In vitro and in vivo studies on a Mg-Sr binary alloy system developed as a new kind of biodegradable metal

Magnesium-based implants accelerate femoral fracture healing through promoting histone lactylation-mediated osteoclastogenesis inhibition

AIMS

To investigate the molecular mechanisms by which magnesium (Mg)-based implants, specifically Mg-containing intramedullary nails (Mg-IMNs), promote femoral fracture healing.

MATERIALS AND METHODS

Rats with femoral fractures were treated with Mg-IMNs. In vitro experiments were conducted to assess the impact of Mg2+ on osteoclastogenesis and histone lactylation. Histological analysis, Western blotting, and qRT-PCR were employed to evaluate osteoclast maturation and the molecular pathways involved. In vivo, lactate was administered to replicate Mg-IMN effects, and lactate production was inhibited to observe potential reversal effects.

KEY FINDINGS

Mg-IMNs significantly enhanced fracture healing by inhibiting osteoclastogenesis. Mg2+ promoted intracellular lactate production, leading to histone lactylation, which suppressed osteoclast maturation by downregulating NFATc1. The P300/H3K18LA/HDAC1 pathway was identified as a key mediator in this process. Additionally, lactate administration mimicked the effects of Mg-IMNs, while blocking lactate reversed these effects.

SIGNIFICANCE

This study uncovers a novel mechanism by which Mg2+ promotes fracture healing through histone lactylation-mediated inhibition of osteoclastogenesis. These findings offer new therapeutic strategies for enhancing fracture repair via epigenetic regulation.

An update on the effect of metals on stemness properties of mesenchymal stem cells

The metal-based devices may corrode, degrade, or release metal ions and fragments after being implanted in the body, exhibiting their own consequences on hosting organs/tissues. The biocompatibility of metal implants has been investigated in various studies using a number of cell types. Mesenchymal stem cells (MSCs) are more relevant cells than others for evaluating the cytocompatibility of metal-based orthopedic implants because they are essential cells for bone regeneration and a promising cell population in regenerative medicine. In this regard, stemness preservation of MSCs is a key property in both body's own repair process and success of renewing/compensating approaches. In general, MSCs adhesion, viability, and function at the cell-metal interface is directly dependent on the metal alloys composing elements, which, along with consideration of compatibility, could guarantee the success of implants. This review scrutinizes the effects of orthopedic metal materials on the biocompatibility and stemness of MSCs at metal interface. Additionally, in vivo, host responses to metal implants are investigated.

Versatile application of magnesium-related bone implants in the treatment of bone defects

Magnesium-related bone implants have garnered significant attention in the treatment of bone defects. The applications of magnesium in promoting bone repair mainly include degradable magnesium-based scaffolds owing to its special physical properties and composite materials modified by magnesium ions because of its biological activity. Although numerous studies have confirmed the unique application advantages and efficacy of magnesium in promoting bone repair, some obvious shortcomings persist, including the rapid degradation of magnesium-based scaffolds. In this review, the deficiencies of magnesium and its alloys in the construction of orthopedic implants and their key influencing factors were summarized; furthermore, some advanced improvement schemes were summarized and analyzed. Additionally, the application strategies of magnesium-modified bone implants are summarized and discussed. Lastly, this review incorporates the latest research and discoveries on magnesium in orthopedic science, comprehensively exploring the mechanism of magnesium's role in the complex microenvironment of bone defects from multiple dimensions. This paper provides a comprehensive summary and analysis of cutting-edge concepts in the design and development of magnesium-based bone implants, considering various perspectives such as the physical properties and biological functions of magnesium.

