Surface characteristics, biocompatibility, and mechanical properties of nickel-titanium plasma-implanted with nitrogen at different implantation voltages

Contactless treatment for scoliosis by electromagnetically controlled shape-memory alloy rods: a preliminary study in rabbits

PURPOSE

To evaluate the safety and efficacy of a system aiming to correct scoliosis called "electromagnetically controlled shape-memory alloy rods" (EC-SMAR) used in a rabbit model.

METHODS

We heat-treated shape-memory alloy (SMA) rods to achieve a transition temperature between 34 and 47 °C and a C-shape austenite phase. We then developed a water-cooled generator capable of generating an alternating magnetic field (100 kHz) for induction heating. We next studied the efficacy of this system in vitro and determined some parameters prior to proceeding with animal experiments. We then employed a rabbit model, in which we fixed a straight rod along the spinous processes intraoperatively, and conducted induction heating postoperatively every 4 days for 1 month, while performing periodic X-ray assessments.

RESULTS

Significant kyphotic deformations with Cobb angles of about 45° (p < 0.01) were created in five rabbits, and no complications occurred throughout the experiment. The rabbits are still very much alive and do not show any signs of discomfort.

CONCLUSIONS

This is the first system that can modulate spinal deformation in a gradual, contactless, noninvasive manner through electromagnetic induction heating applied to SMA alloy rods. Although this study dealt with healthy spines, it provides promising evidence that this device also has the capacity to correct human kyphosis and even scoliosis in the future. These slides can be retrieved under Electronic Supplementary Material.

Ion Release and Surface Characterization of Nanostructured Nitinol during Long-Term Testing

The corrosion resistance of nanostructured nitinol (NiTi) was investigated using long-term tests in solutions simulating physiological fluids at static conditions, reflecting the material structure and metal concentration in the solutions. Mechanical polishing reduced the ion release by a factor of two to three, whereas annealing deteriorated the corrosion resistance. The depassivation and repassivation of nitinol surfaces were considered. We found that nanostructured nitinol might increase the corrosion leaching of titanium into solutions, although the nickel release decreased. Metal dissolution did not occur in the alkaline environment or artificial plasma. A Ni-free surface with a protective 25 nm-thick titanium oxide film resulted from soaking mechanically treated samples of the NiTi wire in a saline solution for two years under static conditions. Hence, the medical application of nanostructured NiTi, such as for the production of medical devices and implants such as stents, shows potential compared with microstructured NiTi.

A randomized double-blinded clinical trial to evaluate the safety and efficacy of a novel superelastic nickel-titanium spinal rod in adolescent idiopathic scoliosis: 5-year follow-up

PURPOSE

To evaluate the safety and efficacy of a superelastic shape-memory alloy (SNT) rod used in the treatment of adolescent idiopathic scoliosis (AIS).

METHODS

AIS Patients with Lenke 1 curves undergoing fusion surgery were randomized (1:1) at the time of surgery to receive either the SNT or a conventional titanium alloy (CTA) rod. Radiographs were obtained preoperatively and postoperatively up to 5 years of follow-up. Parameters assessed included coronal and sagittal Cobb angles, and overall truncal and shoulder balance. Sagittal profiles were subcategorized into Types A (<20°), B (20-40°), and C (>40°).

RESULTS

Twenty-four patients with mean age of 15 years were recruited. A total of 87.0% of subjects were followed up till postoperative 5 years, but all patients had minimum 2 years of follow-up. The fulcrum-bending correction index for the SNT group was 113% at postoperative day 4 and 127% at half-year, while the CTA group was 112% at postoperative day 4 and only 106% at half-year. In terms of sagittal profile, the SNT group moved toward type B profile at half-year follow-up with a mean correction of 7.6°, while no significant change was observed in the CTA group (-0.7°). Nickel levels remained normal, and there were no complications.

CONCLUSIONS

This is the first randomized clinical trial of a novel SNT rod for treating patients with AIS, noting it to be safe and has potential to gradually correct scoliosis over time. This study serves as a pilot and platform to properly power future large-scale studies to demonstrate efficacy and superiority.

