Decoration with electronegative 2D materials based on chemical transition layers on CFR-PEEK implants for promoting osteogenesis

Due to the unique lamellar structures, physicochemical and biological properties, electronegative two-dimensional (2D) materials have been explored for surface modification of carbon fibers reinforced polyetheretherketone (CFR-PEEK) composite. Deposition of electronegative 2D materials based on a porous surface created by concentrated H2SO4 has been studied to promote osteogenesis of CFR-PEEK. Generally, a porous layer will be pre-built on CFR-PEEK through severe corrosion of concentrated sulfuric acid to help the loading of 2D materials. However, the severe corrosion will greatly reduce surface mechanical strength, especially wear resistance and hardness, which increases the risk of collapse or even peeling of the bioactive coating by external force. Herein, instead of the severe corrosion, a mild corrosion by concentrated HNO3 was applied to modify the surface of CFR-PEEK to pre-create a dense transition layer for the further surface decoration of electronegative 2D materials (graphene oxide (GO) and black phosphorus (BP), representatively). The results indicated that hardness and wear resistance of the dense transition layer were markedly higher than those of the porous layer. Although GO and BP can be both loaded on these two transition layers, -SO3H on the porous transition layer showed moderate cytotoxicity, while -NO2 on the dense transition layer showed good cytocompatibility. The dense transition layer displayed higher mineralized deposition in vitro and new bone formation rate in vivo than the porous transition layer, moreover, GO and BP coatings improved osteogenesis. This work offers inspirations for the construction of electronegative 2D material coating on CFR-PEEK based on chemical transition layers.

An investigational time course study of titanium plasma spray on osseointegration of PEEK and titanium implants: an in vivo ovine model

BACKGROUND CONTEXT

Methods to improve osseointegration of orthopedic spinal implants remains a clinical challenge. Materials composed of poly-ether-ether-ketone (PEEK) and titanium are commonly used in orthopedic applications due to their inherent properties of biocompatibility. Titanium has a clinical reputation for durability and osseous affinity, and PEEK offers advantages of a modulus that approximates osseous structures and is radiolucent. The hypothesis for the current investigation was that a titanium plasma spray (TPS) coating may increase the rate and magnitude of circumferential and appositional trabecular osseointegration of PEEK and titanium implants versus uncoated controls.

PURPOSE

Using an in vivo ovine model, the current investigation compared titanium plasma-sprayed PEEK and titanium dowels versus nonplasma-sprayed dowels. Using a time course study of 6 and 12 weeks postoperatively, experimental assays to quantify osseointegration included micro-computed tomography (microCT), biomechanical testing, and histomorphometry.

STUDY DESIGN/SETTING

In-vivo ovine model.

METHODS

Twelve skeletally mature crossbred sheep were equally randomized into postoperative periods of 6 and 12 weeks. Four types of dowel implants-PEEK, titanium plasma-sprayed PEEK (TPS PEEK), titanium, and titanium plasma-sprayed titanium (TPS titanium) were implanted into cylindrical metaphyseal defects in the distal femurs and proximal humeri (one defect per limb, n=48 sites). Sixteen nonoperative specimens (eight femurs and eight humeri) served as zero time-point controls. Half of the specimens underwent destructive biomechanical pullout testing and the remaining half quantitative microCT to quantify circumferential bone volume within 1 mm and 2 mm of the implant surface and histomorphometry to compute direct trabecular apposition.

RESULTS

There were no intra- or perioperative complications. The TPS-coated implants demonstrated significantly higher peak loads at dowel pullout at 6 and 12 weeks compared with uncoated controls (p<.05). No differences were observed across dowel treatments at the zero time-point (p>.05). MicroCT results exhibited no significant differences in circumferential osseointegration between implants within 1 mm or 2 mm of the dowel surface (p>.05). Direct appositional osseointegration of trabecular bone based on histomorphometry was higher for TPS-coated groups, regardless of base material, compared with uncoated treatments at both time intervals (p<.05).

CONCLUSIONS

The current in vivo study demonstrated the biological and mechanical advantages of plasma spray coatings. TPS improved histological incorporation and peak force required for implant extraction.

