The design of additively manufactured lattices to increase the functionality of medical implants

Stochastic lattice-based porous implant design for improving the stress transfer in unicompartmental knee arthroplasty

BACKGROUND

Unicompartmental knee arthroplasty (UKA) has been proved to be a successful treatment for osteoarthritis patients. However, the stress shielding caused by mismatch in mechanical properties between human bones and artificial implants remains as a challenging issue. This study aimed to properly design a bionic porous tibial implant and evaluate its biomechanical effect in reconstructing stress transfer pathway after UKA surgery.

METHODS

Voronoi structures with different strut sizes and porosities were designed and manufactured with Ti6Al4V through additive manufacturing and subjected to quasi-static compression tests. The Gibson-Ashby model was used to relate mechanical properties with design parameters. Subsequently, finite element models were developed for porous UKA, conventional UKA, and native knee to evaluate the biomechanical effect of tibial implant with designed structures during the stance phase.

RESULTS

The internal stress distribution on the tibia plateau in the medial compartment of the porous UKA knee was found to closely resemble that of the native knee. Furthermore, the mean stress values in the medial regions of the tibial plateau of the porous UKA knee were at least 44.7% higher than that of the conventional UKA knee for all subjects during the most loading conditions. The strain shielding reduction effect of the porous UKA knee model was significant under the implant and near the load contact sites. For subject 1 to 3, the average percentages of nodes in bone preserving and building region (strain values range from 400 to 3000 μm/m) of the porous UKA knee model, ranging from 68.7 to 80.5%, were higher than that of the conventional UKA knee model, ranging from 61.6 to 68.6%.

CONCLUSIONS

The comparison results indicated that the tibial implant with designed Voronoi structure offered better biomechanical functionality on the tibial plateau after UKA. Additionally, the model and associated analysis provide a well-defined design process and dependable selection criteria for design parameters of UKA implants with Voronoi structures.

aXonica: A support package for MRI based Neuroimaging

Magnetic Resonance Imaging (MRI) assists in studying the nervous system. MRI scans undergo significant processing before presenting the final images to medical practitioners. These processes are executed with ease due to excellent software pipelines. However, establishing software workstations is non-trivial and requires researchers in life sciences to be comfortable in downloading, installing, and scripting software that is non-user-friendly and may lack basic GUI. As researchers struggle with these skills, there is a dire need to develop software packages that can automatically install software pipelines speeding up building software workstations and laboratories. Previous solutions include NeuroDebian, BIDS Apps, Flywheel, QMENTA, Boutiques, Brainlife and Neurodesk. Overall, all these solutions complement each other. NeuroDebian covers neuroscience and has a wider scope, providing only 51 tools for MRI. Whereas, BIDS Apps is committed to the BIDS format, covering only 45 software related to MRI. Boutiques is more flexible, facilitating its pipelines to be easily installed as separate containers, validated, published, and executed. Whereas, both Flywheel and Qmenta are propriety, leaving four for users looking for 'free for use' tools, i.e., NeuroDebian, Brainlife, Neurodesk, and BIDS Apps. This paper presents an extensive survey of 317 tools published in MRI-based neuroimaging in the last ten years, along with 'aXonica,' an MRI-based neuroimaging support package that is unbiased towards any formatting standards and provides 130 applications, more than that of NeuroDebian (51), BIDS App (45), Flywheel (70), and Neurodesk (85). Using a technology stack that employs GUI as the front-end and shell scripted back-end, aXonica provides (i) 130 tools that span the entire MRI-based neuroimaging analysis, and allow the user to (ii) select the software of their choice, (iii) automatically resolve individual dependencies and (iv) installs them. Hence, aXonica can serve as an important resource for researchers and teachers working in the field of MRI-based Neuroimaging to (a) develop software workstations, and/or (b) install newer tools in their existing workstations.