Biofunctionalisation of porous additively manufactured magnesium-based alloys for Orthopaedic applications: A review

Magnesium (Mg) alloys have gained significant attention as a desirable choice of biodegradable implant for use in bone repair applications, largely owing to their unique material properties. More recently, Mg and Mg-based alloys have been used as load-bearing metallic scaffolds for bone tissue engineering applications, offering promising opportunities in the field. The mechanical properties and relative density of Mg-based alloys closely approximate those of natural human bone tissue, thereby mitigating the risk of stress-shielding effects. Furthermore, the inherent biodegradability of Mg-based alloys eliminates the necessity for a second surgical procedure for the removal of the implant, a frequent requirement with conventional non-degradable implants. However, a notable challenge remains in managing the high corrosion rate of Mg and Mg-based alloys within physiological environments to ensure that they meet the necessary functional requirements. Consequently, a comprehensive analysis and understanding of the corrosion behaviour of Mg and Mg-based alloys, coupled with optimisation of their surface properties, assume pivotal significance to ensure successful clinical application. The personalized 3D printing of Mg and Mg-based alloy implants represents a paradigm shift, offering a plethora of advantages, foremost among them being the enhancement of the bone healing process facilitated by the degradable porous structure conducive to bone ingrowth. Also, the emergence of surface functionalisation techniques for Mg-based implants amalgamates the mechanical and degradation properties inherent to metals with the enhanced biofunctionality offered by these coatings. This synergy presents a highly promising avenue for using Mg-based implants as temporary orthopaedic and dental solutions. This comprehensive review provides a detailed analysis of recent advancements encompassing alloying elements, additive manufacturing processes, lattice structures and biofunctionalised coatings to tailor the corrosion resistance, mechanical properties and biocompatibility of Mg-based orthopaedic implants.

Biodegradable ultrahigh-purity magnesium and its alloy ZX00 promote osteogenesis in the medullary cavity and glycogenolysis in the liver

Magnesium (Mg)-based implants have become an attractive alternative to conventional permanent implants in the orthopedic field. While biocompatibility, degradation kinetics, and osseointegration of Mg-based implants have been mostly investigated, the impact of degradation products on bone remodeling and potential systemic effects remains unclear. The aim of this study was to evaluate the early and mid-term local and systemic tissue responses of degrading ultrahigh-purity ZX00 (Mg-Zn-Ca alloy) and ultrahigh-purity Mg (XHP-Mg) pins in a juvenile healthy rat model. The potential differences between implant types (degradable vs. permanent), implantation, and age-related changes were investigated using titanium (Ti), sham-operated, and control groups (non-intervention), respectively. Degradation products of ZX00 and XHP-Mg pins promote osteogenesis in the medullary cavity by upregulating the expression levels of Bmp2 and Opg within 14 days post-surgery. The higher degradation rate of XHP-Mg resulted in the accumulation of degradation products starting from day 3 and upregulation of different genes, particularly Ccl2 and Cepbp. Besides good osseointegration and new bone tissue formation, we found a more parallel hydroxyapatite/collagen orientation along Mg-based pins in the perimeter region compared to Ti pins. In the liver, reduced glycogen levels in Mg-based pins indicated that degradation products promote glycogenolysis, while only the ZX00 group showed a higher serum glucagon level on day 14. Results suggest that degrading ZX00 and XHP-Mg pins stimulate osteogenesis mainly via Bmp2 and Opg and promote glycogenolysis in the liver, while the higher degradation rate of XHP-Mg pins resulted in upregulation of different genes and metabolites. STATEMENT OF SIGNIFICANCE: Bioresorbable magnesium (Mg)-based implants are promising alternative candidates for orthopedic interventions. Until now, a few in vivo studies explored how Mg-based implants promote osteogenesis in the medullary cavity and modulate systemic tissue responses. Herein, results demonstrate i) the degradation rate of the Mg-based implants has a crucial effect on osteogenesis via regulating Bmp2 and Opg expression in the medullary cavity, ii) a parallel HAp/collagen matrix pattern in ZX00 and XHP-Mg groups compared to the Ti group, iii) both Mg pins promote glycogenolysis in the liver. Our findings highlight the dual role of Mg-based implants in bone remodeling and systemic metabolic modulation. Nevertheless, this is the first study to report the interaction between Mg-based implants and liver metabolism.

