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Jillek B, Szabó P, Kopniczky J, Krafcsik O, Szabó I, Patczai B, Turzó K. Characterizing Surface Morphological and Chemical Properties of Commonly Used Orthopedic Implant Materials and Determining Their Clinical Significance. Polymers (Basel) 2024; 16:1193. [PMID: 38732662 PMCID: PMC11085225 DOI: 10.3390/polym16091193] [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: 03/11/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
The goal of the study was to compare the surface characteristics of typical implant materials used in orthopedic surgery and traumatology, as these determine their successful biointegration. The morphological and chemical structure of Vortex plate anodized titanium from commercially pure (CP) Grade 2 Titanium (Ti2) is generally used in the following; non-cemented total hip replacement (THR) stem and cup Ti alloy (Ti6Al4V) with titanium plasma spray (TPS) coating; cemented THR stem Stainless steel (SS); total knee replacement (TKR) femoral component CoCrMo alloy (CoCr); cemented acetabular component from highly cross-linked ultrahigh molecular weight polyethylene (HXL); and cementless acetabular liner from ultrahigh molecular weight polyethylene (UHMWPE) (Sanatmetal, Ltd., Eger, Hungary) discs, all of which were examined. Visualization and elemental analysis were carried out by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS). Surface roughness was determined by atomic force microscopy (AFM) and profilometry. TPS Ti presented the highest Ra value (25 ± 2 μm), followed by CoCr (535 ± 19 nm), Ti2 (227 ± 15 nm) and SS (170 ± 11 nm). The roughness measured in the HXL and UHMWPE surfaces was in the same range, 147 ± 13 nm and 144 ± 15 nm, respectively. EDS confirmed typical elements regarding the investigated prosthesis materials. XPS results supported the EDS results and revealed a high % of Ti4+ on Ti2 and TPS surfaces. The results indicate that the surfaces of prosthesis materials have significantly different features, and a detailed characterization is needed to successfully apply them in orthopedic surgery and traumatology.
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Affiliation(s)
- Bertalan Jillek
- Department of Orthopedics, Somogy County Mór Kaposi Teaching Hospital, Tallián Gyula u. 20-32, H-7400 Kaposvár, Hungary
| | - Péter Szabó
- Szentágothai Research Center, Environmental Analytical and Geoanalytical Research Group, Ifjúság útja 20., H-7624 Pécs, Hungary;
| | - Judit Kopniczky
- Department of Optics and Quantum Electronics, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary;
| | - Olga Krafcsik
- Department of Atomic Physics, Budapest University of Technology and Economics, Budafoki út 8., H-1111 Budapest, Hungary
| | - István Szabó
- Department of Orthopedics, Somogy County Mór Kaposi Teaching Hospital, Tallián Gyula u. 20-32, H-7400 Kaposvár, Hungary
| | - Balázs Patczai
- Department of Traumatology and Hand Surgery, University of Pécs, Ifjúság u. 13., H-7624 Pécs, Hungary;
| | - Kinga Turzó
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, H-7623 Pécs, Hungary;
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Zheng XQ, Huang J, Lin JL, Song CL. Pathophysiological mechanism of acute bone loss after fracture. J Adv Res 2023; 49:63-80. [PMID: 36115662 PMCID: PMC10334135 DOI: 10.1016/j.jare.2022.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 07/29/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Acute bone loss after fracture is associated with various effects on the complete recovery process and a risk of secondary fractures among patients. Studies have reported similarities in pathophysiological mechanisms involved in acute bone loss after fractures and osteoporosis. However, given the silence nature of bone loss and bone metabolism complexities, the actual underlying pathophysiological mechanisms have yet to be fully elucidated. AIM OF REVIEW To elaborate the latest findings in basic research with a focus on acute bone loss after fracture. To briefly highlight potential therapeutic targets and current representative drugs. To arouse researchers' attention and discussion on acute bone loss after fracture. KEY SCIENTIFIC CONCEPTS OF REVIEW Bone loss after fracture is associated with immobilization, mechanical unloading, blood supply damage, sympathetic nerve regulation, and crosstalk between musculoskeletals among other factors. Current treatment strategies rely on regulation of osteoblasts and osteoclasts, therefore, there is a need to elucidate on the underlying mechanisms of acute bone loss after fractures to inform the development of efficacious and safe drugs. In addition, attention should be paid towards ensuring long-term skeletal health.
