Analytical review on the biocompatibility of surface-treated Ti-alloys for joint replacement applications

INTRODUCTION

With the advancement of joint replacements such as total hip replacement (THR), Titanium (Ti) and its alloys are widely used as implant materials. The bearing surface of Ti improves the longevity of implants. In this perception, researchers design a Ti-alloy that increases the wear and corrosion resistance to enhance osteogenesis and mechanical stability.

AREAS COVERED

: This paper is dedicated to finding the major causes of the failure of THR. Further, this paper provides an overview of the application of metallic alloys and their influencing factors that influence biocompatibility. The most contributing part of this paper focuses on the post-treatment impact on Ti-alloys biocompatibility.

EXPERT OPINION

This paper revealed and discussed that Ti alloys' biocompatibility for orthopedic applications mainly depends on antibacterial activities that decide tissue-implant compatibility. Therefore, performing surface treatment enhances the biocompatibility of Ti alloys. It was also observed that more water contact angle (WCA) induces bacterial growth and enhances cell adhesion. In contrast, the treated surface increases the antibacterial activities at lower WCA. Surface heat treatment with sintering or micro-arc oxidation achieves suitable antibacterial or antimicrobial activities.

Biomimetic injectable hydrogel microspheres with enhanced lubrication and controllable drug release for the treatment of osteoarthritis

The occurrence of osteoarthritis (OA) is highly associated with the reduced lubrication property of the joint, where a progressive and irreversible damage of the articular cartilage and consecutive inflammatory response dominate the mechanism. In this study, bioinspired by the super-lubrication property of cartilage and catecholamine chemistry of mussel, we successfully developed injectable hydrogel microspheres with enhanced lubrication and controllable drug release for OA treatment. Particularly, the lubricating microspheres (GelMA@DMA-MPC) were fabricated by dip coating a self-adhesive polymer (DMA-MPC, synthesized by free radical copolymerization) on superficial surface of photo-crosslinked methacrylate gelatin hydrogel microspheres (GelMA, prepared via microfluidic technology), and encapsulated with an anti-inflammatory drug of diclofenac sodium (DS) to achieve the dual-functional performance. The tribological test and drug release test showed the enhanced lubrication and sustained drug release of the GelMA@DMA-MPC microspheres. In addition, the functionalized microspheres were intra-articularly injected into the rat knee joint with an OA model, and the biological tests including qRT-PCR, immunofluorescence staining assay, X-ray radiography and histological staining assay all revealed that the biocompatible microspheres provided significant therapeutic effect against the development of OA. In summary, the injectable hydrogel microspheres developed herein greatly improved lubrication and achieved sustained local drug release, therefore representing a facile and promising technique for the treatment of OA.

Influence of Ceramic Debris on Osteoblast Behaviors: An In Vivo Study

OBJECTIVE

Wear-induced aseptic loosening has been accepted as one of the main reasons for failure of total hip arthroplasty. Ceramic wear debris is generated following prosthesis implantation and plays an important part in the upregulation of inflammatory factors in total hip arthroplasty. The present study investigates the influence of ceramic debris on osteoblasts and inflammatory factors.

METHODS

Ceramic debris was prepared by mechanical grinding of an aluminum femoral head and added to cultures of MC3T3-E subclone 14 cells at different concentrations (i.e. 0, 5, 10, and 15 μg/mL). Cell proliferation was evaluated using a Cell Counting Kit (CCK-8), and cell differentiation was assessed by mRNA expression of alkaline phosphatase (ALP), osteocalcin (OCN), and osteopontin (OPN). In addition, cell bio-mineralization was evaluated through alizarin red S staining, and release of tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) was measured through enzyme-linked immunosorbent assays (ELISA). Furthermore, mRNA expression of Smad1, Smad4, and Smad5 and protein expression of phosphorylated Smad1, Smad4, and Smad5 were measured by reverse transcriptase polymerase chain reaction (RT-PCR) and western blotting.