Biocompatibility and Inflammatory Potential of Titanium Alloys Cultivated with Human Osteoblasts, Fibroblasts and Macrophages

The biomaterials used to maintain or replace functions in the human body consist mainly of metals, ceramics or polymers. In orthopedic surgery, metallic materials, especially titanium and its alloys, are the most common, due to their excellent mechanical properties, corrosion resistance, and biocompatibility. Aside from the established Ti6Al4V alloy, shape memory materials such as nickel-titanium (NiTi) have risen in importance, but are also discussed because of the adverse effects of nickel ions. These might be reduced by specific surface modifications. In the present in vitro study, the osteoblastic cell line MG-63 as well as primary human osteoblasts, fibroblasts, and macrophages were cultured on titanium alloys (forged Ti6Al4V, additive manufactured Ti6Al4V, NiTi, and Diamond-Like-Carbon (DLC)-coated NiTi) to verify their specific biocompatibility and inflammatory potential. Additive manufactured Ti6Al4V and NiTi revealed the highest levels of metabolic cell activity. DLC-coated NiTi appeared as a suitable surface for cell growth, showing the highest collagen production. None of the implant materials caused a strong inflammatory response. In general, no distinct cell-specific response could be observed for the materials and surface coating used. In summary, all tested titanium alloys seem to be biologically appropriate for application in orthopedic surgery.

Development of Biomimetic NiTi Alloy: Influence of Thermo-Chemical Treatment on the Physical, Mechanical and Biological Behavior

A bioactive layer, free of nickel, has been performed for its greater acceptability and reliability in clinical applications for NiTi shape memory alloys. In the first step, a safe barrier against Ni release has been produced on the surface by means of a thicker rutile/anastase protective layer free of nickel. In the second step, a sodium alkaline titanate hydrogel, which has the ability to induce apatite formation, has been performed from oxidized surface. An improvement of host tissue–implant integration has been achieved in terms of Ni ions release and the bioactivity of the treated NiTi alloys has been corroborated with both in vitro and in vivo studies. The transformation temperatures (A_s, A_f, M_s, and M_f), as well as the critical stresses (σ^β⇔M), have been slightly changed due to this surface modification. Consequently, this fact must be taken into account in order to design new surface modification on NiTi implants.

Wear mechanism and tribological characteristics of porous NiTi shape memory alloy for bone scaffold

The abraded debris might cause osteocytic osteolysis on the interface between implants and bone tissues, thus inducing the subsequent mobilization of implants gradually and finally resulting in the failure of bone implants, which imposes restrictions on the applications of porous NiTi shape memory alloys (SMAs) scaffolds for bone tissue engineering. In this work, the effects of the annealing temperature, applied load, and porosity on the tribological behavior and wear resistance of three-dimensional porous NiTi SMA are investigated systematically. The porous structure and phase transformation during the exothermic process affect the tribological properties and wear mechanism significantly. In general, a larger porosity leads to better tribological resistance but sometimes, SMAs with small porosity possess better wear resistance than ones with higher porosity during the initial sliding stage. It can be ascribed to the better superelasticity of the former at the test temperature. The porous NiTi phase during the exothermic reaction also plays an important role in the wear resistance. Generally, porous NiTi has smaller friction coefficients under high loads due to stress-induced superelasticity. The wear mechanism is discussed based on plastic deformation and microcrack propagation.

Effects of carbon and nitrogen plasma immersion ion implantation on in vitro and in vivo biocompatibility of titanium alloy

Growth of bony tissues on titanium biomedical implants can be time-consuming, thereby prolonging recovery and hospitalization after surgery and a method to improve and expedite tissue-implant integration and healing is thus of scientific and clinical interests. In this work, nitrogen and carbon plasma immersion ion implantation (N-PIII and C-PIII) is conducted to modify Ti-6Al-4V to produce a graded surface layer composed of TiN and TiC, respectively. Both PIII processes do not significantly alter the surface hydrophilicity but increase the surface roughness and corrosion resistance. In vitro studies disclose improved cell adhesion and proliferation of MC3T3-E1 preosteoblasts and L929 fibroblasts after PIII. Micro-CT evaluation conducted 1 to 12 weeks after surgery reveals larger average bone volumes and less bone resorption on the N-PIII and C-PIII titanium alloy pins than the unimplanted one at every time point. The enhancements observed from both the in vitro and in vivo studies can be attributed to the good cytocompatibility, roughness, and corrosion resistance of the TiN and TiC structures which stimulate the response of preosteoblasts and fibroblasts and induce early bone formation. Comparing the two PIII processes, N-PIII is more effective and our results suggest a simple and practical means to improve the surface biocompatibility of medical-grade titanium alloy implants.