CLINICAL SIGNIFICANCE

Plasma spray coatings may offer clinical benefit by improving biological fixation and osseointegration within the first 6 to 12 weeks postoperatively- the critical healing period for implant-based arthrodesis procedures.

Mechanical properties and osteogenesis of CFR-PEEK composite with interface strengthening by graphene oxide for implant application

In this work, 1 wt% of graphite oxide (GO) was used to strengthen the interface of carbon fibers (CF) reinforced polyetheretherketone (CFR-PEEK) composites, so as to obtain sufficiently high mechanical properties and bioactive surfaces which are two fundamental requirements for orthopedic/dental implants. Concretely, aminated GO was grafted onto oxidized CF in aqueous solution in a mild and non-toxic manner, subsequently, the CF grafted by GO was used for injection molding to prepare CFR-PEEK implant. The dispersibility of CF in the composites were remarkably boosted. Mechanical tests indicated that the flexural strength, compressive strength and hardness of CFR-PEEK were increased by 51%, 46%, and 30%, respectively. Furthermore, the flexural modulus increased to 11.67 ± 0.20 GPa and the compression modulus increased to 6.12 ± 0.11 GPa, which both meet the elastic modulus of human bone (6-30 GPa). The wear resistance was slightly improved. In the in vitro cell evaluation, CFR-PEEK with interface strengthening by GO showed no cytotoxicity and exhibited significantly enhanced adhesion and proliferation of Bone marrow mesenchymal stem cells (BMSCs) on the surface. More importantly, osteogenesis-related protein expression in vitro and osteogenetic evaluation in vivo all disclosed greatly accelerated osteo-differentiation of BMSCs on the composites due to the additive effect of GO at the interface. Based on this scheme, the CFR-PEEK composites with the dual functions of mechanical enhancement and osteointegration promotion holds great potential as implants in orthopedic/dental applications.

Beyond Tissue replacement: The Emerging role of smart implants in healthcare

Smart implants are increasingly used to treat various diseases, track patient status, and restore tissue and organ function. These devices support internal organs, actively stimulate nerves, and monitor essential functions. With continuous monitoring or stimulation, patient observation quality and subsequent treatment can be improved. Additionally, using biodegradable and entirely excreted implant materials eliminates the need for surgical removal, providing a patient-friendly solution. In this review, we classify smart implants and discuss the latest prototypes, materials, and technologies employed in their creation. Our focus lies in exploring medical devices beyond replacing an organ or tissue and incorporating new functionality through sensors and electronic circuits. We also examine the advantages, opportunities, and challenges of creating implantable devices that preserve all critical functions. By presenting an in-depth overview of the current state-of-the-art smart implants, we shed light on persistent issues and limitations while discussing potential avenues for future advancements in materials used for these devices.

Implant Materials for Anterior Column Reconstruction of Cervical Spine Tumor

The spine is the most common site of bone metastases. Many cancer patients will ultimately develop spinal metastatic disease with symptomatic epidural spinal cord compression. At present, the main treatment for cervical spine tumors is surgical resection combined with postoperative radiotherapy. Implant materials for cervical spine anterior column reconstruction need to meet amounts of different properties, such as biocompatibility, bioactivity and the ability to maintain long-term mechanical strength. The selection of different materials determines the surgical efficacy and prognosis of patients to a certain extent. This article provides an overview of a variety of implant materials used for anterior column reconstruction after cervical spine tumor resection, introduces and analyzes their properties, advantages, disadvantages, derivatives, and applications in clinical practice, and looks forward to the future development of implant materials.

Controllable graphene oxide-based biocompatible hybrid interface as an anti-fibrotic coating for metallic implants

In tissue engineering, foreign body reactions (FBRs) that may occur after the insertion of medical implants are a considerable challenge. Materials currently used in implants are mainly metals that are non-organic, and the lack of biocompatibility and absence of immune regulations may lead to fibrosis after long periods of implantation. Here, we introduce a highly biocompatible hybrid interface of graphene oxide (GO) and collagen type I (COL-I), where the topological nanostructure can effectively inhibit the differentiation of fibroblasts into myofibroblasts. The structure and roughness of this coating interface can be easily adjusted at the nanoscale level through changes in the GO concentration, thereby effectively inducing the polarization of macrophages to the M1 state without producing excessive amounts of pro-inflammatory factors. Compared to nanomaterials or the extracellular matrix as an anti-fibrotic interface, this hybrid bio-interface has superior mechanical strength, physical structures, and high inflammation. Evidenced by inorganic materials such as glass, titanium, and nitinol, GO-COL shows great potential for use in medical implants and cell-material interfaces.

