Advances and Challenges of Biodegradable Implant Materials with a Focus on Magnesium-Alloys and Bacterial Infections

In vitro calibration and in vivo validation of phenomenological corrosion models for resorbable magnesium-based orthopaedic implants

Metallic bioresorbable orthopaedic implants based on magnesium, iron and zinc-based alloys that provide rigid internal fixation without foreign-body complications associated with permanent implants have great potential as next-generation orthopaedic devices. Magnesium (Mg) based alloys exhibit excellent biocompatibility. However, the mechanical performance of such implants for orthopaedic applications is contingent on limiting the rate of corrosion in vivo throughout the bone healing process. Additionally, the surgical procedure for the implantation of internal bone fixation devices may impart plastic deformation to the device, potentially altering the corrosion rate of the device. The primary objective of this study was to develop a computer-based model for predicting the in vivo corrosion behaviour of implants manufactured from a Mg-1Zn-0.25Ca ternary alloy (ZX10). The proposed corrosion model was calibrated with an extensive range of mechanical and in vitro corrosion testing. Finally, the model was validated by comparing the in vivo corrosion performance of the implants during preliminary animal testing with the corrosion performance predicted by the model. The proposed model accurately predicts the in vitro corrosion rate, while overestimating the in vivo corrosion rate of ZX10 implants. Overall, the model provides a "first-line of design" for the development of new bioresorbable Mg-based orthopaedic devices. STATEMENT OF SIGNIFICANCE: Biodegradable metallic orthopaedic implant devices have emerged as a potential alternative to permanent implants, although successful adoption is contingent on achieving an acceptable degradation profile. A reliable computational method for accurately estimating the rate of biodegradation in vivo would greatly accelerate the development of resorbable orthopaedic implants by highlighting the potential risk of premature implant failure at an early stage of the device development. Phenomenological corrosion modelling approach is a promising computational tool for predicting the biodegradation of implants. However, the validity of the models for predicting the in vivo biodegradation of Mg alloys is yet to be determined. Present study investigates the validity of the phenomenological modelling approach for simulating the biodegradation of resorbable metallic orthopaedic implants by using a porcine model that targets craniofacial applications.

Functionalized magnesium alloys obtained by superplastic forming process retain osteoinductive and antibacterial properties: An in-vitro study

OBJECTIVES

This study aimed to investigate the biocompatibility, osteogenic and antibacterial activity of biomedical devices based on Magnesium (Mg) Alloys manufactured by Superplastic Forming process (SPF) and subjected to Hydrothermal (HT) and Sol-Gel Treatment (Sol-Gel).

METHODS

Mg-SPF devices subjected to Hydrothermal (Mg-SPF+HT) and Sol-Gel Treatment (Mg-SPF+Sol-Gel) were investigated. The biocompatibility of Mg-SPF+Sol-Gel and Mg-SPF+HT devices was observed by indirect and direct cytotoxicity assays, whereas the colonization of sample surfaces was assessed by confocal microscopy. qRT-PCR analysis and microbial growth curve analyses were employed to evaluate the osteogenic and antibacterial activity of both SPF-Mg treated devices, respectively.

RESULTS

Mg-SPF+HT and Mg-SPF+Sol-Gel showed a high degree of biocompatibility. Analysis of mRNA expression of osteogenic genes in cells cultured on Mg-treated devices revealed a significant upregulation of the expression levels of BMP2 and Runx-2. Furthermore, the bacterial growth in strains developed in contact with both the Mg-SPF+HT and Mg-SPF+Sol-Gel devices was lower than that observed in the control.

SIGNIFICANCE

Hydrothermal and Sol-Gel Treatments of Mg alloys obtained through the SPF process demonstrated bioactive, osteogenic and antibacterial activity, offering a promising alternative to conventional Mg-based devices. The obtained Mg-based materials may have the potential to enhance the tunability of temporary devices in maxillary reconstruction, eliminating the need for second surgeries, and ensuring a good bone reconstruction and a reduced implant failure rate due to bacterial infections.

