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Domagalski RS, Dugiełło B, Rokicka S, Czech S, Skowroński R, Rokicka D, Wróbel MP, Strojek K, Stołtny T. Bone graft incorporation failure with inappropriate limb load transfer can lead to aseptic acetabular loosening of metal-on-metal prosthesis: A case report. World J Orthop 2024; 15:668-674. [PMID: 39070935 PMCID: PMC11271694 DOI: 10.5312/wjo.v15.i7.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/11/2024] [Accepted: 05/09/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Aseptic acetabular loosening can result from various factors that can be categorized into groups: patient-related, surgeon-related and implant-related. We present a case of a 63-year-old patient who at first underwent a total hip arthroplasty (THA) using a metal-on-metal bearing due to hip arthrosis. Follow-up visits revealed no complications after the procedure. Two years after the THA, acetabular component loosening occurred due to subsequent trauma of the opposite hip, necessitating a revision THA using a ceramic-on-ceramic bearing. CASE SUMMARY We aim to illustrate a rare case where the primary reason for undergoing THA revision was not only incomplete bone graft incorporation but also improper limb load distribution. Following the revision arthroplasty, a 9-year follow-up visit revealed improvements in all evaluation measures on questionnaire compared to the state before surgery: Harris Hip Score (before surgery: 15; after surgery: 95), Western Ontario and McMaster Universities Arthritis Index (before surgery: 96; after surgery: 0), and Visual Analogue Scale (before surgery: 10; after surgery: 1). CONCLUSION Opposite-hip trauma caused a weight transfer to the limb after a THA procedure. This process led to a stress shielding effect, resulting in acetabular component loosening.
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Affiliation(s)
| | - Bogdan Dugiełło
- District Railway Hospital, Medical University of Silesia, Katowice 40-760, Poland
| | - Sonia Rokicka
- Faculty of Medicine, Medical University of Gdańsk, Gdańsk 80-210, Poland
| | - Szymon Czech
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary Śląskie 41-940, Poland
| | - Rafał Skowroński
- “ALFA” Orthopaedics and Traumatology Center, Białystok 15-763, Poland
| | - Dominika Rokicka
- Department of Internal Medicine, Diabetology and Cardiometabolic Disorders, Faculty of Medical Sciences Zabrze, Medical University of Silesia, Zabrze 41-800, Poland
| | - Marta Patrycja Wróbel
- Department of Internal Medicine, Diabetology and Cardiometabolic Disorders, Faculty of Medical Sciences Zabrze, Medical University of Silesia, Zabrze 41-800, Poland
| | - Krzysztof Strojek
- Department of Internal Medicine, Diabetology and Cardiometabolic Disorders, Faculty of Medical Sciences Zabrze, Medical University of Silesia, Zabrze 41-800, Poland
| | - Tomasz Stołtny
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary Śląskie 41-940, Poland
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Li Y, Vrana NE, Letellier B, Lavalle P, Guilbaud-Chéreau C. The use of supramolecular systems in biomedical applications for antimicrobial properties, biocompatibility, and drug delivery. Biomed Mater 2024; 19:042005. [PMID: 38729193 DOI: 10.1088/1748-605x/ad49f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/10/2024] [Indexed: 05/12/2024]
Abstract
Supramolecular chemistry is versatile for developing stimuli-responsive, dynamic and multifunctional structures. In the context of biomedical engineering applications, supramolecular assemblies are particularly useful as coatings for they can closely mimic the natural structure and organisation of the extracellular matrix (ECM), they can also fabricate other complex systems like drug delivery systems and bioinks. In the current context of growing medical device-associated complications and the developments in the controlled drug delivery and regenerative medicine fields, supramolecular assemblies are becoming an indispensable part of the biomedical engineering arsenal. This review covers the different supramolecular assemblies in different biomedical applications with a specific focus on antimicrobial coatings, coatings that enhance biocompatibility, surface modifications on implantable medical devices, systems that promote therapeutic efficiency in cancer therapy, and the development of bioinks. The introduced supramolecular systems include multilayer coating by polyelectrolytes, polymers incorporated with nanoparticles, coating simulation of ECM, and drug delivery systems. A perspective on the application of supramolecular systems is also included.
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Affiliation(s)
- Yijie Li
- Inserm UMR_S 1121, CNRS EMR 7003, Université de Strasbourg, Biomaterials and Bioengineering, Centre de Recherche en Biomédecine de Strasbourg, 1 rue Eugène Boeckel, Strasbourg F-67000, France
- SPARTHA Medical, Centre de Recherche en Biomédecine de Strasbourg, 1 rue Eugène Boeckel, Strasbourg, France
| | - Nihal Engin Vrana
- SPARTHA Medical, Centre de Recherche en Biomédecine de Strasbourg, 1 rue Eugène Boeckel, Strasbourg, France
| | - Baptiste Letellier
- SPARTHA Medical, Centre de Recherche en Biomédecine de Strasbourg, 1 rue Eugène Boeckel, Strasbourg, France
| | - Philippe Lavalle
- Inserm UMR_S 1121, CNRS EMR 7003, Université de Strasbourg, Biomaterials and Bioengineering, Centre de Recherche en Biomédecine de Strasbourg, 1 rue Eugène Boeckel, Strasbourg F-67000, France
- SPARTHA Medical, Centre de Recherche en Biomédecine de Strasbourg, 1 rue Eugène Boeckel, Strasbourg, France
| | - Chloé Guilbaud-Chéreau
- SPARTHA Medical, Centre de Recherche en Biomédecine de Strasbourg, 1 rue Eugène Boeckel, Strasbourg, France
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Fernandes RJ, Gee A, Kanawati AJ, Siddiqi F, Rasoulinejad P, Zdero R, Bailey CS. Biomechanical Comparison of Subsidence Between Patient-Specific and Non-Patient-Specific Lumbar Interbody Fusion Cages. Global Spine J 2024; 14:1155-1163. [PMID: 36259252 PMCID: PMC11289543 DOI: 10.1177/21925682221134913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Biomechanical study. OBJECTIVES Several strategies to improve the surface of contact between an interbody device and the endplate have been employed to attenuate the risk of cage subsidence. 3D-printed patient-specific cages have been presented as a promising alternative to help mitigate that risk, but there is a lack of biomechanical evidence supporting their use. We aim to evaluate the biomechanical performance of 3D printed patient-specific lumbar interbody fusion cages in relation to commercial cages in preventing subsidence. METHODS A cadaveric model is used to investigate the possible advantage of 3D printed patient-specific cages matching the endplate contour using CT-scan imaging in preventing subsidence in relation to commercially available cages (Medtronic Fuse and Capstone). Peak failure force and stiffness were analyzed outcomes for both comparison groups. RESULTS PS cages resulted in significantly higher construct stiffness when compared to both commercial cages tested (>59%). PS cage peak failure force was 64% higher when compared to Fuse cage (P < .001) and 18% higher when compared to Capstone cage (P = .086). CONCLUSIONS Patient-specific cages required higher compression forces to produce failure and increased the cage-endplate construct' stiffness, decreasing subsidence risk.
