Biodegradable magnesium scaffolds: Part 1: appropriate inflammatory response

Effect of unsoluble corrosion products of WE43 alloys in vitro on macrophages

Magnesium alloys have been used to manufacture biodegradable implants, bone graft substitutes, and cardiovascular stents. WE43 was the most widely used magnesium alloy. The degradation process begins when the magnesium alloy stent is implanted in the body and comes into contact with body fluid. The degradation products include hydrogen, Mg2+ , local alkaline environment, and unsoluble products. A large number of studies focused on Mg2+ and pH in vitro, and in vivo of magnesium alloys, but few studies on unsoluble corrosion products (UCPs). In this study, UCPs of WE43 alloy were prepared by immersion in vitro, and their effects on macrophages were investigated. The results showed that the unsoluble corrosion products were Mg24Y5, Mg12YNd, and MgCO3 ·3H2 O, which were dose-dependent on the apoptosis and necrosis of macrophages. After phagocytosis of UCPs, macrophages mainly metabolize in lysosome, and autophagy also participates in the metabolism of UCPs. It also decreases mitochondrial membrane potential and increases lysosomes, endoplasmic reticulum stress, and P2X7 receptor activation. These will increase reactive oxygen species (ROS) in cells, activating NLRP3 inflammatory corpuscles, activating the downstream pro-IL18 and pro-IL1β, and converting it to IL-18, and IL-1β. However, its pro-inflammatory effect is far lower than that of the classical Lipopolysaccharide (LPS) pro-inflammatory pathway. This work has increased our understanding of magnesium alloy metabolism and provides new ideas for the clinical application of magnesium alloys.

Bone Regeneration Induced by Patient-Adapted Mg Alloy-Based Scaffolds for Bone Defects: Present and Future Perspectives

Treatment of bone defects resulting after tumor surgeries, accidents, or non-unions is an actual problem linked to morbidity and the necessity of a second surgery and often requires a critical healthcare cost. Although the surgical technique has changed in a modern way, the treatment outcome is still influenced by patient age, localization of the bone defect, associated comorbidities, the surgeon approach, and systemic disorders. Three-dimensional magnesium-based scaffolds are considered an important step because they can have precise bone defect geometry, high porosity grade, anatomical pore shape, and mechanical properties close to the human bone. In addition, magnesium has been proven in in vitro and in vivo studies to influence bone regeneration and new blood vessel formation positively. In this review paper, we describe the magnesium alloy's effect on bone regenerative processes, starting with a short description of magnesium's role in the bone healing process, host immune response modulation, and finishing with the primary biological mechanism of magnesium ions in angiogenesis and osteogenesis by presenting a detailed analysis based on a literature review. A strategy that must be followed when a patient-adapted scaffold dedicated to bone tissue engineering is proposed and the main fabrication technologies are combined, in some cases with artificial intelligence for Mg alloy scaffolds, are presented with examples. We emphasized the microstructure, mechanical properties, corrosion behavior, and biocompatibility of each study and made a basis for the researchers who want to start to apply the regenerative potential of magnesium-based scaffolds in clinical practice. Challenges, future directions, and special potential clinical applications such as osteosarcoma and persistent infection treatment are present at the end of our review paper.

Forged to heal: The role of metallic cellular solids in bone tissue engineering

Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.

Bio-Resorption Control of Magnesium Alloy AZ31 Coated with High and Low Molecular Weight Polyethylene Oxide (PEO) Hydrogels

Magnesium AZ31 alloy has been chosen as bio-resorbable temporary prosthetic implants to investigate the degradation processes in a simulating body fluid (SBF) of the bare metal and the ones coated with low and high-molecular-weight PEO hydrogels. Hydrogel coatings are proposed to control the bioresorption rate of AZ31 alloy. The alloy was preliminary hydrothermally treated to form a magnesium hydroxide layer. 2 mm discs were used in bioresorption tests. Scanning electron microscopy was used to characterize the surface morphology of the hydrothermally treated and PEO-coated magnesium alloy surfaces. The variation of pH and the mass of Mg2+ ions present in the SBF corroding medium have been monitored for 15 days. Corrosion current densities (Icorr) and corrosion potentials (Ecorr) were evaluated from potentiodynamic polarisation tests on the samples exposed to the SBF solution. Kinetics of cumulative Mg ions mass released in the corroding solution have been evaluated regarding cations diffusion and mass transport parameters. The initial corrosion rates for the H- and L-Mw PEO-coated specimens were similar (0.95 ± 0.12 and 1.82 ± 0.52 mg/cm2day, respectively) and almost 4 to 5 times slower than that of the uncoated system (6.08 mg/cm2day). Results showed that the highly swollen PEO hydrogel coatings may extend into the bulk solution, protecting the coated metal and efficiently controlling the degradation rate of magnesium alloys. These findings focus more research effort on investigating such systems as tunable bioresorbable prosthetic materials providing idoneous environments to support cells and bone tissue repair.

A detailed mechanism of degradation behaviour of biodegradable as-ECAPed Zn-0.8Mg-0.2Sr with emphasis on localized corrosion attack

In this study, advanced techniques such as atom probe tomography, atomic force microscopy, X-ray photoelectron spectroscopy, and electrochemical impedance spectroscopy were used to determine the corrosion mechanism of the as-ECAPed Zn-0.8Mg-0.2Sr alloy. The influence of microstructural and surface features on the corrosion mechanism was investigated. Despite its significance, the surface composition before exposure is often neglected by the scientific community. The analyses revealed the formation of thin ZnO, MgO, and MgCO₃ layers on the surface of the material before exposure. These layers participated in the formation of corrosion products, leading to the predominant occurrence of hydrozincite. In addition, the layers possessed different resistance to the environment, resulting in localized corrosion attacks. The segregation of Mg on the Zn grain boundaries with lower potential compared with the Zn-matrix was revealed by atom probe tomography and atomic force microscopy. The degradation process was initiated by the activity of micro-galvanic cells, specifically Zn - Mg₂Zn₁₁/SrZn₁₃. This process led to the activity of the crevice corrosion mechanism and subsequent attack to a depth of 250 μm. The corrosion rate of the alloy determined by the weight loss method was 0.36 mm·a^-1. Based on this detailed study, the degradation mechanism of the Zn-0.8Mg-0.2Sr alloy is proposed.

Bone tissue engineering for treating osteonecrosis of the femoral head

Osteonecrosis of the femoral head (ONFH) is a devastating and complicated disease with an unclear etiology. Femoral head-preserving surgeries have been devoted to delaying and hindering the collapse of the femoral head since their introduction in the last century. However, the isolated femoral head-preserving surgeries cannot prevent the natural progression of ONFH, and the combination of autogenous or allogeneic bone grafting often leads to many undesired complications. To tackle this dilemma, bone tissue engineering has been widely developed to compensate for the deficiencies of these surgeries. During the last decades, great progress has been made in ingenious bone tissue engineering for ONFH treatment. Herein, we comprehensively summarize the state-of-the-art progress made in bone tissue engineering for ONFH treatment. The definition, classification, etiology, diagnosis, and current treatments of ONFH are first described. Then, the recent progress in the development of various bone-repairing biomaterials, including bioceramics, natural polymers, synthetic polymers, and metals, for treating ONFH is presented. Thereafter, regenerative therapies for ONFH treatment are also discussed. Finally, we give some personal insights on the current challenges of these therapeutic strategies in the clinic and the future development of bone tissue engineering for ONFH treatment.