Analysis of Tribological and Cytotoxicity Assays of a Biocompatible Mg-Zn-Ca-Pr Alloy

This work covers a Mg-Zn-Ca-Pr alloy fabricated by a novel method of mechanical alloying and spark plasma sintering (SPS). Currently, magnesium alloys used as biomaterials are mostly commercial alloys without consideration of cytotoxicity from the perspective of biosafety. So far, the tribological and cytotoxic properties of Mg-Zn-Ca-Pr alloys have not been investigated. Hence, in the article, the tribological properties, considering wear rate, wear resistance, coefficient of friction, and the roughness of the sintered Mg-Zn-Ca-Pr alloy, are investigated. Cytotoxicity assays have also been carried out. The ball-on-a-disc method is used in the tribological test. Samples before sintering by the SPS method are milled at varying times of 13, 20, and 70 h. Results show that increasing the milling time affects tribology and cytotoxic tests. The longer the milling time, the lower the cell survival rate. The conducted tests reveal cell survival of 90, 82, and 61% for 13, 20, and 70 h, respectively. A reduction of cell viability by over 30% is considered a cytotoxic effect, which was observed only in the 70 h milling-time samples.

Effect of Sr on Mechanical Properties and Corrosion Behavior of Rolled ZM60 Alloy

Mg-6Zn-0.5Mn as a medical magnesium alloy has good biomechanical properties and corrosion resistance, but as a fracture internal-fixation material, its strength, toughness, and corrosion resistance still need to be improved. In this paper, the element Sr, having good biocompatibility, is used as an alloy element. The effects of different Sr contents (0 wt.%, 0.3 wt.%, 0.6 wt.%, 0.9 wt.%, and 1.2 wt.%) on the microstructure, strength, toughness, and corrosion resistance of rolled Mg-6Zn-0.5Mn alloy were studied. The results are as follows. Sr can influence the recrystallization process. When the Sr content is 0.3 wt.% and 0.6 wt.%, the alloy matrix exhibits both non-recrystallized regions and fine recrystallized regions. When the Sr content reaches 0.9 wt.%, the non-recrystallized region decreases significantly, and the fine recrystallized grains develop into equiaxed grains. With the increase of Sr content, the elongation of the alloy decreases. At a content of 0.9 wt.%, the corrosion resistance reaches its optimum value, with an average corrosion rate of 0.75828 mm/y.

Insight the long-term biodegradable Mg-RE-Sr alloy for orthopaedics implant via friction stir processing

Magnesium alloys, noted for their substantial mechanical strength and exceptional biocompatibility, are increasingly being considered for use in biodegradable implants. However, their rapid degradation and significant hydrogen release have limited their applications in orthopaedics. In this study, a novel Mg-RE-Sr alloy was created by friction stir processing to modify its microstructure and enhance its degradation performance. Through microstructural characterization, the friction stir processing effectively refined the grains, accelerated the re-dissolution of precipitates, and ensured a uniform distribution of these phases. The processed alloy demonstrated improved comprehensive properties, with an in vitro corrosion rate of approximately 0.4 mm/y and increases in ultimate tensile strength and elongation by 37 % and 166 %, respectively. Notably, in vivo experiments involving a rat subcutaneous implantation model revealed a slower degradation rate of 0.09 mm/y and a uniform degradation process, basically achieving the requirements for ideal performance in orthopaedic applications. The superior degradation characteristics were attributed to the synergistic effect of attenuated galvanic corrosion and the formation of a dense Y(OH)3/Y2O3 film induced by an exceptional microstructure with a highly solid-soluted matrix and uniformly refined precipitates. Meanwhile, the alloys exhibited excellent biocompatibility and did not cause undesirable inflammation or produce toxic degradation products. These improvements in biocompatibility and degradation characteristics indicate great promise for the use of this friction stir processed alloy in osteosynthesis systems in the clinical setting.

High-performance Mg-Zn alloy achieved by the ultrafine grain and nanoparticle design

Improving the comprehensive performance of low alloyed Mg is a significant challenge for biomedical applications. This paper developed a high-performance Mg-Zn alloy with uniform ultrafine grains and nano-precipitates through a straightforward, high-temperature reciprocating equal channel angle extrusion (ECAP) process and researched the microstructure, mechanical property, degradation behaviour, and biocompatibility of the developed alloy. Results showed that the lean Mg-2Zn alloy successfully refined grain to about 1 μm and produced plenty of nano-particles with uniform distribution, providing high comprehensive mechanical properties (YS: 235 MPa, UTS: 267 MPa, EL: 15.6 %). Additionally, Zn-riched nano-particles in the matrix could decrease the Zn aggregation at the corrosion layer-matrix interface and form a dense oxide film, achieving a low degradation rate (0.13 mm/year in vivo). Finally, this work realizes the low alloy content, low cost, and good properties of one biodegradable Mg alloy, which will benefit the promotion of future clinical applications.

