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Matsuzaka T, Matsugaki A, Ishihara K, Nakano T. Osteogenic tailoring of oriented bone matrix organization using on/off micropatterning for osteoblast adhesion on titanium surfaces. Acta Biomater 2025; 192:487-500. [PMID: 39644943 DOI: 10.1016/j.actbio.2024.12.017] [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: 09/03/2024] [Revised: 11/21/2024] [Accepted: 12/05/2024] [Indexed: 12/09/2024]
Abstract
Titanium (Ti) implants are well known for their mechanical reliability and chemical stability, crucial for successful bone regeneration. Various shape control and surface modification techniques to enhance biological activity have been developed. Despite the crucial importance of the collagen/apatite bone microstructure for mechanical function, antimicrobial properties, and biocompatibility, precise and versatile pattern control for regenerating the microstructure remains challenging. Here, we developed a novel osteogenic tailoring stripe-micropatterned MPC-Ti substrate that induces genetic-level control of oriented bone matrix organization. This biomaterial was created by micropatterning 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer onto a titanium (Ti) surface through a selective photoreaction. The stripe-micropatterned MPC-Ti substrate establishes a distinct interface for cell adhesion, robustly inducing osteoblast cytoskeleton alignment through actin cytoskeletal alignment, and facilitating the formation of a bone-mimicking-oriented collagen/apatite tissue. Moreover, our study revealed that this bone alignment process is promoted through the activation of the Wnt/β-catenin signaling pathway, which is triggered by nuclear deformation induced by strong cellular alignment guidance. This innovative material is essential for personalized next-generation medical devices, offering high customizability and active restoration of the bone microstructure. STATEMENT OF SIGNIFICANCE: This study demonstrates a novel osteogenic tailoring stripe-micropatterned MPC-Ti substrate that induces osteoblast alignment and bone matrix orientation based on genetic mechanism. By employing a light-reactive MPC polymer, we successfully micropatterned the titanium surface, creating a biomaterial that stimulates unidirectional osteoblast alignment and enhances the formation of natural bone-mimetic anisotropic microstructures. The innovative approach of regulating cell adhesion and cytoskeletal alignment activates the Wnt/β-catenin signaling pathway, crucial for both bone differentiation and orientation. This study presents the first biomaterial that artificially induces the construction of mechanically superior anisotropic bone tissue, and it is expected to promote functional bone regeneration by enhancing bone differentiation and orientation-targeting both the quantity and quality of bone tissue.
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Affiliation(s)
- Tadaaki Matsuzaka
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Aira Matsugaki
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Kazuhiko Ishihara
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Karavasili C, Young T, Francis J, Blanco J, Mancini N, Chang C, Bernstock JD, Connolly ID, Shankar GM, Traverso G. Local drug delivery challenges and innovations in spinal neurosurgery. J Control Release 2024; 376:1225-1250. [PMID: 39505215 DOI: 10.1016/j.jconrel.2024.10.055] [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: 06/22/2024] [Revised: 10/11/2024] [Accepted: 10/28/2024] [Indexed: 11/08/2024]
Abstract
The development of novel therapeutics in the field of spinal neurosurgery faces a litany of translational challenges. Achieving precise drug targeting within the confined spaces associated with the spinal cord, canal and vertebra requires the development of next generation delivery systems and devices. These must be capable of overcoming inherent barriers related to drug diffusion, whilst concurrently ensuring optimal drug distribution and retention. In this review, we provide an overview of the most recent advances in the therapeutic management of diseases and disorders affecting the spine, including systems and devices capable of releasing small molecules and biopharmaceuticals that help eliminate pain and restore the mechanical function and stability of the spine. We highlight material-based approaches and minimally invasive techniques that can be employed to provide control over drug release kinetics and improve retention. We also seek to explore how the newest advancements in nanotechnology, biomaterials, additive manufacturing technologies and imaging modalities can be employed in this translational pursuit. Finally, we discuss the landscape of clinical trials and recently approved products aimed at overcoming the complexities associated with drug delivery to the spine.