Investigation on mechanical properties of AZ31B magnesium alloy manufactured by stir casting process

- Nanocomposites of AZ31B with varying compositions of nano-hydroxyapatite and nano alumina were cast by the stir casting process. The primary goal of this research is to investigate and assess if it is feasible to fabricate magnesium metal matrix nano-composites (MMNCs) utilizing the stir casting process for biomedical applications. In this study AZ31B used as matrix and nano alumina (Al2O3) and nano hydroxyapatite (nHA) as a reinforcement. Due to its low weight as a structural metal and excellent strength-to-weight ratio, magnesium is commonly employed in engineering designs in addition to the development of composite materials. Mg alloys are widely used in biomedical due to their lower density. The Brinell hardness test was conducted to examine materials made by casting and forging processes that have a structure which is too coarse or rough for another test. It was observed that AZ31B-5nHa among the others has the highest hardness number. Compression tests were conducted to check the behavior of the MMNC under an applied load. AZ31B-0.5(Al2O3)-0.3nHa among the others has the highest compressive strength. It was observed that adding nHA reinforcement in AZ31B affects the microstructure and mechanical characteristics of a nanocomposite made of magnesium metal matrix, including compressive strength, hardness, corrosion resistance and biocompatibility. This study aims to investigate the effects of reinforcement on a magnesium metal matrix nanocomposite's microstructure and mechanical properties.

Immune response differences in degradable and non-degradable alloy implants

Alloy based implants have made a great impact in the clinic and in preclinical research. Immune responses are one of the major causes of failure of these implants in the clinic. Although the immune responses toward non-degradable alloy implants are well documented, there is a poor understanding of the immune responses against degradable alloy implants. Recently, there have been several reports suggesting that degradable implants may develop substantial immune responses. This phenomenon needs to be further studied in detail to make the case for the degradable implants to be utilized in clinics. Herein, we review these new recent reports suggesting the role of innate and potentially adaptive immune cells in inducing immune responses against degradable implants. First, we discussed immune responses to allergen components of non-degradable implants to give a better overview on differences in the immune response between non-degradable and degradable implants. Furthermore, we also provide potential areas of research that can be undertaken that may shed light on the local and global immune responses that are generated in response to degradable implants.

Mapping knowledge structure and themes trends of biodegradable Mg-based alloy for orthopedic application: A comprehensive bibliometric analysis

Background: Since Lambotte and Payr first studied Mg-based alloys for orthopedics in 1900, the research of this field has finally ushered in vigorous development in the 21st century. From the perspective of quantitative analysis, this paper clearly demonstrated the global research trend from 2005 to 2021 by using bibliometrics and scientometric analysis.

Methods: We obtained the publications from the Web of Science Core Collection (WoSCC) database. The bibliometric and scientometric analysis was conducted by using R software, CiteSpace software, VOSviewer software, Pajek software and Microsoft Excel program.

Results: In total, 1921 publications were retrieved. It can be found that the number of publications is gradually increasing year by year. We can find that the most prolific countrie, institution and researcher are China, Chinese Academy of Sciences and Zheng Yufeng, respectively. The most influential journals in this field are Acta Biomaterialia and Biomaterials, with 16,511 and 12,314 total citations, respectively. By conducting the co-cited documents-based clustering analysis, 16 research hotspots and their representative studies have been identified. Besides, by conducting analysis of keywords, we divided the keyword citation bursts representing the development of the field into three stages.

Conclusion: The number of researches on the biodegradable Mg-based alloys increased sharply all over the world in the 21st century. China has made significant progress in biodegradable Mg-based alloy research. More focus will be placed on osteogenic differentiation, fabrication, graphene oxide, antibacterial property, bioactive glass and nanocomposite, which may be the next popular topics in the field.

Biodegradable magnesium fixation screw for barrier membranes used in guided bone regeneration

An ideal fixation system for guided bone (GBR) regeneration in oral surgery must fulfil several criteria that includes the provision of adequate mechanical fixation, complete resorption when no longer needed, complete replacement by bone, as well as be biocompatible and have a good clinical manageability. For the first time, a biodegradable magnesium fixation screw made of the magnesium alloy WZM211 with a MgF₂ coating has been designed and tested to fulfill these criteria. Adequate mechanical fixation was shown for the magnesium fixation screw in several benchtop tests that directly compared the magnesium fixation screw with an equivalent polymeric resorbable device. Results demonstrated slightly superior mechanical properties of the magnesium device in comparison to the polymeric device even after 4 weeks of degradation. Biocompatibility of the magnesium fixation screw was demonstrated in several in vitro and in vivo tests. Degradation of the magnesium screw was investigated in in vitro and in vivo tests, where it was found that the screw is resorbed slowly and completely after 52 weeks, providing adequate fixation in the early critical healing phase. Overall, the magnesium fixation screw demonstrates all of the key properties required for an ideal fixation screw of membranes used in guided bone regeneration (GBR) surgeries.

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The first comprehensive report on experimental data for a biodegradable metallic fixation pin for use in oral surgery is presented.

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Results demonstrated superior mechanical properties of the Mg fixation pin in comparison to the polymeric pin even after 4 weeks of degradation.

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The MgF₂ coated Mg pin made of alloy WZM211 has a slow corrosion rate with a service time of 4 weeks and is fully resorped at 52 weeks after implantation.

Understanding the Corrosion Behavior of the AZ91D Alloy in Simulated Body Fluid through the Use of Dynamic EIS

Dynamic electrochemical impedance spectroscopy (dynamic EIS) has the capacity to track changes on surfaces in a changing corrosive system, an advantage it holds over classical EIS. We used the dynamic EIS approach to provide insight into the corrosion behavior of the AZ91D Mg alloy in simulated body fluid for 30 h at 25 °C. The results reveal that the impedance response of the alloy is influenced by the immersion time. Between 0 and 7 h, impedance with three time constants was obtained, whereas two-time-constant impedance spectra were obtained between 8 and 30 h of immersion. The results confirm the breakdown of the corrosion product at longer immersion times.

Yes-associated Protein Contributes to Magnesium Alloy-derived Inflammation in Endothelial Cells

Magnesium alloy (Mg alloy) has attracted massive attention in the potential applications of cardiovascular stents because of its good biocompatibility and degradability. However, whether and how the Mg alloy induces inflammation in endothelial cells remains unclear. In the present work, we investigated the activation of Yes-associated protein (YAP) upon Mg alloy stimuli and unveiled the transcriptional function in Mg alloy-induced inflammation. Quantitative RT–PCR, western blotting and immunofluorescence staining showed that Mg alloy inhibited the Hippo pathway to facilitate nuclear shuttling and activation of YAP in human coronary artery endothelial cells (HCAECs). Chromatin immunoprecipitation followed sequencing was carried out to explore the transcriptional function of YAP in Mg alloy-derived inflammation. This led to the observation that nuclear YAP further bonded to the promoter region of inflammation transcription factors and co-transcription factors. This binding event activated their transcription and modified mRNA methylation of inflammation-related genes through regulating the expression of N6-methyladenosine modulators (METTL3, METTL14, FTO and WTAP). This then promoted inflammation-related gene expression and aggravated inflammation in HCAECs. In YAP deficiency cells, Mg alloy-induced inflammation was reduced. Collectively, our data suggest that YAP contributes to the Mg alloy-derived inflammation in HCAECs and may provide a potential therapeutic target that alleviates inflammation after Mg alloy stent implantation.

