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Wei Z, Zhang Z, Zhu W, Weng X. Polyetheretherketone development in bone tissue engineering and orthopedic surgery. Front Bioeng Biotechnol 2023; 11:1207277. [PMID: 37456732 PMCID: PMC10345210 DOI: 10.3389/fbioe.2023.1207277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.
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Affiliation(s)
- Zhanqi Wei
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Ze Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Wei Zhu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Lin CW, Chiang ER, Chen SH, Chen P, Liu HJ, Chiu JCH. Global Compressive Loading from an Ultra-Thin PEEK Button Augment Enhances Fibrocartilage Regeneration of Rotator Cuff Enthesis. Bioengineering (Basel) 2023; 10:bioengineering10050565. [PMID: 37237635 DOI: 10.3390/bioengineering10050565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
A PEEK button is developed to improve the tendon-to-bone compression area. In total, 18 goats were divided into 12-week, 4-week, and 0-week groups. All underwent bilateral detachment of the infraspinatus tendon. In the 12-week group, 6 were fixed with a 0.8-1 mm-thick PEEK augment (A-12, Augmented), and 6 were fixed with the double-row technique (DR-12). Overall, 6 infraspinatus were fixed with PEEK augment (A-4) and without PEEK augment (DR-4) in the 4-week group. The same condition was performed in the 0-week groups (A-0 and DR-0). Mechanical testing, immunohistochemistry assessment, cell responses, tissue alternation, surgical impact, remodeling, and the expression of type I, II, and III collagen of the native tendon-to-bone insertion and new footprint areas were evaluated. The average maximum load in the A-12 group (393.75 (84.40) N) was significantly larger than in the TOE-12 group (229.17 (43.94) N) (p < 0.001). Cell responses and tissue alternations in the 4-week group were slight. The new footprint area of the A-4 group had better fibrocartilage maturation and more type III collagen expression than in DR-4 group. This result proved the novel device is safe and provides superior load-displacement to the double-row technique. There is a trend toward better fibrocartilage maturation and more collagen III secretions in the PEEK augmentation group.
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Affiliation(s)
- Chia-Wei Lin
- Orthopedic Department, Wuri Lin Shin Hospital, Taichung 414, Taiwan
- Department of Clinical Research, De Novo Orthopedics Inc., Taichung 414, Taiwan
| | - En-Rung Chiang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Shih-Hao Chen
- Department of Orthopedic Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan
- Department of Orthopaedics, Tzu-Chi University, Hualien 970, Taiwan
| | - Poyu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Occupational Therapy, Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
| | - Heng-Jui Liu
- Department of Clinical Research, De Novo Orthopedics Inc., Taichung 414, Taiwan
| | - Joe Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Comprehensive Sports Medicine Center (CSMC), Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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Li Y, Xu Y, Xu L, Li T, Li R, Tang X. [Short-term safety and effectiveness of domestic polyether-ether-ketone suture anchors for rotator cuff repair: A multicenter, randomized, single-blind, parallel-controlled noninferiority study]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1335-1342. [PMID: 36382449 PMCID: PMC9681596 DOI: 10.7507/1002-1892.202207131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE A multicenter, randomized, single-blind, parallel-controlled noninferiority study was used to evaluate the short-term safety and effectiveness of domestic polyether-ether-ketone (PEEK) suture anchor for rotator cuff repair by comparing with the imported PEEK suture anchor commonly used in clinical practice. METHODS A total of 59 patients with rotator cuff tears who were admitted between May 2019 and October 2019 were selected as the research objects. Among them, 3 patients were excluded because they did not meet the selection criteria, and 1 patient withdrew from the study because of serious adverse events. A total of 55 patients were included in the study. They were randomly divided into trial group ( n=27) and control group ( n=28). The trial group used PEEK suture anchors produced from REJOIN Company, and the control group used PEEK suture anchors from American Arthrex Company. Two patients in control group were lost to follow-up. Twenty-seven patients in trial group and 26 patients in control group were included in the final quantitative analysis. There was no significant difference ( P>0.05) in gender, age, disease duration, side and sizes of rotator cuff tears, composition ratio of patients with type 2 diabetes, and preoperative American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California at Los Angeles (UCLA) score, and visual analogue scale (VAS) score. The patients were followed up regularly after operation. The postoperative follow-up included safety evaluation (complications, anchor position, and anchor bone reaction) and effectiveness evaluation (shoulder joint function and pain scores, rotator cuff integrity based on Sugaya classification criteria). RESULTS The operations in both groups were successfully completed, and there was no complication related to the operation and suture anchor. All incisions healed by first intention. There was no significant difference in follow-up time between trial group [(5.85±0.77) months] and control group [(5.96±0.72) months] ( t=0.535, P=0.595). MRI examination indicated that the repaired tendons were fixed and the anchors did not get loose or torn. At 1 day, 3 months, and 6 months after operation, there was no patient with grade 3-4 anchor bone reaction in the two groups, and there was no significant difference in the bone reaction grading between groups ( P>0.05). After operation, the VAS scores of the two groups gradually decreased, and the ASES scores, Constant-Murley scores, and UCLA scores gradually increased, and there were significant differences between groups at each time point ( P<0.05). There was no significant difference between groups at different time points ( P>0.05). There was no significant difference in Sugaya classification of rotator cuff integrity at 1 day, 3 months, and 6 months after operation between groups ( P>0.05). CONCLUSION The short-term safety and effectiveness of domestic PEEK suture anchors in rotator cuff tear repair are not significant different from those of imported PEEK suture anchors commonly used in clinical practice.
