Bone healing and mineralization, implant corrosion, and trace metals after nickel-titanium shape memory metal intramedullary fixation

Association between nickel exposure and body compositions in the United States: a population-based cross-sectional study

BACKGROUND

Increasing body fat or decreasing muscle and bone mass were associated with worse health outcomes in the adult population. The effects of nickel exposure on body composition are not known. The aim of the current study was to investigate the relationship between urinary nickel levels and body compositions.

MATERIALS AND METHODS

Two thousand seven hundred sixty-two participants were included in the analysis from the National Health and Nutrition Examination Surveys of 2017-2018 after excluding participants who have missing data on urinary nickel and those with missing all body mass component data. We used weighted generalized linear models to explore the relationship between urinary nickel and body mass components under interpolating missing covariable values. Simultaneously, sensitivity analyses and subgroup analysis were conducted to verify stability of analysis result. Curve fitting and saturation effect analysis were used to explore the possible nonlinear relationship between urine nickel and body compositions.

RESULTS

Among the 2,762 participants, the average urinary nickel level was 1.58 ug/L. The weighted generalized linear models, the sensitivity analyses and subgroup analyses found no significant linear relationship between urinary nickel and body compositions. For body weight, BMI, TLM, ALM, TRF, TOF and BMC, the urine nickel saturation effect values were 0.76, 0.74, 0.5, 0.67, 0.64, 0.48, and 0.45 ug/L, respectively. For each 1 ug/L rise in urinary nickel levels at levels below the turning point, body weight increases (β = 9.06, 95% CI = 2.75, 15.36, p = 0.01), BMI increases (β = 3.20, 95% CI = 1.36, 5.05, p =  < 0.001), TLM decreases (β = -47.39, 95% CI = -97.38, 2.59, p = 0.06), ALM decreases (β = -37.25, 95% CI = -63.25, -11.24, p = 0.01), TRF increases (β = 20.68, 95% CI = 1.50, 39.86, p = 0.03), TOF increases (β = 57.92, 95% CI = -0.12, 115.95, p = 0.05), and BMC decreases (β = -6.84, 95% CI = -12.64, -1.04, p = 0.02).

CONCLUSIONS

In summary, our study demonstrated that a dose-response relationship exists between urinary nickel and body compositions, with a low inflection point level of urinary nickel for the saturation effect.

In-vitro biocompatibility evaluation of cast Ni–Ti alloy produced by vacuum arc melting technique for biomedical and dental applications

The investigated cast Ni50–Ti50 shape memory alloy was prepared using a vacuum arc furnace. The cast samples were subjected to in-vitro biocompatibility studies according to ISO 10993-12:2004, and compared to other samples Ni–Ti orthodontic wires commercially available at the dental market. The cast samples were hydroxyapatite-coated using the electrodeposition technique. The effect of surface treatment on the coating quality was addressed. The hydroxyapatite-coated samples were investigated using electrochemical impedance (EIS) and potentiodynamic techniques. Coated samples were also examined using a scanning electron microscope to inspect the coating morphology. Cytotoxicity tests on MG63 and H9C2 cell lines showed the safety and biocompatibility of the cast NiTi alloy, with a direct relationship between the incubation period of the tested samples and cell viability. Well-adhered hydroxyapatite coating was obtained on the surface-treated NiTi samples using the electrodeposition technique. EDS analysis showed a hydroxyapatite coating having a calcium to phosphorus ratio close to that of the natural bone. Electrochemical tests indicated that the highest corrosion resistance was obtained for the uncoated samples followed by the anodized sample and finally the hydroxyapatite-coated samples due to their high porosity.

Characterization, mechanical properties and corrosion resistance of biocompatible Zn-HA/TiO2 nanocomposite coatings

Biocompatible Zinc-hydroxyapatite-titania and Zinc-hydroxyapatite nanocomposite coatings have been prepared by electrodeposition on NiTi shape memory alloy. Structures of coatings were characterized using X-ray diffraction (XRD). It was found that addition of TiO2 particles cause to reduction of crystallite size of coating. Scanning Electronic Microscope (SEM) observation showed that the Zn-HA/TiO2 coating consists of plate-like regions which can express that this plate-like structure can facilitate bone growth. X-ray photoelectron microscope (XPS) was performed to investigation of chemical state of composite coating and showed that Zinc matrix was bonded to oxygen. high-resolution transmission electron microscope (HRTEM) result illustrated the crystalline structure of nanocomposite coating. Mechanical behavior of coating was evaluated using microhardness and ball on disk wear test. The TiO2 incorporated composite coatings exhibited the better hardness and anti-wear performance than the Zn-HA coatings. Polarization measurements have been used to evaluate the electrochemical coatings performance. The Zn-HA/TiO2 composite coatings showed the highest corrosion resistance compared with Zn-HA and bare NiTi.