Titanium Multi-Topology Metamaterials with Exceptional Strength

Additively manufactured metamaterials are architectured cellular materials that can be engineered through structural innovations to achieve unusual mechanical and multifunctional properties. Among these, hollow-strut lattice (HSL) metamaterials have proven to allow outstanding structural efficiency, with a multifunctional architecture ideal for lightweight, biomedical, microfluidic, and thermal engineering. To capitalize on their structural efficiency and significantly extend their mechanical envelope, a thin-plate lattice topology is seamlessly integrated into the inner hollow space of an HSL topology. This integration serves a dual purpose: to radically enhance the resistance of the irregular HSL nodes to deformation and to uniformly distribute the applied stresses in the new topology for unparalleled strength. Fabricated in titanium alloy Ti-6Al-4V with densities of 1.0-1.8 g cm-3 , this thin-plate integrated hollow-strut lattice (TP-HSL) metamaterials achieve relative yield strength that well surpasses the empirical upper limit of all cellular metals, including HSL and solid-strut lattice (SSL) metamaterials made from various metallic alloys. Furthermore, their absolute yield strength drastically exceeds that of magnesium alloys with comparable densities while inheriting the high corrosion resistance, biocompatibility, heat resistance, and other unique attributes of Ti-6Al-4V. Titanium multi-topology metamaterials expand the boundaries of lightweight multifunctional metallic materials.

Future trends of additive manufacturing in medical applications: An overview

Additive Manufacturing (AM) has recently demonstrated significant medical progress. Due to advancements in materials and methodologies, various processes have been developed to cater to the medical sector's requirements, including bioprinting and 4D, 5D, and 6D printing. However, only a few studies have captured these emerging trends and their medical applications. Therefore, this overview presents an analysis of the advancements and achievements obtained in AM for the medical industry, focusing on the principal trends identified in the annual report of AM3DP.

Method of computational design for additive manufacturing of hip endoprosthesis based on basic-cell concept

Endoprosthetic hip replacement is the conventional way to treat osteoarthritis or a fracture of a dysfunctional joint. Different manufacturing methods are employed to create reliable patient-specific devices with long-term performance and biocompatibility. Recently, additive manufacturing has become a promising technique for the fabrication of medical devices, because it allows to produce complex samples with various structures of pores. Moreover, the limitations of traditional fabrication methods can be avoided. It is known that a well-designed porous structure provides a better proliferation of cells, leading to improved bone remodeling. Additionally, porosity can be used to adjust the mechanical properties of designed structures. This makes the design and choice of the structure's basic cell a crucial task. This study focuses on a novel computational method, based on the basic-cell concept to design a hip endoprosthesis with an unregularly complex structure. A cube with spheroid pores was utilized as a basic cell, with each cell having its own porosity and mechanical properties. A novelty of the suggested method is in its combination of the topology optimization method and the structural design algorithm. Bending and compression cases were analyzed for a cylinder structure and two hip implants. The ability of basic-cell geometry to influence the structure's stress-strain state was shown. The relative change in the volume of the original structure and the designed cylinder structure was 6.8%. Computational assessments of a stress-strain state using the proposed method and direct modeling were carried out. The volumes of the two types of implants decreased by 9% and 11%, respectively. The maximum von Mises stress was 600 MPa in the initial design. After the algorithm application, it increased to 630 MPa for the first type of implant, while it is not changing in the second type of implant. At the same time, the load-bearing capacity of the hip endoprostheses was retained. The internal structure of the optimized implants was significantly different from the traditional designs, but better structural integrity is likely to be achieved with less material. Additionally, this method leads to time reduction both for the initial design and its variations. Moreover, it enables to produce medical implants with specific functional structures with an additive manufacturing method avoiding the constraints of traditional technologies.

