Mechanical behavior of a titanium alloy scaffold mimicking trabecular structure

Designing and additive manufacturing of talus implant for post-traumatic talus avascular necrosis: a case study

New technologies in additive manufacturing and patient-specific CT-based custom implant designs make it possible for previously unimaginable salvage and limb-sparing operations a practical reality. This study presents the design and fabrication of a lattice-structured implant for talus replacement surgery. Our primary case involved a young adult patient who had sustained severe damage to the talus, resulting in avascular necrosis and subsequent bone collapse. This condition caused persistent and debilitating pain, leading the medical team to consider amputation of the left foot at the ankle level as a last resort. Instead, we proposed a Ti6Al4V-based patient-specific implant with lattice structure specifically designed for pan-talar fusion. Finite element simulation is conducted to estimate its performance. To ensure its mechanical integrity, uniaxial compression experiments were conducted. The implant was produced using selective laser melting technology, which allowed for precise and accurate construction of the unique lattice structure. The patient underwent regular monitoring for a period of 24 months. At 2-years follow-up the patient successfully returned to activities without complication. The patient's functional status was improved, limb shortening was minimized.

Studying trabecular bone samples demonstrates a power law relation between deteriorated structure and mechanical properties - a study combining 3D printing with the finite element method

Introduction

The bone volume fraction (BV/TV) significantly contributes to the mechanical properties of trabecular bone. However, when studies compare normal trabeculae against osteoporotic trabeculae (in terms of BV/TV decrease), only an "average" mechanical result has been determined because of the limitation that no two trabecular structures are the same and that each unique trabecular structure can be mechanically tested only once. The mathematic relation between individual structural deterioration and mechanical properties during aging or the osteoporosis process has yet to be further clarified. Three-dimensional (3D) printing and micro-CT-based finite element method (μFEM) can assist in overcoming this issue.

Methods

In this study, we 3D printed structural-identical but BV/TV value-attenuated trabecular bones (scaled up ×20) from the distal femur of healthy and ovariectomized rats and performed compression mechanical tests. Corresponding μFEM models were also established for simulations. The tissue modulus and strength of 3D printed trabecular bones as well as the effective tissue modulus (denoted as Ez) derived from μFEM models were finally corrected by the side-artifact correction factor.

Results

The results showed that the tissue modulus _corrected, strength _corrected and Ez _corrected exhibited a significant power law function of BV/TV in structural-identical but BV/TV value-attenuated trabecular samples.

Discussion

Using 3D printed bones, this study confirms the long-known relationship measured in trabecular tissue with varying volume fractions. In the future, 3D printing may help us attain better bone strength evaluations and even personal fracture risk assessments for patients who suffer from osteoporosis.

Definition, measurement, and function of pore structure dimensions of bioengineered porous bone tissue materials based on additive manufacturing: A review

Bioengineered porous bone tissue materials based on additive manufacturing technology have gradually become a research hotspot in bone tissue-related bioengineering. Research on structural design, preparation and processing processes, and performance optimization has been carried out for this material, and further industrial translation and clinical applications have been implemented. However, based on previous studies, there is controversy in the academic community about characterizing the pore structure dimensions of porous materials, with problems in the definition logic and measurement method for specific parameters. In addition, there are significant differences in the specific morphological and functional concepts for the pore structure due to differences in defining the dimensional characterization parameters of the pore structure, leading to some conflicts in perceptions and discussions among researchers. To further clarify the definitions, measurements, and dimensional parameters of porous structures in bioengineered bone materials, this literature review analyzes different dimensional characterization parameters of pore structures of porous materials to provide a theoretical basis for unified definitions and the standardized use of parameters.

Improve biomechanical stability using intramedullary nails with femoral neck protection in femoral shaft fractures

BACKGROUND AND OBJECTIVE

Elderly patients treated for femoral shaft fractures have a higher risk of hip fracture. We hypothesized that intramedullary nails protecting the femoral neck can improve mechanical strength and reduce the risk of subsequent hip fracture. This study aims to analyze the biomechanical stability using intramedullary nails with or without femoral neck protection through finite element analysis.

METHODS

Thirty finite element models (FEMs) were established, including five different conditions of femoral shaft fracture: Fracture healing, Proximal fractures (Transverse and oblique), Distal fractures (Transverse and oblique), and five different fixation methods. Femoral neck protection groups: cephalomedullary nail (CN), reconstruction nail (RN); No femoral neck protection groups: type-1 of antegrade intramedullary nail (AIN-1), type-2 of antegrade intramedullary nail (AIN-2), and retrograde intramedullary nail (RIN). The maximum stress of bone and internal fixation in the femoral neck region for all type of fixation were calculated to evaluate the biomechanical stability.