A Novel Shape Memory Plate Osteosynthesis for Noninvasive Modulation of Fixation Stiffness in a Rabbit Tibia Osteotomy Model

Nickel-titanium shape memory alloy (NiTi-SMA) implants might allow modulating fracture healing, changing their stiffness through alteration of both elastic modulus and cross-sectional shape by employing the shape memory effect (SME). Hypotheses: a novel NiTi-SMA plate stabilizes tibia osteotomies in rabbits. After noninvasive electromagnetic induction heating the alloy exhibits the SME and the plate changes towards higher stiffness (inverse dynamization) resulting in increased fixation stiffness and equal or better bony healing. In 14 rabbits, 1.0 mm tibia osteotomies were fixed with our experimental plate. Animals were randomised for control or induction heating at three weeks postoperatively. Repetitive X-ray imaging and in vivo measurements of bending stiffness were performed. After sacrifice at 8 weeks, macroscopic evaluation, µCT, and post mortem bending tests of the tibiae were carried out. One death and one early implant dislocation occurred. Following electromagnetic induction heating, radiographic and macroscopic changes of the implant proved successful SME activation. All osteotomies healed. In the treatment group, bending stiffness increased over time. Differences between groups were not significant. In conclusion, we demonstrated successful healing of rabbit tibia osteotomies using our novel NiTi-SMA plate. We demonstrated shape-changing SME in-vivo through transcutaneous electromagnetic induction heating. Thus, future orthopaedic implants could be modified without additional surgery.

Transcutaneous electromagnetic induction heating of an intramedullary nickel-titanium shape memory implant

PURPOSE

Inadequate mechanical stimuli are a major cause for nonunions following surgery for femoral and tibial shaft fractures. Adapting fixation rigidity during the course of fracture healing requires additional surgery. Nickel-titanium (NiTi) implants can change shape and rigidity by employing a temperature-dependent shape-memory effect. As a first step in the development of advanced intramedullary (IM) NiTi devices for fracture healing, this study aimed to test the feasibility and safety of transcutaneous electromagnetic induction heating of an IM NiTi implant in a rat model.

METHODS

In 51 rats, NiTi implants were introduced into the left distal femur. Forty-four animals were transferred to an induction coil, and the implant was electromagnetically heated to temperatures between 40° and 60 °C Blood samples were drawn before and four hours after the procedure. Interleukin (IL)-1, IL-4, IL-10, tumour necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) were measured. Animals were sacrificed at three weeks. Histological specimens from the hind leg and liver were retrieved and examined for inflammatory changes, necrosis or corrosion pits.

RESULTS

All animals successfully underwent the surgical procedure. Following transcutaneous induction heating, target temperature was confirmed in 37/44 rats. Postoperative controls showed no signs of undue limitations. Neither cytokine measurements nor histological specimens showed any significant differences between groups. There were no corrosion pits or necrosis.

CONCLUSION

We conclude that electromagnetic induction heating of IM NiTi implants is feasible and safe in a rat femur model. These findings reflect a further step in the development of novel concepts for IM fracture fixation that might lead to better fracture healing, less patient discomfort and less need for surgical interventions.

Electromagnetic induction heating of an orthopaedic nickel--titanium shape memory device

Shape memory orthopaedic implants made from nickel-titanium (NiTi) might allow the modulation of fracture healing, changing their cross-sectional shape by employing the shape memory effect. We aimed to show the feasibility and safety of contact-free electromagnetic induction heating of NiTi implants in a rat model. A water-cooled generator-oscillator combination was used. Induction characteristics were determined by measuring the temperature increase of a test sample in correlation to generator power and time. In 53 rats, NiTi implants were introduced into the right hind leg. The animals were transferred to the inductor, and the implant was electromagnetically heated to temperatures between 40 and 60°C. Blood samples were drawn before and 4 h after the procedure. IL-1, IL-4, IL-10, TNF-α, and IFN-γ were measured. Animals were euthanized at 3 weeks. Histological specimens from the hind leg and liver were retrieved and examined for inflammatory changes, necrosis, and corrosion pits. Cytokine measurements and histological specimens showed no significant differences among the groups. We concluded that electromagnetic induction heating of orthopedic NiTi implants is feasible and safe in a rat model. This is the first step in the development of new orthopedic implants in which stiffness or rigidity can be modified after implantation to optimize bone-healing.

Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China

Displaced acetabular fractures should be treated surgically. Over the past decade, surgical approaches to the acetabulum and the surgical technique for repair of common fracture patterns have advanced. Excellent outcomes after repair of these injuries can be achieved. The aim of this study was to assess the medium-term results of reconstruction of acetabular fractures by using shape-memory alloy designed by the authors. This is a retrospective review conducted at a level 1 trauma centre. From October 1999 to July 2009, 19 patients with acetabular fractures were treated with our patented Ni-Ti shape-memory alloy acetabular tridimensional memory alloy-fixation system (ATMFS). The ATMFS device was cooled with ice before implantation and then warmed to 40-50°C after implantation to produce balanced axial and compression forces that would stabilise the fracture three dimensionally. Our results are as follows; according to the D'Aubigne-Postel scoring system: Fifteen cases out of 19 (79%) achieved excellent or good clinical results. In two patients, late complications included avascular necrosis of the femoral head (ANFH) associated with posterior dislocation of the hip joint two years after the operation. We also observed two cases of grade II or III ectopic ossification, with good hip function, and one case of traumatic arthritis. In conclusion, these results demonstrate the effectiveness of the ATMFS device for the management of acetabular fracture. The device provides continuous compression of the fracture with minimal disruption to the local blood supply.

Biomechanical comparison of a new staple technique with tension band wiring for transverse patella fractures

BACKGROUND

The tension band wiring technique is the most common method of transverse patella fracture fixation. Since post-operative instabilities have been reported for this technique, alternative osteosynthesis solutions are of interest. We investigated the biomechanical behaviour of a new staple technique for treatment of transverse patella fractures in a cadaveric model.

METHODS

Eight human cadaveric knees with femur and tibia including soft tissue were used. A transverse osteotomy of the patella was created. Each specimen was fixed consecutively with tension band wiring and two Nitinol compression staples. Testing was performed by pull on the quadriceps tendon between a 90 degrees flexed position and full knee extension for up to 5,000 cycles.

FINDINGS

At 1,000 cycles, fracture site displacements in flexion and extension were significantly smaller for the staple group at the ventral aspect of the patella as compared to the tension band wiring group. With a failure criterion of 2mm fracture site displacement, cycles until failure were significantly smaller for the staple group.

INTERPRETATION

This study provides evidence based on a cadaveric model that compression staples have a promising potential to treat transverse patella fractures.

Shape memory alloys: metallurgy, biocompatibility, and biomechanics for neurosurgical applications

SHAPE MEMORY ALLOYS possess distinct dynamic properties with particular applications in neurosurgery. Because of their unique physical characteristics, these materials are finding increasing application where resiliency, conformation, and actuation are needed. Nitinol, the most frequently manufactured shape memory alloy, responds to thermal and mechanical stimuli with remarkable mechanical properties such as shape memory effect, super-elasticity, and high damping capacity. Nitinol has found particular use in the biomedical community because of its excellent fatigue resistance and biocompatibility, with special interest in neurosurgical applications. The properties of nitinol and its diffusionless phase transformations contribute to these unique mechanical capabilities. The features of nitinol, particularly its shape memory effect, super-elasticity, damping capacity, as well as its biocompatibility and biomechanics are discussed herein. Current and future applications of nitinol and other shape memory alloys in endovascular, spinal, and minimally invasive neurosurgery are introduced. An understanding of the metallurgic properties of nitinol provides a foundation for further exploration of its use in neurosurgical implant design.

Surface treatment of NiTi for medical applications

This article gives an overview of methods applied for surface treatment of nickel-titanium shape memory alloys in medical applications. The different methods are classified into the three major groups: <I>removal</I>, <I>oxidation</I> and <I>coating</I>. The principle behind each group of methods is explained and the pros and cons of the different methods are discussed.

Characterization of a Femoral Segmental Nonunion Model in Laboratory Rats: Report of a Novel Surgical Technique

The literature is lacking conclusive results regarding the exact mechanism of maximizing the fracture healing stages with minimal traumatic side effects. This observation mandates the development of a novel surgical procedure using small animals as a model to study fracture healing in the presence of osteoinductive agents. Previously, stabilization of osteotomies in small animal models has mainly been accomplished using Kirschner wires, but the rat's tremendous ability to heal an osteotomy stabilized by this method has masked the effects of osteoinductive agents. Thus, this study proposes using a modified 20-hole, 1.5-mm stainless-steel plate to stabilize a 5-mm segmental defect. Thirty of 32 adult male rats were fully weight-bearing within 2 days and were followed over a 15-week period. Two animals showed evidence of fixation failure due to technical error, and the animals were humanely sacrificed. At the end of the study, the fractures were stable with significantly less bone formation evident when compared to controls (p < .001). Therefore, this technique can effectively be used to evaluate compounds that will enhance bone formation and allows for stable fixation of the control with minimal callus formation or bony ingrowth. The goal of this article is to allow other investigators to reproduce this technique as well as outline the advantages and disadvantages of this novel plating technique versus the former Kirschner wire technique for the study of osteoinductive agents using small animals as a model.