Build parameter influence on strut thickness and mechanical performance in additively manufactured titanium lattice structures

Additively manufactured lattices have been adopted in applications ranging from medical implants to aerospace components. For solid AM components, the effect of build parameters has been well studied but comparably little attention has been paid to the influence of build parameters on lattice performance. For this project, the main aim was to evaluate static compressive mechanical performance of regular and stochastic lattices as a function of build parameters. The second aim was to compare strut dimensions of the metal lattice structures as build parameters were changed. Both regular and stochastic lattices were fabricated with a designed strut diameter of either 200 μm or 300 μm on a laser powder bed fusion machine. A range of laser power (140-180 W), scan speed (1700-2100 mm/s), and laser offset (0-45 μm) were used in fabricating each lattice. Compression tests were performed following the ISO 13314 (2011) standard to measure modulus, yield strength, and ultimate compressive strength values. Laser power adjustments produced the most significant effect on lattice performance. A change of 50 W resulted in roughly a 2X increase in maximum load and modulus for both regular and stochastic lattice structures. Regular lattice structures had a higher mechanical response during the mechanical evaluation. Internal strut diameters varied between build parameters as well, with laser offset adjustments producing the most noticeable change in strut geometry between lattice samples. These findings suggest that build parameter optimization, in lieu of using OEM parameters developed for solid structures, is necessary to ensure the optimum mechanical performance of AM lattice structures.

The role of stiffness-matching in avoiding stress shielding-induced bone loss and stress concentration-induced skeletal reconstruction device failure

It is well documented that overly stiff skeletal replacement and fixation devices may fail and require revision surgery. Recent attempts to better support healing and sustain healed bone have looked at stiffness-matching of these devices to the desired role of limiting the stress on fractured or engrafted bone to compressive loads and, after the reconstructed bone has healed, to ensure that reconstructive medical devices (implants) interrupt the normal loading pattern as little as possible. The mechanical performance of these devices can be optimized by adjusting their location, integration/fastening, material(s), geometry (external and internal), and surface properties. This review highlights recent research that focuses on the optimal design of skeletal reconstruction devices to perform during and after healing as the mechanical regime changes. Previous studies have considered auxetic materials, homogeneous or gradient (i.e., adaptive) porosity, surface modification to enhance device/bone integration, and choosing the device's attachment location to ensure good osseointegration and resilient load transduction. By combining some or all of these factors, device designers work hard to avoid problems brought about by unsustainable stress shielding or stress concentrations as a means of creating sustainable stress-strain relationships that best repair and sustain a surgically reconstructed skeletal site. STATEMENT OF SIGNIFICANCE: Although standard-of-care skeletal reconstruction devices will usually allow normal healing and improved comfort for the patient during normal activities, there may be significant disadvantages during long-term use. Stress shielding and stress concentration are amongst the most common causes of failure of a metallic device. This review highlights recent developments in devices for skeletal reconstruction that match the stiffness, while not interrupting the normal loading pattern of a healthy bone, and help to combat stress shielding and stress concentration. This review summarises various approaches to achieve stiffness-matching: application of materials with modulus close to that of the bone; adaptation of geometry with pre-defined mechanical properties; and/or surface modification that ensures good integration and proper load transfer to the bone.

Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction

In recent years, the field of mandibular reconstruction has made great strides in terms of hardware innovations and their clinical applications. There has been considerable interest in using computer-aided design, finite element modelling, and additive manufacturing techniques to build patient-specific surgical implants. Moreover, lattice implants can mimic mandibular bone's mechanical and structural properties. This article reviews current approaches for mandibular reconstruction, their applications, and their drawbacks. Then, we discuss the potential of mandibular devices with lattice structures, their development and applications, and the challenges for their use in clinical settings.

Deep Learning Accelerated Design of Mechanically Efficient Architected Materials

Lattice structures are known to have high performance-to-weight ratios because of their highly efficient material distribution in a given volume. However, their inherently large void fraction leads to low mechanical properties compared to the base material, high anisotropy, and brittleness. Most works to date have focused on modifying the spatial arrangement of beam elements to overcome these limitations, but only simple beam geometries are adopted due to the infinitely large design space associated with probing and varying beam shapes. Herein, we present an approach to enhance the elastic modulus, strength, and toughness of lattice structures with minimal tradeoffs by optimizing the shape of beam elements for a suite of lattice structures. A generative deep learning-based approach is employed, which leverages the fast inference of neural networks to accelerate the optimization process. Our optimized lattice structures possess superior stiffness (+59%), strength (+49%), toughness (+106%), and isotropy (+645%) compared to benchmark lattices consisting of cylindrical beams. We fabricate our lattice designs using additive manufacturing to validate the optimization approach; experimental and simulation results show good agreement. Remarkable improvement in mechanical properties is shown to be the effect of distributed stress fields and deformation modes subject to beam shape and lattice type.