RESULTS

Maximum equivalent stress values of bone in the femoral neck region for five different conditions of femoral shaft fracture: AIN-2 (77.23 MPa) >RIN (77.15 MPa) > AIN-1 (76.71 MPa) > CN (60.74 MPa) > RN (57.66 MPa) for the fracture healing; RIN (80.05 MPa) > AIN-1 (79.15 MPa) > AIN-2(78.77 MPa) > RN (65.16 MPa) > CN (65.03 MPa) for the proximal transverse fracture; RIN (80.10 MPa) > AIN-2 (79.36 MPa) > AIN-1 (79.18 MPa) > RN (65.09 MPa) > CN (64.96 MPa) for the proximal oblique fracture; RIN (80.24 MPa) > AIN-2 (79.68 MPa) > AIN-1 (79.33 MPa) > CN (65.02 MPa) > RN (64.76 MPa) for the distal transverse fracture; RIN (80.23 MPa) > AIN-2 (79.61 MPa) > AIN-1 (79.35 MPa) > CN (65.06 MPa) > RN (64.76 MPa) for the distal oblique fracture. Maximum equivalent stress of internal fixation in the femoral neck region is greater than the maximum stress of bone and avoids stress concentration of bone for the femoral neck protection groups (CN and RN).

CONCLUSIONS

Intramedullary nails with femoral neck protection in the treatment of femoral shaft fractures improve mechanical strength and prevent secondary hip fractures and decrease the overall risk of reoperation postoperatively.

Recent updates on the biological basis of heterogeneity in bone marrow stromal cells/skeletal stem cells

Based on studies over the last several decades, the self-renewing skeletal lineages derived from bone marrow stroma could be an ideal source for skeletal tissue engineering. However, the markers for osteogenic precursors; i.e., bone marrowderived skeletal stem cells (SSCs), in association with other cells of the marrow stroma (bone marrow stromal cells, BMSCs) and their heterogeneous nature both in vivo and in vitro remain to be clarified. This review aims to highlight: i) the importance of distinguishing BMSCs/SSCs from other "mesenchymal stem/stromal cells", and ii) factors that are responsible for their heterogeneity, and how these factors impact on the differentiation potential of SSCs towards bone. The prospective role of SSC enrichment, their expansion and its impact on SSC phenotype is explored. Emphasis has also been given to emerging single cell RNA sequencing approaches in scrutinizing the unique population of SSCs within the BMSC population, along with their committed progeny. Understanding the factors involved in heterogeneity may help researchers to improvise their strategies to isolate, characterize and adopt best culture practices and source identification to develop standard operating protocols for developing reproducible stem cells grafts. However, more scientific understanding of the molecular basis of heterogeneity is warranted that may be obtained from the robust high-throughput functional transcriptomics of single cells or clonal populations.

3D Printed Multifunctional Ti6Al4V-Based Hybrid Scaffold for the Management of Osteosarcoma

Osteosarcoma is a challenging bone disease which is commonly associated with critically sized bone defects and cancer recurrence. Here, we designed and developed a multifunctional, hierarchical structured bone scaffold which can meet the demanding requirements for osteosarcoma management. The 3D printed Ti6Al4V scaffold with hydrothermally induced TiO2/TiP coating can offer a unique photothermal conversion property for in vitro bone cancer ablation. The scaffold is also infused with drug-laden gelatin/hydroxyapatite nanocomposite, which provides the ideal porous structure for cell adhesion/bone ingrowth and promotes bone regeneration. The scaffold has been thoroughly characterized by SEM/EDX, TEM, XPS, XRD, TGA, and UV-vis, and its in vitro bone cancer ablation efficiency has been validated using MG-63 cells. The hybrid scaffold showed excellent biocompatibility, and its osteointegration function has been demonstrated using an animal model.

Improved Biocompatibility of TiO2 Nanotubes via Co-Precipitation Loading with Hydroxyapatite and Gentamicin

