Effects of reinforcements and gamma‐irradiation on wear performance of ultra‐high molecular weight polyethylene as acetabular cup liner in hip‐joint arthroplasty: A review

Current nanocomposite advances for biomedical and environmental application diversity

Nanocomposite materials are emerging as key players in addressing critical challenges in healthcare, energy storage, and environmental remediation. These innovative systems hold great promise in engineering effective solutions for complex problems. Nanocomposites have demonstrated various advantages such as simplicity, versatility, lightweight, and potential cost-effectiveness. By reinforcing synthetic and natural polymers with nanomaterials, a range of nanocomposites have exhibited unique physicochemical properties, biocompatibility, and biodegradability. Current research on nanocomposites has demonstrated promising clinical and translational applications. Over the past decade, the production of nanocomposites has emerged as a critical nano-structuring methodology due to their adaptability and controllable surface structure. This comprehensive review article systematically addresses two principal domains. A comprehensive survey of metallic and nonmetallic nanomaterials (nanofillers), elucidating their efficacy as reinforcing agents in polymeric matrices. Emphasis is placed on the methodical design and engineering principles governing the development of functional nanocomposites. Additionally, the review provides an exhaustive examination of recent noteworthy advancements in industrial, environmental, biomedical, and clinical applications within the realms of nanocomposite materials. Finally, the review concludes by highlighting the ongoing challenges facing nanocomposites in a wide range of applications.

Mangiferin- and GNPs/ECPP-loaded platform of UH with dual bi-directional dynamic modulation of stem cells/macrophages and osteoblasts/osteoclasts for the prevention of aseptic loosening

Aseptic inflammation and osteolysis triggered by the phagocytosis of implant wear particles by macrophages are important reasons for aseptic loosening (AL) in total joint replacement, which ultimately leads to implant failure. Therefore, the development of implants with long-term effectiveness in preventing AL is a pressing issue. In contrast to the conventional idea of reducing the occurrence of AL through anti-inflammatory treatment, we prepared implants based on a novel concept: to prevent AL by returning the dynamic balance of osteogenesis/osteolysis through dynamic modulation, which is expected to completely resolve the problem of AL. In this study, a natural polyphenol, mangiferin (MAN), and a composite filler (GNPs/ECPP) were loaded into ultrahigh-molecular-weight polyethylene (UH) to construct a hip implant component with the ability to prevent AL. This modified implant was able to improve the oxidation resistance and wear resistance of implants, which could reduce the production of wear particles, recruit BMSCs as well as promote their proliferation/osteogenic differentiation and inhibit macrophage activity and RANKL-induced macrophage osteoclast differentiation in vitro. These effects suggest that this modified implant has achieved the dual bi-directional dynamic modulation of stem cells/macrophages and osteoblasts/osteoclasts for the prevention of aseptic loosening. Notably, in vivo experiments for implantation of wear-particle-coated titanium rods demonstrated that wear particles from the prepared implant significantly promoted the osseointegration capacity of implanted prosthesis (titanium rod) and effectively inhibited peri-prosthesis osteolysis. This work provides a new concept and presents a promising way for the development of durable implant components with long-term protection against AL.

Nanoscale Surface Refinement of CoCrMo Alloy for Artificial Knee Joints via Chemical Mechanical Polishing

In this study, we address the challenge of surface roughness in CoCrMo alloys, typically used in artificial knee joints, which can initiate a cascade of biological responses causing inflammation, osteolysis, joint instability, and increased susceptibility to infection. We propose the application of a chemical mechanical polishing (CMP) technique, using an ecologically responsible slurry composed of 4 wt% SiO2, 0.3 wt% H2O2, 1.0 wt% glycine, and 0.05 wt% benzotriazole. Our innovative approach demonstrated significant improvements, achieving a material removal rate of 30.9 nm/min and reducing the arithmetic mean roughness from 20.76 nm to 0.25 nm, thereby enhancing the nanoscale surface quality of the artificial knee joint alloy. The smoother surface is attributed to a decrease in corrosion potential to 0.18 V and a reduction in corrosion current density from 9.55 µA/cm2 to 4.49 µA/cm2 with the addition of BTA, evidenced by electrochemical tests. Furthermore, the preservation of the phase structure of the CoCrMo alloy, as confirmed by XRD analysis and elemental mapping, ensures the structural integrity of the treated surfaces. These outcomes and our simulation results demonstrate the effectiveness of our CMP method in engineering surface treatments for artificial knee joints to optimize friction behavior and potentially extend their lifespans.

