Failure Analysis of Retrieved Osteosynthesis Implants

Assessment of implant internal stresses under physiological femoral loading: Translation to a simplified bending load model

The success of surgical treatment for fractures hinges on various factors, notably accurate surgical indication. The process of developing and certifying a new osteosynthesis device is a lengthy and costly process that requires multiple cycles of review and validation. Current methods, however, often rely on predecessor standards rather than physiological loads in specific anatomical locations. This study aimed to determine actual loads experienced by an osteosynthesis plate, exemplified by a standard locking plate for the femoral shaft, utilizing finite elements analysis (FEA) and to obtain the bending moments for implant development standard tests. A protocol was developed, involving the creation and validation of a fractured femur model fixed with a locking plate, mechanical testing, and FEA. The model's validation demonstrated exceptional accuracy in predicting deformations, and the FEA revealed peak stresses in the fracture bridging zone. Results of a parametric analysis indicate that larger fracture gaps significantly impact implant mechanical behavior, potentially compromising stability. This study underscores the critical need for realistic physiological conditions in implant evaluations, providing an innovative translational approach to identify internal loads and optimize implant designs. In conclusion, this research contributes to enhancing the understanding of implant performance under physiological conditions, promoting improved designs and evaluations in fracture treatments.

Failure Analysis of Ultra-High Molecular Weight Polyethylene Tibial Insert in Total Knee Arthroplasty

Knee osteoarthritis is treated based on total knee arthroplasty (TKA) interventions. The most frequent failure cause identified in surgical practice is due to wear and oxidation processes of the prothesis' tibial insert. This component is usually manufactured from ultra-high molecular weight polyethylene (UHMWPE). To estimate the clinical complications related to a specific prosthesis design, we investigated four UHMWPE tibial inserts retrieved from patients from Clinical Hospital Colentina, Bucharest, Romania. For the initial analysis of the polyethylene degradation modes, macrophotography was chosen. A light stereomicroscope was used to estimate the structural performance and the implant surface degradation. Scanning electron microscopy confirmed the optical results and fulfilled the computation of the Hood index. The oxidation process in UHMWPE was analyzed based on Fourier-transform infrared spectroscopy (FTIR). The crystallinity degree and the oxidation index were computed in good agreement with the existing standards. Mechanical characterization was conducted based on the small punch test. The elastic modulus, initial peak load, ultimate load, and ultimate displacement were estimated. Based on the aforementioned experimental tests, a variation between 9 and 32 was found in the case of the Hood score. The oxidation index has a value of 1.33 for the reference sample and a maximum of 9.78 for a retrieved sample.

Bone Cements Used for Hip Prosthesis Fixation: The Influence of the Handling Procedures on Functional Properties Observed during In Vitro Study

The failure of hip prostheses is a problem that requires further investigation and analysis. Although total hip replacement is an extremely successful operation, the number of revision surgeries needed after this procedure is expected to continue to increase due to issues with both bone cement types and cementation techniques (depending on the producer). To conduct a comparative analysis, as a surgeon prepared the bone cement and introduced it in the body, this study’s team of researchers prepared three types of commercial bone cements with the samples mixed and placed them in specimens, following the timeline of the surgery. In order to evaluate the factors that influenced the chemical composition and structure of each bone cement sample under specific intraoperative conditions, analyses of the handling properties, mechanical properties, structure, and composition were carried out. The results show that poor handling can impede prosthesis–cement interface efficacy over time. Therefore, it is recommended that manual mixing be avoided as much as possible, as the manual preparation of the cement can sometimes lead to structural unevenness.

Magnesium-Based Alloys Used in Orthopedic Surgery

Magnesium (Mg)-based alloys have become an important category of materials that is attracting more and more attention due to their high potential use as orthopedic temporary implants. These alloys are a viable alternative to nondegradable metals implants in orthopedics. In this paper, a detailed overview covering alloy development and manufacturing techniques is described. Further, important attributes for Mg-based alloys involved in orthopedic implants fabrication, physiological and toxicological effects of each alloying element, mechanical properties, osteogenesis, and angiogenesis of Mg are presented. A section detailing the main biocompatible Mg-based alloys, with examples of mechanical properties, degradation behavior, and cytotoxicity tests related to in vitro experiments, is also provided. Special attention is given to animal testing, and the clinical translation is also reviewed, focusing on the main clinical cases that were conducted under human use approval.

In-Depth Comparative Assessment of Different Metallic Biomaterials in Simulated Body Fluid

Invitro experiments have been conducted on metallic biomaterials used for orthopedic implants in order to determine their behavior when immersed in simulated body fluid (SBF). Thus, 3Ti-based metallic biomaterial samples already available on the marked were purchased and immersed in simulated blood plasma, and kept at 37 °C for 4 months. In-depth characterization consisted of a wide series of structural characterizations of both the samples and SBF. Sample analysis consisted of the following: optical (OM) and scanning electron microscopy (SEM) in order to establish the surface and deep corrosion, mass gain/loss assessment for determining the metallic ions loss and/or protective layer formation, and X-ray diffraction in order to establish if and what kind of layers are formed. SBF analysis consisted of using inductively coupled plasma mass spectroscopy (ICP-MS) in order to establish if and/or how many metallic ions have dissociated from the metallic samples into the SBF, and measurements of pH and electrical conductivity. The key findings of the research are as follows: during the four months while kept in SBF, the samples show surface corrosion degradation and protective layer generation. Also, the amount of metallic ions dissociated into the SBF is making them suitable for use. Taking into account that it is highly improbable for such a large area of metal as the one considered within this work to be exposed to real body fluids and that all the samples have developed protective oxide films, the overall conclusion is that they are appropriate for implant use.