Comparison of Two Different Fixation Techniques for a Segmental Defect in a Rat Femur Model

Studies have attempted to identify the osteogenic effects of bone morphogenetic proteins using a rat femur model, which commonly involves the creation of a critical size defect followed by internal fixation of the femur. Among the most familiar fixation methods are either plating or intramedullary placement of a Kirschner wire (K-wire). There are advantages and disadvantages to each method; however, this study attempts to identify the best method by exploring the histological effects of each technique. The experiment involved two groups with no added treatment: Group P (plate fixation method) and Group K (K-wire fixation method). The animals were allowed a 4-week interval for the femurs to heal, and proximal, distal, and two midshaft cuts were examined under high-power microscopy after the fixation apparatus was removed. Group K exhibited a peculiar fibrotic healing pattern that followed the shaft of the then vacated K-wire and there was minimal new viable bone formation. Group P, however, exhibited a more natural ingrowth of newly formed bone that began at the proximal and distal cuts and proceeded centrally into the core of the defect. Due to the fibrotic tissue in Group K, this study shows that the model is insufficient due to the micromotion created and thus supports plating of critical defects as the fixation method of choice due to the creation of a stable healing environment.

Microstructure, nickel suppression and mechanical characteristics of electropolished and photoelectrocatalytically oxidized biomedical nickel titanium shape memory alloy

A new surface modification protocol encompassing an electropolishing pretreatment (EP) and subsequent photoelectrocatalytic oxidation (PEO) has been developed to improve the surface properties of biomedical nickel titanium (NiTi) shape memory alloy (SMA). Electropolishing is a good way to improve the resistance to localized breakdown of NiTi SMA whereas PEO offers the synergistic effects of advanced oxidation and electrochemical oxidation. Our results indicate that PEO leads to the formation of a sturdy titania film on the EP NiTi substrate. There is an Ni-free zone near the top surface and a graded interface between the titania layer and NiTi substrate, which bodes well for both biocompatibility and mechanical stability. In addition, Ni ion release from the NiTi substrate is suppressed, as confirmed by the 10-week immersion test. The modulus and hardness of the modified NiTi surface increase with larger indentation depths, finally reaching plateau values of about 69 and 3.1GPa, respectively, which are slightly higher than those of the NiTi substrate but much lower than those of a dense amorphous titania film. In comparison, after undergoing only EP, the mechanical properties of NiTi exhibit an inverse change with depth. The deformation mechanism is proposed and discussed. Our results indicate that surface modification by dual EP and PEO can notably suppress Ni ion release and improve the biocompatibility of NiTi SMA while the surface mechanical properties are not compromised, making the treated materials suitable for hard tissue replacements.

Surface mechanical properties, corrosion resistance, and cytocompatibility of nitrogen plasma-implanted nickel-titanium alloys: a comparative study with commonly used medical grade materials

Stainless steel and titanium alloys are the most common metallic orthopedic materials. Recently, nickel-titanium (NiTi) shape memory alloys have attracted much attention due to their shape memory effect and super-elasticity. However, this alloy consists of equal amounts of nickel and titanium, and nickel is a well known sensitizer to cause allergy or other deleterious effects in living tissues. Nickel ion leaching is correspondingly worse if the surface corrosion resistance deteriorates. We have therefore modified the NiTi surface by nitrogen plasma immersion ion implantation (PIII). The surface chemistry and corrosion resistance of the implanted samples were studied and compared with those of the untreated NiTi alloys, stainless steel, and Ti-6Al-4V alloy serving as controls. Immersion tests were carried out to investigate the extent of nickel leaching under simulated human body conditions and cytocompatibility tests were conducted using enhanced green fluorescent protein mice osteoblasts. The X-ray photoelectron spectroscopy results reveal that a thin titanium nitride (TiN) layer with higher hardness is formed on the surface after nitrogen PIII. The corrosion resistance of the implanted sample is also superior to that of the untreated NiTi and stainless steel and comparable to that of titanium alloy. The release of nickel ions is significantly reduced compared with the untreated NiTi. The sample with surface TiN exhibits the highest amount of cell proliferation whereas stainless steel fares the worst. Compared with coatings, the plasma-implanted structure does not delaminate as easily and nitrogen PIII is a viable way to improve the properties of NiTi orthopedic implants.