Designing Advanced Biomedical Biodegradable Mg Alloys: A Review

The increased demand for alloys that can serve as implantation devices with outstanding bio-properties has led to the development of numerous biomedical Mg-based alloys. These alloys have been extensively investigated for their performance in living tissue with mixed results. Hence, there are still major concerns regarding the use of magnesium alloys for such applications. Among the issues raised are elevated corrosion rates, hydrogen generation, and the maintenance of mechanical integrity for designated healing times. In addition, toxicity can arise from the addition of alloying elements that are intended to improve the mechanical integrity and corrosion resistance of Mg alloys. The current work reviews the recent advances in the development of Mg alloys for applications as bio-absorbable materials in living organic environments. In particular, it attempts to develop a roadmap of effective factors that can be utilized when designing Mg alloys. Among the factors reviewed are the effects of alloying additions and processing methods on the exhibited mechanical properties and corrosion rates in simulated bio-fluids used in biomedical applications.

Modifications on porous absorbable Fe-based scaffolds for bone applications: A review from corrosion and biocompatibility viewpoints

Iron (Fe) and Fe-based scaffolds have become a research frontier in absorbable materials which is inherent to their promising mechanical properties including fatigue strength and ductility. Nevertheless, their slow corrosion rate and low biocompatibility have been their major obstacles to be applied in clinical applications. Over the last decade, various modifications on porous Fe-based scaffolds have been performed to ameliorate both properties encompassing surface coating, microstructural alteration via alloying, and advanced topologically order structural design produced by additive manufacturing (AM) techniques. The recent advent of AM produces topologically ordered porous Fe-based structures with an optimized architecture having controllable pore size and strut thickness, intricate internal design, and larger exposed surface area. This undoubtedly opens up new options for controlling Fe corrosion and its structural strengths. However, the in vitro biocompatibility of the AM porous Fe still needs to be addressed considering its higher corrosion rate due to the larger exposed surface area. This review summarizes the latest progress of the modifications on porous Fe-based scaffolds with a specific focus on their responses on the corrosion behavior and biocompatibility.

Comprehensive Review on Design and Manufacturing of Bio-scaffolds for Bone Reconstruction

Bio-scaffolds are synthetic entities widely employed in bone and soft-tissue regeneration applications. These bio-scaffolds are applied to the defect site to provide support and favor cell attachment and growth, thereby enhancing the regeneration of the defective site. The progressive research in bio-scaffold fabrication has led to identification of biocompatible and mechanically stable materials. The difficulties in obtaining grafts and expenditure incurred in the transplantation procedures have also been overcome by the implantation of bio-scaffolds. Drugs, cells, growth factors, and biomolecules can be embedded with bio-scaffolds to provide localized treatments. The right choice of materials and fabrication approaches can help in developing bio-scaffolds with required properties. This review mostly focuses on the available materials and bio-scaffold techniques for bone and soft-tissue regeneration application. The first part of this review gives insight into the various classes of biomaterials involved in bio-scaffold fabrication followed by design and simulation techniques. The latter discusses the various additive, subtractive, hybrid, and other improved techniques involved in the development of bio-scaffolds for bone regeneration applications. Techniques involving multimaterial printing and multidimensional printing have also been briefly discussed.

Biomechanics of Additively Manufactured Metallic Scaffolds-A Review

This review paper is related to the biomechanics of additively manufactured (AM) metallic scaffolds, in particular titanium alloy Ti6Al4V scaffolds. This is because Ti6Al4V has been identified as an ideal candidate for AM metallic scaffolds. The factors that affect the scaffold technology are the design, the material used to build the scaffold, and the fabrication process. This review paper includes thus a discussion on the design of Ti6A4V scaffolds in relation to how their behavior is affected by their cell shapes and porosities. This is followed by a discussion on the post treatment and mechanical characterization including in-vitro and in-vivo biomechanical studies. A review and discussion are also presented on the ongoing efforts to develop predictive tools to derive the relationships between structure, processing, properties and performance of powder-bed additive manufacturing of metals. This is a challenge when developing process computational models because the problem involves multi-physics and is of multi-scale in nature. Advantages, limitations, and future trends in AM scaffolds are finally discussed. AM is considered at the forefront of Industry 4.0, the fourth industrial revolution. The market of scaffold technology will continue to boom because of the high demand for human tissue repair.

Mechanical Behavior and In Vitro Corrosion of Cubic Scaffolds of Pure Magnesium Processed by Severe Plastic Deformation

Reports in the literature show that severe plastic deformation can improve mechanical strength, ductility, and corrosion resistance of pure magnesium, which suggests good performance for biodegradable applications. However, the reported results were based on testing of small samples on limited directions. The present study reports compression testing of larger samples, at different directions, in pure magnesium processed by hot rolling, equal channel angular pressing (ECAP), and high pressure torsion (HPT). The results show that severe plastic deformation through ECAP and HPT reduces anisotropy and increases strength and strain rate sensitivity. Also, scaffolds were fabricated from the material with different processing histories and immersed in Hank’s solution for up to 14 days. The as-cast material displays higher corrosion rate and localized corrosion and it is reported that severe plastic deformation induces uniform corrosion and reduces the corrosion rate.

Biodegradable metals for bone defect repair: A systematic review and meta-analysis based on animal studies

Biodegradable metals are promising candidates for bone defect repair. With an evidence-based approach, this study investigated and analyzed the performance and degradation properties of biodegradable metals in animal models for bone defect repair to explore their potential clinical translation. Animal studies on bone defect repair with biodegradable metals in comparison with other traditional biomaterials were reviewed. Data was carefully collected after identification of population, intervention, comparison, outcome, and study design (PICOS), and following the inclusion criteria of biodegradable metals in animal studies. 30 publications on pure Mg, Mg alloys, pure Zn and Zn alloys were finally included after extraction from a collected database of 2543 publications. A qualitative systematic review and a quantitative meta-analysis were performed. Given the heterogeneity in animal model, anatomical site and critical size defect (CSD), biodegradable metals exhibited mixed effects on bone defect repair and degradation in animal studies in comparison with traditional non-degradable metals, biodegradable polymers, bioceramics, and autogenous bone grafts. The results indicated that there were limitations in the experimental design of the included studies, and quality of the evidence presented by the studies was very low. To enhance clinical translation of biodegradable metals, evidence-based research with data validity is needed. Future studies should adopt standardized experimental protocols in investigating the effects of biodegradable metals on bone defect repair with animal models.

In vitro degradation, haemolysis and cytotoxicity study of Mg-0.4Ce/ZnO2 nanocomposites

Magnesium is an ideal candidate for biodegradable implants, but the major concern is its uncontrollable degradation for application as a biomaterial. The in vitro corrosion and cytotoxicity of Mg‐0.4Ce/ZnO₂ (magnesium nanocomposites) were studied to determine its suitability as a biodegradable material. The polycrystalline nature of Mg‐0.4Ce/ZnO₂ was assessed using an optical microscope. The hydrophobic nature of Mg‐0.4Ce/ZnO₂ was determined by contact angle measurements. The corrosion resistance of magnesium nanocomposites was tested in phosphate buffer solution (PBS) and it was improved by the gradual deposition of a protective layer on its surface after 48 h. The cytotoxicity of Mg‐0.4Ce/ZnO₂ was evaluated by 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) assay and calcium deposition by Alizarin red staining using sarcoma osteogenic (Saos2) cells. The haemocompatibility test of Mg‐0.4Ce/ZnO₂ showed 30% haemolysis, which is higher than the safe value for biomaterials, and cell viability was reduced after 24 h in comparison with control groups. The calcium deposition by sarcoma osteogenic cells showed a brick red colour deposition in both the control group and Mg‐0.4Ce/ZnO₂ after 24 h. The preliminary degradation results of Mg‐0.4Ce/ZnO₂ showed good corrosion resistance; however further improvement is needed in haemolysis and cytotoxicity studies for its use as a biodegradable material for orthopaedic applications.

