Design, Modeling, Additive Manufacturing, and Polishing of Stiffness-Modulated Porous Nitinol Bone Fixation Plates Followed by Thermomechanical and Composition Analysis

The role of stiffness-matching in avoiding stress shielding-induced bone loss and stress concentration-induced skeletal reconstruction device failure

It is well documented that overly stiff skeletal replacement and fixation devices may fail and require revision surgery. Recent attempts to better support healing and sustain healed bone have looked at stiffness-matching of these devices to the desired role of limiting the stress on fractured or engrafted bone to compressive loads and, after the reconstructed bone has healed, to ensure that reconstructive medical devices (implants) interrupt the normal loading pattern as little as possible. The mechanical performance of these devices can be optimized by adjusting their location, integration/fastening, material(s), geometry (external and internal), and surface properties. This review highlights recent research that focuses on the optimal design of skeletal reconstruction devices to perform during and after healing as the mechanical regime changes. Previous studies have considered auxetic materials, homogeneous or gradient (i.e., adaptive) porosity, surface modification to enhance device/bone integration, and choosing the device's attachment location to ensure good osseointegration and resilient load transduction. By combining some or all of these factors, device designers work hard to avoid problems brought about by unsustainable stress shielding or stress concentrations as a means of creating sustainable stress-strain relationships that best repair and sustain a surgically reconstructed skeletal site. STATEMENT OF SIGNIFICANCE: Although standard-of-care skeletal reconstruction devices will usually allow normal healing and improved comfort for the patient during normal activities, there may be significant disadvantages during long-term use. Stress shielding and stress concentration are amongst the most common causes of failure of a metallic device. This review highlights recent developments in devices for skeletal reconstruction that match the stiffness, while not interrupting the normal loading pattern of a healthy bone, and help to combat stress shielding and stress concentration. This review summarises various approaches to achieve stiffness-matching: application of materials with modulus close to that of the bone; adaptation of geometry with pre-defined mechanical properties; and/or surface modification that ensures good integration and proper load transfer to the bone.

Plasma Electrolytic Polishing of Porous Nitinol Structures

In this study, for the first time, the application of plasma electrolytic polishing (PEP) of porous Nitinol structures, mimicking a trabecular bone structure, that were additively manufactured, is reported. The cube-shaped samples were polished in a diagonal position three different times. The effect of PEP was evaluated in terms of the polishing depth, the effect on sample chemical composition and a possible shift of the phase transition temperature using microscopy, the energy dispersive X-ray spectroscopy (EDX), and the differential scanning calorimetry (DSC) techniques, respectively. The obtained results demonstrated that the PEP technique is suitable for polishing porous structures up to a certain depth into the sample inner structure and does not have any influence on the chemical composition and the phase transformation temperatures. However, small changes in the specific enthalpy were observable among the investigated samples. These changes could be attributed to the sample chemical inhomogeneity, measurement error, and/or differences in sample size and shape.

The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions

Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction.

Influence of Structural Porosity and Martensite Evolution on Mechanical Characteristics of Nitinol via In-Silico Finite Element Approach

Nitinol (NiTi) alloys are gaining extensive attention due to their excellent mechanical, superelasticity, and biocompatibility properties. It is difficult to model the complex mechanical behavior of NiTi alloys due to the solid-state diffusionless phase transformations, and the differing elasticity and plasticity presenting from these two phases. In this work, an Auricchio finite element (FE) model was used to model the mechanical behavior of superelastic NiTi and was validated with experimental data from literature. A Representative Volume Element (RVE) was used to simulate the NiTi microstructure, and a microscale study was performed to understand how the evolution of martensite phase from austenite affects the response of the material upon loading. Laser Powder Bed Fusion (L-PBF) is an effective way to build complex NiTi components. Porosity being one of the major defects in Laser Powder Bed Fusion (L-PBF) processes, the model was used to correlate the macroscale effect of porosity (1.4-83.4%) with structural stiffness, dissipated energy during phase transformations, and damping properties. The results collectively summarize the effectiveness of the Auricchio model and show that this model can aid engineers to plan NiTi processing and operational parameters, for example for heat pump, medical implant, actuator, and shock absorption applications.