Multi-length scale strengthening and cytocompatibility of ultra high molecular weight polyethylene bio-composites by functionalized carbon nanotube and hydroxyapatite reinforcement

The mechanical properties, such as hardness and elastic modulus, of ultra-high molecular weight polyethylene (UHMWPE) composites for acetabular cup liner are improved by adding hydroxyapatite (HAp) and carbon nanotubes (CNT). However, the weak adhesion of HAp (H) and CNT (C) with UHMWPE (U) limits the enhancement of mechanical properties. Thus, the surface of these reinforcements is silane-treated to improve the adhesion with polymer via Si-O and C=O bonds, as evidenced from spectroscopy techniques. An increased dispersion and interfacial adhesion of functionalized HAp (fH) and CNT (fC) with the polymer matrix is confirmed by nearly two-fold increased reinforcement fraction (R_f: 0.55) of U-10 wt% fHAp-2 wt.% fCNT (U10fH2fC) in comparison to U-10 wt% HAp-2 wt.% CNT (U10H2C). Additionally, Voronoi Tessellation (VT) on SEM micrographs of U10H2C and U10fH2fC revealed the dispersion of functionalized CNTs in U10fH2fC with a center-to-center distance of 0.076 μm, which is 74% higher for unfunctionalized CNT in U10H2C. The multilength scale strengthening of the UHMWPE matrix is confirmed from atomic level modification via functionalization of fillers which effectively adhered to the polymer chain on a micro-scale level. A uniform distribution of CNTs rendered increased crystallinity (+28%) of U10fH2fC, which in turn resulted in significant improvement in bulk mechanical properties (18%, 49%, and 12% increased hardness (148.1 MPa), elastic modulus (3.51 GPa) and tensile elastic modulus (219.8 MPa), respectively) in comparison to that of U10H2C. Functionalized-HAp/CNT reinforced UHMWPE composites maintained its cytocompatibility in the MTT test and fluorescence microscopy, affirming their potential employment as acetabular cup liners for hip joint arthroplasty.

Contact stress and sliding wear damage tolerance of hydroxyapatite and carbon nanotube reinforced polyethylene cup liner against zirconia femoral head

A finite element modeling (FEM) approach is carried out to estimate the contact stresses such as von-Mises and shear stress on the acetabular cup liner, made up of ultra-high molecular weight polyethylene (UHMWPE)-hydroxyapatite (HAp)-carbon nanotubes (CNT) based composites. The highlights of this work include the effects of liners' material (UHMWPE-HAp-CNT composites), radial clearance (0.05 to 1 mm), and liners' wall thickness (3 to 8 mm) on contact stresses. The thick liner (thickness: 8 mm) with conformal geometry (radial clearance 0.05 mm) produced the lowest contact stresses (von-Mises: 13.8-17.5 MPa and shear stress: 2.3-3.3 MPa). In contrast, the thin liner (thickness: 3 mm) with higher radial clearance (1 mm) showed the highest von-Mises stress (78.6-131.0 MPa) and shear stress (17.0-23.3 MPa). According to ISO 7206-1, nearly 6-7 times reduced contact stresses were observed because of the wider articulating contact area provided by thick cup liner and its conformity with respect to the femoral head. The UHMWPE-2 wt % CNT composite (UC) showed low von-Mises stress (16.1 MPa) and lowest shear stress (2.3 MPa); thus, it is the most damage tolerant material (wear rate: 2.6 × 10-7 mm3/Nm). The excellent mechanical properties such as hardness (165 MPa), elastic modulus (2.28 GPa), and tensile strength (36.7 MPa) are reasoned to elicit an increased sliding-wear resistance of UC. Thus, CNT-based UHMWPE composite can be the potential acetabular cup liner with a thickness of 8 mm and clearance of 0.05 mm without plastic deformation.