A review on in vitro/in vivo response of additively manufactured Ti-6Al-4V alloy

Bone replacement using porous and solid metallic implants, such as Ti-alloy implants, is regarded as one of the most practical therapeutic approaches in biomedical engineering. The bone is a complex tissue with various mechanical properties based on the site of action. Patient-specific Ti-6Al-4V constructs may address the key needs in bone treatment for having customized implants that mimic the complex structure of the natural tissue and diminish the risk of implant failure. This review focuses on the most promising methods of fabricating such patient-specific Ti-6Al-4V implants using additive manufacturing (AM) with a specific emphasis on the popular subcategory, which is powder bed fusion (PBF). Characteristics of the ideal implant to promote optimized tissue-implant interactions, as well as physical, mechanical/chemical treatments and modifications will be discussed. Accordingly, such investigations will be classified into 3B-based approaches (Biofunctionality, Bioactivity, and Biostability), which mainly govern native body response and ultimately the success in implantation.

Surface Free Energy Dominates the Biological Interactions of Postprocessed Additively Manufactured Ti-6Al-4V

Additive manufacturing (AM) has emerged as a disruptive technique within healthcare because of its ability to provide personalized devices; however, printed metal parts still present surface and microstructural defects, which may compromise mechanical and biological interactions. This has made physical and/or chemical postprocessing techniques essential for metal AM devices, although limited fundamental knowledge is available on how alterations in physicochemical properties influence AM biological outcomes. For this purpose, herein, powder bed fusion Ti-6Al-4V samples were postprocessed with three industrially relevant techniques: polishing, passivation, and vibratory finishing. These surfaces were thoroughly characterized in terms of roughness, chemistry, wettability, surface free energy, and surface ζ-potential. A significant increase in Staphylococcus epidermidis colonization was observed on both polished and passivated samples, which was linked to high surface free energy donor γ^– values in the acid–base, γ^AB component. Early osteoblast attachment and proliferation (24 h) were not influenced by these properties, although increased mineralization was observed for both these samples. In contrast, osteoblast differentiation on stainless steel was driven by a combination of roughness and chemistry. Collectively, this study highlights that surface free energy is a key driver between AM surfaces and cell interactions. In particular, while low acid–base components resulted in a desired reduction in S. epidermidis colonization, this was followed by reduced mineralization. Thus, while surface free energy can be used as a guide to AM device development, optimization of bacterial and mammalian cell interactions should be attained through a combination of different postprocessing techniques.

Additively manufactured metallic biomaterials

Metal additive manufacturing (AM) has led to an evolution in the design and fabrication of hard tissue substitutes, enabling personalized implants to address each patient's specific needs. In addition, internal pore architectures integrated within additively manufactured scaffolds, have provided an opportunity to further develop and engineer functional implants for better tissue integration, and long-term durability. In this review, the latest advances in different aspects of the design and manufacturing of additively manufactured metallic biomaterials are highlighted. After introducing metal AM processes, biocompatible metals adapted for integration with AM machines are presented. Then, we elaborate on the tools and approaches undertaken for the design of porous scaffold with engineered internal architecture including, topology optimization techniques, as well as unit cell patterns based on lattice networks, and triply periodic minimal surface. Here, the new possibilities brought by the functionally gradient porous structures to meet the conflicting scaffold design requirements are thoroughly discussed. Subsequently, the design constraints and physical characteristics of the additively manufactured constructs are reviewed in terms of input parameters such as design features and AM processing parameters. We assess the proposed applications of additively manufactured implants for regeneration of different tissue types and the efforts made towards their clinical translation. Finally, we conclude the review with the emerging directions and perspectives for further development of AM in the medical industry.