Improved in vivo osseointegration and degradation behavior of PEO surface-modified WE43 magnesium plates and screws after 6 and 12 months

Magnesium is a highly promising candidate with respect to its future use as a material for resorbable implants. When magnesium degrades, hydrogen gas is released. High doses of gas emergence are reported to impair osseointegration and may therefore lead to fixation failure. The successful delay and reduction of the degradation rate by applying plasma electrolytic oxidation (PEO) as a post processing surface modification method for magnesium alloy has recently been demonstrated. The aim of this study was thus to compare the degradation behavior of a WE43-based plate system with and without respective PEO surface modification and to further investigate osseointegration, as well as the resulting effects on the surrounding bony tissue of both variants in a miniature pig model. WE43 magnesium screws and plates without (WE43) and with PEO surface modification (WE43-PEO) were implanted in long bones of Göttingen Miniature Pigs. At six and twelve months after surgery, micro-CT and histomorphometric analysis was performed. Residual screw volume (SV/TV; WE43: 28.8 ± 21.1%; WE43-PEO: 62.9 ± 31.0%; p = 0.027) and bone implant contact area (BIC; WE43: 18.1 ± 21.7%; WE43-PEO: 51.6 ± 27.7%; p = 0.015) were increased after six months among the PEO-modified implants. Also, surrounding bone density within the cortical bone was not affected by surface modification (BVTV; WE43: 76.7 ± 13.1%; WE43-PEO: 73.1 ± 16.2%; p = 0.732). Intramedullar (BV/TV; WE43: 33.2 ± 16.7%; WE43-PEO 18.4 ± 9.0%; p = 0.047) and subperiosteal (bone area; WE43: 2.6 ± 3.4 mm²; WE43-PEO: 6,9 ± 5.2 mm²; p = 0.049) new bone formation was found for both, surface-modified and non-surface-modified groups. After twelve months, no significant differences of SV/TV and BV/TV were found between the two groups. PEO surface modification of WE43 plate systems improved osseointegration and significantly reduced the degradation rate within the first six months in vivo. Osteoconductive and osteogenic stimulation by WE43 magnesium implants led to overall increased bone growth, when prior PEO surface modification was conducted.

In vitro and in vivo degradation assessment and preventive measures of biodegradable Mg alloys for biomedical applications

Magnesium (Mg) and its alloys have been widely explored as a potential biodegradable implant material. However, the fast degradation of Mg-based alloys under physiological environment has hindered their widespread use for implant applications till date. The present review focuses on in vitro and in vivo degradation of biodegradable Mg alloys, and preventive measures for biomedical applications. Initially, the corrosion assessment approaches to predict the degradation behavior of Mg alloys are discussed along with the measures to control rapid corrosion. Furthermore, this review attempts to explore the correlation between in vitro and in vivo corrosion behavior of different Mg alloys. It was found that the corrosion depends on experimental conditions, materials and the results of different assessment procedures hardly matches with each other. It has been demonstrated the corrosion rate of magnesium can be tailored by alloying elements, surface treatments and heat treatments. Various researches also studied different biocompatible coatings such as dicalcium phosphate dihydrate (DCPD), β-tricalcium phosphate (β-TCP), hydroxyapatite (HA), polycaprolactone (PCL), polylactic acid (PLA), and so on, on Mg alloys to suppress rapid degradation and examine their influence on new bone regeneration as well. This review shows the need for a standard method of corrosion assessment to predict the in vivo corrosion rate based on in vitro data, and thus reducing the in vivo experimentation.

Tantalum as a Novel Biomaterial for Bone Implant: A Literature Review

Titanium (Ti) has been used in metallic implants since the 1950s due to various biocompatible and mechanical properties. However, due to its high Young’s modulus, it has been modified over the years in order to produce a better biomaterial. Tantalum (Ta) has recently emerged as a new potential biomaterial for bone and dental implants. It has been reported to have better corrosion resistance and osteo-regenerative properties as compared to Ti alloys which are most widely used in the bone-implant industry. Currently, Tantalum cannot be widely used yet due to its limited availability, high melting point, and high-cost production. This review paper discusses various manufacturing methods of Tantalum alloys, including conventional and additive manufacturing and also discusses their drawbacks and shortcomings. Recent research includes surface modification of various metals using Tantalum coatings in order to combine bulk material properties of different materials and the porous surface properties of Tantalum. Design modification also plays a crucial role in controlling bulk properties. The porous design does provide a lower density, wider surface area, and more immense specific strength. In addition to improved mechanical properties, a porous design could also escalate the material's biological and permeability properties. With current advancement in additive manufacturing technology, difficulties in processing Tantalum could be resolved. Therefore, Tantalum should be considered as a serious candidate material for future bone and dental implants.

Bioresorption Control and Biological Response of Magnesium Alloy AZ31 Coated with Poly-β-Hydroxybutyrate

Magnesium and its alloys are not normally used as bioresorbable temporary implants due to their high and uncontrolled degradation rate in a physiological liquid environment. The improvement of corrosion resistance to simulated body fluids (SBF) of a magnesium alloy (AZ31) coated with poly-β-hydroxybutyrate (PHB) was investigated. Scanning electron microscopy, Fourier transform infrared spectrometer, and contact angle measurements were used to characterize surface morphology, material composition, and wettability, respectively. pH modification of the SBF corroding medium, mass of Mg2+ ions released, weight loss of the samples exposed to the SBF solution, and electrochemical experiments were used to describe the corrosion process and its kinetics. The material’s biocompatibility was described by evaluating the effect of corrosion by products collected in the SBF equilibrating solution on hemolysis ratio, cytotoxicity, nitric oxide (NO), and total antioxidant capacity (T-AOC). The results showed that the PHB coating can diffusively control the degradation rate of magnesium alloy, improving its biocompatibility: the hemolysis rate of materials was lower than 5%, while in vitro human umbilical vein endothelial cell (HUVEC) compatibility experiments showed that PHB-coated Mg alloy promoted cell proliferation and had no effect on the NO content and that the T-AOC was enhanced compared with the normal group and bare AZ31 alloy. PHB-coated AZ31 magnesium alloy extraction fluids have a less toxic behavior due to the lower concentration of corrosion byproducts deriving from the diffusion control exerted by the PHB coating films both from the metal surface to the solution and vice versa. These findings provide more reference value for the selection of such systems as tunable bioresorbable prosthetic materials.

Local and systemic inflammation after implantation of a novel iron based porous degradable bone replacement material in sheep model

Despite the high potential of healthy bone to regenerate, the reconstruction of large bone defects remains a challenge. Due to the lack of mechanical stability of existing bone substitutes, recently developed degradable metallic alloys are an interesting alternative providing higher load-bearing capabilities. Degradable iron-based alloys therefore might be an attractive innovation. To test the suitability of a newly-designed iron-based alloy for such applications, an animal experiment was performed. Porous iron-based degradable implants with two different densities and a control group were tested. The implants were positioned in the proximal tibia of Merino sheep. Over a period of 6 and 12 months, blood and histological parameters were monitored for signs of inflammation and degradation. In the histological evaluation of the implants` environment we found degraded alloy particles, but no inflammatory reaction. Iron particles were also found within the popliteal lymph nodes on both sides. The serum blood levels of phosphorus, iron and ferritin in the long term groups were elevated. Other parameters did not show any changes. Iron-based degradable porous bone replacement implants showed a good biocompatibility in this experiment. For a clinical application, however, the rate of degradation would have to be significantly increased. Biocompatibility would then have to be re-evaluated.

