Recent advances in the design of titanium alloys for orthopedic applications

Characteristics and biological responses of selective laser melted Ti6Al4V modified by micro-arc oxidation

Background/purpose

Additive manufacturing (AM) technology, such as selective laser melting (SLM), has been used to fabricate medical devices of Ti-6wt.% Al-4wt.%V (Ti6Al4V) alloys in dentistry. Strontium (Sr) has been shown to have the potential to treat osteoporosis. The aim of this study was to investigate the physicochemical and biological properties of strontium-containing coatings on selective laser melted Ti6Al4V (SLM-Ti6Al4V) substrate.

Materials and methods

The disk of Ti6Al4V was prepared by SLM method. The strontium-containing coatings were prepared by micro-arc oxidation (MAO) in aqueous electrolytes. The surface topography, chemical composition, and phase of strontium-containing MAO (SrMAO) coatings were performed by scanning electron microscope (SEM), energy dispersive X-ray spectrometer (EDS), and thin film X-ray diffraction (TF-XRD), respectively. The apatite-forming ability of the MAO coatings was conducted in simulating body fluid (SBF), and the cell proliferation was determined by methylthiazoletetrazolium (MTT) assay.

Results

The microstructure of SLM-Ti6Al4V displays acicular α-phase organization. The TF-XRD results indicated that the phase of SrMAO coating was anatase, rutile, and titanium. The calcium, phosphorus, and strontium were detected in the coatings by EDS. Using the SEM, the surface morphology of SrMAO coatings exhibited a uniform 3D porous structure. The SrMAO coatings could induce a bone-like apatite layer after immersion in SBF, and presented significantly higher cell proliferation than untreated specimens in in-vitro experiments.

Conclusion

All findings in this study indicate that SrMAO coatings formed on SLM-Ti6Al4V surfaces exhibit a benefit on biological responses and thereby are suitable for biomedical applications.

Cleaning Strategies of Synthesized Bioactive Coatings by PEO on Ti-6Al-4V Alloys of Organic Contaminations

The effect of various cleaning methods on coating morphology and their effectiveness in removing organic contaminants has been studied in this research. Bioactive coatings containing titanium oxides and hydroxyapatite (HAP) were obtained through plasma electrolytic oxidation in aqueous electrolytes and molten salts. The cleaning procedure for the coated surface was performed using autoclave (A), ultraviolet light (UV), radio frequency (RF), air plasma (P), and UV-ozone cleaner (O). The samples were characterized using scanning electron microscopy (SEM) with an EDS detector, X-ray photoelectron spectroscopy (XPS), X-ray phase analysis (XRD), and contact angle (CA) measurements. The conducted studies revealed that the samples obtained from molten salt exhibited a finer crystalline structure morphology (275 nm) compared to those obtained from aqueous electrolytes (350 nm). After applying surface cleaning methods, the carbon content decreased from 5.21 at.% to 0.11 at.% (XPS), which directly corresponds to a reduction in organic contaminations and a decrease in the contact angle as follows: A > UV > P > O. This holds true for both coatings obtained in molten salt (25.3° > 19.5° > 10.5° > 7.5°) and coatings obtained in aqueous electrolytes (35.2° > 28.3° > 26.1° > 16.6°). The most effective and moderate cleaning method is ozone treatment.

Corrosion Behavior of Selective Laser Melting (SLM) Manufactured Ti6Al4V Alloy in Saline and BCS Solution

The frequency of surgeries involving the use of metal implants in orthopedic medicine to replace degenerative or fractured joints is increasing, and it is therefore important to optimize the lifespan and quality of these implants. Advances in additive manufacturing (AM), or 3D printing, are creating new opportunities to personalize implants in ways that reduce mechanical stress at the joint implant interface and improve bone ingrowth and implant stability; however, it is not well understood if and to what degree the AM process alters the corrosion behavior of the materials it produces. In this study, six Ti6Al4V prints manufactured via a selective laser melting (SLM) method were examined regarding their corrosion behavior in both saline and bovine calf serum (BCS) solutions. Ecorr and Icorr values were comparable between the CM-Ti6Al4V control and SLM-EDM surfaces; however, SLM surfaces were found to have more narrow passivation behavior evidenced by significant decreases in Epass values relative to CM-Ti6Al4V. We believe this is a consequence of microstructural differences between CM-Ti6Al4V and SLM-Ti6Al4V. Specifically, the SLM-Ti6Al4V demonstrated a dominant α' martensitic microstructure and decreased vanadium-rich β-phase. BCS solution had a detrimental effect on potential parameters, Ecorr and OCP, decreasing these values relative to their saline counterparts. Increased surface roughness of the SLM-printed surface seemed to amplify the effects of the BCS solution. Furthermore, modest decreases in Epass and Ipass were observed in BCS solution, suggesting that the presence of protein may also interfere with passivation behavior. These findings have implications for how SLM-Ti6Al4V implants will perform in vivo and could possibly influence implant longevity and performance.