The role of fretting-frequency on the damage modes of THR modular junction: In-vitro study

According to the National Center for Health Statistics, currently, more than 250,000 total hip replacements annually in the US alone, with an estimated increase to 500,000 by the year 2030. The usage of tapered junctions between the femoral neck and head gives the surgeon flexibility in implant assembly. However, these modular junctions are subjected to micro-motion that may cause chemical and fretting-corrosion at the modular junction. Therefore, it is imperative to study these forces to mitigate their effects. The current study aims to understand the effects of fretting-corrosion as a function of fretting frequencies caused by common physical activities in an in-vitro model of hip modular junctions. The fretting system has a tribological contact condition of flat-on-flat, mounted to a load frame. CoCrMo pins were polished and immersed in a synovial fluid-like electrolyte solution (Bovine calf serum 30 g/l). Electrochemical measurements were made using a potentiostat. Samples then undergo 3600 cycles at 50 μm (to simulate gross slips), with a horizontal load at 200 N, and a frequency of 0.5 Hz, 0.7 Hz, 1 Hz, and 1.5 Hz to simulate Sit Down-Stand Up, Stair Climb, Walking, and Jogging, respectively. Worn surfaces were then examined under optical and scanning electron microscopy. The evolution of free potential as a function of time for tested frequencies shows the initial potential drop and stabilized trend in the potential evolution. The sample group at a higher frequency displays a higher tendency of corrosion than a lower frequency; however, the dissipation energy decreases as a function of fretting frequency. Both electrochemical and mechanical responses correlate to the variation in the fretting frequencies. Organometallic complexes were found on the surfaces of the samples that were subjected to a slower frequency of fretting, whereas mechanical grooving was noticed on samples with a faster frequency. Hence, these preliminary studies suggest that implant failure rates may be altered based on fretting-frequencies induced by physical activity. Further studies will be required to verify the findings and explore the potential role of fretting frequency in the damage modes of the modular junction.

Implantable Materials Update

There are a variety of materials available for surgical reconstruction of the foot and ankle. The material that provides the best physical properties to match the mechanical stress should be chosen. Ideal implant material should be biocompatible, nontoxic, noncarcinogenic, nonpyrogenic, and nonallergenic. Key properties include strength, durability, and resistance to fatigue. The material should have ductility to provide continued strength once it has been adapted to the bone surface. The material should be readily available, affordable, and reproducible. Materials that are available for use are stainless steel, cobalt chrome alloys, titanium and titanium alloys, pyrolytic carbon, thermoplastics, and bioceramics.

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

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

Corrosion and biocompatibility examination of multi-element modified calcium phosphate bioceramic layers

Multi-ions doped bioactive calcium phosphate (dCaP) layers were developed by pulse current deposition onto surgical grade titanium alloy material (Ti6Al4V). The coatings were electrodeposited from base electrolyte containing adequate amounts of calcium nitrate and ammonium dihydrogen phosphate at 70 °C. After electrodeposition, the pure CaP layers were doped with different ions that possess bioactive and antimicrobial properties, such as Zn²⁺, Mg²⁺, Sr²⁺ and Ag⁺ ions. The morphology and structure of coatings were characterized by Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), Energy-dispersive X-ray Spectroscopy (EDX) as well as XRD and FT-IR measurements. The results revealed the pulse current deposited and surface post-treated CaP layer to be mainly in hydroxyapatite phase. The corrosion properties of bioceramic coatings were assessed in conventional simulated body fluid (SBF) in a three electrode open cell by using potentiodynamic polarization measurements over two weeks period. The electrochemical results revealed that the pure calcium phosphate (CaP) coated implant material and the bare implant possess the highest resistivity to corrosion, while the modified calcium phosphate coating showed lower corrosion resistance by at least one order of magnitude. The cell viability measurements showed that the electrochemically deposited CaP layer was biocompatible.