Microstructural Evolution, Mechanical Properties, and Preosteoblast Cell Response of a Post-Processing-Treated TNT5Zr β Ti Alloy Manufactured via Selective Laser Melting

A Ti–34Nb–13Ta–5Zr (TNT5Zr) β Ti alloy with a high strength-to-modulus ratio has been developed, showing its potential to become another candidate material in load-bearing implant applications. This work mainly investigates the microstructural evolution, mechanical properties, and biocompatibility of a post-processing-treated TNT5Zr alloy manufactured via selective laser melting (SLM). Transmission electron microscopy observation shows the existence of the single beta grain matrix and alpha precipitates along the grain boundary in the SLM + HIP manufactured TNT5Zr alloy (TNT5Zr-AF + HIP), and ellipsoidal nano-sized intragranular α″ precipitates (approx. 5–10 nm) were introduced after the subsequent low-temperature aging treatment. The precipitation strengthening enables the SLM + HIP + aging manufactured TNT5Zr (TNT5Zr-AF + HIPA) alloy to show a comparable ultimate tensile strength (853 ± 9 MPa) to that of the reference material (Ti64-AF + HIP, 926 ± 23 MPa). Including the inferior notch-like surface of the test pieces, the slip-band cracking that occurs in this ductile TNT5Zr-AF + HIPA alloy is regarded as the main factor in determining its fatigue strength (170 MPa). In vitro short-term biocompatibility evaluation reveals almost no significant difference in the preosteoblast viability, differentiation, and mineralization between TNT5Zr-AF + HIPA and the reference biomaterial (Ti64-AF + HIP).

Fabrication and Optimisation of Ti-6Al-4V Lattice-Structured Total Shoulder Implants Using Laser Additive Manufacturing

This work aimed to study one of the most important challenges in orthopaedic implantations, known as stress shielding of total shoulder implants. This problem arises from the elastic modulus mismatch between the implant and the surrounding tissue, and can result in bone resorption and implant loosening. This objective was addressed by designing and optimising a cellular-based lattice-structured implant to control the stiffness of a humeral implant stem used in shoulder implant applications. This study used a topology lattice-optimisation tool to create different cellular designs that filled the original design of a shoulder implant, and were further analysed using finite element analysis (FEA). A laser powder bed fusion technique was used to fabricate the Ti-6Al-4V test samples, and the obtained material properties were fed to the FEA model. The optimised cellular design was further fabricated using powder bed fusion, and a compression test was carried out to validate the FEA model. The yield strength, elastic modulus, and surface area/volume ratio of the optimised lattice structure, with a strut diameter of 1 mm, length of 5 mm, and 100% lattice percentage in the design space of the implant model were found to be 200 MPa, 5 GPa, and 3.71 mm⁻¹, respectively. The obtained properties indicated that the proposed cellular structure can be effectively applied in total shoulder-replacement surgeries. Ultimately, this approach should lead to improvements in patient mobility, as well as to reducing the need for revision surgeries due to implant loosening.

The influence of zirconium content on the microstructure, mechanical properties, and biocompatibility of in-situ alloying Ti-Nb-Ta based β alloys processed by selective laser melting

This study investigates Ti-Nb-Ta based β alloys with different zirconium additions (0, 5, 9 wt%) manufactured by SLM. A low level of as-fabricated defects is obtained: the relative density of TNT (Z) alloys is >99.97% with the keyhole size in a range of 3-20 μm. BF TEM images combining SAD patterns of TNT(Z) alloys show single β phase obtained inside the beta matrix; BF-STEM images reveal potential nano-scale grain boundary alpha phase precipitation. Zirconium functions as a neutral element in these high β-stabilized Ti-Nb-Ta based alloys. An increase in Vickers hardness and UTS caused by zirconium additions is observed, which is explained by beta grain refinement because higher degree of undercooling occurs. Corrosion ions of TNT(Z) alloys released from immersion testing at each time intervals show extremely small concentrations (<10 μg/L). It indicated that good biocompatibility during culture with the negligible corrosion ions. High strength-to-modulus ratio β Ti alloys together with excellent biological response show their prospect for biomedical applications.