Elastic-plastic properties of titanium and its alloys modified by fibre laser surface nitriding for orthopaedic implant applications

Laser nitriding is one of the most promising approaches to improve wear resistance of Ti alloy surfaces and may extend the use in orthopaedic implants. In this study, three types of Ti alloys, namely alpha commercially pure Ti ("TiG2"), alpha-beta Ti-6Al-4V ("TiG5"), and beta Ti-35.5Nb-7.3Zr-5.7Ta ("βTi"), were subjected to an open-air laser nitriding treatment. Essential elastic-plastic mechanical properties including elastic modulus, hardness, elastic energy, plasticity index, and hardness-to-elasticity ratio of the laser-treated Ti alloys were characterized using nanoindentation experiment. The results showed that the elastic modulus, hardness and elastic energy values of all Ti samples significantly increased in the nitrided layer compared to respective bare substrates for all three Ti materials. Across different Ti samples, βTi sustained its relatively lower elastic modulus, but presented comparable hardness, elastic energy, plasticity index, as well as hardness-to-elasticity ratio in the nitrided layer compared to the other two Ti alloys. Overall, amongst three medical grade Ti alloys in this study, βTi appeared as the most appealing candidate for joint replacement applications even solely in view of mechanical compatibility when combined with surface laser nitriding. Nevertheless, laser nitriding treatment in this study tended to cause a residual compressive stress on all Ti alloys as displayed by cracks developed in the nitrided layer and analyzed on βTi by X-ray diffraction (XRD) and further nanoindentation tests.

Trends and developments in hip and knee arthroplasty technology

The developments in hip and knee arthroplasty over recent years have aimed to improve outcomes, reduce complications and improve implant survival. This review describes some of the most interesting trends and developments in this important and fast-moving field. Notable developments have included ceramic hip resurfacing, mini hip stems, cementless knee replacement and the wider adoption of the dual mobility articulation for hip arthroplasty. Advances in additive manufacturing and the surface modification of joint replacements offer increasing options for more challenging arthroplasty cases. Robotic assisted surgery is one of the most interesting developments in hip and knee surgery. The recent growth in the use of this technology is providing data that will help determine whether this approach should become the standard of care for hip and knee arthroplasty in the future.

The increased oxygen content in tantalum leads to decreased bioactivity and osteogenic ability of tantalum implants

Tantalum (Ta) implants fabricated by current processing techniques inevitably contain more or less oxygen impurities due to the extremely high melting point and high affinity of oxygen for Ta. Therefore, in this study we investigated whether oxygen impurities cause any effects on the bioactivity of Ta. EDS analysis demonstrated the surface oxygen content difference among different fabricated Ta samples, and the surface water contact angle (WCA) of Ta with high oxygen content (HO-Ta) was significantly higher than that of Ta with medium (MO-Ta) and low (LO-Ta) oxygen content. The in vitro cellular experiments showed that MC3T3-E1 cells on Ta with lower oxygen content exhibited better adhesion, growth, morphological development and in vitro osteogenic ability. Similarly, the in vivo animal experiments indicated the better bone regeneration and ingrowth performances of Ta with lower oxygen content. In addition, the highest ROS production was detected in the HO-Ta group, while the lowest in the LO-Ta group. This study suggests that the oxygen content within Ta, which occurs unavoidably due to technical limitations, negatively affects the bioactivity of Ta in a dose-dependent manner, indicating the need to develop techniques to produce orthopedic all-Ta implants.

Low pressure plasma nitrided CoCrMo alloy utilising HIPIMS discharge for biomedical applications

CoCrMo is a biomedical grade alloy which is widely used in the manufacturing of orthopaedic implants such as hip and knee replacement joints because of it has high hardness, high corrosion resistance, and excellent biocompatibility. However, the release of metal ions due to corrosion and wear of the alloy over time may cause allergic or other adverse reactions in some patients. To date, various surface modification techniques including nitriding, have been used to improve the performance of CoCrMo (F75) alloy. In the current work, a new low-pressure plasma nitriding process is described. Unlike conventional plasma nitriding, the process utilises High Power Impulse Magnetron Sputtering (HIPIMS) discharge, sustained on one Cr target at low power, to further enhance the ionisation of the gas in the vacuum chamber and to avoid coating deposition. The nitriding of CoCrMo alloy has been carried out in a wide range of nitriding voltages (from -500 V to -1100 V) at 400 °C for duration of 4 h. The chemical and phase composition of the nitrided layer has been studied by various advanced surface analyses techniques. The X-ray diffraction data of all the nitrided samples revealed the formation of expanded austenite (γN) phase. Texture analyses revealed that at lower nitriding voltages (-700 V) the predominant crystallographic orientation of the compound layer is (200) whereas at higher voltages (-900 V to -1100 V) the layer develops mixed (111) and (200) texture. For samples nitrided at a lower bias voltage of - 500 V, diffraction peaks for CrN/NbN and Cr₂N were also observed due to the deposition of target materials (Cr and Nb). However, no coating deposition on the substrate surface was observed at higher bias voltages (-700 V and higher) due to sufficient re-sputtering effect. The results obtained from glow discharge optical emission spectroscopy (GDOES) depth profiling showed that the depth of nitriding increased from approximately 0.7 μm at -500 V to 6 μm at -1100 V. In the pin-on-disc tribological test nitrided samples showed low coefficient of friction μ in the range of 0.6-0.7, compared to μ = 0.8 recorded for the untreated substrate. The wear coefficients (Kc) were found to be between 1.79 × 10^-15 m³N^-1m^-1 (-700 V) and 4.62 × 10^-15 m³N^-1m^-1 (-1100 V), which were one order of magnitude lower than the untreated substrate, Kc = 6×10^-14 m³N^-1m^-1. The Knoop microhardness (HK) of nitrided samples significantly increased by a factor of 5 (HK = 2750 at -1100 V) as compared to the untreated substrate, HK = 525, demonstrating the high efficiency of the process. The samples nitrided at -700 V and - 900 V exhibited enhanced corrosion resistance as compared to untreated alloy by avoiding the formation of CrN based compounds which adversely affect the corrosion performance.