Copper and silver ion implantation of aluminium oxide-blasted titanium surfaces: proliferative response of osteoblasts and antibacterial effects

Implant infection still represents a major clinical problem in orthopedic surgery. We therefore tested the in vitro biocompatibility and antibacterial effects of copper (Cu)- and silver (Ag)-ion implantation. Discs of a commonly used titanium alloy (Ti6AlV4) with an aluminium oxide-blasted surface were treated by Cu- or Ag-ion implantation with different dosage regimen (ranging from 1e15-17 ions cm(-2) at energies of 2-20 keV). The samples were seeded with primary human osteoblasts and cell attachment and proliferation was analyzed by an MTT-assay. In comparison to the reference titanium alloy there was no difference in the number of attached viable cells after two days. After seven days the number of viable cells was increased for Cu with 1e17 ions cm(-2) at 2 and 5 keV, and for Ag with 1e16 ions cm(-2) at 5 keV while it was reduced for the highest amount of Ag deposition (1e17 ions cm(-2) at 20 keV). Antibacterial effects on S.aureus and E.coli were marginal for the studied dosages of Cu but clearly present for Ag with 1e16 ions cm(-2) at 2 and 5 keV and 1e17 ions cm(-2) at 20 keV. These results indicate that Ag-ion implantation may be a promising methodological approach for antibacterial functionalization of titanium implants.

Cytocompatibility of medical biomaterials containing nickel by osteoblasts: a systematic literature review

The present review is based on a survey of 21 studies on the cytocompatibility of medical biomaterials containing nickel, as assessed by cell culture of human and animal osteoblasts or osteoblast-like cells. Among the biomaterials evaluated were stainless steel, NiTi alloys, pure Ni, Ti, and other pure metals. The materials were either commercially available, prepared by the authors, or implanted by various techniques to generate a protective layer of oxides, nitrides, acetylides. The observation that the layers significantly reduced the initial release of metal ions and increased cytocompatibility was confirmed in cell culture experiments. Physical and chemical characterization of the materials was performed. This included, e.g., surface characterization (roughness, wettability, corrosion behavior, quantity of released ions, microhardness, and characterization of passivation layer). Cytocompatibility tests of the materials were conducted in the cultures of human or animal osteoblasts and osteoblast-like cells. The following assays were carried out: cell proliferation and viability test, adhesion test, morphology (by fluorescent microscopy or SEM). Also phenotypic and genotypic markers were investigated. In the majority of works, it was found that the most cytocompatible materials were stainless steel and NiTi alloy. Pure Ni was rendered and less cytocompatible. All the papers confirmed that the consequence of the formation of protective layers was in significant increase of cytocompatibility of the materials. This indicates the possible further modifications of the manufacturing process (formation of the passivation layer).

Effect of nitride film coatings on cell compatibility

OBJECTIVE

To evaluate the cytotoxicity of nickel-based alloy surfaces after nitride film coatings.

METHODS

A total of 120 disc-shaped specimens (1.5 x 12.0mm) were prepared from nickel (Ni) alloy ingots and metallurgically ground with silicon carbide (SiC) sandpaper to 1200 grit and used as the ground group. Ninety specimens from the ground group were selected and further polished with 1.0 microm aluminum powder slurry and assigned as the polished group. Titanium nitride (TiN) and titanium-aluminum nitride (TiAlN) film coatings were deposited onto 30 polished specimens each by a reactive radio frequency magnetron sputter deposition system and used as coated groups, respectively. The morphological changes and cytoskeleton of tested human gingival fibroblasts were observed using fluorescence microscopy at 3h and 24h time periods, respectively. An MTT assay was used to assess cell viability at 24h. The results were statistically analyzed (n=5, ANOVA, Scheffe', p<0.05).

RESULTS

After 3h of incubation, cells began to spread on the test surfaces. Spindle-shaped fibroblasts with well-developed cytoskeleton and distinct actin fibers were observed at the 24h incubation point on the polished and coated specimens. Results of the MTT assay revealed that the TiN and TiAlN film coated groups were significantly higher in cell proliferation and viability than the polished and control groups (p<0.05).

SIGNIFICANCE

The biocompatibility of Ni-based alloy was increased significantly after nitride film coating.