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Affiliation(s)
- Renan J.R. Fernandes
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Aaron Gee
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Andrew J. Kanawati
- Department of Orthopaedic Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Fawaz Siddiqi
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
| | - Parham Rasoulinejad
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Radovan Zdero
- Lawson Health Research Institute, London, ON, Canada
| | - Christopher S. Bailey
- Combined Orthopaedic and Neurosurgery Spine Program, London Health Science Centre, London, ON, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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4
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Comba LC, Gagliardi L, Onorato F, Rivera F. Periprosthetic Hip Fractures around the Stem: Can the Stem Design Affect Fracture Features? J Clin Med 2024; 13:2627. [PMID: 38731155 PMCID: PMC11084834 DOI: 10.3390/jcm13092627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/21/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Total hip arthroplasty is one of the most successful orthopedic surgeries; nevertheless, many of these surgeries are the causes of failure, and among them, periprosthetic fractures are one of the major causes of revision. Our study focuses on periprosthetic hip fractures with two different stem designs. The aim of the study was to analyze the obtained results, focusing on the features of periprosthetic stem fractures observed. Methods: We retrospectively reviewed periprosthetic fractures occurring between 2010 and 2023, involving Alloclassic® or CLS® uncemented femoral stems. We analyzed demographic data, proximal femur morphology, and the fracture type. Results: We identified 97 patients. Considering the proximal femur morphology, we found that there was statistically significant prevalence of Dorr A proximal femur morphology in the CLS® group and of Dorr C in the Alloclassic® group. Considering the distribution of the fracture pattern, we reported a non-statistically significant prevalence of the fracture pattern with stable stems in the CLS® group. Conclusions: The choice of the prosthetic design of the femoral stem is a crucial element when planning total hip arthroplasty. However, we found a non-statistically significant difference between the two stems considered, raising questions about the real role of stem design as a primary determinant of periprosthetic hip fractures.
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Affiliation(s)
- Luca Costanzo Comba
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, 12038 Savigliano, Italy
| | - Luca Gagliardi
- Orthopedics and Trauma Department, Univertità degli Studi di Torino, 10100 Turin, Italy
| | - Francesco Onorato
- Orthopedics and Trauma Department, Univertità degli Studi di Torino, 10100 Turin, Italy
| | - Fabrizio Rivera
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, 12038 Savigliano, Italy
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Müller P, Synek A, Stauß T, Steinnagel C, Ehlers T, Gembarski PC, Pahr D, Lachmayer R. Development of a density-based topology optimization of homogenized lattice structures for individualized hip endoprostheses and validation using micro-FE. Sci Rep 2024; 14:5719. [PMID: 38459092 PMCID: PMC10923877 DOI: 10.1038/s41598-024-56327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024] Open
Abstract
Prosthetic implants, particularly hip endoprostheses, often lead to stress shielding because of a mismatch in compliance between the bone and the implant material, adversely affecting the implant's longevity and effectiveness. Therefore, this work aimed to demonstrate a computationally efficient method for density-based topology optimization of homogenized lattice structures in a patient-specific hip endoprosthesis. Thus, the root mean square error (RMSE) of the stress deviations between the physiological femur model and the optimized total hip arthroplasty (THA) model compared to an unoptimized-THA model could be reduced by 81 % and 66 % in Gruen zone (GZ) 6 and 7. However, the method relies on homogenized finite element (FE) models that only use a simplified representation of the microstructural geometry of the bone and implant. The topology-optimized hip endoprosthesis with graded lattice structures was synthesized using algorithmic design and analyzed in a virtual implanted state using micro-finite element (micro-FE) analysis to validate the optimization method. Homogenized FE and micro-FE models were compared based on averaged von Mises stresses in multiple regions of interest. A strong correlation (CCC > 0.97) was observed, indicating that optimizing homogenized lattice structures yields reliable outcomes. The graded implant was additively manufactured to ensure the topology-optimized result's feasibility.
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Affiliation(s)
- Patrik Müller
- Institute of Product Development, Leibniz University of Hannover, Garbsen, 30823, Germany.
| | - Alexander Synek
- TU Wien, Institute for Lightweight Design and Structural Biomechanics, Vienna, 1060, Austria
| | - Timo Stauß
- Institute of Product Development, Leibniz University of Hannover, Garbsen, 30823, Germany
| | - Carl Steinnagel
- Institute of Product Development, Leibniz University of Hannover, Garbsen, 30823, Germany
| | - Tobias Ehlers
- Institute of Product Development, Leibniz University of Hannover, Garbsen, 30823, Germany
| | | | - Dieter Pahr
- TU Wien, Institute for Lightweight Design and Structural Biomechanics, Vienna, 1060, Austria
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, 3500, Austria
| | - Roland Lachmayer
- Institute of Product Development, Leibniz University of Hannover, Garbsen, 30823, Germany
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Sass JO, Sellin ML, Kauertz E, Johannsen J, Weinmann M, Stenzel M, Frank M, Vogel D, Bader R, Jonitz-Heincke A. Advanced Ti-Nb-Ta Alloys for Bone Implants with Improved Functionality. J Funct Biomater 2024; 15:46. [PMID: 38391899 PMCID: PMC10889793 DOI: 10.3390/jfb15020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
The additive manufacturing of titanium-niobium-tantalum alloys with nominal chemical compositions Ti-xNb-6Ta (x = 20, 27, 35) by means of laser beam powder bed fusion is reported, and their potential as implant materials is elaborated by mechanical and biological characterization. The properties of dense specimens manufactured in different build orientations and of open porous Ti-20Nb-6Ta specimens are evaluated. Compression tests indicate that strength and elasticity are influenced by the chemical composition and build orientation. The minimum elasticity is always observed in the 90° orientation. It is lowest for Ti-20Nb-6Ta (43.2 ± 2.7 GPa) and can be further reduced to 8.1 ± 1.0 GPa for open porous specimens (p < 0.001). Furthermore, human osteoblasts are cultivated for 7 and 14 days on as-printed specimens and their biological response is compared to that of Ti-6Al-4V. Build orientation and cultivation time significantly affect the gene expression profile of osteogenic differentiation markers. Incomplete cell spreading is observed in specimens manufactured in 0° build orientation, whereas widely stretched cells are observed in 90° build orientation, i.e., parallel to the build direction. Compared to Ti-6Al-4V, Ti-Nb-Ta specimens promote improved osteogenesis and reduce the induction of inflammation. Accordingly, Ti-xNb-6Ta alloys have favorable mechanical and biological properties with great potential for application in orthopedic implants.