Recent advances in surface-mounted metal-organic framework thin film coatings for biomaterials and medical applications: a review

Coatings of metal-organic frameworks (MOFs) have potential applications in surface modification for medical implants, tissue engineering, and drug delivery systems. Therefore, developing an applicable method for surface-mounted MOF engineering to fabricate protective coating for implant tissue engineering is a crucial issue. Besides, the coating process was desgined for drug infusion and effect opposing chemical and mechanical resistance. In the present review, we discuss the techniques of MOF coatings for medical application in both in vitro and in vivo in various systems such as in situ growth of MOFs, dip coating of MOFs, spin coating of MOFs, Layer-by-layer methods, spray coating of MOFs, gas phase deposition of MOFs, electrochemical deposition of MOFs. The current study investigates the modification in the implant surface to change the properties of the alloy surface by MOF to improve properties such as reduction of the biofilm adhesion, prevention of infection, improvement of drugs and ions rate release, and corrosion resistance. MOF coatings on the surface of alloys can be considered as an opportunity or a restriction. The presence of MOF coatings in the outer layer of alloys would significantly demonstrate the biological, chemical and mechanical effects. Additionally, the impact of MOF properties and specific interactions with the surface of alloys on the anti-microbial resistance, anti-corrosion, and self-healing of MOF coatings are reported. Thus, the importance of multifunctional methods to improve the adhesion of alloy surfaces, microbial and corrosion resistance and prospects are summarized.

Iron-Gold Composites for Biodegradable Implants: In Vitro Investigation on Biodegradation and Biomineralization

The biocompatibility and biodegradation of iron (Fe) make it a suitable candidate for developing biodegradable metallic implants. However, the degradation rate of Fe in a physiological environment is extremely slow and needs to be enhanced to a rate compatible with tissue growth. Incorporating noble metals improves the Fe degradation rate by forming galvanic couples. This study incorporated gold (Au) into Fe at very low concentrations of 1.25 and 2.37 μg/g to improve the degradation rate. The electrochemical corrosion test of the samples revealed that the Au-containing samples showed a four-time and nine-time faster degradation rate than pure Fe. Furthermore, the immersion test and long-term electrochemical impedance spectroscopy conducted in simulated body fluid (SBF) revealed that the Au-incorporated samples exhibited increased bioactivity and degraded faster than pure Fe. Integrating nanogold into a Fe matrix increased the in situ formation of hydroxyapatite on the sample's surface and did not cause toxicity to L929-murine fibroblast cells. It is suggested that Fe-Au composites with low concentrations of Au can be used to tailor the biodegradation rate and promote the biomineralization of Fe-based implants in the physiological environment.

A Simple Replica Method as the Way to Obtain a Morphologically and Mechanically Bone-like Iron-Based Biodegradable Material

Porous iron-based scaffolds were prepared by the simple replica method using polyurethane foam as a template and applying the sintering process in a tube furnace. Their surface morphology was characterized using scanning electron microscopy (SEM) and phase homogeneity was confirmed using X-ray diffraction (XRD). Corrosion behavior was determined using immersion and potentiodynamic polarization methods in phosphate buffered saline (PBS). The surface energy was calculated by studying the changes of enthalpy of calorimetric immersion. A preliminary biological test was also carried out and was done using the albumin adsorption procedure. Results of our work showed that in using the simple replica method it is possible to obtain iron biomaterial with morphology and mechanical properties almost identical to bones, and possessing adequate wettability, which gives the potential to use this material as biomaterial for scaffolds in orthopedics.

Characterisation of Selected Materials in Medical Applications

Tissue engineering is an interdisciplinary field of science that has developed very intensively in recent years. The first part of this review describes materials with medical and dental applications from the following groups: metals, polymers, ceramics, and composites. Both positive and negative sides of their application are presented from the point of view of medical application and mechanical properties. A variety of techniques for the manufacture of biomedical components are presented in this review. The main focus of this work is on additive manufacturing and 3D printing, as these modern techniques have been evaluated to be the best methods for the manufacture of medical and dental devices. The second part presents devices for skull bone reconstruction. The materials from which they are made and the possibilities offered by 3D printing in this field are also described. The last part concerns dental transitional implants (scaffolds) for guided bone regeneration, focusing on polylactide–hydroxyapatite nanocomposite due to its unique properties. This section summarises the current knowledge of scaffolds, focusing on the material, mechanical and biological requirements, the effects of these devices on the human body, and their great potential for applications.