Preliminary tribological results of a new total temporary hip joint prosthesis spacer

Temporary antibiotic-loaded cement spacers are widely used for treating chronic periprosthetic hip infections. The aim of this study is to evaluate the short-term tribological performance of ultra-high-molecular-weight polyethylene (UHMWPE) and (60Co) gamma-irradiated cross-linked UHMWPE (XLPE) self-mated systems as frictional pairs for temporary total hip spacers. A three-axial hip joint simulator, FIME II, was used to test the UHMWPE and XLPE self-mated systems under variable load profiles. A fetal bovine serum solution was used as a lubricant. After simulation tests, wear measurements of damaged coupled surfaces were made with a coordinate measuring machine. Finally, surfaces were characterized with scanning electron microscopy, Raman spectroscopy, Fourier transform infrared spectroscopy, and nanoindentation tests. The mass loss test results for UHMWPE were 11.91 ± 3.43 mg for the cups and 4.57 ± 0.92 mg for the heads. Whereas, the results for XLPE showed a significant reduction, with mean mass loss values of 6.59 ± 0.14 mg for the cups and 2.82 ± 0.59 mg for the heads, suggesting the viability of the self-mated XLPE contact pair for a temporary total hip spacer.

Influence of crystallinity on wear behavior of ultrahigh molecular weight polyethylene and the wear mechanism

In this paper, the crystallinity (X c) of ultra-high molecular weight polyethylene (UHMWPE) parts was adjusted within a wide range from 40 to 60%, and the influence of X c on wear performance and its relevant mechanism were surveyed. The volume wear rate of UHMWPE parts continuously decreased with increasing X c. Structural characterization revealed that the closely packing crystalline structure composed of high X c and large-size lamellae improves resistance to plastic deformation, which is responsible for excellent anti-wear performance. The efficiency of improving the wear resistance by high X c is comparable with the traditional method of irradiation-induced crosslink. But the latter may severely harm the anti-oxidation capacity. So, increasing X c is a promising candidate to develop high-performance UHMWPE materials with superior wear resistance.

Multifunctional Hydroxyapatite Composites for Orthopedic Applications: A Review

Being a bioactive material, hydroxyapatite (HAp) is regarded as one of the most attractive ceramic biomaterials for bone and hard-tissue replacement and regeneration. Despite its substantial biocompatibility, osteoconductivity, and compositional similarity to that of bone, the employment of HAp is still limited in orthopedic applications due to its poor mechanical (low fracture toughness and bending strength) and antibacterial properties. These significant challenges lead to the notion of developing novel HAp-based composites via different fabrication routes. HAp, when efficaciously combined with functionally graded materials and antibacterial agents, like Ag, ZnO, Co, etc., form composites that render remarkable crack resistance and toughening, as well as enhance its bactericidal efficacy. The addition of different materials and a fabrication method, like 3D printing, greatly influence the porosity of the structure and, in turn, control cell adhesion, thereby enabling biological fixation of the material. This article encompasses an elaborate discussion on different multifunctional HAp composites developed for orthopedic applications with particular emphasis on the incorporation of functionally graded materials and antibacterial agents. The influence of 3D printing on the fabrication of HAp-based scaffolds, and the different in vitro and in vivo studies conducted on these, have all been included here. Furthermore, the present review not only provides insights and broad understanding by elucidating recent advancements toward 4D printing but also directs the reader to future research directions in design and application of HAp-based composite coatings and scaffolds.