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Affiliation(s)
- Jan-Oliver Sass
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany
| | - Marie-Luise Sellin
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany
| | - Elisa Kauertz
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany
| | - Jan Johannsen
- Fraunhofer Research Institution for Additive Manufacturing Technologies IAPT, Am Schleusengraben 14, 21029 Hamburg, Germany
| | | | | | - Marcus Frank
- Medical Biology and Electron Microscopy Center, Rostock University Medical Center, Strempelstraße 14, 18057 Rostock, Germany
- Department Life, Light and Matter, University of Rostock, 18051 Rostock, Germany
| | - Danny Vogel
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany
| | - Rainer Bader
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany
- Department Life, Light and Matter, University of Rostock, 18051 Rostock, Germany
| | - Anika Jonitz-Heincke
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057 Rostock, Germany
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Kazemirad S, Yazdi MA. The assessment of implant shape-dependent failure mechanisms in primary total hip arthroplasty using finite element analysis. Comput Methods Biomech Biomed Engin 2024:1-14. [PMID: 38247427 DOI: 10.1080/10255842.2023.2301676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024]
Abstract
The three mechanisms known to be responsible for the failure of uncemented femoral stems in primary total hip arthroplasty (THA) are the stress shielding, excessive bone-implant interface stress, and excessive initial micromotion. Since implant designers usually have to sacrifice two mechanisms to improve the other one, the aim of this study was to assess which of them plays a more important role in the failure of uncemented stems. Two hip implant stems which are widely used in the primary THA and their mid-term clinical outcomes are available, were selected. Then, the amount of the three failure mechanisms created by each stem during the normal walking gait cycle was determined for a 70 kg female patient using the finite element method. The results indicated that the stem with better clinical outcome induced an average of 36.6% less stress shielding in the proximal regions of femur bone compared with the other stem. However, the maximum bone-implant interface stress and maximum initial micromotion were, respectively, 30 and 155% higher for the stem with better clinical outcomes. It was therefore concluded that the stress shielding has a more significant impact on the mid-term life of uncemented stems. However, care must be taken to ensure that the other two failure mechanisms do not exceed a certain threshold. It was also observed that the thinner and shorter stem created a smaller amount of stress shielding in the femur bone. The outcomes of this study can be used to design new hip implant stems that can potentially last longer.
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Affiliation(s)
- Siavash Kazemirad
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammad Ali Yazdi
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
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8
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Chmielewska A, Dean D. The role of stiffness-matching in avoiding stress shielding-induced bone loss and stress concentration-induced skeletal reconstruction device failure. Acta Biomater 2024; 173:51-65. [PMID: 37972883 DOI: 10.1016/j.actbio.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
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.
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Affiliation(s)
- Agnieszka Chmielewska
- The Department of Materials Science and Engineering, The Ohio State University, Columbus, OH 43210, USA.
| | - David Dean
- The Department of Materials Science and Engineering, The Ohio State University, Columbus, OH 43210, USA; Department of Plastic & Reconstructive Surgery, The Ohio State University, Columbus, OH 43212, USA
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9
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Šugár P, Antala R, Šugárová J, Kováčik J, Pata V. Study on Surface Roughness, Morphology, and Wettability of Laser-Modified Powder Metallurgy-Processed Ti-Graphite Composite Intended for Dental Application. Bioengineering (Basel) 2023; 10:1406. [PMID: 38135997 PMCID: PMC10740645 DOI: 10.3390/bioengineering10121406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
In this study, the surface laser treatment of a new type of dental biomaterial, a Ti-graphite composite, prepared by low-temperature powder metallurgy, was investigated. Different levels of output laser power and the scanning speed of the fiber nanosecond laser with a wavelength of 1064 nm and argon as a shielding gas were used in this experiment. The surface integrity of the machined surfaces was evaluated to identify the potential for the dental implant's early osseointegration process, including surface roughness parameter documentation by contact and non-contact methods, surface morphology assessment by scanning electron microscopy, and surface wettability estimation using the sessile drop technique. The obtained results showed that the surface roughness parameters attributed to high osseointegration relevance (Rsk, Rku, and Rsm) were not significantly influenced by laser power, and on the other hand, the scanning speed seems to have the most prevalent effect on surface roughness when exhibiting statistical differences in all evaluated profile roughness parameters except Rvk. The obtained laser-modified surfaces were hydrophilic, with a contact angle in the range of 62.3° to 83.2°.
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Affiliation(s)
- Peter Šugár
- Institute of Production Technologies, Faculty of Materials Science and Technology, Slovak University of Technology, J. Bottu 25, 917 24 Trnava, Slovakia; (R.A.); (J.Š.)
| | - Richard Antala
- Institute of Production Technologies, Faculty of Materials Science and Technology, Slovak University of Technology, J. Bottu 25, 917 24 Trnava, Slovakia; (R.A.); (J.Š.)
| | - Jana Šugárová
- Institute of Production Technologies, Faculty of Materials Science and Technology, Slovak University of Technology, J. Bottu 25, 917 24 Trnava, Slovakia; (R.A.); (J.Š.)
| | - Jaroslav Kováčik
- Slovak Academy of Sciences, Institute of Materials and Machine Mechanics, Dúbravská cesta 9, 845 13 Bratislava, Slovakia;
| | - Vladimír Pata
- Department of Production Engineering, Faculty of Technology, Tomas Bata University, Vavrečkova 5669, 960 01 Zlín, Czech Republic;
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10
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Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, Alshammari AS, Misran N, Soliman MS, Mahmud S, Khandakar A. Advancement in total hip implant: a comprehensive review of mechanics and performance parameters across diverse novelties. J Mater Chem B 2023; 11:10507-10537. [PMID: 37873807 DOI: 10.1039/d3tb01469j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.
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Affiliation(s)
- Md Mohiuddin Soliman
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohammad Tariqul Islam
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Muhammad E H Chowdhury
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Farayi Musharavati
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar.
| | - Touhidul Alam
- Pusat Sains Ankasa (ANGKASA), Institut Perubahan Iklim, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Selangor, Malaysia.
| | - Ahmed S Alshammari
- Department of Electrical Engineering, College of Engineering, University Hail, Hail 81481, Saudi Arabia.