An overview of magnesium-based implants in orthopaedics and a prospect of its application in spine fusion

Due to matching biomechanical properties and significant biological activity, Mg-based implants present great potential in orthopedic applications. In recent years, the biocompatibility and therapeutic effect of magnesium-based implants have been widely investigated in trauma repair. In contrast, the R&D work of Mg-based implants in spinal fusion is still limited. This review firstly introduced the general background for Mg-based implants. Secondly, the mechanical properties and degradation behaviors of Mg and its traditional and novel alloys were reviewed. Then, different surface modification techniques of Mg-based implants were described. Thirdly, this review comprehensively summarized the biological pathways of Mg degradation to promote bone formation in neuro-musculoskeletal circuit, angiogenesis with H-type vessel formation, osteogenesis with osteoblasts activation and chondrocyte ossification as an integrated system. Fourthly, this review followed the translation process of Mg-based implants via updating the preclinical studies in fracture fixation, sports trauma repair and reconstruction, and bone distraction for large bone defect. Furthermore, the pilot clinical studies were involved to demonstrate the reliable clinical safety and satisfactory bioactive effects of Mg-based implants in bone formation. Finally, this review introduced the background of spine fusion surgeryand the challenges of biological matching cage development. At last, this review prospected the translation potential of a hybrid Mg-PEEK spine fusion cage design.

A comprehensive review on the role of strontium in biodegradable metals

Biodegradable metals, including magnesium, iron, and zinc alloys, have attracted extensive attention due to their good biodegradability and biocompatibility. However, the mechanical properties and corrosion rates of most biodegradable metallic materials have not yet reached the ideal level required for clinical applications. Strontium, as an element of Group IIA in the periodic table of elements, has similar chemical and biological properties to calcium. It can promote bone tissue development and increase bone strength. In addition, strontium can also promote angiogenesis and facilitate the repair of infarcted heart activity. Thus, strontium is commonly used as one of the most alloying elements to improve the in vitro and in vivo properties of biodegradable metals. Besides, strontium is also widely used in various bioactive coatings to improve the comprehensive properties of biodegradable metals. This paper outlines the role of strontium in the human body and summarizes recent research and applications of strontium-containing biodegradable metallic materials. Finally, this paper also provides an outlook on the challenges faced in applying and researching strontium in biodegradable metals.

Data analysis of the influence of microstructure, composition, and loading conditions on stress corrosion cracking behavior of Mg alloys

Stress corrosion cracking (SCC) can be a crucial problem in applying rare earth (RE) Magnesium alloys in environments where mechanical loads and electrochemical driven degradation processes interact. It has been proven already that the SCC behavior is associated with microstructural features, compositions, loading conditions, and corrosive media, especially in-vivo. However, it is still unclear when and how mechanisms acting on multiple scales and respective system descriptors predictable contribute to SCC for the wide set of existing Mg alloys. In the present work, suitable literature data along SCC of Mg alloys has been analyzed to enable the development of a reliable SCC model for MgGd binary alloys. Pearson correlation coefficient and linear fitting are utilized to describe the contribution of selected parameters to corrosion and mechanical properties. Based on our data analysis, a parameter ranking is obtained, providing information on the SCC impact with regard to ultimate tensile strength (UTS) and fracture elongation of respective materials. According to the analyzed data, SCC susceptibility can be grouped and mapped onto Ashby type diagrams for UTS and elongation of respective base materials tested in air and in corrosive media. The analysis reveals the effect of secondary phase content as a crucial materials descriptor for our analyzed materials and enables better understanding towards SCC model development for Mg-5Gd alloy based implant.