Biodegradable iron-silicon implants produced by additive manufacturing

Due to many negative and undesirable side effects from the use of permanent implants, the development of temporary implants based on biocompatible and biodegradable materials is a promising area of modern medicine. In the presented study, we have investigated complex-shaped iron-silicon (Fe-Si) scaffolds that can be used as potential biodegradable framework structures for creating solid implants for bone grafting. Since iron and silicon are biocompatible materials, and their alloy should also have biocompatibility. It has been demonstrated that cells UC-MSC and 3T3 were attached to, spread, and proliferated on the Fe-Si scaffolds' surface. Most of UC-MSC and 3T3 remained viable, only single dead cells were observed. According to the results of biological testing, the scaffolds have shown that deposition of calcium phosphate particles occurs on day one in the scaffold at the defect site that can be used as a primary marker of osteodifferentiation. These results demonstrate that the 3D-printed porous iron-silicon (Fe-Si) alloy scaffolds are promising structures for bone grafting and regeneration.

Zn-Mg and Zn-Cu alloys for stenting applications: From nanoscale mechanical characterization to in vitro degradation and biocompatibility

In the recent decades, zinc (Zn) and its alloys have been drawing attention as promising candidates for bioresorbable cardiovascular stents due to its degradation rate more suitable than magnesium (Mg) and iron (Fe) alloys. However, its mechanical properties need to be improved in order to meet the criteria for vascular stents. This work investigates the mechanical properties, biodegradability and biocompatibility of Zn-Mg and Zn-Cu alloys in order to determine a proper alloy composition for optimal stent performance. Nanoindentation measurements are performed to characterize the mechanical properties at the nanoscale as a function of the Zn microstructure variations induced by alloying. The biodegradation mechanisms are discussed and correlated to microstructure, mechanical performance and bacterial/cell response. Addition of Mg or Cu alloying elements refined the microstructure of Zn and enhanced yield strength (YS) and ultimate tensile strength (UTS) proportional to the volume fraction of secondary phases. Zn-1Mg showed the higher YS and UTS and better performance in terms of degradation stability in Hanks' solution. Zn-Cu alloys presented an antibacterial effect for S. aureus controlled by diffusion mechanisms and by contact. Biocompatibility was dependent on the degradation rate and the nature of the corrosion products.

In vitro and in vivo degradation assessment and preventive measures of biodegradable Mg alloys for biomedical applications

Magnesium (Mg) and its alloys have been widely explored as a potential biodegradable implant material. However, the fast degradation of Mg-based alloys under physiological environment has hindered their widespread use for implant applications till date. The present review focuses on in vitro and in vivo degradation of biodegradable Mg alloys, and preventive measures for biomedical applications. Initially, the corrosion assessment approaches to predict the degradation behavior of Mg alloys are discussed along with the measures to control rapid corrosion. Furthermore, this review attempts to explore the correlation between in vitro and in vivo corrosion behavior of different Mg alloys. It was found that the corrosion depends on experimental conditions, materials and the results of different assessment procedures hardly matches with each other. It has been demonstrated the corrosion rate of magnesium can be tailored by alloying elements, surface treatments and heat treatments. Various researches also studied different biocompatible coatings such as dicalcium phosphate dihydrate (DCPD), β-tricalcium phosphate (β-TCP), hydroxyapatite (HA), polycaprolactone (PCL), polylactic acid (PLA), and so on, on Mg alloys to suppress rapid degradation and examine their influence on new bone regeneration as well. This review shows the need for a standard method of corrosion assessment to predict the in vivo corrosion rate based on in vitro data, and thus reducing the in vivo experimentation.