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Norbahiah Misran
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohamed S Soliman
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
- Department of Electrical Engineering, Faculty of Energy Engineering, Aswan University, Aswan, 81528, Egypt
| | - Sakib Mahmud
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Amith Khandakar
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
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Kiselevskiy MV, Anisimova NY, Kapustin AV, Ryzhkin AA, Kuznetsova DN, Polyakova VV, Enikeev NA. Development of Bioactive Scaffolds for Orthopedic Applications by Designing Additively Manufactured Titanium Porous Structures: A Critical Review. Biomimetics (Basel) 2023; 8:546. [PMID: 37999187 PMCID: PMC10669447 DOI: 10.3390/biomimetics8070546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
We overview recent findings achieved in the field of model-driven development of additively manufactured porous materials for the development of a new generation of bioactive implants for orthopedic applications. Porous structures produced from biocompatible titanium alloys using selective laser melting can present a promising material to design scaffolds with regulated mechanical properties and with the capacity to be loaded with pharmaceutical products. Adjusting pore geometry, one could control elastic modulus and strength/fatigue properties of the engineered structures to be compatible with bone tissues, thus preventing the stress shield effect when replacing a diseased bone fragment. Adsorption of medicals by internal spaces would make it possible to emit the antibiotic and anti-tumor agents into surrounding tissues. The developed internal porosity and surface roughness can provide the desired vascularization and osteointegration. We critically analyze the recent advances in the field featuring model design approaches, virtual testing of the designed structures, capabilities of additive printing of porous structures, biomedical issues of the engineered scaffolds, and so on. Special attention is paid to highlighting the actual problems in the field and the ways of their solutions.
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Affiliation(s)
- Mikhail V. Kiselevskiy
- N.N. Blokhin National Medical Research Center of Oncology (N.N. Blokhin NMRCO), Ministry of Health of the Russian Federation, 115478 Moscow, Russia;
- Department of Casting Technologies and Artistic Processing of Materials, National University of Science and Technology “MISIS”, 119049 Moscow, Russia
| | - Natalia Yu. Anisimova
- N.N. Blokhin National Medical Research Center of Oncology (N.N. Blokhin NMRCO), Ministry of Health of the Russian Federation, 115478 Moscow, Russia;
- Department of Casting Technologies and Artistic Processing of Materials, National University of Science and Technology “MISIS”, 119049 Moscow, Russia
| | - Alexei V. Kapustin
- Laboratory for Metals and Alloys under Extreme Impacts, Ufa University of Science and Technology, 450076 Ufa, Russia (A.A.R.); (D.N.K.); (V.V.P.); (N.A.E.)
| | - Alexander A. Ryzhkin
- Laboratory for Metals and Alloys under Extreme Impacts, Ufa University of Science and Technology, 450076 Ufa, Russia (A.A.R.); (D.N.K.); (V.V.P.); (N.A.E.)
| | - Daria N. Kuznetsova
- Laboratory for Metals and Alloys under Extreme Impacts, Ufa University of Science and Technology, 450076 Ufa, Russia (A.A.R.); (D.N.K.); (V.V.P.); (N.A.E.)
| | - Veronika V. Polyakova
- Laboratory for Metals and Alloys under Extreme Impacts, Ufa University of Science and Technology, 450076 Ufa, Russia (A.A.R.); (D.N.K.); (V.V.P.); (N.A.E.)
| | - Nariman A. Enikeev
- Laboratory for Metals and Alloys under Extreme Impacts, Ufa University of Science and Technology, 450076 Ufa, Russia (A.A.R.); (D.N.K.); (V.V.P.); (N.A.E.)
- Laboratory for Dynamics and Extreme Characteristics of Promising Nanostructured Materials, Saint Petersburg State University, 199034 St. Petersburg, Russia
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Guo W, Li B, Li P, Zhao L, You H, Long Y. Review on vat photopolymerization additive manufacturing of bioactive ceramic bone scaffolds. J Mater Chem B 2023; 11:9572-9596. [PMID: 37727909 DOI: 10.1039/d3tb01236k] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Bone defects frequently occur in clinical settings due to trauma, disease, tumors, and other causes. The clinical use of autologous bones and allograft bone, however, has several limitations, such as limited sources, donor site morbidity, and immunological rejection. Nevertheless, there is newfound hope for regenerating and repairing bone defects through the development and integration of bone tissue engineering scaffold and additive manufacturing (AM) technology, also known as 3D printing. In particular, vat photopolymerization (VPP)-AM of bioactive ceramic bone scaffolds has garnered significant interest from interdisciplinary researchers in recent years. On the one hand, VPP-AM demonstrates clear advantages in printing accuracy and speed compared to other AM and non-AM technologies. On the other hand, bioactive ceramic materials exhibit superior bioactivity, biodegradability, and mechanical properties compared to metals, polymers, and bioinert ceramics, making them one of the most promising biomaterials for developing bone scaffolds. This paper reviews the research progress of VPP-AM of bioactive ceramic bone scaffolds, covering the process principles of various VPP-AM technologies, the performance requirements and preparation process of VPP ceramic slurry, the VPP process of bioactive ceramic bone scaffolds, and the research progress on different material types of VPP bioactive ceramic scaffolds. Firstly, we provide a brief introduction to the process principles and medical applications of various VPP technologies. Secondly, we explore the composition of the VPP ceramic slurry system, discussing the function of various components and their effects on printing quality. Thirdly, we delve into the performance requirements of bone scaffolds and summarize the research progress of VPP bioactive ceramic bone scaffolds of various material types including hydroxyapatite (HA), tricalcium phosphate (TCP), bioglass (BG), etc.; Finally, we discuss the challenges currently faced by VPP-AM bioactive ceramic bone scaffolds and propose possible development directions for the future.