Molecular Modelling of Peptide-Based Materials for Biomedical Applications

The molecular-level interactions between peptides and medically-relevant biomaterials, including nanoparticles, have the potential to advance technologies aimed at improving performance for medical applications including tissue implants and regenerative medicine. Peptides can possess materials-selective non-covalent adsorption properties, which in this instance can be exploited to enhance the biocompatibility and possible multi-functionality of medical implant materials. However, at present, their successful implementation in medical applications is largely on a trial-and-error basis, in part because a deep comprehension of general structure/function relationships at these interfaces is currently lacking. Molecular simulation approaches can complement experimental characterisation techniques and provide a wealth of relevant details at the atomic scale. In this Chapter, progress and prospects for advancing peptide-mediated medical implant surface treatments via molecular simulation is summarised for two of the most widely-found medical implant interfaces, titania and hydroxyapatite.

Is zirconia a viable alternative to titanium for oral implant? A critical review

PURPOSE

Titanium based implant systems, though considered as the gold standard for rehabilitation of edentulous spaces, have been criticized for many inherent flaws. The onset of hypersensitivity reactions, biocompatibility issues, and an unaesthetic gray hue have raised demands for more aesthetic and tissue compatible material for implant fabrication. Zirconia is emerging as a promising alternative to conventional Titanium based implant systems for oral rehabilitation with superior biological, aesthetics, mechanical and optical properties. This review aims to critically analyze and review the credibility of Zirconia implants as an alternative to Titanium for prosthetic rehabilitation.

STUDY SELECTION

The literature search for articles written in the English language in PubMed and Cochrane Library database from 1990 till December 2016. The following search terms were utilized for data search: "zirconia implants" NOT "abutment", "zirconia implants" AND "titanium implants" AND "osseointegration", "zirconia implants" AND compatibility.

RESULTS

The number of potential relevant articles selected were 47. All the human in vivo clinical, in vitro, animals' studies were included and discussed under the following subheadings: Chemical composition, structure and phases; Physical and mechanical properties; Aesthetic and optical properties; Osseointegration and biocompatibility; Surface modifications; Peri-implant tissue compatibility, inflammation and soft tissue healing, and long-term prognosis.

CONCLUSIONS

Zirconia implants are a promising alternative to titanium with a superior soft-tissue response, biocompatibility, and aesthetics with comparable osseointegration. However, further long-term longitudinal and comparative clinical trials are required to validate zirconia as a viable alternative to the titanium implant.

Influence of Cu content on the cell biocompatibility of Ti-Cu sintered alloys

The cell toxicity and the cell function of Ti-Cu sintered alloys with different Cu contents (2, 5, 10 and 25 wt.%, respectively) have been investigated in comparison with commercial pure titanium in order to assess the influence of Cu content on the cell biocompatibility of the Ti-Cu alloys. The cytotoxicity was studied by examining the MG63 cell response by CCK8 assessment. The cell morphology was evaluated by acridine orange/ethidium bromide (AO/EB) fluorescence and observed under scanning electronic microscopy (SEM). The cell function was monitored by measuring the AKP activity. It has been shown by the AO/EB morphology results that the cell death on both cp-Ti sample and Ti-Cu samples is due to apoptosis rather than necrosis. Although more apoptotic cells were found on the Ti-2Cu and Ti-5Cu samples, no evidence of Cu content dependent manner of apoptosis has been found. SEM observation indicated very good cell adhesion and spread on the cp-Ti sample and the Ti-Cu samples with different Cu contents. CCK8 results displayed that increase in the Cu content in Ti-Cu alloys does not bring about any difference in the cell viability. In addition, AKP test results indicated that no difference in the differentiation of MG63 was found between the cp-Ti and the Ti-Cu samples and among the Ti-Cu samples. All results indicated that Ti-Cu alloys exhibit very good cell biocompatibility and the Cu content up to 25 wt.% in the Ti-Cu alloys has no influence on the cell proliferation and differentiation.