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Affiliation(s)
- Yinghao Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Yang Xu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Longwei Xu
- Department of Orthopedics, Lishui People's Hospital, Lishui Yunnan, 323000, P. R. China
| | - Tao Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Ran Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Xin Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
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Selection of animal bone surrogate samples for orthopaedic screw testing based on human radius CT-derived bone morphology. Med Eng Phys 2022; 103:103786. [DOI: 10.1016/j.medengphy.2022.103786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/26/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
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Abstract
Smart scaffolds based on shape memory polymer (SMPs) have been increasingly studied in tissue engineering. The unique shape actuating ability of SMP scaffolds has been utilized to improve delivery and/or tissue defect filling. In this regard, these scaffolds may be self-deploying, self-expanding, or self-fitting. Smart scaffolds are generally thermoresponsive or hydroresponsive wherein shape recovery is driven by an increase in temperature or by hydration, respectively. Most smart scaffolds have been directed towards regenerating bone, cartilage, and cardiovascular tissues. A vast variety of smart scaffolds can be prepared with properties targeted for a specific tissue application. This breadth of smart scaffolds stems from the variety of compositions employed as well as the numerous methods used to fabricated scaffolds with the desired morphology. Smart scaffold compositions span across several distinct classes of SMPs, affording further tunability of properties using numerous approaches. Specifically, these SMPs include those based on physically cross-linked and chemically cross-linked networks and include widely studied shape memory polyurethanes (SMPUs). Various additives, ranging from nanoparticles to biologicals, have also been included to impart unique functionality to smart scaffolds. Thus, given their unique functionality and breadth of tunable properties, smart scaffolds have tremendous potential in tissue engineering.
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Affiliation(s)
- Michaela R Pfau
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA.
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA. and Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843, USA and Department of Chemistry, Texas A&M University, College Station, TX 77843, USA
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Kim JH, Kim YS, Park I, Lee HJ, Han SY, Jung S, Shin SJ. A Comparison of Open-Construct PEEK Suture Anchor and Non-Vented Biocomposite Suture Anchor in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial. Arthroscopy 2020; 36:389-396. [PMID: 31864818 DOI: 10.1016/j.arthro.2019.08.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare radiologic bone ingrowth and the clinical outcomes of an open-construct (PEEK) (polyether ether ketone) suture anchor with those of a non-vented biocomposite suture anchor in patients with arthroscopic rotator cuff repair. METHODS Sixty-nine patients were randomly allocated into 2 groups based on type of suture anchors used for rotator cuff repair; group 1: open-construct PEEK anchor (36 patients), group 2: non-vented biocomposite anchor (33 patients). The status of bone ingrowth into the anchor and the presence of cyst formation were evaluated at 6 months postoperatively by computed tomography scan using the Modified Barber's ossification scale. The American Shoulder and Elbow Surgeons score, Constant score, and visual analog scale score for pain and range of motion were evaluated. Magnetic resonance imaging or ultrasonography was performed at 12 months postoperatively to examine the integrity of the repaired rotator cuff tendon. RESULTS Significant improvements in shoulder function and pain relief were observed regardless of the anchor used (both Group 1 and 2; P < .001). No differences were found in functional scores and range of motion between the 2 groups. Group 1 showed better bone ingrowth grades than group 2 (poor 2.8 vs 24.2%, fair 27.8 vs 39.4%, good 38.9 vs 33.3%, and excellent 30.6 vs 3.0%; P < .001). The rate of cyst formation around the anchor on the 6 months' postoperative computed tomography (group 1: 14% and group 2: 12%) and re-tear rate at 12 months (5% each) showed no difference between the 2 groups. CONCLUSIONS Shoulder function was improved after complete rotator cuff repair and similar clinical outcomes were achieved regardless of suture anchor material and shape. However, the open-construct PEEK anchor provided better bone ingrowth into the anchor than the non-vented biocomposite anchor at 6 months after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Level I; Prospective Randomized Trial.