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Affiliation(s)
- Wang Guo
- Guangxi Key Laboratory of Manufacturing System and Advanced Manufacturing Technology, School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
- State Key Laboratory of Featured Metal Materials and Life-cycle Safety for Composite Structures, Guangxi University, Nanning 530004, China
| | - Bowen Li
- Guangxi Key Laboratory of Manufacturing System and Advanced Manufacturing Technology, School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
| | - Ping Li
- Guangxi Key Laboratory of Manufacturing System and Advanced Manufacturing Technology, School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
| | - Lei Zhao
- Guangxi Key Laboratory of Manufacturing System and Advanced Manufacturing Technology, School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
| | - Hui You
- Guangxi Key Laboratory of Manufacturing System and Advanced Manufacturing Technology, School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
- State Key Laboratory of Featured Metal Materials and Life-cycle Safety for Composite Structures, Guangxi University, Nanning 530004, China
| | - Yu Long
- Guangxi Key Laboratory of Manufacturing System and Advanced Manufacturing Technology, School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
- State Key Laboratory of Featured Metal Materials and Life-cycle Safety for Composite Structures, Guangxi University, Nanning 530004, China
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Baba K, Mori Y, Chiba D, Kuwahara Y, Kurishima H, Tanaka H, Kogure A, Kamimura M, Yamada N, Ohtsu S, Oyama M, Masahashi N, Hanada S, Itoi E, Aizawa T. TiNbSn stems with gradient changes of Young's modulus and stiffness reduce stress shielding compared to the standard fit-and-fill stems. Eur J Med Res 2023; 28:214. [PMID: 37400903 DOI: 10.1186/s40001-023-01199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/26/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The difference between Young's moduli of the femur and the stem causes stress shielding (SS). TiNbSn (TNS) stem has a low Young's modulus and strength with gradient functional properties during the change in elastic modulus with heat treatment. The aim of this study was to investigate the inhibitory effect of TNS stems on SS and their clinical outcomes compared to conventional stems. METHODS This study was a clinical trial. Primary THA was performed using a TNS stem from April 2016 to September 2017 for patients in the TNS group. Unilateral THA was performed using a Ti6Al4V alloy stem from January 2007 to February 2011 for patients in the control group. The TNS and Ti6Al4V stems were matched in shape. Radiographs were obtained at the 1- and 3-year follow-ups. Two surgeons independently checked the SS grade and appearance of cortical hypertrophy (CH). The Japanese Orthopaedic Association (JOA) scores before and 1 year after surgery were assessed as clinical scores. RESULTS None of the patients in the TNS group had grade 3 or 4 SS. In contrast, in the control group, 24% and 40% of patients had grade 3 and 4 SS at the 1- and 3-year follow-ups, respectively. The SS grade was lower in the TNS group than in the control group at the 1- and 3-year follow-ups (p < 0.001). The frequencies of CH in both groups were no significant difference at the 1- and 3-year follow-ups. The JOA scores of the TNS group significantly improved at 1 year after surgery and were comparable to control group. CONCLUSION The TNS stem reduced SS at 1 and 3 years after THA compared to the proximal-engaging cementless stem, although the shapes of the stems matched. The TNS stem could reduce SS, stem loosening, and periprosthetic fractures. TRIAL REGISTRATION Current Controlled Trials. ISRCTN21241251. https://www.isrctn.com/search?q=21241251 . The date of registration was October 26, 2021. Retrospectively registered.
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Affiliation(s)
- Kazuyoshi Baba
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yoshiyuki Kuwahara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroaki Kurishima
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Atsushi Kogure
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masayuki Kamimura
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Norikazu Yamada
- Department of Orthopaedic Surgery, Sendai Red Cross Hospital, 2‑43‑3 Yagiyamahoncho, Taihaku‑ku, Sendai, Miyagi, 982-8501, Japan
| | - Susumu Ohtsu
- Department of Orthopaedic Surgery, Osaki Citizen Hospital, 3-8-1 Furukawahonami, Osaki, Miyagi, 989-6183, Japan
| | - Masamizu Oyama
- Department of Orthopaedic Surgery, Sendai Red Cross Hospital, 2‑43‑3 Yagiyamahoncho, Taihaku‑ku, Sendai, Miyagi, 982-8501, Japan
| | - Naoya Masahashi
- Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan
| | - Shuji Hanada
- Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi, 981-0911, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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14
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Rana M, Karmakar S, Bandyopadhyay A, Roychowdhury A. Design and manufacturing of patient-specific Ti6Al4V implants with inhomogeneous porosity. J Mech Behav Biomed Mater 2023; 143:105925. [PMID: 37244075 DOI: 10.1016/j.jmbbm.2023.105925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 05/29/2023]
Abstract
Stress shielding remains a challenge in orthopaedic implants, including total hip arthroplasty. Recent development in printable porous implants offers improved patient-specific solutions by providing adequate stability and reducing stress shielding possibilities. This work presents an approach for designing patient-specific implants with inhomogeneous porosity. A novel group of orthotropic auxetic structures is introduced, and their mechanical properties are computed. These auxetic structure units were distributed at different locations on the implant along with optimized pore distribution to achieve optimum performance. A computer tomography (CT) based finite element (FE) model was used to evaluate the performance of the proposed implant. The optimized implant and the auxetic structures were manufactured using laser powder bed-based laser metal additive manufacturing. Validation was done by comparing FE results with experimentally measured directional stiffness and Poisson's ratio of the auxetic structures and strain on the optimized implant. The correlation coefficient for the strain values was within a range of 0.9633-0.9844. Stress shielding was mainly observed in Gruen zones 1, 2, 6, and 7. The average stress shielding on the solid implant model was 56%, reduced to 18% when the optimized implant was used. This significant reduction in stress shielding can decrease the risk of implant loosening and create an osseointegration-friendly mechanical environment on the surrounding bone. The proposed approach can be effectively applied to the design of other orthopaedic implants to minimize stress shielding.
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Affiliation(s)
- Masud Rana
- Department of Aerospace Engineering & Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, 711103, India
| | - Santanu Karmakar
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, 711103, India
| | - Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA, 99164-2920, USA.
| | - Amit Roychowdhury
- Department of Aerospace Engineering & Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, 711103, India.
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15
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Mori Y, Mori N. Approaches to reduce periprosthetic bone resorption after total hip arthroplasty. J Bone Miner Metab 2023; 41:575-576. [PMID: 37029833 DOI: 10.1007/s00774-023-01423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
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16
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Kashin AD, Sedelnikova MB, Uvarkin PV, Ugodchikova AV, Luginin NA, Sharkeev YP, Khimich MA, Bakina OV. Functionalizing Diatomite-Based Micro-Arc Coatings for Orthopedic Implants: Influence of TiO 2 Addition. Biomimetics (Basel) 2023; 8:280. [PMID: 37504168 PMCID: PMC10377051 DOI: 10.3390/biomimetics8030280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
The method of micro-arc oxidation has been utilized to synthesize a protective biocompatible coating for a bioresorbable orthopedic Mg implant. This paper presents the results of comprehensive research of micro-arc coatings based on diatomite-a biogenic material consisting of shells of diatom microalgae. The main focus of this study was the functionalization of diatomite-based micro-arc coatings by incorporating particles of titania (TiO2) into them. Various properties of the resulting coatings were examined and evaluated. XRD analysis revealed the formation of a new magnesium orthosilicate phase-forsterite (Mg2SiO4). It was established that the corrosion current density of the coatings decreased by 1-2 orders of magnitude after the inclusion of TiO2 particles, depending on the coating process voltage. The adhesion strength of the coatings increased following the particle incorporation. The processes of dissolution of both coated and uncoated samples in a sodium chloride solution were studied. The in vitro cell viability was assessed, which showed that the coatings significantly reduced the cytotoxicity of Mg samples.