Multi-scale mechanical and morphological characterisation of sintered porous magnesium-based scaffolds for bone regeneration in critical-sized defects

Magnesium (Mg) and its alloys are very promising degradable, osteoconductive and osteopromotive materials to be used as regenerative treatment for critical-sized bone defects. Under load-bearing conditions, Mg alloys must display sufficient morphological and mechanical resemblance to the native bone they are meant to replace to provide adequate support and enable initial bone bridging. In this study, unique highly open-porous Mg-based scaffolds were mechanically and morphologically characterised at different scales. In situ X-ray computed tomography (XCT) mechanics, digital volume correlation (DVC), electron microscopy and nanoindentation were combined to assess the influence of material properties on the apparent (macro) mechanics of the scaffold. The results showed that Mg exhibited a higher connected structure (38.4mm^-3 and 6.2mm^-3 for Mg and trabecular bone (Tb), respectively) and smaller spacing (245µm and 629µm for Mg and Tb, respectively) while keeping an overall appropriate porosity of 55% in the range of trabecular bone (30-80%). This fully connected and highly porous structure promoted lower local strain compared to the trabecular bone structure at material level (i.e. -22067 ± 8409µε and -40120 ± 18364µε at 6% compression for Mg and trabecular bone, respectively) and highly ductile mechanical behaviour at apparent level preventing premature scaffold failure. Furthermore, the Mg scaffolds exceeded the physiological strain of bone tissue generated in daily activities such as walking or running (500-2000µε) by one order of magnitude. The yield stress was also found to be close to trabecular bone (2.06MPa and 6.67MPa for Mg and Tb, respectively). Based on this evidence, the study highlights the overall biomechanical suitability of an innovative Mg-based scaffold design to be used as a treatment for bone critical-sized defects. STATEMENT OF SIGNIFICANCE: Bone regeneration remains a challenging field of research where different materials and solutions are investigated. Among the variety of treatments, biodegradable magnesium-based implants represent a very promising possibility. The novelty of this study is based on the characterisation of innovative magnesium-based implants whose structure and manufacturing have been optimised to enable the preservation of mechanical integrity and resemble bone microarchitecture. It is also based on a multi-scale approach by coupling high-resolution X-ray computed tomography (XCT), with in situ mechanics, digital volume correlation (DVC) as well as nano-indentation and electron-based microscopy imaging to define how degradable porous Mg-based implants fulfil morphological and mechanical requirements to be used as critical bone defects regeneration treatment.

Tailoring grain sizes of the biodegradable iron-based alloys by pre-additive manufacturing microalloying

We demonstrated the design of pre-additive manufacturing microalloying elements in tuning the microstructure of iron (Fe)-based alloys for their tunable mechanical properties. We tailored the microalloying stoichiometry of the feedstock to control the grain sizes of the metallic alloy systems. Two specific microalloying stoichiometries were reported, namely biodegradable iron powder with 99.5% purity (BDFe) and that with 98.5% (BDFe-Mo). Compared with the BDFe, the BDFe-Mo powder was found to have lower coefficient of thermal expansion (CTE) value and better oxidation resistance during consecutive heating and cooling cycles. The selective laser melting (SLM)-built BDFe-Mo exhibited high ultimate tensile strength (UTS) of 1200 MPa and fair elongation of 13.5%, while the SLM-built BDFe alloy revealed a much lower UTS of 495 MPa and a relatively better elongation of 17.5%, indicating the strength enhancement compared with the other biodegradable systems. Such an enhanced mechanical behavior in the BDFe-Mo was assigned to the dominant mechanism of ferrite grain refinement coupled with precipitate strengthening. Our findings suggest the tunability of outstanding strength-ductility combination by tailoring the pre-additive manufacturing microalloying elements with their proper concentrations.

Bioresorbable Magnesium-Based Alloys as Novel Biomaterials in Oral Bone Regeneration: General Review and Clinical Perspectives

Bone preservation and primary regeneration is a daily challenge in the field of dental medicine. In recent years, bioresorbable metals based on magnesium (Mg) have been widely investigated due to their bone-like modulus of elasticity, their high biocompatibility, antimicrobial, and osteoconductive properties. Synthetic Mg-based biomaterials are promising candidates for bone regeneration in comparison with other currently available pure synthetic materials. Different alloys based on Mg were developed to fit clinical requirements. In parallel, advances in additive manufacturing offer the possibility to fabricate experimentally bioresorbable metallic porous scaffolds. This review describes the promising clinical results of resorbable Mg-based biomaterials for bone repair in osteosynthetic application and discusses the perspectives of use in oral bone regeneration.

Modifying an Implant: A Mini-review of Dental Implant Biomaterials

Dental implants have been used as far back as 2000BC, and since then have developed into highly sophisticated solutions for tooth replacement. It is becoming increasingly important for the materials used in dental implants to exhibit and maintain favorable long-term mechanical, biological and more recently, aesthetic properties. This review aims to assess the biomaterials used in modern dental implants, introducing their properties, and concentrating on modifications to improve these biomaterials. Focus is drawn to the prominent biomaterials, titanium (Ti) and zirconia due to their prevalence in implant dentistry. Additionally, novel coatings and materials with potential use as viable improvements or alternatives are reviewed. An effective dental biomaterial should osseointegrate, maintain structural integrity, resist corrosion and infection, and not cause systemic toxicity or cytotoxicity. Current materials such as bioactive glass offer protection against biofilm formation, and when combined with a titanium‐zirconium (TiZr) alloy, provide a reliable combination of properties to represent a competitive alternative. Further long-term clinical studies are needed to inform the development of next-generation materials.Significance StatementBiomaterials have become essential for modern implants. A suitable implant biomaterial integrates into the body to perform a key function, whilst minimizing negative immune response. Focusing on dentistry, the use of dental implants for tooth replacement requires a balance between bodily response, mechanical structure and performance, and aesthetics. This mini-review addresses the use of biomaterials in dental implants with significant comparisons drawn between Ti and zirconia. Attention is drawn to optimizing surface modification processes and the additional use of coatings. Alternatives and novel developments are addressed, providing potential implications of combining biomaterials to form novel composites that combine and synergize the benefits of each material.

Preliminary study on modelling, fabrication by photo-chemical etching and in vivo testing of biodegradable magnesium AZ31 stents

Magnesium metal (Mg) is a promising material for stent applications due to its biocompatibility and ability to be resorbed by the body. Manufacturing of stents by laser cutting has become an industry standard. Our alternative approach uses photo-chemical etching to transfer a pattern of the stent onto a Mg sheet. In this study, we present three stages of creating and validating a stent prototype, which includes design and simulation using finite element analysis (FEA), followed by fabrication based on AZ31 alloy and, finally, in vivo testing in peripheral arteries of domestic pigs. Due to the preliminary character of this study, only six stents were implanted in two domestic farm pigs weighing 25–28 kg and they were evaluated after 28 days, with an interim follow-up on day 14. The left and right superficial femoral, the left iliac, and the right renal artery were selected for this study. The diameters of the stented artery segments were evaluated at the time of implantation, on day 14 and then, finally, on day 28, by quantitative vessel analysis (QVA) using fluoroscopic imaging. Optical Coherence Tomography (OCT) imaging displayed some malposition, breaks, stacking, and protrusion into the lumen at the proximal, distal, and mid-sections of the stented arteries. The stents degraded with time, but simultaneously became embedded in the intima. After 28 days, the animals were euthanized, and explanted vessels were fixed for micro-CT imaging and histology studies. Micro-CT imaging revealed stent morphological and volumetric changes due to the in-body degradation. An in vivo corrosion rate of 0.75 mm/year was obtained by the CT evaluation. The histology suggested no-life threatening effects, although moderate injury, inflammation, and endothelialization scores were observed.