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Affiliation(s)
- Christina Karavasili
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Thomas Young
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Joshua Francis
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Julianna Blanco
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nicholas Mancini
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Charmaine Chang
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Joshua D Bernstock
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Giovanni Traverso
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
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Zhang H, Liu S, Hao R, Yao J. Comparative evaluation of autologous dental bone powder and deproteinized bovine bone mineral allografts for oral implant bone deficits. Clin Oral Investig 2024; 28:637. [PMID: 39523225 DOI: 10.1007/s00784-024-05973-z] [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: 06/20/2024] [Accepted: 09/29/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVE To compare the effectiveness of autologous dental bone powder grafts with deproteinized bovine bone mineral (DBBM) allografts in oral implant bone deficiency. METHODS Between January 2021 and January 2023, we enrolled 120 patients with inadequate bone for oral implantation, dividing them into an experimental group and a control group (60 each). The experimental group received autologous dental bone powder grafts, while the control group received DBBM allografts. Wound healing was assessed using the early healing index (EHI) with 5 days of closure as the baseline timeline, as Grade I: full closure without a fibrin line, Grade II: closure with a fibrin line, and Grade III: closure with fibrin covering the incision. Additional outcomes included buccal and palatal alveolar bone height, alveolar bone width at 3 (W1), 7 (W2), and 11 mm (W3) below the top of the alveolar ridge, and bone density measured before and 3 months after tooth extraction. The altered shape of the alveolar bone at the extraction site was assessed at 3- and 6-months post-extraction. Implant success rate was also evaluated at 15 days and 1 month after implantation. Comparisons were made using independent t-tests, paired t-tests, χ² tests, and Z tests, as appropriate. RESULTS The experimental group had a lower wound healing time and a greater prevalence of EHI categorization class I compared to the control group (P < 0.05). Three months after tooth extraction, there was no statistically significant difference in buccal and palatal alveolar bone heights between the experimental group and the pre-treatment measurements (P > 0.05). However, the control group showed a decrease in buccal and palatal alveolar bone heights compared to the pre-treatment period, while the experimental group had greater bone heights than the control group (P < 0.05). Three months after extraction, the widths of W1, W2, and W3 decreased in both groups. However, the experimental group maintained greater widths compared to the control group (P < 0.05). At 3 months post-extraction, both groups showed an increase in alveolar bone density at the extraction site. Notably, the experimental group had a higher bone density compared to the control group as well as new bone contour score of the alveolar bone at the extraction site (P < 0.05). However, at 6 months after extraction, there was no statistically significant difference in the new bone contour score of the alveolar bone at the extraction site between the two groups (P > 0.05). There was no significant difference in the implant success rate between the two groups. (P > 0.05). CONCLUSIONS Autologous dental bone powder grafting promotes initial alveolar bone regeneration, enhances wound healing, and increases new bone density, providing favorable surgical conditions for dental implants. However, by 6 months, there was no significant difference in bone contour compared to DBBM allografts, indicating similar long-term clinical outcomes for both materials.
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Affiliation(s)
- Hongpeng Zhang
- Department of Stomatology, First Hospital of Handan City, Handan, Hebei Province, China
| | - Shuo Liu
- Department of Stomatology, First Hospital of Handan City, Handan, Hebei Province, China.