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Affiliation(s)
- Alexander D Kashin
- Laboratory of Physics of Nanostructured Biocomposites, Institute of Strength Physics and Materials Science of SB RAS, Tomsk 634055, Russia
| | - Mariya B Sedelnikova
- Laboratory of Physics of Nanostructured Biocomposites, Institute of Strength Physics and Materials Science of SB RAS, Tomsk 634055, Russia
| | - Pavel V Uvarkin
- Laboratory of Physics of Nanostructured Biocomposites, Institute of Strength Physics and Materials Science of SB RAS, Tomsk 634055, Russia
| | - Anna V Ugodchikova
- Laboratory of Physics of Nanostructured Biocomposites, Institute of Strength Physics and Materials Science of SB RAS, Tomsk 634055, Russia
- Laboratory of Plasma Synthesis of Materials, Troitsk Institute for Innovation & Fusion Research, Moscow Region, Troitsk 108840, Russia
| | - Nikita A Luginin
- Laboratory of Physics of Nanostructured Biocomposites, Institute of Strength Physics and Materials Science of SB RAS, Tomsk 634055, Russia
| | - Yurii P Sharkeev
- Laboratory of Physics of Nanostructured Biocomposites, Institute of Strength Physics and Materials Science of SB RAS, Tomsk 634055, Russia
- Research School of High-Energy Physics, National Research Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Margarita A Khimich
- Laboratory of Nanobioengineering, Institute of Strength Physics and Materials Science of SB RAS, Tomsk 634055, Russia
| | - Olga V Bakina
- Laboratory of Nanobioengineering, Institute of Strength Physics and Materials Science of SB RAS, Tomsk 634055, Russia
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17
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Seetharaman S, Sankaranarayanan D, Gupta M. Magnesium-Based Temporary Implants: Potential, Current Status, Applications, and Challenges. J Funct Biomater 2023; 14:324. [PMID: 37367288 DOI: 10.3390/jfb14060324] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Biomedical implants are important devices used for the repair or replacement of damaged or diseased tissues or organs. The success of implantation depends on various factors, such as mechanical properties, biocompatibility, and biodegradability of the materials used. Recently, magnesium (Mg)-based materials have emerged as a promising class of temporary implants due to their remarkable properties, such as strength, biocompatibility, biodegradability, and bioactivity. This review article aims to provide a comprehensive overview of current research works summarizing the above-mentioned properties of Mg-based materials for use as temporary implants. The key findings from in-vitro, in-vivo, and clinical trials are also discussed. Further, the potential applications of Mg-based implants and the applicable fabrication methods are also reviewed.
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Affiliation(s)
- Sankaranarayanan Seetharaman
- Department of Mechanical Engineering, College of Design and Engineering, National University of Singapore, 9 Engineering Drive 1, Block EA #07-08, Singapore 117575, Singapore
- Advanced Remanufacturing and Technology Centre (ARTC), Agency for Science, Technology and Research (A*STAR), 3 Cleantech Loop, #01/01 CleanTech Two, Singapore 637143, Singapore
| | - Dhivya Sankaranarayanan
- Department of Mechanical Engineering, College of Design and Engineering, National University of Singapore, 9 Engineering Drive 1, Block EA #07-08, Singapore 117575, Singapore
| | - Manoj Gupta
- Department of Mechanical Engineering, College of Design and Engineering, National University of Singapore, 9 Engineering Drive 1, Block EA #07-08, Singapore 117575, Singapore
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18
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A Machine-Learning-Based Approach for Predicting Mechanical Performance of Semi-Porous Hip Stems. J Funct Biomater 2023; 14:jfb14030156. [PMID: 36976080 PMCID: PMC10054603 DOI: 10.3390/jfb14030156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Novel designs of porous and semi-porous hip stems attempt to alleviate complications such as aseptic loosening, stress shielding, and eventual implant failure. Various designs of hip stems are modeled to simulate biomechanical performance using finite element analysis; however, these models are computationally expensive. Therefore, the machine learning approach is incorporated with simulated data to predict the new biomechanical performance of new designs of hip stems. Six types of algorithms based on machine learning were employed to validate the simulated results of finite element analysis. Afterwards, new designs of semi-porous stems with outer dense layers of 2.5 and 3 mm and porosities of 10–80% were used to predict the stiffness of the stems, stresses in outer dense layers, stresses in porous sections, and factor of safety under physiological loads using machine learning algorithms. It was determined that decision tree regression is the top-performing machine learning algorithm as per the used simulation data in terms of the validation mean absolute percentage error which equals 19.62%. It was also found that ridge regression produces the most consistent test set trend as compared with the original simulated finite element analysis results despite relying on a relatively small data set. These predicted results employing trained algorithms provided the understanding that changing the design parameters of semi-porous stems affects the biomechanical performance without carrying out finite element analysis.
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19
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Ferri M, Chiromito EMS, de Carvalho AJF, Morselli D, Degli Esposti M, Fabbri P. Fine Tuning of the Mechanical Properties of Bio-Based PHB/Nanofibrillated Cellulose Biocomposites to Prevent Implant Failure Due to the Bone/Implant Stress Shielding Effect. Polymers (Basel) 2023; 15:polym15061438. [PMID: 36987218 PMCID: PMC10051535 DOI: 10.3390/polym15061438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/24/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
A significant mechanical properties mismatch between natural bone and the material forming the orthopedic implant device can lead to its failure due to the inhomogeneous loads distribution, resulting in less dense and more fragile bone tissue (known as the stress shielding effect). The addition of nanofibrillated cellulose (NFC) to biocompatible and bioresorbable poly(3-hydroxybutyrate) (PHB) is proposed in order to tailor the PHB mechanical properties to different bone types. Specifically, the proposed approach offers an effective strategy to develop a supporting material, suitable for bone tissue regeneration, where stiffness, mechanical strength, hardness, and impact resistance can be tuned. The desired homogeneous blend formation and fine-tuning of PHB mechanical properties have been achieved thanks to the specific design and synthesis of a PHB/PEG diblock copolymer that is able to compatibilize the two compounds. Moreover, the typical high hydrophobicity of PHB is significantly reduced when NFC is added in presence of the developed diblock copolymer, thus creating a potential cue for supporting bone tissue growth. Hence, the presented outcomes contribute to the medical community development by translating the research results into clinical practice for designing bio-based materials for prosthetic devices.