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Affiliation(s)
- Xuan-Qi Zheng
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Jie Huang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Jia-Liang Lin
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Chun-Li Song
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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Complications of patients with bone tumors treated with carbon-fiber plates: an international multicenter study. Sci Rep 2022; 12:18969. [PMID: 36348055 PMCID: PMC9643370 DOI: 10.1038/s41598-022-23519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022] Open
Abstract
Carbon-fiber (CF) plates are a promising alternative to metal plates. However, reported experience in orthopaedic oncology remains limited. The aim of this study was to identify complications of patients with bone tumors treated with CF plates. Between February 2015 and May 2021, 13 centers retrospectively registered patients with bone tumors that were reconstructed using CF plates. Complications were identified, and timing and etiology of complications were noted. Similar complications were tabulated and classified based on mechanical, non-mechanical and paediatric complications. Mechanical complications included: (1) aseptic loosening or graft-host non-union, and (2) structural complications. Non-mechanical complications included: (3) soft tissue complications, (4) infection and (5) tumor progression. Specific paediatric complications included (6) growth arrest resulting in longitudinal or angular deformity. Ninety-six patients were included with a median follow-up time of 35 months. In total, 22 (23%) patients had complications. Mechanical complications included: 1 (1%) aseptic loosening, 2 (2%) non-unions, and 7 (7%) structural complications. Non-mechanical complications included 1 (1%) soft tissue complication, 4 (4%) infections and 5 (5%) tumor progressions. Paediatric complications occurred in 2 (2%) patients. This study suggests CF plates are safe to use in demanding reconstructions after bone tumor resections, presenting a seemingly low complication profile.
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In silico analysis of modular bone plates. J Mech Behav Biomed Mater 2021; 124:104847. [PMID: 34555620 DOI: 10.1016/j.jmbbm.2021.104847] [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: 05/26/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inventory management or immediate availability of fracture plates can be problematic since for each surgical intervention a specific plate of varying size and functionality must be ordered. Modularization of the standard monolithic plate is proposed to address this issue. METHODS The effects of four different unit module design parameters (type, degree of modularization, connector screw diameter, sandwich ratio) on the plate bending stiffness and failure are investigated in a finite element four-point-bending analysis. A chosen, best-performing modular plate is then tested in silico for a simple diaphyseal tibial fracture scenario under anatomical compressional, torsional, and bending loads. RESULTS A modularization strategy is proposed to match the monolithic plate bending properties as closely as possible. With the best combination of design parameters, a fully modularized equivalent length plate with a 42.3% decrease in stiffness and 46.2% decrease in strength could be assembled. The chosen modular plate also displayed sufficient mechanical performance under the fracture fixation scenarios for a potentially successful osteosynthesis. CONCLUSIONS Via computational methods, the viability of the modularization strategy as an alternate to the traditional monolithic plate is demonstrated. As a further realized advantage, the modular plates can alleviate stress shielding thanks to the reduced stiffness.
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Zaidenberg EE, Voor M, Pereira E, Rossi LA, Zaidenberg CR. Bicortical versus unicortical fixation of plated clavicular fractures: A biomechanical study. Shoulder Elbow 2021; 13:426-432. [PMID: 34394740 PMCID: PMC8355658 DOI: 10.1177/1758573220914217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE To compare the biomechanical properties of three plate stabilization techniques for midshaft clavicle fractures: anatomical bicortical locking construct, anatomical unicortical locking construct, and reconstruction bicortical locking construct. METHODS We analyzed superior plating of the clavicle using an anatomical clavicle plate (Acumed) with both bicortical or unicortical screw fixation and a locking reconstruction plate (DePuy-Synthes). Twenty-one fourth generation composite clavicles were used for non-destructive stiffness testing in axial loading, bending, and torsion. Fifteen composite clavicles and 17 foam clavicles were used for cyclic failure testing using a combined loading method that included all three loading modes. RESULTS No significant differences were found between the three constructs in torsional stiffness nor in vertical bending loading. In axial loading, the anatomical bicortical locking construct was significantly stiffer than either anatomical unicortical locking construct or the reconstruction bicortical locking construct. The unicortical fixation was also significantly stiffer than the reconstruction bicortical locking construct. Regarding failure testing, there was not a significant difference between the bicortical and unicortical anatomical locking constructs; however, both were significantly stronger than bicortical screw fixation in the reconstruction plate. CONCLUSION Based on the biomechanical performance of these constructs, unicortical locked plate fixation may be a reasonable option in the treatment of displaced midshaft clavicle fracture fixation.