Auricle Reconstruction With a Nickel???Titanium Shape Memory Alloy as the Framework

OBJECTIVE

The objective of this study is to explore the biocompatibility and implantability of a nickel-titanium (NiTi) alloy in auricle reconstruction.

METHODS AND MATERIALS

Twelve New Zealand rabbits underwent subcutaneous implantation with a NiTi alloy framework shaped like the human auricle under general anesthesia. The implant was inserted after skin expansion. Implant vascularization was evaluated at months 1, 3, 6, 9, and 12 after implantation by histologic analysis. Immunohistochemical methods were used to examine expression of vascular endothelial growth factor in tissue around the implant. The fibrovascular ingrowth rate of implants was determined by bone scanning using (99m)Tc-PYP. The surface of the NiTi alloy implant was examined microscopically with scanning electron microscopy.

RESULT

The implant harvested showed only partial vascularization at 1 month and completely vascularized at 3 months. The amount of vascular endothelial growth factor-positive cells was markedly increased at 6 months and reached the highest number at 3 months. The fibrovascular ingrowth rate of implant was assessed by (99m)Tc-PYP bone scan using ratios of (99m)Tc-PYP activity in placement regions versus the contralateral normal region. One rabbit had exposure of the NiTi alloy framework as a result of overlying skin flap necrosis. It was rescued with animal skin without the complete removal of the framework. All the other rabbits tolerated the implant well, and there were no complications.

CONCLUSION

The NiTi alloy implant represents an alternative implant for auricular reconstruction.

Carbon plasma immersion ion implantation of nickel–titanium shape memory alloys

Nickel-titanium (NiTi) shape memory alloys possess super-elasticity in addition to the well-known shape memory effect and are potentially suitable for orthopedic implants. However, a critical concern is the release of harmful Ni ions from the implants into the living tissues. We propose to enhance the corrosion resistance and other surface and biological properties of NiTi using carbon plasma immersion ion implantation and deposition (PIII&D). Our corrosion and simulated body fluid tests indicate that either an ion-mixed amorphous carbon coating fabricated by PIII&D or direct carbon PIII can drastically improve the corrosion resistance and block the out-diffusion of Ni from the materials. Our tribological tests show that the treated surfaces are mechanically more superior and cytotoxicity tests reveal that both sets of plasma-treated samples favor adhesion and proliferation of osteoblasts.

Investigation of nickel suppression and cytocompatibility of surface-treated nickel-titanium shape memory alloys by using plasma immersion ion implantation

Nickel-titanium (NiTi) shape memory alloys are increasingly being used in orthopedic applications. However, there is a concern that Ni is harmful to the human body. We have recently investigated the use of nitrogen, or oxygen plasma immersion ion implantation to mitigate this deleterious effect. Our results reveal that the near-surface Ni concentration in all the treated samples is significantly suppressed. In addition, our in vitro tests show that the plasma-treated surfaces are cytologically compatible allowing the attachment and proliferation of osteoblasts. Among the two types of samples, the best biological effects are found on the samples with nitrogen implantation.

[Bone integration and apposition of porous and non porous metallic orthopaedic biomaterials]

The objective of this study was to evaluate the functionality of two intervertebral fusion implants, a porous nickel-titanium and a conventional titanium cage system in a sheep model. Eighteen sheep each received the two-implant devices at L2-L3 and L4-L5 lumbar levels. The sheep were sacrificed at three different postsurgical periods: three, six and 12 months. Lumbar segments were harvested. Qualitative (macroscopic and microscopic) and quantitative (histomorphometric) histological analysis were carried out on histological slides. The results indicated that a porous nickel-titanium had obtained a better osseointegration than the titanium implant. The functionality of two implants seemed to be influenced by the implant structure and shape. However, biocompatibility of two implants seemed comparable.

