resorbed. The in vitro response of mesenchymal stem cells on bioactive crystalline TiO(2)/HA surfaces functionalized with BMP-2 was examined and compared with the cell behavior on nonfunctionalized HA layers, crystalline TiO(2) surfaces, and native titanium oxide surfaces. The crystalline TiO(2) and the HA surfaces showed to be more favorable than the native titanium oxide surface in terms of cell viability and cell morphology as well as initial cell differentiation. Furthermore, cell differentiation on BMP-2-functionalized HA surfaces was found to be significantly higher than on the other surfaces indicating that the simple soaking process can be used for incorporating active molecules, promoting fast bone osseointegration to HA layers.

Assessing surface area evolution during biomimetic growth of hydroxyapatite coatings

The surface area of biomimetically deposited hydroxyapatite (HA) coatings on metallic implants is important for the biological performance of the implant. Thus, a nondestructive method of assessing this quantity directly on the solid substrate would be highly valuable. The objective of this study was to develop such a method and for the first time assess the evolution of surface area of HA during biomimetic growth. The surface area of a TiO2-covered titanium substrate was measured prior to and following the biomimetic coating deposition using Ar gas adsorption at 77 K. The presence of HA on the surface was verified with scanning electron microscopy and X-ray diffraction. The specific surface area of the coating was found to increase linearly during 1 week of deposition at a rate of approximately 100 cm2 day-1 (g substrate)-1. The presented method may be used as a tool for studying the evolution in surface area of coatings on solid substrates during biomimetic deposition or other growth processes.

Bioceramic dip-coating on Ti-6Al-4V and 316L SS implant materials

The focus of the present study is based on more economical and rapid bioceramic coating on the most common implant substrates such as Ti-6Al-4V and 316L SS used often in orthopedics. For ceramic dip coating of implant substrates, Hydroxyapatite (HA) powder, Ca10(PO4)6(OH)2, P2O5, Na2CO3 and KH2PO4 are used to provide the gel. Ceramic films on sandblasted substrates have been deposited by using a newly manufactured dip-coating apparatus. Sample characterization is evaluated by SEM and XRD analysis. A smooth and homogeneous coating films have been obtained and average of 20 MPa bonding strength has been achieved for both Ti-6Al-4V and 316L SS alloys after sintering at 750 degrees C under flowing argon. The level of importance of the process parameters on coating was determined by using analysis of variance (ANOVA). The current process appears to be cheap, easy, and flexible to shape variations and high production rates for orthopedic applications.

Laser processing of bioactive tricalcium phosphate coating on titanium for load-bearing implants

Laser-engineered net shaping (LENS), a commercial rapid prototyping (RP) process, was used to coat titanium with tricalcium phosphate (TCP) ceramics to improve bone cell-materials interactions. During LENS coating process, the Nd:YAG laser melts the top surface of Ti substrate in which calcium phosphate powder is fed to create a TCP-Ti composite layer. It was found that an increase in laser power and/or powder feed rate increases the thickness of the coating. However, coating thickness decreased with increasing laser scan speed. TCP coating showed columnar titanium grains at the substrate side of the coating and transitioned to equiaxed titanium grains at the outside. When the scan speed was reduced from 15 to 10mms(-1), coating hardness increased from 882+/-67 to 1049+/-112Hv due to an increase in the volume fraction of TCP in the coating. Coated surfaces showed uniformly distributed TCP particles and X-ray diffraction data confirmed the absence of any undesirable phases, while maintaining a high level of crystallinity. The effect of TCP coating on cell-material interaction was examined by culturing osteoprecursor cells (OPC1) on coated surfaces. The results indicated that TCP coating had good biocompatibility where OPC1 cells attached and proliferated on the coating surface. The coating also initiated cell differentiation, ECM formation and biomineralization.

Hydroxyapatite dip coated and uncoated titanium poly-axial pedicle screws: an in vivo bovine model

STUDY DESIGN

A 1-year-old calf was implanted with titanium pedicle screws either uncoated (n = 7) or coated with hydroxyapatite (n = 7) by the dipping method on the pedicles of vertebrae (t10-l3).

OBJECTIVE

To evaluate biomechanical and histomorphologic responses to titanium pedicle screws uncoated and coated with hydroxyapatite.

SUMMARY OF BACKGROUND DATA

Failure of fixation caused by loosening of pedicle screws is a problem in spinal surgery. Enhancement of the fixation ability of screws by coating with biocompatible materials may improve prognosis of surgery.

METHODS

The calf was euthanized 4 months after implantation for determination of insertion and extraction torques for screws, and histologic and scanning electron microscopic examinations of areas screw embedded.

RESULTS

Insertion torques did not differ by the kind of screws (99 +/- 5.7 Ncm). However, extraction torques for screws coated with hydroxyapatite were higher than for screws uncoated (249 vs. 133 Ncm, P < 0.01). As compared with uncoated screws, implanted areas for hydroxyapatite-coated screws were denser, had more cracks, and provided better bonding. Fibrous tissue and new bone formation were observed around the areas of uncoated and hydroxyapatite-coated screws embedded, respectively.

CONCLUSIONS

Hydroxyapatite coating of titanium pedicle screws by the dipping method improved fixation and vertebral bone-implant interface, suggesting a decreased risk of a screw-loosening problem.