RESULTS

The ceramic debris had irregular shapes and sizes, and analysis of the size distribution using a particle size analyzer indicated that approximately 90% of the ceramic debris was smaller than 3.2 μm (2.0 ± 0.4 μm), which is considered clinically relevant. The results for mRNA expression of ALP, OCN, and OPN and alizarin red S staining indicated that cell differentiation and bio-mineralization were significantly inhibited by the presence of ceramic debris at all tested concentrations (P < 0.05, and the values decreased gradually with the increase of ceramic debris concentration), but the results of the CCK-8 assay showed that cell proliferation was not significantly affected (P > 0.05; there was no significant difference between the groups at 1, 3, and 5 days). In addition, the results of ELISA, RT-PCR, and western blotting demonstrated that ceramic debris significantly promoted the release of inflammatory factors, including TNF-α, IL-β, and IL-6 (P < 0.05, and the values increased gradually with the increase of ceramic debris concentration), and also greatly reduced the mRNA expression of Smad1, Smad4, and Smad5 (the values decreased gradually with the increase of ceramic debris concentration) as well as protein expression of phosphorylated Smad1, Smad4, and Smad5.

CONCLUSION

Ceramic debris may affect differentiation and bio-mineralization of MC3T3-E subclone 14 cells through the bone morphogenetic protein/Smad signaling pathway.

Bioinspired Surface Functionalization of Titanium for Enhanced Lubrication and Sustained Drug Release

Titanium and its alloys have long been used as implantable biomaterials in orthopedics; however, to the best of our knowledge, few studies were reported to investigate surface functionalization of titanium for enhanced lubrication and sustained drug release. In the present study, titania nanotube arrays (TNTs) were prepared by anodization as effective drug nanocarriers, using titanium as the substrate. Meanwhile, motivated by articular cartilage-inspired superlubricity and mussel-inspired adhesion, a copolymer containing both dopamine methacrylamide and 2-methacryloyloxyethyl phosphorylcholine was synthesized (DMA-MPC) and spontaneously grafted onto the TNT surface, which was validated by characterization techniques such as scanning electron microscopy, water contact angle measurements, and X-ray photoelectron spectroscopy. Additionally, the lubrication test showed that copolymer-grafted TNTs have remarkably reduced friction coefficients compared with bare TNTs. Furthermore, the drug release test demonstrated that copolymer-grafted TNTs inhibited burst drug release and achieved sustained drug release in comparison with bare TNTs. In conclusion, the bioinspired surface functionalization strategy developed here, namely DMA-MPC copolymer-grafted TNTs, can be applied to modify orthopedic biomaterials (such as titanium) for enhanced lubrication and sustained drug release.

Phospholipid-Coated Mesoporous Silica Nanoparticles Acting as Lubricating Drug Nanocarriers

Osteoarthritis (OA) is a severe disease caused by wear and inflammation of joints. In this study, phospholipid-coated mesoporous silica nanoparticles (MSNs@lip) were prepared in order to treat OA at an early stage. The phospholipid layer has excellent lubrication capability in aqueous media due to the hydration lubrication mechanism, while mesoporous silica nanoparticles (MSNs) act as effective drug nanocarriers. The MSNs@lip were characterized by scanning electron microscope, transmission electron microscope, Fourier transform infrared spectrum, X-ray photoelectron spectrum, thermogravimetric analysis and dynamic light scattering techniques to confirm that the phospholipid layer was coated onto the surface of MSNs successfully. A series of tribological tests were performed under different experimental conditions, and the results showed that MSNs@lip with multi-layers of phospholipids greatly reduced the friction coefficient in comparison with MSNs. Additionally, MSNs@lip demonstrated sustained drug release behavior and were biocompatible based on CCK-8 assay using MC3T3-E1 cells. The MSNs@lip developed in the present study, acting as effective lubricating drug nanocarriers, may represent a promising strategy to treat early stage OA by lubrication enhancement and drug delivery therapy.

Effects of Cemented Hip Stem Pre-heating on Stem Push-out Strength

OBJECTIVE

To determine the effect on ultimate push-out load and cement-stem surface shear strength of thermally manipulating the cobalt-chromium-molybdenum (CoCrMo) alloy stems of bone cement-stem constructs.

METHODS

Satin-finished CoCrMo alloy stems were allocated to the following three groups with the predetermined temperatures: T24, ambient (24 °C); T37, body (37 °C); and T44, pre-heated stem (>44 °C). They were then inserted into hand-mixed high viscosity bone cement. Ultimate push-out load to failure was assessed with a servo hydraulic testing machine and the surface shear strength calculated. Data were compared among groups using the Kruskal-Wallis with Dunn's test. A P value of less than 0.05 was considered statistically significant.