Corrosion resistance, surface mechanical properties, and cytocompatibility of plasma immersion ion implantation-treated nickel-titanium shape memory alloys

Nickel-titanium shape memory alloys are promising materials in orthopedic applications because of their unique properties. However, for prolonged use in a human body, deterioration of the corrosion resistance of the materials becomes a critical issue because of the increasing possibility of deleterious ions released from the substrate to living tissues. We have investigated the use of nitrogen, acetylene, and oxygen plasma immersion ion implantation (PIII) to improve the corrosion resistance and mechanical properties of the materials. Our results reveal that the corrosion resistance and mechanical properties such as hardness and elastic modulus are significantly enhanced after surface treatment. The release of nickel is drastically reduced as compared with the untreated control. In addition, our in vitro tests show that the plasma-treated surfaces are well tolerated by osteoblasts. Among the three types of samples, the best biological effects are observed on the nitrogen PIII samples.

Tensile deformation of NiTi wires

We examine the structure and properties of cold drawn Ti-50.1 at % Ni and Ti-50.9 at % Ni shape memory alloy wires. Wires with both compositions possess a strong <111> fiber texture in the wire drawing direction, a grain size on the order of micrometers, and a high dislocation density. The more Ni rich wires contain fine second phase precipitates, while the wires with lower Ni content are relatively free of precipitates. The wire stress-strain response depends strongly on composition through operant deformation mechanisms, and cannot be explained based solely on measured differences in the transformation temperatures. We provide fundamental connections between the material structure, deformation mechanisms, and resulting stress-strain responses. The results help clarify some inconsistencies and common misconceptions in the literature. Ramifications on materials selection and design for emerging biomedical applications of NiTi shape memory alloys are discussed.

Biocompatibility and strength properties of nitinol shape memory alloy suture in rabbit tendon

Nitinol (NiTi) is a promising new tendon suture material with good strength, easy handling and good super-elastic properties. NiTi sutures were implanted for biocompatibility testing into the right medial gastrocnemius tendon in 15 rabbits for 2, 6 and 12 weeks. Additional sutures were implanted in subcutaneous tissue for strength measurements in order to determine the effect of implantation on strength properties of NiTi suture material. Braided polyester sutures (Ethibond) of approximately the same diameter were used as control. Encapsulating membrane formation around the sutures was minimal in the case of both materials. The breaking load of NiTi was significantly greater compared to braided polyester. Implantation did not affect the strength properties of either material.

Comparative corrosion performance of black oxide, sandblasted, and fine-drawn nitinol wires in potentiodynamic and potentiostatic tests: Effects of chemical etching and electropolishing

The corrosion performance of sandblasted (SB) and smooth fine-drawn (FD) medical-use nitinol wires was compared with the performance of wires with black oxide (BO) formed in air during their manufacture. Potentiodynamic and ASTM F746 potentiostatic tests in a 0.9 % NaCl solution were conducted on wires in their as-received, chemically etched, aged in boiling water, and electropolished states. As-received wires with various surface finishes revealed breakdown potentials in the range from -100 mV to +500 mV; similar passive current density, 10(-6) A/cm(2); and a wide hysteresis on the reverse scan, demonstrating strong susceptibility to localized corrosion. Chemically etched wires with original black oxide displayed consistent corrosion performance and surpassed, in corrosion resistance, electropolished wires that showed significantly lower breakdown (400-700 mV) and localized corrosion potentials ( approximately -50 to +113 mV). Sandblasted and fine-drawn wires exhibited rather inconsistent corrosion behavior. In potentiodynamic tests these wires could perform with equal probability either on the level of pretreated BO wires or rather similar to as-received wires. Both SB and FD wires revealed low breakdown potentials in the PS regime. SEM analysis performed before tests indicated that sandblasting was not efficient for the complete removal of the original scaling, and fine drawing aggravated the situation, resulting in a persistent scaling that contributed to the inferior corrosion performance. Inclusions (oxides, carbides, and oxidized carbides) inherited from the bulk and retained on electropolished surfaces are the cause of their inferior performance compared to chemically etched surfaces. In electropolished wires corrosion was initiated around inclusions.

In vitro cytotoxicity evaluation of a 50.8% NiTi single crystal

To our knowledge, the biocompatibility of nickel-titanium (NiTi) single crystals has not been reported. Yet certain orientations of single crystals present several advantages over the polycrystalline form in terms of maximal strain, fatigue resistance, and temperature range of superelasticity. Therefore we tested the in vitro biocompatibility of 50.8% NiTi single crystals in the orientation <001> after four different heat treatments in a helium atmosphere followed by mechanical polishing. The study was performed on the material extracts after immersion of the specimens in cell culture medium (DMEM) for 7 days at 37 degrees C. Cytotoxicity studies were performed on L-929 mouse fibroblasts using the MTT assay. J-774 macrophages were used to assess the potential inflammatory effect of the extracts by IL1-beta and TNF-alpha dosages (sandwich ELISA method). Exposure of L-929 to material extracts did not affect cell viability. In addition, IL1-beta and TNF-alpha secretion was not stimulated after incubation with NiTi extracts compared to the negative controls. These results were predictable since atomic absorption spectroscopy did not detect nickel ions in the extracts with a resolution of 1 ppm. Within the limits of in vitro testing, our results demonstrate that the TiNi(50.8%) single crystals do not trigger a cytotoxic reaction.