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Affiliation(s)
- Martina Ferri
- Department of Civil, Chemical, Environmental and Materials Engineering, Università di Bologna, Via Terracini 28, 40131 Bologna, Italy
- National Interuniversity Consortium of Materials Science and Technology (INSTM), Via Giusti 9, 50121 Firenze, Italy
| | - Emanoele Maria Santos Chiromito
- Department of Materials Engineering, Engineering School of São Carlos, University of São Paulo, Av. João Dagnone, 1100, São Carlos 13563-120, SP, Brazil
| | - Antonio Jose Felix de Carvalho
- Department of Materials Engineering, Engineering School of São Carlos, University of São Paulo, Av. João Dagnone, 1100, São Carlos 13563-120, SP, Brazil
| | - Davide Morselli
- Department of Civil, Chemical, Environmental and Materials Engineering, Università di Bologna, Via Terracini 28, 40131 Bologna, Italy
- National Interuniversity Consortium of Materials Science and Technology (INSTM), Via Giusti 9, 50121 Firenze, Italy
| | - Micaela Degli Esposti
- Department of Civil, Chemical, Environmental and Materials Engineering, Università di Bologna, Via Terracini 28, 40131 Bologna, Italy
- National Interuniversity Consortium of Materials Science and Technology (INSTM), Via Giusti 9, 50121 Firenze, Italy
- Correspondence: (M.D.E.); (P.F.); Tel.: +39-051-2090363 (M.D.E.); +39-051-2090364 (P.F.)
| | - Paola Fabbri
- Department of Civil, Chemical, Environmental and Materials Engineering, Università di Bologna, Via Terracini 28, 40131 Bologna, Italy
- National Interuniversity Consortium of Materials Science and Technology (INSTM), Via Giusti 9, 50121 Firenze, Italy
- Correspondence: (M.D.E.); (P.F.); Tel.: +39-051-2090363 (M.D.E.); +39-051-2090364 (P.F.)
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20
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Querebillo CJ. A Review on Nano Ti-Based Oxides for Dark and Photocatalysis: From Photoinduced Processes to Bioimplant Applications. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:982. [PMID: 36985872 PMCID: PMC10058723 DOI: 10.3390/nano13060982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Catalysis on TiO2 nanomaterials in the presence of H2O and oxygen plays a crucial role in the advancement of many different fields, such as clean energy technologies, catalysis, disinfection, and bioimplants. Photocatalysis on TiO2 nanomaterials is well-established and has advanced in the last decades in terms of the understanding of its underlying principles and improvement of its efficiency. Meanwhile, the increasing complexity of modern scientific challenges in disinfection and bioimplants requires a profound mechanistic understanding of both residual and dark catalysis. Here, an overview of the progress made in TiO2 catalysis is given both in the presence and absence of light. It begins with the mechanisms involving reactive oxygen species (ROS) in TiO2 photocatalysis. This is followed by improvements in their photocatalytic efficiency due to their nanomorphology and states by enhancing charge separation and increasing light harvesting. A subsection on black TiO2 nanomaterials and their interesting properties and physics is also included. Progress in residual catalysis and dark catalysis on TiO2 are then presented. Safety, microbicidal effect, and studies on Ti-oxides for bioimplants are also presented. Finally, conclusions and future perspectives in light of disinfection and bioimplant application are given.
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Affiliation(s)
- Christine Joy Querebillo
- Leibniz-Institute for Solid State and Materials Research (IFW) Dresden, Helmholtzstr. 20, 01069 Dresden, Germany
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21
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Mori Y, Fujimori S, Kurishima H, Inoue H, Ishii K, Kubota M, Kawakami K, Mori N, Aizawa T, Masahashi N. Antimicrobial Properties of TiNbSn Alloys Anodized in a Sulfuric Acid Electrolyte. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1487. [PMID: 36837117 PMCID: PMC9968052 DOI: 10.3390/ma16041487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
TiNbSn alloy is a high-performance titanium alloy which is biosafe, strong, and has a low Young's modulus. TiNbSn alloy has been clinically applied as a material for orthopedic prosthesis. Anodized TiNbSn alloys with acetic and sulfuric acid electrolytes have excellent biocompatibility for osseointegration. Herein, TiNbSn alloy was anodized in a sulfuric acid electrolyte to determine the antimicrobial activity. The photocatalytic activities of the anodic oxide alloys were investigated based on their electronic band structure and crystallinity. In addition, the cytotoxicity of the anodized TiNbSn alloy was evaluated using cell lines of the osteoblast and fibroblast lineages. The antimicrobial activity of the anodic oxide alloy was assessed according to the ISO 27447 using methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Escherichia coli. The anodic oxide comprised rutile and anatase titanium dioxide (TiO2) and exhibited a porous microstructure. A well-crystallized rutile TiO2 phase was observed in the anodized TiNbSn alloy. The methylene blue degradation tests under ultraviolet illumination exhibited photocatalytic activity. In antimicrobial tests, the anodized TiNbSn alloy exhibited robust antimicrobial activities under ultraviolet illumination for all bacterial species, regardless of drug resistance. Therefore, the anodized TiNbSn alloy can be used as a functional biomaterial with low Young's modulus and excellent antimicrobial activity.
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Affiliation(s)
- Yu Mori
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Satoko Fujimori
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hiroaki Kurishima
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hiroyuki Inoue
- Department of Materials Science, Graduate School of Engineering, Osaka Metropolitan University, 1-1 Gakuen-machi, Naka-ku, Sakai 599-8531, Japan
| | - Keiko Ishii
- Department of Medical Microbiology, Mycology, and Immunology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Maya Kubota
- Graduate School of Engineering, Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan
| | - Kazuyoshi Kawakami
- Department of Medical Microbiology, Mycology, and Immunology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Toshimi Aizawa
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Naoya Masahashi
- Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan
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22
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Tantalum as Trabecular Metal for Endosseous Implantable Applications. Biomimetics (Basel) 2023; 8:biomimetics8010049. [PMID: 36810380 PMCID: PMC9944482 DOI: 10.3390/biomimetics8010049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
During the last 20 years, tantalum has known ever wider applications for the production of endosseous implantable devices in the orthopedic and dental fields. Its excellent performances are due to its capacity to stimulate new bone formation, thus improving implant integration and stable fixation. Tantalum's mechanical features can be mainly adjusted by controlling its porosity thanks to a number of versatile fabrication techniques, which allow obtaining an elastic modulus similar to that of bone tissue, thus limiting the stress-shielding effect. The present paper aims at reviewing the characteristics of tantalum as a solid and porous (trabecular) metal, with specific regard to biocompatibility and bioactivity. Principal fabrication methods and major applications are described. Moreover, the osteogenic features of porous tantalum are presented to testify its regenerative potential. It can be concluded that tantalum, especially as a porous metal, clearly possesses many advantageous characteristics for endosseous applications but it presently lacks the consolidated clinical experience of other metals such as titanium.
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23
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Kamel Shehata MEM, Mustapha K, Shehata E. Finite Element and Multivariate Random Forests Modelling for Stress Shield Attenuation in Customized Hip Implants. FORCES IN MECHANICS 2022. [DOI: 10.1016/j.finmec.2022.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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24
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Ho WF, Wong KK, Lee MH, Thomas JL, Chang YC, Wu SC, Hsu HC, Lin HY. Biocompatibility of a Ti-Rich Medium-Entropy Alloy with Glioblastoma Astrocytoma Cells. Int J Mol Sci 2022; 23:ijms232314552. [PMID: 36498880 PMCID: PMC9741175 DOI: 10.3390/ijms232314552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
Titanium and titanium alloys are widely used in medical devices and implants; thus, the biocompatibility of these metals is of great importance. In this study, glioblastoma astrocytoma cellular responses to Ti65-Zr18-Nb16-Mo1 (Ti65M, metastable medium-entropy alloy), Ti-13Nb-7Sn-4Mo (TNSM, titanium alloy), and commercially pure titanium (CP-Ti) were studied. Several physical parameters (crystal phase structure, surface roughness and hardness) of the titanium alloys were measured, and the correlation with the cellular viability was investigated. Finally, the relative protein expression in cellular proliferation pathways was measured and compared with mRNA expression assessed with quantitative real-time reverse transcription polymerase chain reaction assay (qRT-PCR).