RESULTS

According to Kruskal-Wallis analysis, ultimate push-out load and surface shear strength differed significantly between the groups (P = 0.001). The T37 and T44 groups had higher ultimate push-out loads and surface shear strengths than the T24 group (P = 0.04 and 0.001, respectively). However, there was no statistically significant difference in these two variables between the T37 and T44 groups (P = 0.08).

CONCLUSIONS

Pre-heating CoCrMo alloy stems enhance the ultimate push-out load and surface shear strength in vitro. The suggested temperature is 37 °C. This technique is recommended for hip arthroplasty procedures.

Composite poly(l-lactic-acid)/silk fibroin scaffold prepared by electrospinning promotes chondrogenesis for cartilage tissue engineering

Nanofibrous materials produced by electrospinning have attracted considerable attention from researchers in regenerative medicine. A combination of nanofibrous scaffold and chondrocytes is considered promising for repair of cartilage defect or damage. In the present study, we fabricated a poly(l-lactic-acid) (PLLA)/silk fibroin (SF) nanofibrous scaffold by electrospinning and evaluated its chondrogenic potential. The PLLA/SF nanofibers were characterized for diameter, surface wettability, swelling ratio, and tensile strength. Throughin vitroexperiments, PLLA/SF scaffold-chondrocyte interactions were investigated relative to the unmodified PLLA scaffold with regard to cellular adhesion, spreading, and proliferation by scanning electron microscopy and confocal laser scanning microscopy, and through analyses of DNA, sulfated glycosaminoglycan, and collagen. In addition, hematoxylin-eosin and Alcian blue-nuclear fast red staining were used to observe growth of chondrocytes, and secretion and distribution of cartilage-specific extracellular matrices in the scaffolds. Expressions of cartilage-related genes (collagen II, aggrecan, sox9, collagen I, and collagen X) were detected by real-time quantitative PCR. The PLLA/SF scaffold had better hydrophilicity, and could support chondrocytes adhesion and spreading more effectively than the unmodified PLLA scaffold. Chondrocytes secreted more cartilage-specific extracellular matrices and maintained their phenotype on the PLLA/SF scaffold. So it is concluded that the PLLA/SF scaffold is more conducive toin vitroformation of cartilage-like new tissues than the unmodified PLLA scaffold, and may be a promising material in cartilage tissue engineering.

Preparation and evaluation of an Arg-Gly-Asp-modified chitosan/hydroxyapatite scaffold for application in bone tissue engineering

Bone tissue engineering has become a promising method for the repair of bone defects, and the production of a scaffold with high cell affinity and osseointegrative properties is crucial for successful bone substitute. Chitosan (CS)/hydroxyapatite (HA) composite was prepared by in situ compositing combined with lyophilization, and further modified by arginine‑glycine‑aspartic acid (RGD) via physical adsorption. In order to evaluate the cell adhesion rate, viability, morphology, and alkaline phosphatase (ALP) activity, the RGD‑CS/HA scaffold was seeded with bone marrow stromal cells (BMSCs). The osseointegrative properties of the RGD‑CS/HA scaffold were evaluated by in vivo heterotopic ossification and in vivo bone defect repair. After 4 h culture with the RGD‑CS/HA scaffold, the adhesion rate of the BMSCs was 80.7%. After 3 days, BMSCs were fusiform in shape and evenly distributed on the RGD‑CS/HA scaffold. Formation of extracellular matrix and numerous cell‑cell interactions were observed after 48 h of culture, with an ALP content of 0.006 ± 0.0008 U/l/ng. Furthermore, the osseointegrative ability and biomechanical properties of the RGD‑CS/HA scaffold were comparable to that of normal bone tissue. The biocompatibility, cytocompatibility, histocompatibility and osseointegrative properties of the RGD‑CS/HA scaffold support its use in bone tissue engineering applications.

Improved method for planning intramedullary guiding rod entry point in total knee arthroplasty

BACKGROUND

To study the accuracy of using the deepest point of the intercondylar notch (DPIN) as a reference point for femoral intramedullary (IM) guiding rod entrance in total knee arthroplasty (TKA) with 3-D reconstruction in Chinese subjects.

METHODS

A total of 50 normal femurs in 25 Chinese subjects (mean age 25.6 ± 2.9 years; range 18-29 years) were chosen from the lower extremities computed tomography digital imaging and communications in medicine (DICOM) database for this study. The DICOM data were imported into Mimics 10.0 software. A cylinder (radius = 4 mm; length = 20 cm) was used to simulate ideal insertion of a IM guiding rod into the femoral canal. DPIN was taken as a reference point for calculating the relative position of the rod's entry point.