Corrosion resistance of stressed NiTi and stainless steel orthodontic wires in acid artificial saliva

The purpose of this study was to investigate the corrosion resistance of stressed NiTi and stainless steel orthodontic wires using cyclic potentiodynamic and potentiostatic tests in acid artificial saliva at 37 degrees C. An atomic force microscope was used to measure the 3-D surface topography of as-received wires. Scanning electron microscope observations were carried out before and after the cyclic potentiodynamic tests. The surface chemical analysis was characterized using X-ray photoelectron spectroscopy and Auger electron spectroscopy after the potentiostatic tests. The cyclic potentiodynamic test results showed that the pH had a significant influence on the corrosion parameters of the stressed NiTi and stainless steel wires (p < 0.05). The pitting potential, protection potential, and passive range of stressed NiTi and stainless steel wires decreased on decreasing pH, whereas the passive current density increased on decreasing pH. The load had no significant influence on the above corrosion parameters (p > 0.05). For all pH and load conditions, stainless steel wire showed higher pitting potential and wider passive range than NiTi wire (p < 0.001), whereas NiTi wire had lower passive current density than stainless steel wire (p < 0.001). The corrosion resistance of the stressed NiTi and stainless steel wires was related to the surface characterizations, including surface defect and passive film.

Calcium phosphate coating of nickel-titanium shape-memory alloys. Coating procedure and adherence of leukocytes and platelets

Nickel-titanium shape-memory alloys (NiTi-SMA) were coated with calcium phosphate by dipping in oversaturated calcium phosphate solution. The layer thickness (typically 5-20 micrometer) can be varied by choice of the immersion time. The porous nature of the layer of microcrystals makes it mechanically stable enough to withstand both the shape-memory transition upon cooling and heating and also strong bending of the material (superelastic effect). This layer may improve the biocompatibility of NiTi-SMA, particulary for osteosynthetic devices by creating a more physiological surface and by restricting a potential nickel release. The adherence of human leukocytes (peripheral blood mononuclear cells and polymorphonuclear neutrophil granulocytes) and platelets to the calcium phosphate layer was analyzed in vitro. In comparison to non-coated NiTi-SMA, leukocytes and platelets showed a significantly increased adhesion to the coated NiTi-SMA.

Stabilization of acute, complete acromioclavicular joint dislocations with a new C hook implant

Although coracoclavicular fixation is currently popular for type III acromioclavicular (AC) dislocations, a surgical gold standard is lacking. The purpose of this study was to evaluate the preliminary outcome of surgical treatment of complete AC dislocations with a new nitinol C hook implant. When the implant is cooled (<5 degrees C), it softens enough to be easily inserted under the coracoid process with a hole drilled in the clavicle. Cooling is induced with ice water. When the implant reaches body temperature, it hardens and anatomic reduction is achieved. Patients with acute type III AC dislocations were prospectively evaluated. The AC ligament was reinserted with the use of a bone anchor, and the position of the joint was restored by fixing it with a new C hook. Clinical and radiographic control checkups were carried out at 3, 8, and 12 weeks and 2 years postoperatively. Certain patient-related variables, functional status, symptom severity, and patient satisfaction were assessed. By 12 weeks, all patients had achieved full functional status. Radiographs showed accurate anatomic reduction. Overall subjective satisfaction was very good in all cases. No complications or implant failures occurred. On the basis of this pilot study, the new C hook implant provides secure anatomic reduction with very good functional recovery and patient satisfaction. The main benefit of the implant is the ease of insertion. It preserves the articular surfaces and allows slight movement of the AC joint during abduction of the arm. The C hook implant is a new surgical concept with potentially better patient recovery.