Covalent Attachment of P15 Peptide to Ti Alloy Surface Modified with Polymer to Enhance Osseointegration of Implants

Titanium (Ti) and its alloys are used in orthopedic and dental implants due to their excellent physical properties and biocompatibility. Although Ti exhibits superior osteoconductive properties compared to those of polymer-based implants, improved bone-on growth properties are required for enhanced surgical outcomes and improved recovery surgical interventions. Herein, we demonstrate a novel surface modification strategy to enhance the osteoconductivity of Ti surfaces through the grafting-from procedure of a reactive copolymer via surface-initiated atom transfer radical polymerization (SI-ATRP). Then, postpolymerization conjugation of the P15 peptide, an osteoblast binding motif, was successfully carried out. Subsequent in vitro studies revealed that the surface modification promoted osteoblast attachment on the Ti discs at 6 and 24 h. Moreover, mineral matrix deposition by osteoblasts was greater for the surface-modified Ti than for plain Ti and P15 randomly absorbed onto the Ti surface. These results suggest that the strategy for postpolymerization incorporation of P15 onto a Ti surface with a polymer interface may provide improved osseointegration outcomes, leading to enhanced quality of life for patients.

On the Corrosion Behaviour of Low Modulus Titanium Alloys for Medical Implant Applications: A Review

The corrosion behaviour of new generation titanium alloys (β-type with low modulus) for medical implant applications is of paramount importance due to their possible detrimental effects in the human body such as release of toxic metal ions and corrosion products. In spite of remarkable advances in improving the mechanical properties and reducing the elastic modulus, limited studies have been done on the electrochemical corrosion behaviour of various types of low modulus titanium alloys including the effect of different beta-stabilizer alloying elements. This development should aim for a good balance between mechanical properties, design features, metallurgical aspects and, importantly, corrosion resistance. In this article, we review several significant factors that can influence the corrosion resistance of new-generation titanium alloys such as fabrication process, body electrolyte properties, mechanical treatments, alloying composition, surface passive layer, and constituent phases. The essential factors and their critical features are discussed. The impact of various amounts of α and β phases in the microstructure, their interactions, and their dissolution rates on the surface passive layer and bulk corrosion behaviour are reviewed and discussed in detail. In addition, the importance of different corrosion types for various medical implant applications is addressed in order to specify the significance of every corrosion phenomenon in medical implants.

Effect of niobium content on the microstructure and Young's modulus of Ti-xNb-7Zr alloys for medical implants

New generation titanium alloys with low elastic moduli are promising materials for medical implants, particularly load-bearing orthopaedic implants. In this paper, the effect of niobium content on the microstructure and mechanical properties of new Ti alloys including Ti-23Nb-7Zr, Ti-28Nb-7Zr and Ti-33Nb-7Zr (wt%) is studied. Ti-23Nb-7Zr was found to mainly form α΄ and α″- phases, while both the Ti-28Nb-7Zr and Ti-33Nb-7Zr consisted of α″ and β-phases with an increased amount of β-phase in the alloy with 33 wt% of Nb. X-ray diffraction and microstructural analyses showed that the addition of Nb stabilises the β-phase in the solution treated condition with the depleting amount of α΄ and α″- phases. The hardness and Young's modulus values were highest in Ti-23Nb-7Zr which is attributed to the high fraction of α΄- phase in this alloy. The Young's moduli achieved for the three alloys through nanoindentation were 35.9, 29.1 and 29.0 GPa, respectively. The new alloys are encouraging candidates for orthopaedic implants due to their low elastic modulus which can help inhibit stress shielding, although biocompatibility tests (in-vitro and in-vivo) are suggested for future work.

Mechanical testing of antimicrobial biocomposite coating on metallic medical implants as drug delivery system

Post-operative infection often occurs following orthopedic and dental implant placement requiring systemically administered antibiotics. However, this does not provide long-term protection. Over the last few decades, alternative methods involving slow drug delivery systems based on biodegradable poly-lactic acid and antibiotic loaded hydroxyapatite microspheres were developed to prevent post-operative infection. In this study, thermally anodised and untreated Ti6Al4V discs were coated with Poly-Lactic Acid (PLA) containing Gentamicin (Gm) antibiotic-loaded coralline Hydroxyapatite (HAp) are investigated. Following chemical characterization, mechanical properties of the coated samples were measured using nanoindentation and scratch tests to determine the elastic modulus, hardness and bonding adhesion between film and substrate. It was found that PLA biocomposite multilayered films were around 400nm thick and the influence and effect of the substrate were clearly observed during the nanoindentation studies with heavier loads. Scratch tests of PLA coated samples conducted at ~160nm depth showed the minimal difference in the measured friction between Gm and non Gm containing films. It is also observed that the hardness values of PLA film coated anodised samples ranged from 0.45 to 1.9GPa (dependent on the applied loads) against untreated coated samples which ranged from 0.28 to 0.8GPa.