In Vivo Imaging of Biodegradable Implants and Related Tissue Biomarkers

Non-invasive longitudinal imaging of osseointegration of bone implants is essential to ensure a comprehensive, physical and biochemical understanding of the processes related to a successful implant integration and its long-term clinical outcome. This study critically reviews the present imaging techniques that may play a role to assess the initial stability, bone quality and quantity, associated tissue remodelling dependent on implanted material, implantation site (surrounding tissues and placement depth), and biomarkers that may be targeted. An updated list of biodegradable implant materials that have been reported in the literature, from metal, polymer and ceramic categories, is provided with reference to the use of specific imaging modalities (computed tomography, positron emission tomography, ultrasound, photoacoustic and magnetic resonance imaging) suitable for longitudinal and non-invasive imaging in humans. The advantages and disadvantages of the single imaging modality are discussed with a special focus on preclinical imaging for biodegradable implant research. Indeed, the investigation of a new implant commonly requires histological examination, which is invasive and does not allow longitudinal studies, thus requiring a large number of animals for preclinical testing. For this reason, an update of the multimodal and multi-parametric imaging capabilities will be here presented with a specific focus on modern biomaterial research.

Zinc and cerium synergistically enhance the mechanical properties, corrosion resistance, and osteogenic activity of magnesium as resorbable biomaterials

Magnesium and its alloys have the potential to serve as a revolutionary class of biodegradable materials, specifically in the field of degradable implants for orthopedics. However, the corrosion rate of commercially pure magnesium is high and does not match the rate of regeneration of bone tissues. In this work, magnesium alloys containing zinc and cerium, either alone or in combination, were investigated and compared with commercially-pure magnesium as biomaterials. The microstructure, mechanical properties, corrosion resistance, and response of osteoblastsin vitrowere systematically assessed. Results reveal that alloying with Ce results in grain refinement and weakening of texture. The tensile test revealed that the ternary alloy offered the best combination of elastic modulus (41.1 ± 0.5 GPa), tensile strength (234.5 ± 4.5 MPa), and elongation to break (17.1 ± 0.4%). The ternary alloy was also the most resistant to corrosion (current of 0.85 ± 0.05 × 10^-4A cm^-2) in simulated body fluid than the other alloys. The response of MC3T3-E1 cellsin vitrorevealed that the ternary alloy imparts minimal cytotoxicity. Interestingly, the ternary alloy was highly efficient in supporting osteogenic differentiation, as revealed by the expression of alkaline phosphatase and calcium deposition. In summary, the extruded Mg alloy containing both Zn and Ce exhibits a combination of mechanical properties, corrosion resistance, and cell response that is highly attractive for engineering biodegradable orthopedic implants.

Effect of sterilization on 3-point dynamic response to in vitro bending of an Mg implant

Background

The aim of the study is to characterize a biomedical magnesium alloy and highlighting the loss of mechanical integrity due to the sterilization method. Ideally, when using these alloys is to delay the onset of degradation so that the implant can support body loads and avoid toxicological effects due to the release of metal ions into the body.

Methods

Standardized procedures according to ASTM F-1264 and ISO-10993-5 were used, respecting detailed methodological controls to ensure accuracy and reproducibility of the results, this testing methodology is carried out in accordance with the monographs of the Pharmacopoeia for the approval of medical devices and obtaining a health registration. An intramedullary implant (IIM) manufactured in magnesium (Mg) WE43 can support loads of the body in the initial period of bone consolidation without compromising the integrity of the fractured area. A system with these characteristics would improve morbidity and health costs by avoiding secondary surgical interventions.

Results

As a property, the fatigue resistance of Mg in aggressive environments such as the body environment undergoes progressive degradation, however, the autoclave sterilization method drastically affects fatigue resistance, as demonstrated in tests carried out under in vitro conditions. Coupled with this phenomenon, the relatively poor biocompatibility of Mg WE43 alloys has limited applications where they can be used due to low acceptance rates from agencies such as the FDA. However, Mg alloy with elements such as yttrium and rare earth elements (REEs) have been shown to delay biodegradation depending on the method of sterilization and the physiological solution used. With different sterilization techniques, it may be possible to keep toxicological effects to a minimum while still ensuring a balance between the integrity of fractured bone and implant degradation time. Therefore, the evaluation of fatigue resistance of WE43 specimens sterilized and tested in immersion conditions (enriched Hank’s solution) and according to ASTM F-1264, along with the morphological, crystallinity, and biocompatibility characterization of the WE43 alloy allows for a comprehensive evaluation of the mechanical and biological properties of WE43.