In Vitro Physical-Chemical Behaviour Assessment of 3D-Printed CoCrMo Alloy for Orthopaedic Implants

In this study, a CoCrMo-based metallic alloy was manufactured using a 3D-printing method with metallic powder and a laser-based 3D printer. The obtained material was immersed in a simulated body fluid (SBF) similar to blood plasma and kept 2 months at 37 °C and in relative motion against the SBF in order to mimic the real motion of body fluids against an implant. At determined time intervals (24, 72, 168, 336, and 1344 h), both the metallic sample and SBF were characterized from a physical-chemical point of view in order to assess the alloy’s behaviour in the SBF. Firstly, the CoCrMo based metallic sample was characterized by scanning electron microscopy (SEM) for assessing surface corrosion and X-ray diffraction (XRD) for determining if and/or what kind of spontaneous protective layer was formed on the surface; secondly, the SBF was characterized by pH, electrical conductivity (EC), and inductively coupled plasma mass spectroscopy (ICP-MS) for assessing the metal ion release. We determined that a 3D-printed CoCrMo alloy does not represent a potential biological hazard in terms of the concentration of metal ion releases, since it forms, in a relatively short period of time, a protective CoCr layer on its exposed surface.

Review of calcium-sulphate-based ceramics and synthetic bone substitutes used for antibiotic delivery in PJI and osteomyelitis treatment

Infection in orthopaedic and trauma surgery remains a destructive complication with particularly challenging diagnosis and treatment due to bacterial antibiotic resistance and biofilm formation.

Along with surgical debridement and systemic antibiotics, an important type of adjuvant therapy is local antibiotic delivery, with the purpose of eliminating bacterial colonization and biofilm development.

Calcium sulphate, as a synthetic absorbable biomaterial used for local antibiotic delivery, has experienced an increasing popularity during the last decade, with multiple promoted advantages such as predictable antibiotic elution kinetics, complete and quick biodegradation, good biocompatibility, and limited associated complications.

A series of commercially available antibiotic-delivery systems based on calcium sulphate are under investigation and in clinical use, with different presentations, compositions, and application techniques.

The current article presents the main available calcium-sulphate-based products and the existing data about the clinical and preclinical research results, stemming from their implementation as local antibiotic carriers for surgical site and implant-associated infections treatment and prevention.

Cite this article: EFORT Open Rev 2021;6:297-304. DOI: 10.1302/2058-5241.6.200083

Microstructural Analysis of Fractured Orthopedic Implants

In this paper, fracture behavior of four types of implants with different geometries (pure titanium locking plate, pure titanium femoral implant, Ti-6Al-4V titanium alloy pelvic implant, X2CrNiMo18 14-3 steel femoral implant) was studied in detail. Each implant fractured in the human body. The scanning electron microscopy (SEM) was used to determine the potential cause of implants fracture. It was found that the implants fracture mainly occurred in consequence of mechanical overloads resulting from repetitive, prohibited excessive limb loads or singular, un-intendent, secondary injures. Among many possible loading types, the implants were subjected to an excessive fatigue loads with additional interactions caused by screws that were mounted in their threaded holes. The results of this work enable to conclude that the design of orthopedic implants is not fully sufficient to transduce mechanical loads acting over them due to an increasing weight of treated patients and much higher their physical activity.

The Role of Biomaterials in Upper Digestive Tract Transoral Reconstruction

This study aims to establish whether the use of biomaterials, particularly polydimethylsiloxane (PDMS), for surgical reconstruction of the esophagus with templates, Montgomery salivary tube, after radical oncology surgery for malignant neoplasia is an optimal choice for patients' safety and for optimal function preservation and organ rehabilitation. Structural analysis by Raman spectrometry and biomechanical properties with dynamic mechanical analysis are performed for fatigue strength and toughness, essential factors in durability of a prosthesis in the reconstruction practice of the esophagus. Nanocomposites with silicone elastomers and nanoparticles used in implantable devices and in reconstruction surgery present risks of infection and fatigue strength when required to perform a mechanical effort for long periods of time. This report takes into account the effect of silver (Ag) nanoparticles on the fatigue strength using polydimethylsiloxane (PDMS) matrix, representative for silicon elastomers used in implantable devices. PDMS with 5% (wt) Ag nanoparticles of 100-150 nm during mechanical fatigue testing at shear strength loses elasticity properties after 400 loading-unloading cycles and up to 15% shear strain. The fatigue strength, toughness, maximum shear strength, as well as clinical properties are key issues in designing Montgomery salivary tube and derivates with appropriate biomechanical behavior for each patient. Prosthesis design needs to indulge both clinical outcomes as well as design methods and research in the field of biomaterials.