Ultraviolet treatment restores bioactivity of titanium mesh plate degraded by contact with medical gloves

Titanium mesh plate (Ti mesh) used for bone augmentation inadvertently comes into contact with medical gloves during trimming and bending. We tested the hypotheses that glove contact degrades the biological capability of Ti mesh and that ultraviolet treatment (UV) can restore this capability. Three groups of Ti mesh specimens were prepared: as-received (AR), after glove contact (GC), and after glove contact followed by UV treatment. The AR and GC meshes were hydrophobic, but GC mesh was more hydrophobic. AR and GC meshes had significant amounts of surface carbon, and Si content was higher for GC mesh than for AR mesh. UV mesh was hydrophilic, and carbon and silicon content values were significantly lower in this group than in the AR and GC groups. The number, alkaline phosphatase activity, and mineralization ability of attached osteoblasts were significantly lower in the GC group than in the AR group and markedly higher in the UV group than in the AR group. In conclusion, glove contact caused chemical contamination of Ti mesh, which significantly reduced its bioactivity. UV treatment restored bioactivity in contaminated Ti mesh, which outperformed even the baseline Ti mesh.

A hydrogenated black TiO2 coating with excellent effects for photothermal therapy of bone tumor and bone regeneration

The clinical treatment of bone tumors usually brings about residual tumor cells and large bone defects after tumor removal surgery. To solve this problem, it is imperative to develop a novel implant with bi-functions for eliminating the residual tumor cells and repairing bone defects. In this study, hydrogenated black TiO₂ (H-TiO₂) coating with hierarchical micro/nano-topographies is fabricated by induction suspension plasma spraying (ISPS). The fabricated H-TiO₂ coating possessed excellent and controllable photothermal effect in inhibiting the tumor growth under 808 nm NIR laser irradiation in vitro and in vivo. The hierarchical hybrid micro/nano-structured surface and Ti-OH groups improved the adhesion, proliferation, differentiation and osteogenic gene expressions of rat bone mesenchymal stem cells (rBMSCs). These results demonstrate that the H-TiO₂ coating may be a promising implant material for the treatment of bone tumors and bone regeneration.

Engineered titanium implants for localized drug delivery: recent advances and perspectives of Titania nanotubes arrays

INTRODUCTION

Therapeutics delivery to bones to treat skeletal diseases or prevent postsurgical infections is challenging due to complex and solid bone structure that limits blood supply and diffusion of therapeutics administered by systemic routes to reach effective concentration. Titanium (Ti) and their alloys are employed as mainstream implant materials in orthopedics and dentistry; having superior mechanical/biocompatibility properties which could provide an alternative solution to address this problem.

AREAS COVERED

This review presents an overview of recent development of Ti drug-releasing implants, with emphasis on nanoengineered Titania nanotubes (TNTs) structures, for solving key problems to improve implants osseointegration, overcome inflammation and infection together with providing localized drug delivery (LDD) for bone diseases including cancer. Critical analysis of the advantages/disadvantages of developed concepts is discussed, their drug loading/releasing performances and specific applications.

EXPERT OPINION

LDD to bones can address many disorders and postsurgical conditions such as inflammation, implants rejection and infection. To this end, TNTs-Ti implants represent a potential promise for the development of new generation of multifunctional implants with drug release functions. Even this concept is extensively explored recently, there is a strong need for more preclinical studies using animal models to confirm the long-term safety and stability of TNTs-Ti implants for real-life medical applications.

Neuronal PAS domain 2 (Npas2) facilitated osseointegration of titanium implant with rough surface through a neuroskeletal mechanism

Titanium (Ti) biomaterials have been applied to a wide range of implantable medical devices. When placed in bone marrow, Ti-biomaterials integrate to the surrounding bone tissue by mechanisms that are not fully understood. We have previously identified an unexpected upregulation of circadian clock molecule neuronal PAS domain 2 (Npas2) in successfully integrated implant with a rough surface. This study aimed to elucidate the molecular mechanism of osseointegration through determining the role of Npas2. Human bone marrow stromal cells (BMSC) that were cultured on a Ti disc with SLA surface exhibited increased NPAS2 expression compared to BMSC cultured on a machined surface. A mouse model was developed in which miniature Ti implants were surgically placed into femur bone marrow. The implant push-out test and bone-to-implant contact measurements demonstrated the establishment of osseointegration in 3 weeks. By contrast, in Npas2 functional knockout (KO) mice, the implant push-out value measured for SLA surface Ti implant was significantly decreased. Npas2 KO mice demonstrated normal femur bone structure surrounding the Ti implant; however, the recovered implants revealed abnormal remnant mineralized tissue, which lacked dense collagen architecture typically found on recovered implants from wild type mice. To explore the mechanisms leading to the induced Npas2 expression, an unbiased chemical genetics analysis was conducted using mouse BMSC carrying an Npas2-reporter gene for high throughput screening of Library of Pharmacologically Active Compounds. Npas2 modulating compounds were found clustered in regulatory networks of the α2-adrenergic receptor and its downstream cAMP/CREB signaling pathway. Mouse primary BMSC exposed to SLA Ti disc significantly increased the expression of α2-adrenergic receptors, but the expression of β2-adrenergic receptor was unaffected. Our data provides the first evidence that peripheral clock gene component Npas2 plays a role in facilitating the enhanced osseointegration through neuroskeletal regulatory pathways induced by BMSC in contact with rough surface Ti implant.