RESULTS

The mean rod entry point position in the coronal plane was 2.94 ± 1.12 mm (range 0.79-4.91 mm) medial and 6.01 ± 2.09 mm (range 2.49-9.51 mm) anterior to the DPIN, with no significant difference between sides. All potential angle errors were below 2°.

CONCLUSION

The results of this study show that the DPIN can serve as a reference for surgeons using an IM guide system in TKA.

The influence of age, gender and treatment with steroids on the incidence of osteonecrosis of the femoral head during the management of severe acute respiratory syndrome: a retrospective study

Corticosteroid use has been implicated in the development of osteonecrosis of the femoral head (ONFH). The exact mechanism and predisposing factors such as age, gender, dosage, type and combination of steroid treatment remain controversial. Between March and July 2003, a total of 539 patients with severe acute respiratory syndrome (SARS) were treated with five different types of steroid. There were 129 men (24%) and 410 women (76%) with a mean age of 33.7 years (21 to 59). Routine screening was undertaken with radiographs, MRI and/or CT to determine the incidence of ONFH. Of the 129 male patients with SARS, 51 (39.5%) were diagnosed as suffering from ONFH, compared with only 79 of 410 female patients (19.3%). The incidence of ONFH in the patients aged between 20 and 49 years was much higher than that of the group aged between 50 and 59 years (25.9% (127 of 491) versus 6.3% (3 of 48); p = 0.018). The incidence of ONFH in patients receiving one type of steroid was 12.5% (21 of 168), which was much lower than patients receiving two different types (28.6%; 96 of 336) or three different types of steroid (37.1%; 13 of 35).

Biotribological properties at the stem-cement interface lubricated with different media

BACKGROUND

Debonding of the stem-cement interface occurs inevitably in-vivo under physiological loading, and pseudo-synovial fluid is subsequently pumped into this interface, serving as the lubricant. However, the influence of protein adsorption onto the femoral stem surface has not been well taken into consideration in previous in vitro studies.

MATERIALS AND METHODS

The biotribological properties at the stem-cement interface were investigated through a series of fretting frictional tests using polished stainless steel 316L stem and smooth bone cement, lubricated by three different media at body temperature, i.e. 100% calf serum, 25% calf serum, and 0.9% saline solution. The surface characterization of the femoral stem was evaluated sequentially using optical microscope, optical interferometer, scanning electron microscope, and Raman spectroscopy.

RESULTS

The friction coefficient generally kept stable during the test, and the minimum value (0.254) was obtained when 100% calf serum was used as the lubricant. Slight scratches were detected within the contact area for the stainless steel 316L stems lubricated by 100% calf serum and 25% calf serum, which was further surrounded by the adsorbed protein film with alveolate feature. Additionally, a wear scar was present within the contact area when 0.9% saline solution was used as the lubricant.

CONCLUSIONS

Protein adsorption onto the stainless steel 316L stem surface affected the biotribological properties at the stem-cement interface under oscillatory fretting mechanism. Generation of wear debris at the stem-cement interface may be postponed by modification of physicochemical properties of the femoral stem to promote protein adsorption.

The influence of bone cement type on production of fretting wear on the femoral stem surface: a preliminary study

BACKGROUND

It has been reported that bone cement correlates with survivorship of cemented total hip replacement. However, little research has been published to investigate the influence of bone cement type on production of fretting wear on the femoral stem.

METHODS

In the present study, we performed six in vitro wear simulations using the same type of femoral stem (polished Exeter V40™) and three different bone cements (Simplex P, Palacos R, and CMW 3).

FINDINGS

Fretting wear was consistently reproduced on the stem surface and the wear locations compared well with the results of retrieval studies. Selected 3D surface parameters were utilised to quantitatively evaluate fretting wear and no significant difference was identified in terms of fretting wear severity between these simulations. The bone cements were all badly damaged in those sites contacting the fretting wear areas on the femoral stem. Additionally, there were plenty of wear debris present on the cement surface, and the energy dispersive X-ray analysis confirmed that it was just cement particles for Simplex P bone cement, whilst it included metallic particles for Palacos R and CMW 3 bone cements.

INTERPRETATION

This preliminary study shed some light on the influence of bone cement type on production of fretting wear on the femoral stem surface but further research is needed to gain a better understanding on this issue.