Additive Manufacturing: An Opportunity for the Fabrication of Near-Net-Shape NiTi Implants

Nickel–titanium (NiTi) is a shape-memory alloy, a type of material whose name is derived from its ability to recover its original shape upon heating to a certain temperature. NiTi falls under the umbrella of metallic materials, offering high superelasticity, acceptable corrosion resistance, a relatively low elastic modulus, and desirable biocompatibility. There are several challenges regarding the processing and machinability of NiTi, originating from its high ductility and reactivity. Additive manufacturing (AM), commonly known as 3D printing, is a promising candidate for solving problems in the fabrication of near-net-shape NiTi biomaterials with controlled porosity. Powder-bed fusion and directed energy deposition are AM approaches employed to produce synthetic NiTi implants. A short summary of the principles and the pros and cons of these approaches is provided. The influence of the operating parameters, which can change the microstructural features, including the porosity content and orientation of the crystals, on the mechanical properties is addressed. Surface-modification techniques are recommended for suppressing the Ni ion leaching from the surface of AM-fabricated NiTi, which is a technical challenge faced by the long-term in vivo application of NiTi.

Biomechanics of Additively Manufactured Metallic Scaffolds-A Review

This review paper is related to the biomechanics of additively manufactured (AM) metallic scaffolds, in particular titanium alloy Ti6Al4V scaffolds. This is because Ti6Al4V has been identified as an ideal candidate for AM metallic scaffolds. The factors that affect the scaffold technology are the design, the material used to build the scaffold, and the fabrication process. This review paper includes thus a discussion on the design of Ti6A4V scaffolds in relation to how their behavior is affected by their cell shapes and porosities. This is followed by a discussion on the post treatment and mechanical characterization including in-vitro and in-vivo biomechanical studies. A review and discussion are also presented on the ongoing efforts to develop predictive tools to derive the relationships between structure, processing, properties and performance of powder-bed additive manufacturing of metals. This is a challenge when developing process computational models because the problem involves multi-physics and is of multi-scale in nature. Advantages, limitations, and future trends in AM scaffolds are finally discussed. AM is considered at the forefront of Industry 4.0, the fourth industrial revolution. The market of scaffold technology will continue to boom because of the high demand for human tissue repair.

Plasma Electrolytic Polishing of Nitinol: Investigation of Functional Properties

A novel, environmentally friendly, fast, and flexible polishing process for Nitinol parts is presented in this study. Nitinol samples with both superelastic and shape memory properties at room temperature were investigated. The chemical contamination and surface roughness of superelastic Nitinol plates were examined before and after plasma electrolytic polishing. The shift in phase transformation temperature and tensile strength before and after the polishing process were analysed using Nitinol wire with shape memory properties. The obtained experimental results were compared to the data obtained on reference samples examined in the as-received condition. It was found that plasma electrolytic polishing, when the right process parameters are applied, is capable of delivering Nitinol parts with extremely high surface quality. Moreover, it was experimentally proven that plasma electrolytic polishing does not have a negative impact on functionality or mechanical properties of polished parts.

Investigation of Post-Processing of Additively Manufactured Nitinol Smart Springs with Plasma-Electrolytic Polishing

Additive manufacturing of Nitinol is a promising field, as it can circumvent the challenges associated with its conventional production processes and unlock unique advantages. However, the accompanying surface features such as powder adhesions, spatters, ballings, or oxide discolorations are undesirable in engineering applications and therefore must be removed. Plasma electrolytic polishing (PeP) might prove to be a suitable finishing process for this purpose, but the effects of post-processing on the mechanical and functional material properties of additively manufactured Nitinol are still largely unresearched. This study seeks to address this issue. The changes on and in the part caused by PeP with processing times between 2 and 20 min are investigated using Nitinol compression springs manufactured by Laser Beam Melting. As a benchmark for the scanning electron microscope images, the differential scanning calorimetry (DSC) measurements, and the mechanical load test cycles, conventionally fabricated Nitinol springs of identical geometry with a medical grade polished surface are used. After 5 min of PeP, a glossy surface free of powder adhesion is achieved, which is increasingly levelled by further polishing. The shape memory properties of the material are retained without a shift in the transformation temperatures being detectable. The decreasing spring rate is primarily attributable to a reduction in the effective wire diameter. Consequently, PeP has proven to be an applicable and effective post-processing method for additively manufactured Nitinol.