Adhesion and Scratch Testing of Antibiotic Loaded Poly-Lactic Acid Biocomposite Thin Films on Metallic Implants

Surface modifications have been progressively applied in order to improve the mechanical, biological and chemical properties of metallic dental and orthopedic implants. Therefore, the novel and multifunctional biocomposites coating matrices, which also consist of local and targeted drug delivery systems, are the most recent applications in the medical field. In this study, gentamicin antibiotic containing HAp bioceramics were utilized in a biodegradable poly-lactic acid thin film matrix which was applied to Ti6Al4V metallic implant surfaces. nanoindentation and scratch test methods were applied. It was observed that, bonding between coating and the substrate is strong enough to be used in implant applications. Additionally, it was observed that the hardness and young modulus values of uncoated Ti6Al4V disc which were 4.3 and 125.2 GPa, respectively. However, under the same testing conditions, it was also observed that the H values (0.6-0.8GPa) and the E (50-60 GPa) values of PLA-HAp biocomposite coated samples are slightly higher than the H values (0.4-0.6 GPa) and the E values (40-50GPa) of only PLA coated sample.

Castability and mechanical properties of Ti-15Mo-5Zr-3Al alloy in dental casting

The castability, mechanical properties, and fracture characteristics of Ti-15Mo-5Zr-3Al alloy were compared with those of Ti-6Al-7Nb alloy and pure titanium (CP Ti) for application of this β-type titanium alloy in cast dental prostheses. Cast specimens were prepared with a centrifugal casting machine. A tensile test was performed according to ISO standard 22674. The castability index for Ti-15Mo-5Zr-3Al was lower than those for Ti-6Al-7Nb and CP Ti. The tensile strength of Ti-15Mo-5Zr-3Al was 852 MPa, which was lower than that of Ti-6Al-7Nb and higher than that of CP Ti. The proof strength of Ti-15Mo-5Zr-3Al was 799 MPa, which was comparable to that of Ti-6Al-7Nb and higher than that of CP Ti. The elastic modulus of Ti-15Mo-5Zr-3Al was 81.0 GPa, which was lower than the values for Ti-6Al-7Nb and CP Ti. Elongation of Ti-15Mo-5Zr-3Al was 5.1%, which was comparable to that of Ti-6Al-7Nb and less than that of CP Ti. The shape of the fractured segment was narrower for Ti-15Mo-5Zr-3Al than for Ti-6Al-7Nb and CP Ti. The deformation characteristics of Ti-15Mo-5Zr-3Al may result in decreased stress relative to increased strain during plastic deformation in the stress-strain diagram. In conclusion, Ti-15Mo-5Zr-3Al alloy has a low elastic modulus and exhibits limited ductile plastic deformation in cast dental prostheses.

Engineering of Micro- to Nanostructured 3D-Printed Drug-Releasing Titanium Implants for Enhanced Osseointegration and Localized Delivery of Anticancer Drugs

Primary and secondary bone cancers are major causes of pathological bone fractures which are usually treated through implant fixation and chemotherapy. However, both approaches face many limitations. On one hand, implants may suffer from poor osseointegration, and their rejection results in repeated surgery, patient's suffering, and extensive expenses. On the other hand, there are severe systemic adverse effects of toxic chemotherapeutics which are administrated systemically. In this paper, in order to address these two problems, we present a new type of localized drug-releasing titanium implants with enhanced implants' biointegration and drug release capabilities that could provide a high concentration of anticancer drugs locally to treat bone cancers. The implants are fabricated by 3D printing of Ti alloy followed by an anodization process featuring unique micro- (particles) and nanosurface (tubular arrays) topography. We successfully demonstrate their enhanced bone osseointegration and drug loading capabilities using two types of anticancer drugs, doxorubicin (DOX) and apoptosis-inducing ligand (Apo2L/TRAIL). In vitro study showed strong anticancer efficacy against cancer cells (MDA-MB-231-TXSA), confirming that these drug-releasing implants can be used for localized chemotherapy for treatment of primary and secondary bone cancers together with fracture support.

Fortifying the Bone-Implant Interface Part 1: An In Vitro Evaluation of 3D-Printed and TPS Porous Surfaces

BACKGROUND

An aging society and concomitant rise in the incidence of impaired bone health have led to the need for advanced osteoconductive spinal implant surfaces that promote greater biological fixation (e.g. for interbody fusion cages, sacroiliac joint fusion implants, and artificial disc replacements). Additive manufacturing, i.e. 3D-printing, may improve bone integration by generating biomimetic spinal implant surfaces that mimic bone morphology. Such surfaces may foster an enhanced cellular response compared to traditional implant surfacing processes.