Bioreactivity of decellularized animal, plant, and fungal scaffolds: perspectives for medical applications

Numerous biomedical applications imply supportive materials to improve protective, antibacterial, and regenerative abilities upon surgical interventions, oncotherapy, regenerative medicine, and others. With the increasing variability of the possible sources, the materials of natural origin are among the safest and most accessible biomedical tools. Animal, plant, and fungal tissues can further undergo decellularization to improve their biocompatibility. Decellularized scaffolds lack the most reactive cellular material, nuclear and cytoplasmic components, that predominantly trigger immune responses. At the same time, the outstanding initial three-dimensional microarchitecture, biomechanical properties, and general composition of the scaffolds are preserved. These unique features make the scaffolds perfect ready-to-use platforms for various biomedical applications, implying cell growth and functionalization. Decellularized materials can be repopulated with various cells upon request, including epithelial, endothelial, muscle and neuronal cells, and applied for structural and functional biorepair within diverse biological sites, including the skin and musculoskeletal, cardiovascular, and central nervous systems. However, the molecular and cellular mechanisms behind scaffold and host tissue interactions remain not fully understood, which significantly restricts their integration into clinical practice. In this review, we address the essential aspects of decellularization, scaffold preparation techniques, and its biochemical composition and properties, which determine the biocompatibility and immunogenicity of the materials. With the integrated evaluation of the scaffold profile in living systems, decellularized animal, plant, and fungal scaffolds have the potential to become essential instruments for safe and controllable biomedical applications.

Additively manufactured biodegradable porous metals

Partially due to the unavailability of ideal bone substitutes, the treatment of large bony defects remains one of the most important challenges of orthopedic surgery. Additively manufactured (AM) biodegradable porous metals that have emerged since 2018 provide unprecedented opportunities for fulfilling the requirements of an ideal bone implant. First, the multi-scale geometry of these implants can be customized to mimic the human bone in terms of both micro-architecture and mechanical properties. Second, a porous structure with interconnected pores possesses a large surface area, which is favorable for the adhesion and proliferation of cells and, thus, bony ingrowth. Finally, the freeform geometrical design of such biomaterials could be exploited to adjust their biodegradation behavior so as to maintain the structural integrity of the implant during the healing process while ensuring that the implant disappears afterwards, paving the way for full bone regeneration. While the AM biodegradable porous metals that have been studied so far have shown many unique properties as compared to their solid counterparts, the unprecedented degree of flexibility in their geometrical design has not yet been fully exploited to optimize their properties and performance. In order to develop the ideal bone implants, it is important to take advantage of the full potential of AM biodegradable porous metals through detailed and systematic study on their biodegradation behavior, mechanical properties, biocompatibility, and bone regeneration performance. This review paper presents the state of the art in AM biodegradable porous metals and is focused on the effects of material type, processing, geometrical design, and post-AM treatments on the mechanical properties, biodegradation behavior, in vitro biocompatibility, and in vivo bone regeneration performance of AM porous Mg, Fe, and Zn as well as their alloys. We also identify a number of knowledge gaps and the challenges encountered in adopting AM biodegradable porous metals for orthopedic applications and suggest some promising areas for future research.

Effects of degradable magnesium on paracrine signaling between human umbilical cord perivascular cells and peripheral blood mononuclear cells

Human mesenchymal stem cells (MSC) interact with numerous immune cells that can promote regenerative processes and inhibit inflammatory responses. We hypothesised that the cross-talk between human umbilical cord perivascular cells (HUCPV; an alternative source of MSC) and peripheral blood mononuclear cells (PBMC) could be influenced by degradable transwell magnesium (Mg). To study the correlations between paracrine signaling and specific cellular behaviour during the host response to Mg, we used a transwell coculture system for up to 7 days. The proliferation and viability of both cell types were not significantly influenced by Mg. When HUCPV were cultured with degradable Mg, a moderate inflammation (e.g., lower secretions of pro-inflammatory interleukin 1 beta and IL2, and tumour necrosis factor alpha, interferon gamma, anti-inflammatory interleukins 4, 5, 10, 13, and 1 receptor antagonists and granulocyte colony stimulating factor), and an increased pro-healing M2 macrophage phenotype were observed. Moreover, when PBMC were cultured with degradable Mg, the expression of migration/wound healing related cytokines (interleukin 8, granulocyte-macrophage colony-stimulating factor, monocyte chemoattractant protein 1 and macrophage inflammatory protein 1α/β) was upregulated, accompanied by an increase in the migration ability of HUCPV (cell scratch assay). In addition, an increased pro-osteogenic potential was demonstrated via an increase of osteoblastic markers (e.g., alkaline phosphatase activity, specific gene expression and cytokine release). These results collectively imply that Mg possesses osteo-immunomodulatory properties. They also help to design Mg-based bone substitute biomaterials capable of exhibiting desired immune reactions and good clinical performance.

Impact of Wound Closure on the Corrosion Rate of Biodegradable Mg-Ca-Zn Alloys in the Oral Environment

Magnesium alloys have exhibited a rapid rate of corrosion and thus early implant failure, so this study was designed to investigate the longer-term effects and in particular on wound closure. The aim of the study is to evaluate Mg-Ca-Zn Alloys as promising biodegradable implants in the field of maxillofacial surgery, which have so far never been evaluated for the changing conditions from a saliva to a serum-like environment after wound closure. Magnesium-0.6/calcium-0.8 wt.% zinc alloys were either immersed for 10 days in artificial saliva or 10 days in Hank's salt solution as control groups. The test group was transferred from artificial saliva to Hank's salt solution after 5 days in order to simulate wound closure. Corrosion rates were determined by immersion testing. Additional electron microscopy and energy dispersive X-ray spectroscopy (EDX) were performed. Prior artificial saliva exposure led to significantly decreased (p = 0.0272) corrosion rates after transfer to Hank's solution in comparison to sole Hank's solution exposure (0.1703 vs. 0.6675 mg/(cm²·day)) and sole artificial saliva exposure (0.3180 mg/(cm²·day)), which both exhibit a strong increase after 5 days. The results were in accordance with the scanning electron microscopy and EDX pictures. Prior saliva exposure could protect from increasing corrosion rates after wound closure. Thus Mg-Ca-Zn Alloys are promising future implant alloys in oral surgery, whereas other surgical fields without saliva exposure have to deal with accelerated corrosion rates after 5 days.

Development of a novel biodegradable porous iron-based implant for bone replacement

Bone replacement and osteosynthesis require materials which can at least temporarily bear high mechanical loads. Ideally, these materials would eventually degrade and would be replaced by bone deposited from the host organism. To date several metals, notably iron and iron-based alloys have been identified as suitable materials because they combine high strength at medium corrosion rates. However, currently, these materials do not degrade within an appropriate amount of time. Therefore, the aim of the present study is the development of an iron-based degradable sponge-like (i.e. cellular) implant for bone replacement with biomechanically tailored properties. We used a metal powder sintering approach to manufacture a cylindrical cellular implant which in addition contains phosphor as an alloying element. No corrosion inhibiting effects of phosphorus have been found, the degradation rate was not altered. Implant prototypes were tested in an animal model. Bone reaction was investigated at the bone-implant-interface and inside the cellular spaces of the implant. Newly formed bone was growing into the cellular spaces of the implant after 12 months. Signs of implant degradation were detected but after 12 months, no complete degradation could be observed. In conclusion, iron-based open-porous cellular biomaterials seem promising candidates for the development of self-degrading and high load bearing bone replacement materials.