Effect of Build Orientation on the Microstructure, Mechanical and Corrosion Properties of a Biodegradable High Manganese Steel Processed by Laser Powder Bed Fusion

In the last decade, additive manufacturing technologies like laser powder bed fusion (LPBF) have emerged strongly. However, the process characteristics involving layer-wise build-up of the part and the occurring high, directional thermal gradient result in significant changes of the microstructure and the related properties compared to traditionally fabricated materials. This study presents the influence of the build direction (BD) on the microstructure and resulting properties of a novel austenitic Fe-30Mn-1C-0.02S alloy processed via LPBF. The fabricated samples display a {011} texture in BD which was detected by electron backscatter diffraction. Furthermore, isolated binding defects could be observed between the layers. Quasi-static tensile and compression tests displayed that the yield, ultimate tensile as well as the compressive yield strength are significantly higher for samples which were built with their longitudinal axis perpendicular to BD compared to their parallel counterparts. This was predominantly ascribed to the less severe effects of the sharp-edged binding defects loaded perpendicular to BD. Additionally, a change of the Young’s modulus in dependence of BD could be demonstrated, which is explained by the respective texture. Potentiodynamic polarization tests conducted in a simulated body fluid revealed only slight differences of the corrosion properties in dependence of the build design.

Innovative Options for Bone Metastasis Treatment: An Extensive Analysis on Biomaterials-Based Strategies for Orthopedic Surgeons

Bone is the third most frequent site of metastasis, with a particular incidence in breast and prostate cancer patients. For example, almost 70% of breast cancer patients develop several bone metastases in the late stage of the disease. Bone metastases are a challenge for clinicians and a burden for patients because they frequently cause pain and can lead to fractures. Unfortunately, current therapeutic options are in most cases only palliative and, although not curative, surgery remains the gold standard for bone metastasis treatment. Surgical intervention mostly provides the replacement of the affected bone with a bioimplant, which can be made by materials of different origins and designed through several techniques that have evolved throughout the years simultaneously with clinical needs. Several scientists and clinicians have worked to develop biomaterials with potentially successful biological and mechanical features, however, only a few of them have actually reached the scope. In this review, we extensively analyze currently available biomaterials-based strategies focusing on the newest and most innovative ideas while aiming to highlight what should be considered both a reliable choice for orthopedic surgeons and a future definitive and curative option for bone metastasis and cancer patients.

Failure Analysis of Biometals

Metallic biomaterials (biometals) are widely used for the manufacture of medical implants, ranging from load-bearing orthopaedic prostheses to dental and cardiovascular implants, because of their favourable combination of properties including high strength, fracture toughness, biocompatibility, and wear and corrosion resistance [...]

Additively Manufactured NiTi and NiTiHf Alloys: Estimating Service Life in High-Temperature Oxidation

In this study, the effect of the addition of Hf on the oxidation behavior of NiTi alloy, which was processed using additive manufacturing and casting, is studied. Thermogravimetric analyses (TGA) were performed at the temperature of 500, 800, and 900 °C to assess the isothermal and dynamic oxidation behavior of the Ni50.4Ti29.6Hf20 at.% alloys for 75 h in dry air. After oxidation, X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray spectroscopy were used to analyze the oxide scale formed on the surface of the samples during the high-temperature oxidation. Two stages of oxidation were observed for the NiTiHf samples, an increasing oxidation rate during the early stage of oxidation followed by a lower oxidation rate after approximately 10 h. The isothermal oxidation curves were well matched with a logarithmic rate law in the initial stage and then by parabolic rate law for the next stage. The formation of multi-layered oxide was observed for NiTiHf, which consists of Ti oxide, Hf oxide, and NiTiO3. For the binary alloys, results show that by increasing the temperature, the oxidation rate increased significantly and fitted with parabolic rate law. Activation energy of 175.25 kJ/mol for additively manufactured (AM) NiTi and 60.634 kJ/mol for AM NiTiHf was obtained.