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Affiliation(s)
- Ezequiel E Zaidenberg
- Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina,Anatomy Department, School of Medicine,
University of Buenos Aires, Buenos Aires, Argentina,Ezequiel E Zaidenberg, Instituto de Ortopedia y
Traumatología “Carlos E. Ottolenghi,” Potosí 4215 (C1199ACK), Buenos Aires, Argentina.
| | - Michael Voor
- Department of Orthopaedics, Bioengineering
Laboratory, University of Louisville, Louisville, USA
| | - Enrique Pereira
- Department of Orthopaedics, Instituto
Argentino de Diagnostico y Tratamiento, Buenos Aires, Argentina
| | - Luciano A Rossi
- Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlos R Zaidenberg
- Anatomy Department, School of Medicine,
University of Buenos Aires, Buenos Aires, Argentina
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Park YU, Kim SJ, Kim HN. Minimally invasive plate osteosynthesis using the oblong hole of a locking plate for comminuted distal fibular fractures. J Orthop Surg Res 2021; 16:281. [PMID: 33906661 PMCID: PMC8077965 DOI: 10.1186/s13018-021-02441-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nonunion is a rare complication for distal fibular fractures. However, when there is a high degree of comminution, nonunion may occur. In this article, we describe a novel technique that uses the oblong hole of a locking plate to lengthen the fibula for fracture reduction. This technique is straightforward and allows for easy control of the comminuted fracture to restore length and rotation at the time of plate application without opening the fracture site. Methods Thirty-five consecutive patients, who were treated with the minimally invasive plate osteosynthesis (MIPO) technique for comminuted distal fibular fractures were retrospectively studied. The study included 19 men and 16 women, with a mean age of 47.0 years (range, 20 to 72). There were 3 lateral malleolar fractures with deltoid injury, 11 bimalleolar fractures, 7 trimalleolar fractures, and 14 distal tibiofibular fractures. The quality of fracture reduction was assessed by comparing the radiologic parameters (fibular length, talocrural angle, and medial clear space) between the affected ankle and the contralateral uninjured ankle. Results Two patients were not reachable and 5 declined to visit the clinic. For these 7 patients, the latest outcomes that were measured prospectively were used. Postoperative radiographs showed well-aligned ankle mortise, with fibular length restoration. The mean Olerud-Molander ankle score was 82.1 ± 10.7 at a mean of 27.2 months (range, 12 to 58). There was one case of nonunion and one case of superficial peroneal nerve injury. Conclusion The MIPO technique, using the oblong hole of a locking plate, achieved satisfactory restoration of length and rotation, bone union, and clinical outcomes for the comminuted distal fibular fractures.
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Affiliation(s)
- Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopedic Surgery, Dongtan Sacred Hospital, Hallym University, Hwaseong, South Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, Republic of Korea.
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Abstract
Effective fracture surgery requires contouring orthopaedic implants in multiple planes. The amount of force required for contouring is dependent on the amount and type of material contained within the plane to be altered. The type of contouring used depends on the desired plate function; for example, buttress mode often requires some degree of undercontouring, whereas compression plating may require prebending. Other reasons to contour a plate include matching patient anatomy either to maximize fixation options or to reduce implant prominence. Precontoured plates can be convenient and help to facilitate soft-tissue friendly techniques but have the potential to introduce malreduction if the plate position and fit are not carefully monitored.
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Charbonnier B, Manassero M, Bourguignon M, Decambron A, El-Hafci H, Morin C, Leon D, Bensidoum M, Corsia S, Petite H, Marchat D, Potier E. Custom-made macroporous bioceramic implants based on triply-periodic minimal surfaces for bone defects in load-bearing sites. Acta Biomater 2020; 109:254-266. [PMID: 32194263 DOI: 10.1016/j.actbio.2020.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 12/16/2022]
Abstract
The architectural features of synthetic bone grafts are key parameters for regulating cell functions and tissue formation for the successful repair of bone defects. In this regard, macroporous structures based on triply-periodic minimal surfaces (TPMS) are considered to have untapped potential. In the present study, custom-made implants based on a gyroid structure, with (GPRC) and without (GP) a cortical-like reinforcement, were specifically designed to fit an intended bone defect in rat femurs. Sintered hydroxyapatite implants were produced using a dedicated additive manufacturing technology and their morphological, physico-chemical and mechanical features were characterized. The implants' integrity and ability to support bone ingrowth were assessed after 4, 6 and 8 weeks of implantation in a 3-mm-long, femoral defect in Lewis rats. GP and GPRC implants were manufactured with comparable macro- to nano-architectures. Cortical-like reinforcement significantly improved implant effective stiffness and resistance to fracture after implantation. This cortical-like reinforcement also concentrated new bone formation in the core of the GPRC implants, without affecting newly formed bone quantity or maturity. This study showed, for the first time, that custom-made TPMS-based bioceramic implants could be produced and successfully implanted in load-bearing sites. Adding a cortical-like reinforcement (GPRC implants) was a relevant solution to improve implant mechanical resistance, and changed osteogenic mechanism compared to the GP implants. STATEMENT OF SIGNIFICANCE: Architectural features are known to be key parameters for successful bone repair using synthetic bioceramic bone graft. So far, conventional manufacturing techniques, lacking reproducibility and complete control of the implant macro-architecture, impeded the exploration of complex architectures, such as triply periodic minimal surfaces (TPMS), which are foreseen to have an unrivaled potential for bone repair. Using a new additive manufacturing process, macroporous TPMS-based bioceramics implants were produced in calcium phosphate, characterized and implanted in a femoral defect in rats. The results showed, for the first time, that such macroporous implants can be successfully implanted in anatomical load-bearing sites when a cortical-like outer shell is added. This outer shell also concentrated new bone formation in the implant center, without affecting new bone quantity or maturity.