METHODS

This study investigated the response of human osteoblasts to additive manufactured (AM) trabecular-like titanium implant surfaces compared to traditionally machined base material with titanium plasma spray (TPS) coated surfaces, with and without a nanocrystalline hydroxyapatite (HA) coating. For TPS-coated discs, wrought Ti6Al4V ELI was machined and TPS-coating was applied. For AM discs, Ti6Al4V ELI powder was 3D-printed to form a solid base and trabecular-like porous surface. The HA-coating was applied via a precipitation dip-spin method. Surface porosity, pore size, thickness, and hydrophilicity were characterized. Initial cell attachment, proliferation, alkaline phosphatase (ALP) activity, and calcium production of hFOB cells (n=5 per group) were measured.

RESULTS

Cells on AM discs exhibited expedited proliferative activity. While there were no differences in mean ALP expression and calcium production between TPS and AM discs, calcium production on the AM discs trended 48% higher than on TPS discs (p=0.07). Overall, HA-coating did not further enhance results compared to uncoated TPS and AM discs.

CONCLUSIONS

Results demonstrate that additive manufacturing allows for controlled trabecular-like surfaces that promote earlier cell proliferation and trends toward higher calcium production than TPS coating. Results further showed that nanocrystalline HA may not provide an advantage on porous titanium surfaces.

CLINICAL RELEVANCE

Additive manufactured porous titanium surfaces may induce a more osteogenic environment compared to traditional TPS, and thus present as an attractive alternative to TPS-coating for orthopedic spinal implants.

Substrate Stiffness Controls Osteoblastic and Chondrocytic Differentiation of Mesenchymal Stem Cells without Exogenous Stimuli

Stem cell fate has been linked to the mechanical properties of their underlying substrate, affecting mechanoreceptors and ultimately leading to downstream biological response. Studies have used polymers to mimic the stiffness of extracellular matrix as well as of individual tissues and shown mesenchymal stem cells (MSCs) could be directed along specific lineages. In this study, we examined the role of stiffness in MSC differentiation to two closely related cell phenotypes: osteoblast and chondrocyte. We prepared four methyl acrylate/methyl methacrylate (MA/MMA) polymer surfaces with elastic moduli ranging from 0.1 MPa to 310 MPa by altering monomer concentration. MSCs were cultured in media without exogenous growth factors and their biological responses were compared to committed chondrocytes and osteoblasts. Both chondrogenic and osteogenic markers were elevated when MSCs were grown on substrates with stiffness <10 MPa. Like chondrocytes, MSCs on lower stiffness substrates showed elevated expression of ACAN, SOX9, and COL2 and proteoglycan content; COMP was elevated in MSCs but reduced in chondrocytes. Substrate stiffness altered levels of RUNX2 mRNA, alkaline phosphatase specific activity, osteocalcin, and osteoprotegerin in osteoblasts, decreasing levels on the least stiff substrate. Expression of integrin subunits α1, α2, α5, αv, β1, and β3 changed in a stiffness- and cell type-dependent manner. Silencing of integrin subunit beta 1 (ITGB1) in MSCs abolished both osteoblastic and chondrogenic differentiation in response to substrate stiffness. Our results suggest that substrate stiffness is an important mediator of osteoblastic and chondrogenic differentiation, and integrin β1 plays a pivotal role in this process.

Surface Functionalization of Titanium Alloy with miR-29b Nanocapsules To Enhance Bone Regeneration

Titanium and its alloys have been widely used over the past 3 decades as implants for healing bone defects. Nevertheless, the bioinert property of titanium alloy limits its clinical application and surface modification method is frequently performed to improve the biological and chemical properties. Recently, the delivery of microRNA with osteogenesis capability has been recognized as a promising tool to enhance bone regeneration of implants. Here, we developed a biodegradable coating to modify the titanium surface in order to enhance osteogenic bioactivity. The previous developed nanocapsules were used as the building blocks, and then a bioactive titanium coating was designed to entrap the miR-29b nanocapsules. This coating was not only favorable for cell adhesion and growth but also provided sufficient microRNA transfection efficacy and osteoinductive potential, resulting in a significant enhancement of bone regeneration on the surface of bioinert titanium alloy.

Corrosion behavior of Ti-39Nb alloy for dentistry

To increase an orthopedic implant's lifetime, researchers are now concerned on the development of new titanium alloys with suitable mechanical properties (low elastic modulus-high fatigue strength), corrosion resistance and good workability. Corrosion resistance of the newly developed titanium alloys should be comparable with that of pure titanium. The effect of medical preparations containing fluoride ions represents a specific problem related to the use of titanium based materials in dentistry. The aim of this study was to determine the corrosion behavior of β titanium alloy Ti-39Nb in physiological saline solution and in physiological solution containing fluoride ions. Corrosion behavior was studied using standard electrochemical techniques and X-ray photoelectron spectroscopy. It was found that corrosion properties of the studied alloy were comparable with the properties of titanium grade 2. The passive layer was based on the oxides of titanium and niobium in several oxidation states. Alloying with niobium, which was the important part of the alloy passive layer, resulted in no significant changes of corrosion behavior. In the presence of fluoride ions, the corrosion resistance was higher than the resistance of titanium.