The bioeffects of degradable products derived from a biodegradable Mg-based alloy in macrophages via heterophagy

Biodegradable magnesium alloys are promising candidates for use in biomedical applications. However, degradable particles (DPs) derived from Mg-based alloys have been observed in tissue in proximity to sites of implantation, which might result in unexpected effects. Although previous in vitro studies have found that macrophages can take up DPs, little is known about the potential phagocytic pathway and the mechanism that processes DPs in cells. Additionally, it is necessary to estimate the potential bioeffects of DPs on macrophages. Thus, in this study, DPs were generated from a Mg-2.1Nd-0.2Zn-0.5Zr alloy (JDBM) by an electrochemical method, and then macrophages were incubated with the DPs to reveal the potential impact. The results showed that the cell viability of macrophages decreased in a concentration-dependent manner in the presence of DPs due to effects of an apoptotic pathway. However, the DPs were phagocytosed into the cytoplasm of macrophages and further degraded in phagolysosomes, which comprised lysosomes and phagosomes, by heterophagy instead of autophagy. Furthermore, several pro-inflammatory cytokines in macrophages were upregulated by DPs through the induction of reactive oxygen species (ROS) production. To the best of our knowledge, this is the first study to show that DPs derived from a Mg-based alloy are consistently degraded in phagolysosomes after phagocytosis by macrophages via heterophagy, which results in an inflammatory response owing to ROS overproduction. Thus, our research has increased the knowledge of the metabolism of biodegradable Mg metal, which will contribute to an understanding of the health effects of biodegradable magnesium metal implants used for tissue repair. STATEMENT OF SIGNIFICANCE: Biomedical degradable Mg-based alloys have great promise in applied medicine. Although previous studies have found that macrophages can uptake degradable particles (DPs) in vitro and observed in the sites of implantation in vivoin vivo, few studies have been carried out on the potential bioeffects relationship between DPs and macrophages. In this study, we analyzed the bioeffects of DPs derived from a Mg-based alloy on the macrophages. We illustrated that the DPs were size-dependently engulfed by macrophages via heterophagy and further degraded in the phagolysosome rather than autophagosome. Furthermore, DPs were able to induce a slight inflammatory response in macrophages by inducing ROS production. Thus, our research enhances the knowledge of the interaction between DPs of Mg-based alloy and cells, and offers a new perspective regarding the use of biodegradable alloys.

Degradation and osteogenic induction of a SrHPO4-coated Mg-Nd-Zn-Zr alloy intramedullary nail in a rat femoral shaft fracture model

Magnesium and Mg-based alloys are promising biomaterials for orthopedic implants because of their degradability, osteogenic effects, and biocompatibility. However, the drawbacks of these materials include high hydrogen gas production, unexpected corrosion resistance, and insufficient mechanical strength duration. Surface modification can protect these biomaterials and induce osteogenesis. In this work, a SrHPO₄ coating was developed for our patented biodegradable Mg-Nd-Zn-Zr alloy (abbr. JDBM) through a chemical deposition method. The coating was characterized by in vitro immersion, ion release, and cytotoxicity tests, which showed a slower corrosion behavior and excellent cell viability. RNA sequencing of MC3T3E1 cells treated with SrHPO₄-coated JDBM ion release test extract showed increased Tlr4, followed by the activation of the downstream PI3K/Akt signaling pathway, causing proliferation and growth of pre-osteoblasts. An intramedullary nail (IMN) was implanted in a femoral fracture rat model. Mechanical test, radiological and histological analysis suggested that SrHPO₄-coated JDBM has superior mechanical properties, induces more bone formation, and decreases the degradation rate compared with uncoated JDBM and the administration of TLR4 inhibitor attenuated the new bone formation for fracture healing. SrHPO₄ is a promising coating for JDBM implants, particularly for long-bone fractures.

Corrosion Resistance and Biocompatibility Assessment of a Biodegradable Hydrothermal-Coated Mg-Zn-Ca Alloy: An in Vitro and in Vivo Study

A hydrothermal (HT) coating was applied to the biomedical Mg-Zn-Ca alloy surface by microarc oxidation (MAO) and heat treatment. Then, the corrosion resistance and biocompatibility of the coated alloy was evaluated in vitro and in vivo. The corrosion rate (CR) of HT-coated implants was significantly lower in experiment. In addition, this CR increased over time in vivo but was stable, albeit higher, in vitro. The proliferation, adhesion, and live activity of bone marrow stem cells (BMSCs) were significantly greater on the surface of the HT-coated Mg alloy in vitro. Serum Mg²⁺ was always within the normal range in rabbits with implants, although Ca²⁺ was higher than normal for both uncoated and coated scaffolds. There were no significant pathological effects on the main organs of alloy-implanted rabbits compared with healthy animals. Thus, the HT coating significantly improved the corrosion resistance and biocompatibility of the Mg-Zn-Ca alloy.

Effect of Hydrothermal (Sr)-Hydroxyapatite Coatings on the Corrosion Resistance and Mg2+ Ion Release to Enhance Osteoblastic Cell Responses of AZ91D Alloy

The biomedical applications of Mg-based alloys are limited by their rapid corrosion rate in the body fluid. In this study, the hydrothermal synthesis is employed to produce protective bioactive hydroxyapatite coating (HAC) and strontium-substituted hydroxyapatite coating (Sr-HAC) to further enhance the corrosion resistance and in vitro biocompatibility of biodegradable AZ91D Mg alloy in physiological environments. For comparison, the brucite Mg(OH)₂ prepared by the alkaline pre-treatment is designated as a control group. Experimental evidences of XRD and XPS analysis confirm that Sr²⁺ ions can be incorporated into HA crystal structure. It is noted that the hydrothermally synthesized Sr-HAC conversion coating composed of a specific surface topography with the nanoscaled flake-like fine crystallites is constructed on the AZ91D Mg alloy. The hydrophilicity of Mg substrate is effectively enhanced with the decrease in static contact angles after performing alkaline and hydrothermal treatments. Potentiodynamic polarization measurements reveal that the nanostructured Sr-HAC-coated specimens exhibit superior corrosion resistance than HAC and alkaline pre-treated Mg(OH)₂. Moreover, immersion tests demonstrate that Sr-HAC provides favorable long-term stability for the Mg alloy with decreasing concentration of released Mg²⁺ ions in the SBF and the reduced corrosion rate during the immersion length of 30 days. The cells cultured on Sr-HAC specimens exhibit higher viability than those on the alkaline-pre-treated Mg(OH)₂ and HAC specimens. The Sr-substituted HA coating with a nanostructured surface topography can help to stimulate the cell viability of osteoblastic cells.

Inflammatory response to magnesium-based biodegradable implant materials

Biodegradability and mechanical properties of magnesium alloys are attractive for orthopaedic and cardiovascular applications. In order to study their cytotoxicity usually bone cells are used. However, after implantation, diverse and versatile cells are recruited and interact. Among the first ones coming into play are cells of the immune system, which are responsible for the inflammatory reaction. Macrophages play a central role in the inflammatory process due to the production of cytokines involved in the tissue healing but also in the possible failure of the implants. In order to evaluate the in vitro influence of the degradation products of magnesium-based alloys on cytokine release, the extracts of pure magnesium and two magnesium alloys (with gadolinium and silver as alloying elements) were examined in an inflammatory in vitro model. Human promonocytic cells (U937 cells) were differentiated into macrophages and further cultured with magnesium-based extracts for 1 and 3 days (simulating early and late inflammatory reaction phases), either at 37 °C or at 39 °C (mimicking normal and inflammatory conditions, respectively). All extracts exhibit very good cytocompatibility on differentiated macrophages. Results suggest that M1 and even more M2 profiles of macrophage were stimulated by the extracts of Mg. Furthermore, Mg-10Gd and Mg-2Ag extracts introduced a nuancing effect by rather inhibiting macrophage M1 profile. Magnesium-based biomaterials could thus induce a faster inflammation resolution while improving tissue repair. STATEMENT OF SIGNIFICANCE: Macrophage are the key-cells during inflammation and can influence the fate of tissue healing and implant performance. Magnesium-based implants are biodegradable and bioactive. Here we selected an in vitro system to model early and late inflammation and effect of pyrexia (37 °C versus 39 °C). We showed the beneficial and nuancing effects of magnesium (Mg) and the selected alloying elements (silver (Ag) and gadolinium (Gd)) on the macrophage polarisation. Mg extracts exacerbated simultaneously the macrophage M1 and M2 profiles while Mg-2Ag and Mg-10Gd rather inhibited the M1 differentiation. Furthermore, 39 °C exhibited protective effect by either decreasing cytokine production or promoting anti-inflammatory ones, with or without extracts. Mg-based biomaterials could thus induce a faster inflammation resolution while improving tissue repair.