| | - Rui Hao
- Department of Stomatology, First Hospital of Handan City, Handan, Hebei Province, China
| | - Jing Yao
- Department of Stomatology, First Hospital of Handan City, Handan, Hebei Province, China
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Li H, Yang X. Effect of Surface Morphologies on the In Vitro and In Vivo Properties of Biomedical Metallic Materials. ACS Biomater Sci Eng 2024; 10:6017-6028. [PMID: 39269725 DOI: 10.1021/acsbiomaterials.4c00942] [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] [Indexed: 09/15/2024]
Abstract
Metallic biomaterials, including traditional bioinert materials (such as stainless steel, cobalt-chromium alloys, pure titanium, and titanium alloys), novel biodegradable metals (such as pure magnesium and magnesium alloys, pure zinc and zinc alloys, and pure iron and iron alloys), and biomedical metallic glasses, have been widely used and studied as various biomedical implants and devices. Many scientists and researchers have investigated their superior biomechanical properties, corrosion behavior, and biocompatibility. However, their surface characteristics are of extreme importance due to continuing interactions between the surface/interface of an implanted metallic biomaterial and the surrounding physiological environment. Surface morphologies on these metallic biomaterials can modulate their in vitro and in vivo biological responses. In this review, we have summarized and investigated the effect of various surface morphologies on the corrosion behavior, cellular response, antibacterial activity, and osteogenesis of biomedical metallic materials. In addition, future research directions and challenges of surface morphologies on biomedical metallic materials have been elaborated. This review can lay a theoretical and practical foundation for further research and development on biomedical metallic materials.
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Affiliation(s)
- Huafang Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Xuan Yang
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing 100083, China
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Segi N, Nakashima H, Shinjo R, Kagami Y, Machino M, Ito S, Ouchida J, Morishita K, Oishi R, Yamauchi I, Imagama S. Trabecular Bone Remodeling After Posterior Lumbar Interbody Fusion: Comparison of Three-Dimensional Porous Tantalum and Titanium-Coated Polyetheretherketone Interbody Cages. Global Spine J 2024; 14:2106-2115. [PMID: 37060284 PMCID: PMC11418715 DOI: 10.1177/21925682231170613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The criteria for determining completion of intervertebral stability after posterior lumbar interbody fusion (PLIF) remain controversial. Several new radiological indicators of bone growth and osteointegration have been established. We compared computed tomography (CT) findings related to osteointegration after PLIF with interbody cages of two different materials and designs. METHODS We retrospectively analyzed data from 103 patients who underwent PLIF with three-dimensional porous tantalum (Tn) cages or titanium-coated polyetheretherketone (TiP) cages. CT images obtained 3 months and 1 year after surgery were examined for trabecular bone remodeling (TBR), cancellous condensation (CC), and vertebral endplate cyst (VEC) formation. The incidences of each finding were compared by cage type, and rates of instrument failure and pseudarthrosis were determined. RESULTS Three months postoperatively, 87% of the levels with Tn cages exhibited TBR, whereas 96% of those with TiP cages did not (P < .001). Most levels with Tn cages levels exhibited TBR and no CC 3 months (81%) and 1 year (94%) after surgery. Although 78% of levels with TiP cages exhibited CC and no TBR 3 months after surgery, 59% exhibited both CC and TBR 1 year after surgery. Significantly fewer VECs formed around the Tn cages than around the TiP cages both 3 months (P = .002) and 1 year (P < .001) after surgery. Implant-related problems occurred at levels that exhibited neither TBR nor CC. CONCLUSIONS The porous tantalum cage may enable intervertebral stability that is comparable to bony fusion soon after surgery.
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Affiliation(s)
- Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Aichi, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuichi Shinjo
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Aichi, Japan
| | - Yujiro Kagami
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Aichi, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuaki Morishita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryotaro Oishi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ippei Yamauchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Watanabe R, Matsugaki A, Gokcekaya O, Ozasa R, Matsumoto T, Takahashi H, Yasui H, Nakano T. Host bone microstructure for enhanced resistance to bacterial infections. BIOMATERIALS ADVANCES 2023; 154:213633. [PMID: 37775399 DOI: 10.1016/j.bioadv.2023.213633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
Postoperative bacterial infection is a serious complication of orthopedic surgery. Not only infections that develop in the first few weeks after surgery but also late infections that develop years after surgery are serious problems. However, the relationship between host bone and infection activation has not yet been explored. Here, we report a novel association between host bone collagen/apatite microstructure and bacterial infection. The bone-mimetic-oriented micro-organized matrix structure was obtained by prolonged controlled cell alignment using a grooved-structured biomedical titanium alloy. Surprisingly, we have discovered that highly aligned osteoblasts have a potent inhibitory effect on Escherichia coli adhesion. Additionally, the oriented collagen/apatite micro-organization of the bone matrix showed excellent antibacterial resistance against Escherichia coli. The proposed mechanism for realizing the antimicrobial activity of the micro-organized bone matrix is by the controlled secretion of the antimicrobial peptides, including β-defensin 2 and β-defensin 3, from the highly aligned osteoblasts. Our findings contribute to the development of anti-infective strategies for orthopedic surgeries. The recovery of the intrinsically ordered bone matrix organization provides superior antibacterial resistance after surgery.