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Neacsu IA, Arsenie LV, Trusca R, Ardelean IL, Mihailescu N, Mihailescu IN, Ristoscu C, Bleotu C, Ficai A, Andronescu E. Biomimetic Collagen/Zn 2+-Substituted Calcium Phosphate Composite Coatings on Titanium Substrates as Prospective Bioactive Layer for Implants: A Comparative Study Spin Coating vs. MAPLE. NANOMATERIALS (BASEL, SWITZERLAND) 2019; 9:E692. [PMID: 31058851 PMCID: PMC6566990 DOI: 10.3390/nano9050692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/22/2019] [Accepted: 04/26/2019] [Indexed: 01/20/2023]
Abstract
Synthesis of biomimetic materials for implants and prostheses is a hot topic in nanobiotechnology strategies. Today the major approach of orthopaedic implants in hard tissue engineering is represented by titanium implants. A comparative study of hybrid thin coatings deposition was performed by spin coating and matrix-assisted pulsed laser evaporation (MAPLE) onto titanium substrates. The Collagen-calcium phosphate (Coll-CaPs) combination was selected as the best option to mimic natural bone tissue. To accelerate the mineralization process, Zn2+ ions were inserted by substitution in CaPs. A superior thin film homogeneity was assessed by MAPLE, as shown by scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) microscopy. A decrease of P-O and amide absorbance bands was observed as a consequence of different Zn2+ amounts. A variety of structural modifications of the apatite layer are then generated, which influenced the confinement process towards the collagen template. The in-vitro Simulated Body Fluid (SBF) assay demonstrated the ability of Coll/Zn2+-CaPs coatings to stimulate the mineralization process as a result of synergic effects in the collagen-Zn2+ substituted apatite. For both deposition methods, the formation of droplets associated to the growth of CaPs particulates inside the collagen matrix was visualized. This supports the prospective behavior of MAPLE biomimetic coatings to induce mineralization, as an essential step of fast implant integration with vivid tissues.
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Affiliation(s)
- Ionela Andreea Neacsu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Polizu Street No.1, 011061 Bucharest, Romania.
| | - Laura Vasilica Arsenie
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Polizu Street No.1, 011061 Bucharest, Romania.
| | - Roxana Trusca
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Polizu Street No.1, 011061 Bucharest, Romania.
| | - Ioana Lavinia Ardelean
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Polizu Street No.1, 011061 Bucharest, Romania.
| | - Natalia Mihailescu
- National Institute for Laser, Plasma and Radiation Physics, Atomiştilor Street No. 409, 077125 Măgurele, Romania.
| | - Ion Nicolae Mihailescu
- National Institute for Laser, Plasma and Radiation Physics, Atomiştilor Street No. 409, 077125 Măgurele, Romania.
| | - Carmen Ristoscu
- National Institute for Laser, Plasma and Radiation Physics, Atomiştilor Street No. 409, 077125 Măgurele, Romania.
| | - Coralia Bleotu
- Stefan S. Nicolau' Institute of Virology, Romanian Academy, 011061 Bucharest, Romania.
| | - Anton Ficai
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Polizu Street No.1, 011061 Bucharest, Romania.
- Academy of Romanian Scientists, Splaiul Independentei Street No. 54, 011061 Bucharest, Romania.
| | - Ecaterina Andronescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Polizu Street No.1, 011061 Bucharest, Romania.
- Academy of Romanian Scientists, Splaiul Independentei Street No. 54, 011061 Bucharest, Romania.
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