In vivo evaluation of a high-strength, high-ductility stainless steel for use in surgical implants

A review on manufacturing processes of cobalt-chromium alloy implants and its impact on corrosion resistance and biocompatibility

Cobalt-Chromium (CoCr) alloys are currently used for various cardiovascular, orthopedic, fracture fixation, and dental implants. A variety of processes such as casting, forging, wrought processing, hot isostatic pressing, metal injection molding, milling, selective laser melting, and electron beam melting are used in the manufacture of CoCr alloy implants. The microstructure and precipitates (carbides, nitrides, carbonitrides, and intermetallic compounds) formed within the alloy are primarily determined by the type of manufacturing process employed. Although the effects of microstructure and precipitates on the physical and mechanical properties of CoCr alloys are well reviewed and documented in the literature, the effects on corrosion resistance and biocompatibility are not comprehensively reviewed. This article reviews the various processes used to manufacture CoCr alloy implants and discusses the effects of manufacturing processes on corrosion resistance and biocompatibility. This review concludes that the microstructure and precipitates formed in the alloy are unique to the manufacturing process employed and have a significant impact on the corrosion resistance and biocompatibility of CoCr alloys. Additionally, a historical and scientific overview of corrosion and biocompatibility for metallic implants is included in this review. Specifically, the failure of CoCr alloys when used in metal-on-metal bearing surfaces of total hip replacements is highlighted. It is recommended that the type of implant/application (orthopedic, dental, cardiovascular, etc.) should be the first and foremost factor to be considered when selecting biomaterials for medical device development.

Novel Method for the Production of Titanium Foams to Reduce Stress Shielding in Implants

Titanium foams have potential applications in orthopedic and dental implants because of their low elastic modulus and good bone in-growth properties. In the present study, a novel method for the preparation of three-dimensional interconnected microporous titanium foams has been developed. This method is based on the insertion of a filler metal into the titanium metal by arc melting, followed by its removal by an electrochemical dealloying process for the development of foams. Complete removal of the filler metal by the electrochemical dealloying process was confirmed by an X-ray diffractometry (XRD) analysis, whereas scanning electron microscopy (SEM) analysis of the developed foams showed the development of interconnected porosity. Ti foams with different levels of porosities were successfully developed by varying the amount of the filler metal. Mechanical and thermal characterizations of the developed foams were carried out using compression testing and laser flash apparatus, respectively. The yield strength and elastic modulus of the developed foams were found to decrease by increasing the volume fraction of pores. The elastic modulus of the developed titanium foams (15.5-36 GPa) was found to be closer to that of human bones, whereas their yield strength (147-170 MPa) remained higher than that of human bones. It is therefore believed that the developed Ti foams can help in reducing the problem of stress shielding observed in orthopedic implants. The thermal diffusivity of the developed foams (4.3-0.69 mm²/s) was found to be very close to that of human dentine.

Delivering an Immunocastration Vaccine via a Novel Subcutaneous Implant

Immunocastration relies on the vaccine-mediated stimulation of an immune response to gonadotropin-releasing hormone (GnRH) in order to interrupt spermatogenesis. This approach offers a less painful alternative to traditional castration approaches but the current, commercially available options require multiple doses of vaccine to maintain sterility. Thus, a series of pilot studies were conducted to determine the feasibility of a single-dose immunocastration vaccine implant. These five studies utilized a total of 44 Holstein bulls to determine the optimal vaccine composition and validate the ability of a stainless-steel subcutaneous implant to deliver a vaccine. Outcome measures included the duration of implant retention, scrotal dimensions and temperature, implant site temperature, anti-GnRH antibodies, and serum testosterone concentration. Over the course of several studies, anti-GnRH antibodies were successfully stimulated by vaccine implants. No significant treatment effects on scrotal dimensions or testosterone were detected over time, but changes in spermatogenesis were detected across treatment groups. Results indicate that a single-dose implantable immunocastration vaccine elicits a humoral immune response and could impact spermatogenesis in bulls. These findings provide opportunities for the refinement of this technology to improve implant retention over longer periods of time. Taken together, this approach will offer producers and veterinarians an alternative to physical castration methods, to improve animal welfare during routine livestock management procedures.

Angle-stable interlocking nailing in a canine critical-sized femoral defect model for bone regeneration studies: In pursuit of the principle of the 3R’s

Introduction: Critical-sized long bone defects represent a major therapeutic challenge and current treatment strategies are not without complication. Tissue engineering holds much promise for these debilitating injuries; however, these strategies often fail to successfully translate from rodent studies to the clinical setting. The dog represents a strong model for translational orthopedic studies, however such studies should be optimized in pursuit of the Principle of the 3R’s of animal research (replace, reduce, refine). The objective of this study was to refine a canine critical-sized femoral defect model using an angle-stable interlocking nail (AS-ILN) and reduce total animal numbers by performing imaging, biomechanics, and histology on the same cohort of dogs.

Methods: Six skeletally mature hounds underwent a 4 cm mid-diaphyseal femoral ostectomy followed by stabilization with an AS-ILN. Dogs were assigned to autograft (n = 3) or negative control (n = 3) treatment groups. At 6, 12, and 18 weeks, healing was quantified by ordinal radiographic scoring and quantified CT. After euthanasia, femurs from the autograft group were mechanically evaluated using an established torsional loading protocol. Femurs were subsequently assessed histologically.