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Affiliation(s)
- Jong-Ho Kim
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - In Park
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul, Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sang-Yup Han
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sehoon Jung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul, Korea.
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Lenz M, Gueorguiev B, Garces JBG, Swords MP, Rammelt S, Hofmann GO, Zderic I, Ernst M, Richards RG, Sands AK. Axial and shear pullout forces of composite, porcine and human metatarsal and cuboid bones. J Orthop Translat 2018; 14:67-73. [PMID: 30094182 PMCID: PMC6071584 DOI: 10.1016/j.jot.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/06/2018] [Accepted: 06/04/2018] [Indexed: 11/08/2022] Open
Abstract
Objectives The varying mechanical properties of human bone have influence on the study results. Pullout and shear forces of human bone were compared to different substitutes to evaluate their suitability for biomechanical studies. Methods After bone mineral density (BMD) determination, axial pullout tests were performed with cortical 3.5 mm nonlocking (NL) and 2.7 mm head locking (HL) screws on human, porcine and polyurethane composite bones. Porcine and human constructs were additionally loaded in shear direction. Results Apparent BMD was significantly lower in osteoporotic (159 mgHA/ccm ± 56) and nonosteoporotic (229 mgHA/ccm ± 25) human bone than that in porcine bone (325 mgHA/ccm ± 42; p < 0.01). Axial construct stiffness and ultimate pullout force of porcine bone (NL: 666N/mm ± 226, 910N ± 140; HL: 309N/mm ± 88, 744N ± 185) was significantly different from composite bone (NL: 1284N/mm ± 161; 1175N ± 116; HL: 1241N/mm ± 172, 1185N ± 225) and osteoporotic human bone (NL: 204N/mm ± 121, 185N ± 113; HL: 201N/mm ± 65; 189N ± 58) but not from nonosteoporotic human bone (NL: 620N/mm ± 205, 852N ± 281; HL: 399N/mm ± 224; 567N ± 242). Porcine bone exhibited an ultimate shear force (NL: 278N ± 99; HL: 431N ± 155) comparable to nonosteoporotic human bone (NL: 207 ± 68: HL: 374N ± 137). Conclusion Screw pullout and shear forces of porcine bone are close to nonosteoporotic human bone. The translational potential of this article Human bone specimens used in biomechanical studies are predominantly of osteoporotic bone quality. Conclusions on nonosteoporotic human bone behaviour are difficult. Alternatives such as porcine bone and composite bone were investigated, and it could be shown that screw pullout and screw shear forces of porcine bone are close to nonosteoporotic human bone.
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Affiliation(s)
- Mark Lenz
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos-Platz, Switzerland.,Dept. of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, D-07747 Jena, Germany
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos-Platz, Switzerland
| | | | - Michael P Swords
- Mid-Michigan Orthopaedic Institute, 830 West Lakee Lansing Road Suite 190, East Lansing, MI 48823, USA
| | - Stefan Rammelt
- University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Gunther O Hofmann
- Dept. of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, D-07747 Jena, Germany
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos-Platz, Switzerland
| | - Manuela Ernst
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos-Platz, Switzerland
| | | | - Andrew K Sands
- New York Presbyterian - Lower Manhattan Hospital, 170 William Street, New York, NY 10038, USA
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