Porous titanium-nickel for intervertebral fusion in a sheep model: part 2. Surface analysis and nickel release assessment

Porous titanium-nickel (PTN) devices represent an alternative to traditional cage implants. PTN materials possess an interconnecting network of pores with capillarity properties that may promote bone ingrowth, long-term fixation, and intervertebral fusion without the need for bone grafting. However, their considerable surface area and nickel content may elicit concerns over sensitization potential. Therefore, PTN surface corrosion and nickel release resistance must be carefully studied. To evaluate this possibility, a PTN interbody fusion device (IFD) was compared to a conventional nonporous cage made of TiAlV, a well-known biocompatible biomaterial, in a sheep model. PTN and TiAlV IFDs were inserted at two non-contiguous lumbar sites for 3, 6, and 12 months postsurgery. Their surface was then evaluated by scanning electron microscopy (SEM) combined with backscattered electron analysis (BSE). No evidence of surface corrosion was observed either pre- or postimplantation, regardless of device type. Dosage of nickel ions was also performed with the use of inductively coupled plasma-mass spectrometry (ICP-MS). Blood nickel levels were observed to be within acceptable levels at all postinstrumentation times. Nickel content in PTN-adjacent tissue, as well as in detoxification and remote organs, was equivalent both in PTN-treated and control sheep. Therefore, porous titanium-nickel demonstrated resistance to both in vivo surface corrosion and nickel ion release and compared very well with a conventional titanium implant in the course of a 12-month sheep study.

Easy assessment of the biocompatibility of Ni-Ti alloys by in vitro cell culture experiments on a functionally graded Ni-NiTi-Ti material

The biocompatibility of nickel-titanium alloys was investigated by single-culture experiments on functionally graded samples with a stepwise change in composition from pure nickel to pure titanium, including an Ni-Ti shape memory alloy for a 50:50 mixture. This approach permitted a considerable decrease of experimental resources by simultaneously studying a full variation of composition. The results indicate a good biocompatibility for a nickel content up to about 50%. The cells used in the biocompatibility studies comprised osteoblast-like osteosarcoma cells (SAOS-2, MG-63), primary human osteoblasts (HOB), and murine fibroblasts (3T3).

Bone modeling controlled by a nickel-titanium shape memory alloy intramedullary nail

Nitinol (NiTi) shape memory metal alloy makes it possible to prepare functional implants that apply a continuous bending force to the bone. The purpose of this study was to find out if bone modeling can be controlled with a functional intramedullary NiTi nail. Pre-shaped intramedullary NiTi nails (length 26 mm, thickness 1.0-1.4 mm) with a curvature radius of 25-37 mm were implanted in the cooled martensite form in the medullary cavity of the right femur in eight rats, where they restored their austenite form, causing a bending force. After 12 weeks, the operated femurs were compared with their non-operated contralateral counterpairs. Anteroposterior radiographs demonstrated significant bowing, as indicated by the angle between the distal articular surface and the long axis of the femur (p = 0.003). Significant retardation of longitudinal growth and thickening of operated femurs were also seen. Quantitative densitometry showed a significant increase in the average cross-sectional cortical area (p = 0.001) and cortical thickness (p = 0.002), which were most obvious in the mid-diaphyseal area. Cortical bone mineral density increased in the proximal part of the bone and decreased in the distal part. Polarized light microscopy of the histological samples revealed that the new bone induced by the functional intramedullary nail was mainly woven bone. In conclusion, this study showed that bone modeling can be controlled with a functional intramedullary nail made of nickel-titanium shape memory alloy.

Effect of nickel-titanium shape memory metal alloy on bone formation

The aim of this study was to determine the biocompatibility of NiTi alloy on bone formation in vivo. For this purpose we used ectopic bone formation assay which goes through all the events of bone formation and calcification. Comparisons were made between Nitinol (NiTi), stainless steel (Stst) and titanium-aluminium (6%)-vanadium (4%) alloy (Ti-6Al-4V), which were implanted for 8 weeks under the fascia of the latissimus dorsi muscle in 3-month-old rats. A light-microscopic examination showed no chronic inflammatory or other pathological findings in the induced ossicle or its capsule. New bone replaced part of the decalcified matrix with mineralized new cartilage and bone. The mineral density was measured with peripheral quantitative computed tomography (pQCT). The total bone mineral density (BMD) values were nearly equal between the control and the NiTi samples, the Stst samples and the Ti-6Al-4V samples had lower BMDs. Digital image analysis was used to measure the combined area of new fibrotic tissue and original implanted bone matrix powder around the implants. There were no significant differences between the implanted materials, although Ti-6Al-4V showed the largest matrix powder areas. The same method was used for measurements of proportional cartilage and new bone areas in the ossicles. NiTi showed the largest cartilage area (p < or = 0.05). Between implant groups the new bone area was largest in NiTi. We conclude that NiTi has good biocompatibility, as its effects on ectopic bone formation are similar to those of Stst, and that the ectopic bone formation assay developed here can be used for biocompatibility studies.