The antibacterial properties of titanium make it useful for clinical applications. Hydroxyapatite (HA) is widely utilized as a coating on orthopedic implants to improve osteointegration. Titanium oxide nanotubes (TNT) are recognized as a promising solution for local antibiotic therapy in bone implants. It is demonstrated that the utilization of HA-coated titanium can improve the biocompatibility of bone implants. This research aims to examine the antibacterial properties and biocompatibility of the TiO2 nanotubes by loading HA and gentamicin. In vitro testing, the characterization of drug release, cell adhesion and proliferation, bacteria culture, and antibacterial tests were conducted. During the in vivo experiments, Staphylococcus aureus was implanted into the femur of rats. The animals were sacrificed at four weeks followed by microbiological and clinical assessments on the bone, which were conducted by removing the implants followed by agar plating. The in vitro cell incubation demonstrated that the TiO2 nanotubes loaded with hydroxyapatite and gentamicin had better cellular compatibility compared to Cp–Ti. In addition, in vitro elution testing showed that gentamicin was released from the hydroxyapatite/TiO2 nanotubes for as long as 22 days. The release time was much longer than the TNT loaded with gentamicin at only 6 h. All animals in the gentamicin/HA/TNT group were free of infection compared to those in the Cp–Ti, TNT, and HA/gentamicin/TNT groups. There was a considerable reduction in the rates of infection among the rats with gentamicin-HA-TNT coatings compared to standard titanium. These results indicated that the co-precipitation of gentamicin and HA loading using the TNT method provided a novel prophylactic method against prosthetic infections and other biomedical applications.

Preliminary Clinical and Radiographic Evaluation of a Novel Resorbable Implant of Polylactic Acid (PLA) for Tibial Tuberosity Advancement (TTA) by Modified Maquet Technique (MMT)

Our objectives were to determine whether PLA implants can be used in TTA with successful results; secondly, to observe whether they provide a faster bone healing; finally, to determine whether weight or age influences bone healing scores. PLA cages were created with a 3D printer. TTA by MMT with PLA implants was performed in 24 patients. Follow-ups were carried out pre-surgical, at 1, 2, and 5 months and consisted of a radiographic study and a lameness assessment. A comparison was performed in terms of weight and age. Patients data, time between follow-up examinations, healing score, and lameness score were compared between patients using commercial software for statistically significant differences p < 0.05. Eighteen dogs finished the study. The ossification degrees presented statistically significant differences between each other. PLA implants maintained the advancement in 100% of cases. Comparing weight and age did not present any statistically significant differences between groups. Lameness presented statistically significant differences between follow-up examinations. Complications were observed in 20.8%. PLA implants for TTA provide good functional results, presenting an acceptable rate of complications. They provide a faster bone healing of the osteotomy gap, which was not affected by age or body weight, and have a clinical recovery time similar to metallic implants.

An alternative ex vivo method to evaluate the osseointegration of Ti-6Al-4V alloy also combined with collagen

Due to the increasing number of orthopedic implantation surgery and advancements in biomaterial manufacturing, chemistry and topography, there is an increasing need of reliable and rapid methods for the preclinical investigation of osseointegration and bone ingrowth. Implant surface composition and topography increase osteogenicity, osteoinductivity, osteoconductivity and osseointegration of a prosthesis. Among the biomaterials used to manufacture an orthopedic prosthesis, titanium alloy (Ti-6Al-4V) is the most used. Type I collagen (COLL I) induces cell function, adhesion, differentiation and bone extracellular matrix component secretion and it is reported to improve osseointegration if immobilized on the alloy surface. The aim of the present study was to evaluate the feasibility of an alternative ex vivo model, developed by culturing rabbit cortical bone segments with Ti-6Al-4V alloy cylinders (Ti-POR), fabricated through the process of electron beam melting (EBM), to evaluate osseointegration. In addition, a comparison was made with Ti-POR coated with COLL I (Ti-POR-COLL) to evaluate osseointegration in terms of bone-to-implant contact (BIC) and new bone formation (nBAr/TAr) at 30, 60 and 90 d of culture. After 30 and 60 d of culture, BIC and nBAr/TAr resulted significantly higher in Ti-POR-COLL implants than in Ti-POR. No differences have been found at 90 d of culture. With the developed model it was possible to distinguish the biomaterial properties and behavior. This study defined and confirmed for the first time the validity of the alternative ex vivo method to evaluate osseointegration and that COLL I improves osseointegration and bone growth of Ti-6Al-4V fabricated through EBM.

Evaluation of biocompatibility and osseointegration of Nb-xTi-Zr alloys for use as dental implant materials

The aim of this study was to evaluate the biocompatibility and osteogenic potential of 50%Nb-xTi-Zr (NTZ, x=20%, 30%, 40% by weight) alloys as compared with dental commercial pure titanium (cpTi). Cell cytotoxity assay, fluorescence microscopy and electron microscopy were used to measure the in vitro biocompatibility of NTZ. The expression of alkaline phosphatase (ALP), integrin β1, osteocalcin (OC), Ki67 and collagen-I (Col-I) at the mRNA level was measured by real-time reverse transcription-polymerase chain reaction (RT-PCR). Osseointegration ability was determined using X-ray evaluation and histological analysis in vivo. Compared with the MG63 cells grown on cpTi on day 3, the viability, adherence and proliferation rates of cells cultured on NTZ alloys were significantly improved (p < 0.05). Furthermore, similar expression levels of Ki67, Col-Ⅰ, OC and ALP were found in the MG63 cells grown on NTZ alloys and those grown on cpTi. The Cbf α1 level was significantly higher for the 50%Nb-30%Ti-Zr (NTZ3) than for the cpTi group on day 6 (p < 0.01), indicating that NTZ alloys can induce osteogenesis. A considerable amount of new bone formation and osseointegration was observed around NTZ3 implants compared with cpTi implants in vivo. Collectively, NTZ3 showed superior biocompatibility and osteogenic activity; therefore, NTZ3 may be an excellent replacement for dental Ti implants.