Enhanced Mechanical Properties, Corrosion Resistance, Cytocompatibility, Osteogenesis, and Antibacterial Performance of Biodegradable Mg-2Zn-0.5Ca-0.5Sr/Zr Alloys for Bone-Implant Application

Magnesium (Mg) alloys are widely used in bone fixation and bone repair as biodegradable bone-implant materials. However, their clinical application is limited due to their fast corrosion rate and poor mechanical stability. Here, the development of Mg-2Zn-0.5Ca-0.5Sr (MZCS) and Mg-2Zn-0.5Ca-0.5Zr (MZCZ) alloys with improved mechanical properties, corrosion resistance, cytocompatibility, osteogenesis performance, and antibacterial capability is reported. The hot-extruded (HE) MZCZ sample exhibits the highest ultimate tensile strength of 255.8 ± 2.4 MPa and the highest yield strength of 208.4 ± 2.8 MPa and an elongation of 15.7 ± 0.5%. The HE MZCS sample shows the highest corrosion resistance, with the lowest corrosion current density of 0.2 ± 0.1 µA cm-2 and the lowest corrosion rate of 4 ± 2 µm per year obtained from electrochemical testing, and a degradation rate of 368 µm per year and hydrogen evolution rate of 0.83 ± 0.03 mL cm-2 per day obtained from immersion testing. The MZCZ sample shows the highest cell viability in relation to MC3T3-E1 cells among all alloy extracts, indicating good cytocompatibility except at 25% concentration. Furthermore, the MZCZ alloy shows good antibacterial capability against Staphylococcus aureus.

The Characterization of a Biodegradable Mg Alloy after Powder Bed Fusion with Laser Beam/Metal Processing for Custom Shaped Implants

A new Mg-Zn-Zr-Ca alloy in a powder state, intended to be used for custom shaped implants, was obtained via a mechanical alloying method from pure elemental powder. Further, the obtained powder alloy was processed by a PBF-LB/M (powder bed fusion with laser beam/of metal) procedure to obtain additive manufactured samples for small biodegradable implants. A series of microstructural, mechanical and corrosion analyses were performed. The SEM (scanning electron microscopy) analysis of the powder alloy revealed a good dimensional homogeneity, with a uniform colour, no agglutination and almost rounded particles, suitable for the powder bed fusion procedure. Further, the PBF-LB/M samples revealed a robust and unbreakable morphology, with a suitable porosity (that can reproduce that of cortical bone) and without an undesirable balling effect. The tested Young's modulus of the PBF-LB/M samples, which was 42 GPa, is close to that of cortical bone, 30 GPa. The corrosion tests that were performed in PBS (Phosphate-buffered saline) solution, with three different pH values, show that the corrosion parameters have a satisfactory evolution comparative to the commercial ZK 60 alloy.

Exploration of microstructural characteristics, mechanical properties, andin vitrobiocompatibility of biodegradable porous magnesium scaffolds for orthopaedic implants

In this study, porous magnesium (Mg) scaffolds were investigated with varying strontium (Sr) and constant zinc (Zn) concentrations through the powder metallurgy process. All samples were examined at room temperature to evaluate their microstructure, mechanical andin-vitrodegradation behaviour and biological properties. Results indicated that adding Sr was associated with fine average grain size, increased mechanical strength, and a decreased corrosion rate. All samples show tiny isolated and open interconnected pores (porosities: 18%-30%, pores: 127-279 µm) with a suitable surface roughness of less than 0.5 µm. All the provided samples possess mechanical and hemocompatible properties that closely resemble natural bone. Mg-4Zn-2Sr has the highest hardness (102.61 ± 15.1 HV) and compressive strength (24.80 MPa) than Mg-4Zn-0.5Sr (85 ± 8.5 HV, 22.14 MPa) and Mg-4Zn-1Sr (97.71 ± 11.2 HV, 18.06 MPa). Immersion results revealed that samples in phosphate-buffered saline solutions have excellent degradability properties, which makes them a promising biodegradable material for orthopaedic applications. The scaffold with the highest Sr concentration shows the best optimised mechanical and degradation behaviour out of the three porous scaffolds, with a 2.7% hemolysis rate.