Can a nickel-titanium memory-shape device serve as a substitute for the stapler in gastrointestinal anastomosis? A systematic review and meta-analysis

BACKGROUND

Recently, a nickel-titanium (NiTi) memory-shape device has been successfully used in gastrointestinal anastomosis. The aim of this study was to investigate the feasibility and safety of the device.

METHODS

Four databases, reference lists, and the World Health Organization International Clinical Trials Registry Platform were systematically searched for randomized controlled trials assessing the clinical efficacy of a NiTi memory-shape device compared with that of a stapler in gastrointestinal or colorectal anastomosis.

RESULTS

Seven randomized controlled trials regarding the use of compression anastomosis clips (CACs) were enrolled for meta-analysis. The use of CACs was associated with a significant reduction in hospital duration (mean = -0.88 d; 95% confidence interval [CI], -1.38 to -0.38), the time to flatus (mean = -0.36 d; 95% CI, -0.08 to -0.04), and the start of oral intake (mean = -0.45 d; 95% CI, -0.83 to -0.06), as well as a nonsignificant change in postoperative complications and mortality. These clinical outcomes did not significantly change with the use of compression anastomosis rings.

CONCLUSIONS

Colonic anastomosis with a CAC is likely to reduce hospital duration, time to flatus, and the start of oral intake without influencing mortality or postoperative complications and may be a safe and preferable choice in colonic anastomosis. Further well-designed trials should be performed to determine the safety and efficacy of the newly developed compression anastomosis ring in both ileocolic and colorectal anastomosis.

Molecular plasma deposition: biologically inspired nanohydroxyapatite coatings on anodized nanotubular titanium for improving osteoblast density

In order to begin to prepare a novel orthopedic implant that mimics the natural bone environment, the objective of this in vitro study was to synthesize nanocrystalline hydroxyapatite (NHA) and coat it on titanium (Ti) using molecular plasma deposition (MPD). NHA was synthesized through a wet chemical process followed by a hydrothermal treatment. NHA and micron sized hydroxyapatite (MHA) were prepared by processing NHA coatings at 500°C and 900°C, respectively. The coatings were characterized before and after sintering using scanning electron microscopy, atomic force microscopy, and X-ray diffraction. The results revealed that the post-MPD heat treatment of up to 500°C effectively restored the structural and topographical integrity of NHA. In order to determine the in vitro biological responses of the MPD-coated surfaces, the attachment and spreading of osteoblasts (bone-forming cells) on the uncoated, NHA-coated, and MHA-coated anodized Ti were investigated. Most importantly, the NHA-coated substrates supported a larger number of adherent cells than the MHA-coated and uncoated substrates. The morphology of these cells was assessed by scanning electron microscopy and the observed shapes were different for each substrate type. The present results are the first reports using MPD in the framework of hydroxyapatite coatings on Ti to enhance osteoblast responses and encourage further studies on MPD-based hydroxyapatite coatings on Ti for improved orthopedic applications.

Fracture of titanium nitride-coated femoral component after total knee arthroplasty

We report a case of fracture of a titanium nitride-coated femoral component 3 years after primary total knee arthroplasty (TKA). The fracture was at the medial condylar area just posterior to the medial peg of the femoral component. The backside of the broken medial condylar portion of the femoral component was devoid of cement. Debonding of the component is a possible cause of the stress fracture. To our knowledge, this is the first case report of the fracture of the femoral component manufactured from titanium alloy.

LEVEL OF EVIDENCE

IV.

The bone tissue compatibility of a new Ti35Nb2Ta3Zr alloy with a low Young's modulus

Titanium (Ti) alloys of the β-type are highly attractive metallic materials for biomedical applications due to their low elastic modulus, high corrosion resistance and notable biocompatibility. A new β-type Ti35Nb2Ta3Zr alloy with a low Young's modulus of approximately 48 GPa was previously fabricated. In the present study, the biocompatibility of this alloy was evaluated. In an in vitro assay, the Ti35Nb2Ta3Zr alloy did not markedly affect the adhesion of MG63 osteoblast cells, but it increased their proliferation, alkaline phosphatase (ALP) activity, calcium deposition and mRNA expression of osteogenic genes (i.e., ALP, osteocalcin, osteopontin). In an in vivo study, no marked histological differences were observed between the new bone formed on the surface of Ti35Nb2Ta3Zr and that formed on the surface of control Ti6Al4V rods placed in the medullary canal of rabbit femurs. Additionally, no significant differences were observed in the failure load of Ti35Nb2Ta3Zr and Ti6Al4V in pull-out tests. In conclusion, the Ti35Nb2Ta3Zr alloy with a lower elastic modulus closer to that of human bone has significant bone tissue compatibility equal to that of Ti6Al4V, which has been widely used in orthopedic applications.