3D Printing Technologies in Metallic Implants: A Thematic Review on the Techniques and Procedures

Additive manufacturing (AM) is among the most attractive methods to produce implants, the processes are very swift and it can be precisely controlled to meet patient's requirement since they can be produced in exact shape, dimension, and even texture of different living tissues. Until now, lots of methods have emerged and used in this field with diverse characteristics. This review aims to comprehensively discuss 3D printing (3DP) technologies to manufacture metallic implants, especially on techniques and procedures. Various technologies based on their main properties are categorized, the effecting parameters are introduced, and the history of AM technology is briefly analyzed. Subsequently, the utilization of these AM-manufactured components in medicine along with their effectual variables is discussed, and special attention is paid on to the production of porous scaffolds, taking pore size, density, etc., into consideration. Finally, 3DP of the popular metallic systems in medical applications such as titanium, Ti6Al4V, cobalt-chromium alloys, and shape memory alloys are studied. In general, AM manufactured implants need to comply with important requirements such as biocompatibility, suitable mechanical properties (strength and elastic modulus), surface conditions, custom-built designs, fast production, etc. This review aims to introduce the AM technologies in implant applications and find new ways to design more sophisticated methods and compatible implants that mimic the desired tissue functions.

Challenges on optimization of 3D-printed bone scaffolds

Advances in biomaterials and the need for patient-specific bone scaffolds require modern manufacturing approaches in addition to a design strategy. Hybrid materials such as those with functionally graded properties are highly needed in tissue replacement and repair. However, their constituents, proportions, sizes, configurations and their connection to each other are a challenge to manufacturing. On the other hand, various bone defect sizes and sites require a cost-effective readily adaptive manufacturing technique to provide components (scaffolds) matching with the anatomical shape of the bone defect. Additive manufacturing or three-dimensional (3D) printing is capable of fabricating functional physical components with or without porosity by depositing the materials layer-by-layer using 3D computer models. Therefore, it facilitates the production of advanced bone scaffolds with the feasibility of making changes to the model. This review paper first discusses the development of a computer-aided-design (CAD) approach for the manufacture of bone scaffolds, from the anatomical data acquisition to the final model. It also provides information on the optimization of scaffold's internal architecture, advanced materials, and process parameters to achieve the best biomimetic performance. Furthermore, the review paper describes the advantages and limitations of 3D printing technologies applied to the production of bone tissue scaffolds.

New Zr-Ti-Nb Alloy for Medical Application: Development, Chemical and Mechanical Properties, and Biocompatibility

The concept of mechanical biocompatibilities is considered an important factor for orthopedics and dental implants. The high Young modulus of traditional Ti-based alloys can lead to stress-shielding syndrome and late postoperative complications. The development of new Al- and V-free Ti alloys with a low elastic modulus is a critical task for implantology. Despite the relatively low Young modulus and appropriate biological response of metastable beta-Ti alloys, their production requires complex metallurgical solutions and a high final cost that limit commercial application. The current research aimed to develop a Zr-Ti-Nb system with a low Young modulus suitable for biomedical application, including orthopedics and dental implantology. Two different charges were used for new alloy production with melting in a vacuum-arc furnace VDP-1 under atmospheric control (argon + helium) with a non-consumable tungsten electrode and a water-cooled copper crystallizer. Post-treatment included a forging-rolling process to produce a bar suitable for implant production. SEM with EDX and the mechanical parameters of the new alloy were evaluated, and a cell culture experiment provided a biocompatibility assessment. The chemical composition of the new alloy can be represented as 59.57-19.02-21.41 mass% of Zr-Ti-Nb. The mechanical properties are characterized by an extremely low Young modulus—27,27 GPa for the alloy and 34.85 GPa for the bar. The different master alloys used for Zr-Ti-Nb production did not affect the chemical compound and mechanical parameters so it was possible to use affordable raw materials to decrease the final price of the new product. The cell culture experiment demonstrated a full biocompatibility, indicating that this new alloy can be used for dental and orthopedics implant production.