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Affiliation(s)
- Ryota Watanabe
- Teijin Nakashima Medical Co. Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama 709-0625, Japan; Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Aira Matsugaki
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Ozkan Gokcekaya
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Ryosuke Ozasa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Takuya Matsumoto
- Department of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Hiroyuki Takahashi
- Teijin Nakashima Medical Co. Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama 709-0625, Japan.
| | - Hidekazu Yasui
- Teijin Nakashima Medical Co. Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama 709-0625, Japan.
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
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Matsugaki A, Ito M, Kobayashi Y, Matsuzaka T, Ozasa R, Ishimoto T, Takahashi H, Watanabe R, Inoue T, Yokota K, Nakashima Y, Kaito T, Okada S, Hanawa T, Matsuyama Y, Matsumoto M, Taneichi H, Nakano T. Innovative design of bone quality-targeted intervertebral spacer: accelerated functional fusion guiding oriented collagen and apatite microstructure without autologous bone graft. Spine J 2023; 23:609-620. [PMID: 36539040 DOI: 10.1016/j.spinee.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND CONTEXT Although autologous bone grafting is widely considered as an ideal source for interbody fusion, it still carries a risk of nonunion. The influence of the intervertebral device should not be overlooked. Requirements for artificial spinal devices are to join the vertebrae together and recover the original function of the spine rapidly. Ordered mineralization of apatite crystals on collagen accelerates bone functionalization during the healing process. Particularly, the stable spinal function requires the ingrowth of an ordered collagen and apatite matrix which mimics the intact intervertebral microstructure. This collagen and apatite ordering is imperative for functional bone regeneration, which has not been achieved using classical autologous grafting. PURPOSE We developed an intervertebral body device to achieve high stability between the host bone and synthesized bone by controlling the ordered collagen and apatite microstructure. STUDY DESIGN This was an in vivo animal study. METHODS Intervertebral spacers with a through-pore grooved surface structure, referred to as a honeycomb tree structure, were produced using metal 3D printing. These spacers were implanted into normal sheep at the L2-L3 or L4-L5 disc levels. As a control group, grafting autologous bone was embedded. The mechanical integrity of the spacer/bone interface was evaluated through push-out tests. RESULTS The spacer with honeycomb tree structure induced anisotropic trabecular bone growth with textured collagen and apatite orientation in the through-pore and groove directions. The push-out load of the spacer was significantly higher than that of the conventional autologous graft spacer. Moreover, the load was significantly correlated with the anisotropic texture of the newly formed bone matrix. CONCLUSIONS The developed intervertebral spacer guided the regenerated bone matrix orientation of collagen and apatite, resulting in greater strength at the spacer/host bone interface than that obtained using a conventional gold-standard autologous bone graft. CLINICAL SIGNIFICANCE Our results provide a foundation for designing future spacers for interbody fusion in human.
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Affiliation(s)
- Aira Matsugaki
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Manabu Ito
- Department of Spine and Spinal Cord Disorders, National Hospital Organization, Hokkaido Medical Center,5-7-1-1, Yamanote, Nishi-ku, Sapporo, Hokkaido, 063-0005, Japan
| | - Yoshiya Kobayashi
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Tadaaki Matsuzaka
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Ryosuke Ozasa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takuya Ishimoto
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Takahashi
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Ryota Watanabe
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Takayuki Inoue
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Katsuhiko Yokota
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Yoshio Nakashima
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takao Hanawa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
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