A Dose-Dependent Spatiotemporal Response of Angiogenesis Elicited by Zn Biodegradation during the Initial Stage of Bone Regeneration

Zinc (Zn) plays a crucial role in bone metabolism and imbues biodegradable Zn-based materials with the ability to promote bone regeneration in bone trauma. However, the impact of Zn biodegradation on bone repair, particularly its influence on angiogenesis, remains unexplored. This study reveals that Zn biodegradation induces a consistent dose-dependent spatiotemporal response in angiogenesis,both in vivo and in vitro. In a critical bone defect model, an increase in Zn release intensity from day 3 to 10 post-surgery is observed. By day 10, the CD31-positive area around the Zn implant significantly surpasses that of the Ti implant, indicating enhanced angiogenesis. Furthermore,angiogenesis exhibits a distance-dependent pattern closely mirroring the distribution of Zn signals from the implant. In vitro experiments demonstrate that Zn extraction fosters the proliferation and migration of human umbilical vein endothelial cells and upregulates the key genes associated with tube formation, such as HIF-1α and VEGF-A, peaking at a concentration of 22.5 µM. Additionally, Zn concentrations within the range of 11.25-45 µM promote the polarization of M0-type macrophages toward the M2-type, while inhibiting polarization toward the M1-type. These findings provide essential insights into the biological effects of Zn on bone repair, shedding light on its potential applications.

Magnetism-enhanced biomaterial Mg guide wire by MAP process for development of catheter insertion

The surface topography of implant tools has indicated an interfacial contact in degradation still being discovered; however, the glossy texture of a tiny magnesium wire is important for absorbable medical devices. This paper investigated the alterations of surface quality by a magnetic abrasive polishing method using a rotational magnetic field-assisted system with input parameters of revolution, abrasive media, magnetic pole, flux density, vibration, and amplitude that could noticeably enhance asperities along a sample. Furthermore, the blood flow simulation is used to analyze flow within blood vessels while maintaining the surface roughness conditions of the guide wire. The results are compared and discussed. Magnetic field simulation is employed to investigate the magnetic field strength in the polishing zone. Scanning Electron Microscopy (SEM) provides visual aids for recognizing the differences between pre-and post-workpieces of magnesium wire. The experimental results reveal that a wire diameter of 0.50 mm predominantly achieves surface morphology from the initial roughness of 0.22 μm to 0.05 μm. The results corroborate that the distribution of blood in the circulatory system was relatively stable. Hence, this study establishes a crucial benchmark for the precision polishing of ultra-thin magnesium wires, which is vital for their use as high-precision biodegradable medical devices.

In vitro and in vivo study on fine-grained Mg-Zn-RE-Zr alloy as a biodegradeable orthopedic implant produced by friction stir processing

Magnesium alloys containing biocompatible components show tremendous promise for applications as temporary biomedical devices. However, to ensure their safe use as biodegradeable implants, it is essential to control their corrosion rates. In concentrated Mg alloys, a microgalvanic coupling between the α-Mg matrix and secondary precipitates exists which results in increased corrosion rate. To address this challenge, we engineered the microstructure of a biodegradable Mg-Zn-RE-Zr alloy by friction stir processing (FSP), improving its corrosion resistance and mechanical properties simultaneously. The FS processed alloy with refined grains and broken and uniformly distributed secondary precipitates showed a relatively uniform corrosion morphology accompanied with the formation of a stable passive layer on the alloy surface. In vivo corrosion evaluation of the processed alloy in a small animal model showed that the material was well-tolerated with no signs of inflammation or harmful by-products. Remarkably, the processed alloy supported bone until it healed till eight weeks with a low in vivo corrosion rate of 0.7 mm/year. Moreover, we analyzed blood and histology of the critical organs such as liver and kidney, which showed normal functionality and consistent ion and enzyme levels, throughout the 12-week study period. These results demonstrate that the processed Mg-Zn-RE-Zr alloy offers promising potential for osseointegration in bone tissue healing while also exhibiting controlled biodegradability due to its engineered microstructure. The results from the present study will have profound benefit for bone fracture management, particularly in pediatric and elderly patients.