Topology Optimisation for Compliant Hip Implant Design and Reduced Strain Shielding

Stiff total hip arthroplasty implants can lead to strain shielding, bone loss and complex revision surgery. The aim of this study was to develop topology optimisation techniques for more compliant hip implant design. The Solid Isotropic Material with Penalisation (SIMP) method was adapted, and two hip stems were designed and additive manufactured: (1) a stem based on a stochastic porous structure, and (2) a selectively hollowed approach. Finite element analyses and experimental measurements were conducted to measure stem stiffness and predict the reduction in stress shielding. The selectively hollowed implant increased peri-implanted femur surface strains by up to 25 percentage points compared to a solid implant without compromising predicted strength. Despite the stark differences in design, the experimentally measured stiffness results were near identical for the two optimised stems, with 39% and 40% reductions in the equivalent stiffness for the porous and selectively hollowed implants, respectively, compared to the solid implant. The selectively hollowed implant's internal structure had a striking resemblance to the trabecular bone structures found in the femur, hinting at intrinsic congruency between nature's design process and topology optimisation. The developed topology optimisation process enables compliant hip implant design for more natural load transfer, reduced strain shielding and improved implant survivorship.

Nylon lattice design parameter effects on additively manufactured structural performance

Lattice structures are used in a multitude of applications from medical to aerospace, and their adoption in these applications has been further enabled by additive manufacturing. Lattice performance is governed by a multitude of variables and estimating this performance may be needed during various phases of the design and validation process. Numerical modeling and constitutive relationships are common methodologies to assess performance, address risks, lower costs, and accelerate time to market for innovative and potentially life altering products. These methods are usually accompanied by engineering rationales to justify the methods appropriateness. However, engineering analyses and numerical models should be validated using experimental data when possible to quantify the accuracy of their predictions under conditions relevant to their planned use. In this work, a set of lattice design parameters are evaluated using numerical modeling and experimental methods under quasi-static tensile, compressive, and shear modalities. Regular body centered cubic (BCC) and stochastic Voronoi Tessellation Method (VTM) lattices are constructed with three different cell lengths (2.5 mm, 4.0 mm, 5.0 mm) and various strut diameter thicknesses (ranging from 0.536 mm-1.3506 mm) while maintaining the lattice's relative density (0.2 and 0.3). Some strut diameters were selected to challenge the AM process limits. Specimens were fabricated in nylon 12 on a laser powder bed fusion system. Optical microscopy showed up to a 28.6% difference between as-designed and fabricated strut diameters. Simulated reaction loads revealed up to a 4.6% difference in BCC lattices within a constant relative density at a 1.4 mm displacement boundary condition while the VTM samples had up to a 19.5% difference. Errors between the experimental and simulated lattice reaction loads were as high as 97.0%. This error magnitude appears to strongly correlate with lattice strut diameter. These results showcase that a computational estimation, even one with reasonable assumptions, may erroneously characterize the performance of these lattice structures, and that these assumptions should be challenged by experimentally evaluating and validating critical quantities of interest.

Different Approaches for Manufacturing Ti-6Al-4V Alloy with Triply Periodic Minimal Surface Sheet-Based Structures by Electron Beam Melting

Targeting biomedical applications, Triply Periodic Minimal Surface (TPMS) gyroid sheet-based structures were successfully manufactured for the first time by Electron Beam Melting in two different production Themes, i.e., inputting a zero (Wafer Theme) and a 200 µm (Melt Theme) wall thickness. Initial assumption was that in both cases, EBM manufacturing should yield the structures with similar mechanical properties as in a Wafer-mode, as wall thickness is determined by the minimal beam spot size of ca 200 µm. Their surface morphology, geometry, and mechanical properties were investigated by means of electron microscopy (SEM), X-ray Computed Tomography (XCT), and uniaxial tests (both compression and tension). Application of different manufacturing Themes resulted in specimens with different wall thicknesses while quasi-elastic gradients for different Themes was found to be of 1.5 GPa, similar to the elastic modulus of human cortical bone tissue. The specific energy absorption at 50% strain was also similar for the two types of structures. Finite element simulations were also conducted to qualitatively analyze the deformation process and the stress distribution under mechanical load. Simulations demonstrated that in the elastic regime wall, regions oriented parallel to the load are primarily affected by deformation. We could conclude that gyroids manufactured in Wafer and Melt Themes are equally effective in mimicking mechanical properties of the bones.