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Affiliation(s)
- Wen-Fu Ho
- Department of Chemical and Materials Engineering, National University of Kaohsiung, Kaohsiung 81148, Taiwan
- Correspondence: (W.-F.H.); (H.-Y.L.)
| | - Ka-Kin Wong
- Department of Chemical and Materials Engineering, National University of Kaohsiung, Kaohsiung 81148, Taiwan
| | - Mei-Hwa Lee
- Department of Materials Science and Engineering, I-Shou University, Kaohsiung 84001, Taiwan
| | - James L. Thomas
- Department of Physics and Astronomy, University of New Mexico, Albuquerque, NM 87131, USA
| | - Ya-Chun Chang
- Department of Chemical and Materials Engineering, National University of Kaohsiung, Kaohsiung 81148, Taiwan
| | - Shih-Ching Wu
- Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan
| | - Hsueh-Chuan Hsu
- Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan
| | - Hung-Yin Lin
- Department of Chemical and Materials Engineering, National University of Kaohsiung, Kaohsiung 81148, Taiwan
- Correspondence: (W.-F.H.); (H.-Y.L.)
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25
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In Silico Contact Pressure of Metal-on-Metal Total Hip Implant with Different Materials Subjected to Gait Loading. METALS 2022. [DOI: 10.3390/met12081241] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The use of material for implant bearing has a vital role in minimizing failures that endanger implant recipients. Evaluation of contact pressure of bearing material can be the basis for material selection and have correlations with wear that contribute to the need of revision operations. The current paper aims to investigate three different metallic materials, namely cobalt chromium molybdenum (CoCrMo), stainless steel 316L (SS 316L), and titanium alloy (Ti6Al4V) for application in metal-on-metal bearing of total hip implant in terms of contact pressure. In silico model based on finite element simulation has been considered to predict contact pressure of metal-on-metal bearings under normal walking conditions. It is found that the use of Ti6Al-4V-on-Ti6Al4V is superior in its ability to reduce contact pressure by more than 35% compared to the other studied metal-on-metal couple bearings.
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26
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Evaluation of Microstructure and Mechanical Properties of a Ti10Mo8Nb Alloy for Biomedical Applications. METALS 2022. [DOI: 10.3390/met12071065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The growth of the elderly population is urging for more suitable biomaterials to allow the performance of better surgical and implant procedures and accelerate the patient’s healing because the elderly are more vulnerable to orthopedic and dental problems. β-phase Ti alloys can improve the mechanical properties of implants by reducing their elastic modulus and, consequently, the effects of stress shielding within bones. Therefore, the objective of this article is to study a novel ternary β-phase alloy of Ti10Mo8Nb produced by an electric arc furnace and rotary forge. The microstructure and mechanical properties of the Ti10Mo8Nb alloy were investigated in order to evaluate its suitability for biomedical applications and compare its characteristics with those present in Ti-alloys commerced or widely researched for prosthetic purposes. A tensile test, Vickers microhardness test, use of microstructure of optical microscopy for examination of microstructure, X-ray diffraction and hemolysis analysis were carried out. Thus, the Ti10Mo8Nb alloy showed suitable properties for biomedical applications, as well as having the potential to reduce the possibility to occur stress shielding after prosthetic implantations, especially for orthopedics and dentistry.
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27
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Martin V, Garcia M, Montemor MDF, Fernandes JCS, Gomes PS, Fernandes MH. Simulating In Vitro the Bone Healing Potential of a Degradable and Tailored Multifunctional Mg-Based Alloy Platform. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9060255. [PMID: 35735498 PMCID: PMC9219794 DOI: 10.3390/bioengineering9060255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023]
Abstract
This work intended to elucidate, in an in vitro approach, the cellular and molecular mechanisms occurring during the bone healing process, upon implantation of a tailored degradable multifunctional Mg-based alloy. This was prepared by a conjoining anodization of the bare alloy (AZ31) followed by the deposition of a polymeric coating functionalized with hydroxyapatite. Human endothelial cells and osteoblastic and osteoclastic differentiating cells were exposed to the extracts from the multifunctional platform (having a low degradation rate), as well as the underlying anodized and original AZ31 alloy (with higher degradation rates). Extracts from the multifunctional coated alloy did not affect cellular behavior, although a small inductive effect was observed in the proliferation and gene expression of endothelial and osteoblastic cells. Extracts from the higher degradable anodized and original alloys induced the expression of some endothelial genes and, also, ALP and TRAP activities, further increasing the expression of some early differentiation osteoblastic and osteoclastic genes. The integration of these results in a translational approach suggests that, following the implantation of a tailored degradable Mg-based material, the absence of initial deleterious effects would favor the early stages of bone repair and, subsequently, the on-going degradation of the coating and the subjacent alloy would increase bone metabolism dynamics favoring a faster bone formation and remodeling process and enhancing bone healing.
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Affiliation(s)
- Victor Martin
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal; (V.M.); (M.G.); (P.S.G.)
- LAQV/REQUIMTE, University of Porto, 4100-007 Porto, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, 1649-003 Lisboa, Portugal
- CQE, IMS, Departamento de Engenharia Química, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisboa, Portugal; (M.d.F.M.); (J.C.S.F.)
- EST Setúbal, CDP2T, Instituto Politécnico de Setúbal, 2910-761 Setúbal, Portugal
| | - Mónica Garcia
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal; (V.M.); (M.G.); (P.S.G.)
| | - Maria de Fátima Montemor
- CQE, IMS, Departamento de Engenharia Química, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisboa, Portugal; (M.d.F.M.); (J.C.S.F.)
| | - João Carlos Salvador Fernandes
- CQE, IMS, Departamento de Engenharia Química, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisboa, Portugal; (M.d.F.M.); (J.C.S.F.)
| | - Pedro Sousa Gomes
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal; (V.M.); (M.G.); (P.S.G.)
- LAQV/REQUIMTE, University of Porto, 4100-007 Porto, Portugal
| | - Maria Helena Fernandes
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal; (V.M.); (M.G.); (P.S.G.)
- LAQV/REQUIMTE, University of Porto, 4100-007 Porto, Portugal
- Correspondence:
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