In vitro and in vivo degradation behavior of Mg-0.45Zn-0.45Ca (ZX00) screws for orthopedic applications

Magnesium (Mg) alloys have become a potential material for orthopedic implants due to their unnecessary implant removal, biocompatibility, and mechanical integrity until fracture healing. This study examined the in vitro and in vivo degradation of an Mg fixation screw composed of Mg-0.45Zn-0.45Ca (ZX00, in wt.%). With ZX00 human-sized implants, in vitro immersion tests up to 28 days under physiological conditions, along with electrochemical measurements were performed for the first time. In addition, ZX00 screws were implanted in the diaphysis of sheep for 6, 12, and 24 weeks to assess the degradation and biocompatibility of the screws in vivo. Using scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX), micro-computed tomography (μCT), X-ray photoelectron spectroscopy (XPS), and histology, the surface and cross-sectional morphologies of the corrosion layers formed, as well as the bone-corrosion-layer-implant interfaces, were analyzed. Our findings from in vivo testing demonstrated that ZX00 alloy promotes bone healing and the formation of new bone in direct contact with the corrosion products. In addition, the same elemental composition of corrosion products was observed for in vitro and in vivo experiments; however, their elemental distribution and thicknesses differ depending on the implant location. Our findings suggest that the corrosion resistance was microstructure-dependent. The head zone was the least corrosion-resistant, indicating that the production procedure could impact the corrosion performance of the implant. In spite of this, the formation of new bone and no adverse effects on the surrounding tissues demonstrated that the ZX00 is a suitable Mg-based alloy for temporary bone implants.

The Synergistic Effect of Trace Ag and Hot Extruding on the Microstructure and Properties of a Biodegradable Mg-Zn-Sr-Ag Alloy

To further improve the mechanical properties and corrosion resistance of the biodegradable magnesium (Mg) alloy, the Mg-4Zn-0.5Sr-xAg alloy (x = 0.2 wt.%, 0.5 wt.%, 1.0 wt.%, and 2.0 wt.%) was smelted in vacuum under the protection of inert gas. The effect of the Ag content on the microstructure and mechanical properties of Mg-4Zn-0.5Sr was tested. The results show that the comprehensive properties of Mg-4Zn-0.5Sr-0.5Ag are best. The grain size of the Mg-4Zn-0.5Sr-0.5Ag alloy is minimal, that is, 83.28 μm. The average tensile strength (σb), yield strength (σs), elongation (ε), and hardness for the Mg-4Zn-0.5Sr-0.5Ag alloy is 168.00 MPa, 88.00 MPa, 12.20%, and 59.90 HV, respectively. To further improve the properties of cast Mg-4Zn-0.5Sr-0.5Ag alloy, extruding treatment was conducted. After extrusion deformation, the grain size of the alloy was significantly refined to 9 μm; at the same time, fine second phases were formed and evenly distributed in the matrix. And then, the mechanical properties of the alloy are significantly enhanced due to the effect of fine crystal strengthening and dispersion strengthening. The σb, σs, ε, and hardness value for the extruded Mg-4Zn-0.5Sr-0.5Ag alloy are 236.00 MPa, 212.00 MPa, 18.97%, and 65.42 HV, respectively. Under the synergistic action of adding the Ag element and extrusion treatment, the grain size of the alloy was significantly refined and the coarse second phase in the alloy became refined to disperse in the matrix, which benefits the formation of electric couples characterized as small cathode-large anode between the second phase and Mg matrix. During full immersion, corrosion products covered on the large anode surface could reduce the galvanic corrosion tendency.