Conclusions

These results will support decision-making to generate a change in the current perspective of biomaterials utilized in medical devices (MDs), to be considered by manufacturers and health regulatory agencies. An implant manufactured in WE43 alloy can be used as an intramedullary implant, considering keeping elements such as yttrium-REEs below as specified in its designation and with the help of a coating that allows increasing the life of the implant in vivo.

Biodegradation ZK50 magnesium alloy compression screws: Mechanical properties, biodegradable characteristics and implant test

BACKGROUND

Magnesium alloy implants have lower stress load and can be absorbed gradually, but their degradation rates are too fast generally. A magnesium alloy contained 5% Zn and 0.5% Zr (ZK50) which have lower degradation rate are designed to be applied to cannulated bone screw.

METHODS

An oxidation heat treatment of 380 °C for 2 h proceeds to modify the ZK50 Mg alloy (ZK50-H). The microstructure observation, degradation tests and Biocompatibility analysis are proceeded between ZK50 and ZK50-H. Finally, a mini-pig implantation test is proceeded to provide a reference of implant application for future pre-clinical evaluation.

RESULTS

The heat treatment can improve the mechanical properties. A passive ceramic layer formed after simulated body fluid (SBF) solution immersion can restrict the degradation effectively. The cytotoxicity test shows the initial biosafety of ZK50 Mg alloy. A mini-pig implantation test of bone screw has proceeded to confirm the advanced biocompatibility. The ZK50-H screws can maintain enough support at least 8 weeks which the fracture of bone can get curing. The excellent osteoinduction of ZK50-H has a positive effect to growth of new bones and help the mini-pig regain heal faster in 12 weeks.

CONCLUSION

This study shows ZK50-H Mg alloy screw is a feasible degradation implant and can be carried out the next-step clinical experiments.

Properties of Titanium Oxide Coating on MgZn Alloy by Magnetron Sputtering for Stent Application

Constructing surface coatings is an effective way to improve the corrosion resistance and biocompatibility of magnesium alloy bioabsorbable implants. In this present work, a titanium oxide coating with a thickness of about 400 nm was successfully prepared on a MgZn alloy surface via a facile magnetron sputtering route. The surface features were characterized using scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and the contact angle method. The corrosion behavior and biocompatibility were evaluated. The results indicated that the amorphous TiO2 coating with a flat and dense morphology was obtained by magnetron-sputtering a titanium oxide target. The corrosion current density decreased from 1050 (bare MgZn alloy) to 49 μA/cm2 (sample with TiO2 coating), suggesting a significant increase in corrosion resistance. In addition, the TiO2 coating showed good biocompatibilities, including significant reduced hemolysis and platelet adhesion, and increased endothelial cell viability and adhesion.

Graphene Family Nanomaterial Reinforced Magnesium-Based Matrix Composites for Biomedical Application: A Comprehensive Review

Together with the enhancement of the load-bearing implant process for bone substitution and reproduction, an increasing requirement was observed concerning biodegradable magnesium and its alloys with lighter density and outstanding characteristics. Regardless of the current great potential of Mg utilization currently, the broader use of Mg alloys continues to be constrained by several natural causes, such as low resistance of corrosion, inadequate mechanical integrity during the healing process, and poor antibacterial performance. In this perspective, Mg-based composite encapsulated within graphene family nanomaterials (GFNs) such as graphene (Gr), graphene oxide (GO), graphene nanoplatelets (GNPs), and reduced graphene oxide (rGO) as reinforcement agents present great antibacterial activity, as well as cellular response and depicted numerous benefits for biomedical use. Magnesium matrix nanocomposites reinforced with GFNs possess enhanced mechanical properties and high corrosion resistance (low concentration graphene). It is worth noting that numerous elements including the production technique of the Mg-based composite containing GFNs and the size, distribution, and amounts of GFNs in the Mg-based matrix have a crucial role in their properties and applications. Then, the antibacterial mechanisms of GFN-based composite are briefly described. Subsequently, the antibacterial and strengthening mechanisms of GFN-embedded Mg-based composites are briefly described. This review article is designed to wrap up and explore the most pertinent research performed in the direction of Mg-based composites encapsulated within GFNs. Feasible upcoming investigation directions in the field of GFN-embedded Mg-based composites are discussed in detail.