Topological design and biomechanical evaluation for 3D printed multi-segment artificial vertebral implants

Customized spinal implants fabricated by additive manufacturing have been increasingly used clinically to restore the physiological functions. However, the mechanisms and methods about the design for the spinal implants are not clear, especially for the reconstruction of multi-segment vertebral. This study aims to develop a novel multi-objective optimization methodology based on various normal spinal activities, to design the artificial vertebral implant (AVI) with lightweight, high-strength and high-stability. The biomechanical performance for two types of AVI was analyzed and compared under different loading conditions by finite element method. These implants were manufactured via selective laser melting technology and evaluated via compressive testing. Results showed the maximum Mises stress of the optimized implant under various load cases were about 41.5% of that of the trussed implant, and below fatigue strength of 3D printed titanium materials. The optimized implant was about 2 times to trussed implant in term of the maximum compression load and compression stiffness to per unit mass, which indicated the optimized implant can meet the safety requirement. Finally, the optimized implant has been used in clinical practice and good short-term clinical outcomes were achieved. Therefore, the novel developed method provides a favorable guarantee for the design of 3D printed multi-segment artificial vertebral implants.

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

I22: SAXS/WAXS beamline at Diamond Light Source - an overview of 10 years operation

Beamline I22 at Diamond Light Source is dedicated to the study of soft-matter systems from both biological and materials science. The beamline can operate in the range 3.7 keV to 22 keV for transmission SAXS and 14 keV to 20 keV for microfocus SAXS with beam sizes of 240 µm × 60 µm [full width half-maximum (FWHM) horizontal (H) × vertical (V)] at the sample for the main beamline, and approximately 10 µm × 10 µm for the dedicated microfocusing platform. There is a versatile sample platform for accommodating a range of facilities and user-developed sample environments. The high brilliance of the insertion device source on I22 allows structural investigation of materials under extreme environments (for example, fluid flow at high pressures and temperatures). I22 provides reliable access to millisecond data acquisition timescales, essential to understanding kinetic processes such as protein folding or structural evolution in polymers and colloids.

3D Printed Polyurethane Scaffolds for the Repair of Bone Defects

Critical-size bone defects are those that will not heal without intervention and can arise secondary to trauma, infection, and surgical resection of tumors. Treatment options are currently limited to filling the defect with autologous bone, of which there is not always an abundant supply, or ceramic pastes that only allow for limited osteo-inductive and -conductive capacity. In this study we investigate the repair of bone defects using a 3D printed LayFomm scaffold. LayFomm is a polymer blend of polyvinyl alcohol (PVA) and polyurethane (PU). It can be printed using the most common method of 3D printing, fused deposition modeling, before being washed in water-based solutions to remove the PVA. This leaves a more compliant, micro-porous PU elastomer. In vitro analysis of dental pulp stem cells seeded onto macro-porous scaffolds showed their ability to adhere, proliferate and form mineralized matrix on the scaffold in the presence of osteogenic media. Subcutaneous implantation of LayFomm in a rat model showed the formation of a vascularized fibrous capsule, but without a chronic inflammatory response. Implantation into a mandibular defect showed significantly increased mineralized tissue production when compared to a currently approved bone putty. While their mechanical properties are insufficient for use in load-bearing defects, these findings are promising for the use of polyurethane scaffolds in craniofacial bone regeneration.