Results: Surgery was performed without complication and the AS-ILN provided appropriate fixation for the duration of the study. Dogs assigned to the autograft group achieved radiographic union by 12 weeks, whereas the negative control group experienced non-union. At 18 weeks, median bone and soft tissue callus volume were 9,001 mm³ (range: 4,939–10,061) for the autograft group and 3,469 mm³ (range: 3,085–3,854) for the negative control group. Median torsional stiffness for the operated, autograft treatment group was 0.19 Nm/° (range: 0.19–1.67) and torque at failure was 12.0 Nm (range: 1.7–14.0). Histologically, callus formation and associated endochondral ossification were identified in the autograft treatment group, whereas fibrovascular tissue occupied the critical-sized defect in negative controls.

Conclusion: In a canine critical-sized defect model, the AS-ILN and described outcome measures allowed refinement and reduction consistent with the Principle of the 3R’s of ethical animal research. This model is well-suited for future canine translational bone tissue engineering studies.

Materials for Orthopedic Bioimplants: Modulating Degradation and Surface Modification Using Integrated Nanomaterials

Significant research and development in the field of biomedical implants has evoked the scope to treat a broad range of orthopedic ailments that include fracture fixation, total bone replacement, joint arthrodesis, dental screws, and others. Importantly, the success of a bioimplant depends not only upon its bulk properties, but also on its surface properties that influence its interaction with the host tissue. Various approaches of surface modification such as coating of nanomaterial have been employed to enhance antibacterial activities of a bioimplant. The modified surface facilitates directed modulation of the host cellular behavior and grafting of cell-binding peptides, extracellular matrix (ECM) proteins, and growth factors to further improve host acceptance of a bioimplant. These strategies showed promising results in orthopedics, e.g., improved bone repair and regeneration. However, the choice of materials, especially considering their degradation behavior and surface properties, plays a key role in long-term reliability and performance of bioimplants. Metallic biomaterials have evolved largely in terms of their bulk and surface properties including nano-structuring with nanomaterials to meet the requirements of new generation orthopedic bioimplants. In this review, we have discussed metals and metal alloys commonly used for manufacturing different orthopedic bioimplants and the biotic as well as abiotic factors affecting the failure and degradation of those bioimplants. The review also highlights the currently available nanomaterial-based surface modification technologies to augment the function and performance of these metallic bioimplants in a clinical setting.

A fatigue life analysis of small fragment screws

OBJECTIVES

To conduct a comparative fatigue analysis of several commonly used small fragment screws.

DESIGN

Biomechanical laboratory study.

SETTING

Research laboratory.

MAIN OUTCOME MEASUREMENTS

A fatigue life analysis of seven different types of small fragment screws was conducted using a Wohler fatigue-testing machine. Four different types of 3.5-millimeter cortical screws were subjected to fatigue analysis. These included solid stainless steel screws from Synthes Ltd. (core diameter 2.4 millimeters), Zimmer Inc. (core diameter 2.4 millimeter), and Smith and Nephew Richards Inc. (core diameter 2.4 millimeters) and cannulated stainless steel screws from Synthes Ltd. (core diameter 2.5 millimeters). In addition, three types of 4.0-millimeter cancellous screws were tested. These included stainless steel screws from Synthes Ltd. (core diameter 1.9 millimeters), titanium screws from Synthes Ltd. (core diameter 2.0 millimeters), and titanium alloy screws from DePuy-Ace (core diameter 2.8 millimeters). Fatigue lives, as reflected by mean cycles to failure, were compared.

RESULTS

The four types of cortical screws had longer fatigue lives than the Synthes cancellous screws did ( p < 0.001) but shorter fatigue lives than the DePuy-Ace cancellous screws did ( p < 0.0001). Among the cortical screws, the cannulated and solid Synthes screws and the solid Zimmer screws did not differ statistically. The Smith and Nephew Richards cortical screws failed at statistically fewer cycles than the Synthes solid and cannulated cortical screws did ( p < 0.003) but did not statistically differ from the Zimmer screws. The DePuy-Ace titanium alloy cancellous screw had the longest fatigue life of the tested implants by a large margin ( p < 0.0001). The Synthes pure titanium and stainless steel cancellous screws did not significantly differ.

CONCLUSIONS

This analysis supports core diameter as the principal factor determining fatigue life as the results paralleled implant geometry. This design modification to improve bending and fatigue strength may come at a price to pullout strength, however, because of a decreased major-to-minor diameter and increased pitch. Cortical screws differed in fatigue performance despite identical dimensions, presumably highlighting the importance of implant processing and machining. Cannulated cortical screws performed well relative to solid screws, thereby supporting their clinical use. Pure titanium and stainless steel cancellous screws performed similarly in fatigue despite differing material properties, presumably because of geometric design differences. This report highlights some of the differences in the in vitro fatigue performance among several commonly used small fragment screws.

Fatigue failure of cortical bone screws

An experimental study of the fatigue life of cortical bone screws under conditions which stimulated in vivo usage was performed. The two most important factors influencing fatigue life were axial screw tension (the force normal of the plate to bone) and the cyclic shearing load. All screws failed at the root of the thread in the interface between the plate and the bone. A modified screw design effectively resisted fatigue under the described experimental conditions.