Translational status of biomedical Mg devices in China

Magnesium (Mg) and its alloys as temporary medical implants with biodegradable and properly mechanical properties have been investigated for a long time. There are already three kinds of biodegradable Mg implants which are approved by Conformite Europeene (CE) or Korea Food and Drug Administration (KFDA), but not China Food and Drug Administration (CFDA, now it is National Medical Products Administration, NMPA). As we know, Chinese researchers, surgeons, and entrepreneurs have tried a lot to research and develop biodegradable Mg implants which might become other new approved implants for clinical applications. So in this review, we present the representative Mg implants of three categories, orthopedic implants, surgical implants, and intervention implants and provide an overview of current achievement in China from academic publications and Chinese patents. We would like to provide a systematic way to translate Mg and its alloy implants from experiment designs to clinical products.

Recent advances in biomaterials for 3D scaffolds: A review

Considering the advantages and disadvantages of biomaterials used for the production of 3D scaffolds for tissue engineering, new strategies for designing advanced functional biomimetic structures have been reviewed. We offer a comprehensive summary of recent trends in development of single- (metal, ceramics and polymers), composite-type and cell-laden scaffolds that in addition to mechanical support, promote simultaneous tissue growth, and deliver different molecules (growth factors, cytokines, bioactive ions, genes, drugs, antibiotics, etc.) or cells with therapeutic or facilitating regeneration effect. The paper briefly focuses on divers 3D bioprinting constructs and the challenges they face. Based on their application in hard and soft tissue engineering, in vitro and in vivo effects triggered by the structural and biological functionalized biomaterials are underlined. The authors discuss the future outlook for the development of bioactive scaffolds that could pave the way for their successful imposing in clinical therapy.

Development of magnesium implants by application of conjoint-based quality function deployment

Biodegradable magnesium-based implants are the subject of a great deal of research for different orthopedic and vascular applications. The targeted design and properties depend on the specific medical function and location in the body. Development of the biomaterial requires a comprehensive understanding of the biological interaction between the implant and the host tissue, as well as of the behavior in the physiological environment in vivo. Research into and the development of innovative magnesium implants entails interdisciplinary research efforts and communication between materials science, bioscience, and medical experts. The present study provides a transparent planning and communication tool for market-oriented implant development processes. The objective was to identify medical needs at an early stage of the development process and to quantify the importance of the engineering characteristics of different research fields that cater to specific implant requirements. The method is demonstrated by the performance of a survey-based conjoint analysis, which was integrated into a quality function deployment approach. Twenty-seven medical professionals and 29 biomaterial scientists assessed the importance of identified medical requirements, whereby the control of mechanical integrity and degradation along with nontoxicity and nonimmunogenicity showed the highest number of preferences. The evaluation of implant options by 31 experts indicated that the engineering characteristic with the highest importance was the condition and sterilization of the surface. These values can be used to set priorities in strategic decisions. Research trials can be aligned to medical preferences, ensuring high product quality and an effective development process. This is the first paper to report on the application of conjoint-based quality function deployment in biomaterial research.

Comparison of magnesium versus titanium screw fixation for biplane chevron medial malleolar osteotomy in the treatment of osteochondral lesions of the talus

PURPOSE

This retrospective study aimed to compare the clinical and radiological outcomes of patients who underwent biplane chevron medial malleolar osteotomy (MMO) for osteochondral lesions of the talus (OLT), fixed with either magnesium (Mg) or titanium (Ti) screws.

METHODS

A total of 22 patients (12 male and 10 female) with a mean age of 40.6 ± 12.5 years (range 18-56 years) who underwent MMO for OLT treatment were included in this retrospective study. Of the 22 patients, MMO was fixed with bioabsorbable Mg screws (Alloy: MgYREZr) in 11 patients, and in the remaining 11 patients (one bilateral) MMO was fixed with Ti screws. All patients were followed up for at least 1 year with a mean of 20.7 ± 8.9 months (range 12-49 months). The American Orthopedic Foot and Ankle Society (AOFAS) scale and the visual analog scale (VAS) were used to evaluate the clinical results. Union of the osteotomy, postoperative displacement and all other complications were followed and analyzed.

RESULTS

An improvement in the AOFAS scale and VAS points were recorded in both groups with no statistically significant difference between the groups (p 0.079 and 0.107, respectively). Complete union of the osteotomy was obtained in all patients. One patient in the Ti group required implant removal due to pain and irritation. There were no other significant complications in either group.

CONCLUSIONS

The results of this study showed that bioabsorbable Mg compression screws have similar therapeutic efficacy to Ti screws in respect of functional and radiological outcomes in MMO fixation. Bioabsorbable Mg screw is an alternative fixation material which can be safely used for MMO in ankle surgery.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Manufacturing and Characterization of Zn-WC as Potential Biodegradable Material

This work presents the manufacturing and characterization of zinc-tungsten carbide (Zn-WC) nanocomposite as a potential biodegradable material. A highly homogeneous WC nanoparticle dispersion in a Zn matrix was achieved by molten salt assisted stir casting followed with hot rolling. The Vickers microhardness and ultimate tensile strength of zinc were enhanced more than 50% and 87%, respectively, with the incorporation of up to 4.4 vol. % WC nanoparticles. Additionally, Zn-WC nanocomposite retained high ductility (> 65%). However, the electrical and thermal conductivities were reduced by 12% and 21%, respectively. The significant enhancement in mechanical strength makes nanoparticle-reinforced zinc a promising candidate material for biodegradable metallic implants for a wide range of clinical applications, including orthopaedic and cardiovascular implants as well as bioresorbable electronics.

Mechanical and biocorrosive properties of magnesium-aluminum alloy scaffold for biomedical applications

This study investigates the morphology, microstructure, compressive behavior, biocorrosion properties, and cytocompatibility of magnesium (Mg)-aluminum (Al) alloy (AE42) scaffolds for their potential use in biodegradable biomedical applications. Mg alloy scaffolds were successfully synthesized via a camphene-based freeze-casting process with precisely controlled heat treatment. The average porosity was approximately 52% and the median pore diameter was ∼13 μm. Salient deformation mechanisms were identified using acoustic emission (AE) signals and adaptive sequential k-means (ASK) analysis. Twinning, dislocation slip, strut bending, and collapse were dominant during compressive deformation. Nonetheless, the overall compressive behavior and deformation mechanisms were similar to those of bulk Mg based on ASK analysis. The corrosion potential of the Mg alloy scaffold (-1.44 V) was slightly higher than that of bulk AE42 (-1.60 V), but the corrosion rate of the Mg alloy scaffold was faster than that of bulk AE42 due to the enhanced surface area of the Mg alloy scaffold. As a result of cytocompatibility evaluation following ISO10993-5, the concentration of the Mg alloy scaffold extract reducing cell growth rate to 50% (IC₅₀) was 10.7%, which is higher (less toxic) than 5%, suggesting no severe inflammation by implantation into muscle.