Physical-Mechanical Characteristics and Microstructure of Ti6Al7Nb Lattice Structures Manufactured by Selective Laser Melting

The demand of lattice structures for medical applications is increasing due to their ability to accelerate the osseointegration process, to reduce the implant weight and the stiffness. Selective laser melting (SLM) process offers the possibility to manufacture directly complex lattice applications, but there are a few studies that have focused on biocompatible Ti6Al7Nb alloy. The purpose of this work was to investigate the physical-mechanical properties and the microstructure of three dissimilar lattice structures that were SLM-manufactured by using Ti6Al7Nb powder. In particular, the strut morphology, the fracture characterization, the metallographic structure, and the X-ray phase identification were analyzed. Additionally, the Gibson-Ashby prediction model was adapted for each lattice topology, indicating the theoretical compressive strength and Young modulus. The resulted porosity of these lattice structures was approximately 56%, and the pore size ranged from 0.40 to 0.91 mm. Under quasi-static compression test, three failure modes were recorded. Compared to fully solid specimens, the actual lattice structures reduce the elastic modulus from 104 to 6-28 GPa. The struts surfaces were covered by a large amount of partial melted grains. Some solidification defects were recorded in struts structure. The fractographs revealed a brittle rupture of struts, and their microstructure was mainly α' martensite with columnar grains. The results demonstrate the suitability of manufacturing lattice structures made of Ti6Al7Nb powder having unique physical-mechanical properties which could meet the medical requirements.

The status and challenges of replicating the mechanical properties of connective tissues using additive manufacturing

The ability to fabricate complex structures via precise and heterogeneous deposition of biomaterials makes additive manufacturing (AM) a leading technology in the creation of implants and tissue engineered scaffolds. Connective tissues (CTs) remain attractive targets for manufacturing due to their "simple" tissue compositions that, in theory, are replicable through choice of biomaterial(s) and implant microarchitecture. Nevertheless, characterisation of the mechanical and biological functions of 3D printed constructs with respect to their host tissues is often limited and remains a restriction towards their translation into clinical practice. This review aims to provide an update on the current status of AM to mimic the mechanical properties of CTs, with focus on arterial tissue, articular cartilage and bone, from the perspective of printing platforms, biomaterial properties, and topological design. Furthermore, the grand challenges associated with the AM of CT replacements and their subsequent regulatory requirements are discussed to aid further development of reliable and effective implants.

Mechanical performance of highly permeable laser melted Ti6Al4V bone scaffolds

Critically engineered stiffness and strength of a scaffold are crucial for managing maladapted stress concentration and reducing stress shielding. At the same time, suitable porosity and permeability are key to facilitate biological activities associated with bone growth and nutrient delivery. A systematic balance of all these parameters are required for the development of an effective bone scaffold. Traditionally, the approach has been to study each of these parameters in isolation without considering their interdependence to achieve specific properties at a certain porosity. The purpose of this study is to undertake a holistic investigation considering the stiffness, strength, permeability, and stress concentration of six scaffold architectures featuring a 68.46-90.98% porosity. With an initial target of a tibial host segment, the permeability was characterised using Computational Fluid Dynamics (CFD) in conjunction with Darcy's law. Following this, Ashby's criterion, experimental tests, and Finite Element Method (FEM) were employed to study the mechanical behaviour and their interdependencies under uniaxial compression. The FE model was validated and further extended to study the influence of stress concentration on both the stiffness and strength of the scaffolds. The results showed that the pore shape can influence permeability, stiffness, strength, and the stress concentration factor of Ti6Al4V bone scaffolds. Furthermore, the numerical results demonstrate the effect to which structural performance of highly porous scaffolds deviate, as a result of the Selective Laser Melting (SLM) process. In addition, the study demonstrates that stiffness and strength of bone scaffold at a targeted porosity is linked to the pore shape and the associated stress concentration allowing to exploit the design freedom associated with SLM.

Current Biomedical Applications of 3D Printing and Additive Manufacturing

Additive manufacturing (AM) has emerged over the past four decades as a cost-effective, on-demand modality for fabrication of geometrically complex objects. The ability to design and print virtually any object shape using a diverse array of materials, such as metals, polymers, ceramics and bioinks, has allowed for the adoption of this technology for biomedical applications in both research and clinical settings. Current advancements in tissue engineering and regeneration, therapeutic delivery, medical device fabrication and operative management planning ensure that AM will continue to play an increasingly important role in the future of healthcare. In this review, we outline current biomedical applications of common AM techniques and materials.