Electrochemical Analysis and In Vitro Assay of Mg-0.5Ca-xY Biodegradable Alloys

In recent years, biodegradable Mg-based materials have been increasingly studied to be used in the medical industry and beyond. A way to improve biodegradability rate in sync with the healing process of the natural human bone is to alloy Mg with other biocompatible elements. The aim of this research was to improve biodegradability rate and biocompatibility of Mg-0.5Ca alloy through addition of Y in 0.5/1.0/1.5/2.0/3.0wt.%. To characterize the chemical composition and microstructure of experimental Mg alloys, scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), light microscopy (LM), and X-ray diffraction (XRD) were used. The linear polarization resistance (LPR) method was used to calculate corrosion rate as a measure of biodegradability rate. The cytocompatibility was evaluated by MTT assay (3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide) and fluorescence microscopy. Depending on chemical composition, the dendritic α-Mg solid solution, as well as lamellar Mg₂Ca and Mg₂₄Y₅ intermetallic compounds were found. The lower biodegradability rates were found for Mg-0.5Ca-2.0Y and Mg-0.5Ca-3.0Y which have correlated with values of cell viability. The addition of 2-3 wt.%Y in the Mg-0.5Ca alloy improved both the biodegradability rate and cytocompatibility behavior.

Characterization of an Extruded Mg-Dy-Nd Alloy during Stress Corrosion with C-Ring Tests

This study focuses on the characterization of the failure behavior of an extruded Mg10Dy1Nd alloy during stress corrosion. The microstructure, hardness, strength and corrosion behavior of binary alloys Mg10Dy and Mg1Nd are compared to those of the ternary alloy system. The ternary alloy Mg-Dy-Nd that is not fully recrystallized has the highest hardness but lacks ductility. The investigated alloys twin during plastic deformation. Static C-ring tests in Ringer solution were used to evaluate the stress corrosion properties, and stress corrosion could not be found. None of the alloys failed by fracturing, but corrosion pits formed to various extents. These corrosion pits were elliptical in shape and located below the surface. Some of the pits reduced the remaining wall thickness significantly, but the stress increased by the notch effect did not lead to crack initiation. Furthermore, the C-ring specimen was subjected to compressive loading until fracture. Whereas the Mg1Nd alloy showed ductile behavior, the alloys containing Dy fractured on the tensile side. The crack initiation and growth were mainly influenced by the twin boundaries. The Mg10Dy1Nd alloy had an inhomogeneous microstructure and low ductility, which resulted in a lower fracture toughness than that of the Mg10Dy alloy. There were features that indicate hydrogen-assisted fracture. Although adding Nd decreased the fracture toughness, it reduced the grain size and had a positive influence on the corrosion rate during immersion testing.

Study of the Morphology and Properties of Biocompatible Ca-P Coatings on Mg Alloy

Magnesium alloys are considered as potential biomaterials for use in orthopedic implantology. The main barrier to the use of Mg alloys in medicine is their overly fast and irregular degradation in body fluids. The use of protective calcium phosphate coatings to increase the corrosion resistance of Mg alloy (AM50 alloy: 4 wt.% Al, 0.3 wt.% Mn, 0.2 wt.% Zn, rest Mg) was examined in this study. The scientific goal of the study was the assessment of the influence of calcium phosphate layer morphology on the corrosion process in Ringer's solution. Modification of the coating morphology was obtained by changing the chemical composition of the phosphatizing bath using NaOH (NaAM50 sample) or ZnSO₄ (ZnAM50 sample). In practice, a more dense and uniform coating could be obtained by the immersion of AM50 alloy in a solution containing ZnSO₄ (ZnAM50 sample). In this study, an adhesion test performed on the ZnAM50 sample indicated that the critical load was 1.35 N. XRD phase analysis confirmed that the obtained coatings included dicalcium phosphate dihydrate (CaHPO₄*2H₂O). The coatings prepared on the NaAM50 and ZnAM50 samples are effective barriers against the progress of corrosion deeper into the substrate. After 120 h immersion in Ringer's solution, the volume of the evolved hydrogen was 5.6 mL/cm² for the NaAM50 and 3.4 mL/cm² for the ZnAM50 sample.