Effect of reactive oxygen species overproduction on osteogenesis of porous titanium implant in the present of diabetes mellitus

Clinical evidence indicates diabetes as a majorrisk factor for titaniumimplant treatment with high failure rates and poor osteointegration, but the underlying mechanism involved remains elusive.We hypothesize that reactive oxygen species (ROS) overproduction may contribute to the impaired osteogenesis of porous titanium implants (pTi) under diabetic conditions. To test this hypothesis, we culturedprimary rabbit osteoblasts onto pTi and studied the cellular performance when subjected to normal serum (NS), diabetic serum (DS), DS + NAC (a potent ROS inhibitor) and NS + H(2)O(2)(an oxidant).In-vivo performance of pTi was investigated by transplanting them intofemoral condyledefects of diabetic rabbits, which received vehicle or NAC treatment respectively.Results showed that diabetic conditions induced significant cellular apoptosis, depressedosteoblast function evidenced by impairedcell attachment and morphology, decreased cell proliferation anddifferentiation, andcompromised in-vivo osteogenesis ofpTi, while cellular ROSgeneration was increased derived from mitochondrial dysfunction. Scavenging ROS with NAC markedly attenuated cell apoptosis and osteoblast dysfunction, and improved bone ingrowth within pTi. Furthermore, treatment withH(2)O(2) exerted similar adverse effect on cellular behavior as diabetes. This study furthers our knowledge on the potential role of ROS overproduction in the diabetes-induced impaired osteogenesis of titanium implants, and indicates anti-oxidative treatment as a promising strategy to promote the treatment efficacy of pTi in diabetic patients.

Covalent attachment of P15 peptide to titanium surfaces enhances cell attachment, spreading, and osteogenic gene expression

P15, a synthetic 15 amino acid peptide, mimics the cell-binding domain within the alpha-1 chain of human collagen is being tested in clinical trials to determine if it enhances bone formation in spinal fusions. We hypothesize that covalent attachment of P15 to titanium implants may also serve to promote osseointegration. To test this hypothesis, we measured osteoblast and mesenchymal cell adhesion, proliferation, and maturation on P15 tethered to a titanium (Ti-P15) surface. P15 peptide was covalently bonded to titanium alloy surfaces and incubated with osteoblast like cells. Cell toxicity, adhesion, spreading, and differentiation was then evaluated. Real-time quantitative PCR, Western blot analysis, and fluorescent immunohistochemistry was performed to measure osteoblast gene expression and differentiation. There was no evidence of toxicity. Significant increases in early cell attachment, spreading, and proliferation were observed on the Ti-P15 surface. Increased filapodial attachments, α(2) integrin expression, and phosphorylated focal adhesion kinase immunostaining indicated activation of integrin signaling pathways. qRT-PCR analysis indicated there was significant increase in osteogenic differentiation markers in cells grown on Ti-P15 compared to control-Ti. Western blotting confirmed these findings. Surface modification of titanium with P15 significantly increased cell attachment, spreading, osteogenic gene expression, and differentiation. Results of this study suggest that Ti-P15 has the potential to safely enhance bone formation and promote osseointegration of titanium implants.

Hardness and microstructure of Ti-15Mo-5Zr-3Al alloy for dental casting

OBJECTIVE

The hardness and microstructures of Ti-15Mo-5Zr-3Al alloy castings were investigated for application to dental cast prostheses.

MATERIALS AND METHODS

Cast specimens of Ti-15Mo-5Zr-3Al alloy, Ti-6Al-7Nb alloy and CP Ti were prepared using a centrifugal-type casting machine and a magnesia-based investment material. The hardness of the cross-sections of the cast specimens were measured. The microstructure of the castings was observed using an optical microscope and was then analyzed by X-ray diffractometry.

RESULTS AND CONCLUSIONS

The hardness of Ti-15Mo-5Zr-3Al alloy at the inner part of the castings was 361 Hv, while the hardnesses of Ti-6Al-7Nb alloy and CP Ti were 384 and 269 Hv, respectively. The thickness of the surface hardened layer for Ti-15Mo-5Zr-3Al alloy was thinner than those for Ti-6Al-7Nb alloy and CP Ti. The microstructure of the Ti-15Mo-5Zr-3Al alloy casting was confirmed to be β phase.

Response of human bone marrow stromal cells to a novel ultra-fine-grained and dispersion-strengthened titanium-based material

A novel titanium-based material, containing no toxic or expensive alloying elements, was compared to the established biomaterials: commercially pure titanium (c.p.Ti) and Ti6Al4V. This material (Ti/1.3HMDS) featured similar hardness, yield strength and better wear resistance than Ti6Al4V, as well as better electrochemical properties at physiological pH7.4 than c.p.Ti grade 1 of our study. These excellent properties were obtained by utilizing an alternative mechanism to produce a microstructure of very fine titanium silicides and carbides (<100 nm) embedded in an ultra-fine-grained Ti matrix (365 nm). The grain refinement was achieved by high-energy ball milling of Ti powder with 1.3 wt.% of hexamethyldisilane (HMDS). The powder was consolidated by spark plasma sintering at moderate temperatures of 700 degrees C. The microstructure was investigated by optical and scanning electron microscopy (SEM) and correlated to the mechanical properties. Fluorescence microscopy revealed good adhesion of human mesenchymal stem cells on Ti/1.3HMDS comparable to that on c.p.Ti or Ti6Al4V. Biochemical analysis of lactate dehydrogenase and specific alkaline phosphatase activities of osteogenically induced hMSC exhibited equal proliferation and differentiation rates in all three cases. Thus the new material Ti/1.3HMDS represents a promising alternative to the comparatively weak c.p.Ti and toxic elements containing Ti6Al4V.