Evidence for inoculum size and gas interfaces as critical factors in bacterial biofilm formation on magnesium implants in an animal model

Infections of medical implants caused by bacterial biofilms are a major clinical problem. Bacterial colonization is predicted to be prevented by alkaline magnesium surfaces. However, in experimental animal studies, magnesium implants prolonged infections. The reason for this peculiarity likely lies within the ‒still largely hypothetical‒ mechanism by which infection arises. Investigating subcutaneous magnesium implants infected with bioluminescent Pseudomonas aeruginosa via in vivo imaging, we found that the rate of implant infections was critically dependent on a surprisingly high quantity of injected bacteria. At high inocula, bacteria were antibiotic-refractory immediately after infection. High cell densities are known to limit nutrient availability, restricting proliferation and trigger quorum sensing which could both contribute to the rapid initial resistance. We propose that gas bubbles such as those formed during magnesium corrosion, can then act as interfaces that support biofilm formation and permit long-term survival. This model could provide an explanation for the apparent ineffectiveness of innovative contact-dependent bactericidal implant surfaces in patients. In addition, the model points toward air bubbles in tissue, either by inclusion during surgery or by spontaneous gas bubble formation later on, could constitute a key risk factor for clinical implant infections.

Development of magnesium implants by application of conjoint-based quality function deployment

Biodegradable magnesium-based implants are the subject of a great deal of research for different orthopedic and vascular applications. The targeted design and properties depend on the specific medical function and location in the body. Development of the biomaterial requires a comprehensive understanding of the biological interaction between the implant and the host tissue, as well as of the behavior in the physiological environment in vivo. Research into and the development of innovative magnesium implants entails interdisciplinary research efforts and communication between materials science, bioscience, and medical experts. The present study provides a transparent planning and communication tool for market-oriented implant development processes. The objective was to identify medical needs at an early stage of the development process and to quantify the importance of the engineering characteristics of different research fields that cater to specific implant requirements. The method is demonstrated by the performance of a survey-based conjoint analysis, which was integrated into a quality function deployment approach. Twenty-seven medical professionals and 29 biomaterial scientists assessed the importance of identified medical requirements, whereby the control of mechanical integrity and degradation along with nontoxicity and nonimmunogenicity showed the highest number of preferences. The evaluation of implant options by 31 experts indicated that the engineering characteristic with the highest importance was the condition and sterilization of the surface. These values can be used to set priorities in strategic decisions. Research trials can be aligned to medical preferences, ensuring high product quality and an effective development process. This is the first paper to report on the application of conjoint-based quality function deployment in biomaterial research.

The Effect of Surface Treatments on the Degradation of Biomedical Mg Alloys-A Review Paper

This report reviews the effects of chemical, physical, and mechanical surface treatments on the degradation behavior of Mg alloys via their influence on the roughness and surface morphology. Many studies have been focused on technically-used AZ alloys and a few investigations regarding the surface treatment of biodegradable and Al-free Mg alloys, especially under physiological conditions. These treatments tailor the surface roughness, homogenize the morphology, and decrease the degradation rate of the alloys. Conversely, there have also been reports which showed that rough surfaces lead to less pitting and good cell adherence. Besides roughness, there are many other parameters which are much more important than roughness when regarding the degradation behavior of an alloy. These studies, which indicate the relationship between surface treatments, roughness and degradation, require further elaboration, particularly for biomedical Mg alloy applications.

Biodegradable Metals

Over the last two decades, significant scientific efforts have been devoted to developingbiodegradable metal implants for orthopedic and cardiovascular applications, mainly due to theirimproved mechanical properties compared to those of biodegradable polymers [...]