Influence of Ag and/or Sr Dopants on the Mechanical Properties and In Vitro Degradation of β-Tricalcium Phosphate-Based Ceramics

β-tricalcium phosphate has good biodegradability and biocompatibility; it is widely perceived as a good material for treating bone deficiency. In this research, different contents of strontium (Sr) and silver (Ag) ion-doped β-tricalcium phosphate powders were prepared using the sol-gel method. After obtaining the best ratio of pore-forming agent and binder, the as-synthesized powders were sintered in a muffle for 5 h at 1000 °C to obtain the samples. Then, these samples were degraded in vitro in simulated body fluids. The samples were tested using a series of characterization methods before and after degradation. Results showed that the amount of Sr and/or Ag doping had an effect on the crystallinity and structural parameters of the samples. After degradation, though the compressive strength of these samples decreased overall, the compressive strength of the undoped samples was higher than that of the doped samples. Notably, apatite-like materials were observed on the surface of the samples. All the results indicate that Sr and/or Ag β-TCP has good osteogenesis and proper mechanical properties; it will be applied as a prospective biomaterial in the area of bone repair.

Biodegradable Magnesium Alloys for Personalised Temporary Implants

The objective of this experimental work was to examine and characterise the route for obtaining demonstrative temporary biodegradable personalised implants from the Mg alloy Mg-10Zn-0.5Zr-0.8Ca (wt.%). This studied Mg alloy was obtained in its powder state using the mechanical alloying method, with shape and size characteristics suitable for ensuing 3D additive manufacturing using the SLM (selective laser melting) procedure. The SLM procedure was applied to various processing parameters. All obtained samples were characterised microstructurally (using XRD-X-ray diffraction, and SEM-scanning electron microscopy); mechanically, by applying a compression test; and, finally, from a corrosion resistance viewpoint. Using the optimal test processing parameters, a few demonstrative temporary implants of small dimensions were made via the SLM method. Our conclusion is that mechanical alloying combined with SLM processing has good potential to manage 3D additive manufacturing for personalised temporary biodegradable implants of magnesium alloys. The compression tests show results closer to those of human bones compared to other potential metallic alloys. The applied corrosion test shows result comparable with that of the commercial magnesium alloy ZK60.

Magnesium-Based Temporary Implants: Potential, Current Status, Applications, and Challenges

Biomedical implants are important devices used for the repair or replacement of damaged or diseased tissues or organs. The success of implantation depends on various factors, such as mechanical properties, biocompatibility, and biodegradability of the materials used. Recently, magnesium (Mg)-based materials have emerged as a promising class of temporary implants due to their remarkable properties, such as strength, biocompatibility, biodegradability, and bioactivity. This review article aims to provide a comprehensive overview of current research works summarizing the above-mentioned properties of Mg-based materials for use as temporary implants. The key findings from in-vitro, in-vivo, and clinical trials are also discussed. Further, the potential applications of Mg-based implants and the applicable fabrication methods are also reviewed.

Facilitated osteogenesis of magnesium implant by coating of strontium incorporated calcium phosphate

This study investigated the corrosion resistance and biocompatibility of magnesium coated with strontium-doped calcium phosphate (Sr-CaP) for dental and orthopedic applications. Sr-CaP was coated on biodegradable magnesium using a chemical dipping method. Magnesium coated with Sr-CaP exhibited better corrosion resistance than pure magnesium. Sr-CaP-coated magnesium showed excellent cell proliferation and differentiation. Additionally, new bone formation was confirmed in vivo. Therefore, Sr-CaP-coated magnesium with reduced degradation and improved biocompatibility can be used for orthopedic and dental implant applications.

An osteogenic magnesium alloy with improved corrosion resistance, antibacterial, and mechanical properties for orthopedic applications

The aim of this study was to develop a novel biodegradable magnesium (Mg) alloy for bone implant applications. We used scandium (Sc; 2 wt %) and strontium (Sr; 2 wt %) as alloying elements due to their high biocompatibility, antibacterial efficacy, osteogenesis, and protective effects against corrosion. In the present work, we also examined the effect of a heat treatment process on the properties of the Mg-Sc-Sr alloy. Alloys were manufactured using a metal casting process followed by heat treatment. The microstructure, corrosion, mechanical properties, antibacterial activity, and osteogenic activity of the alloy were assessed in vitro. The results showed that the incorporation of Sc and Sr elements controlled the corrosion, reduced the hydrogen generation, and enhanced mechanical properties. Furthermore, alloying with Sc and Sr demonstrated a significantly enhanced antibacterial activity and decreased biofilm formation compared to control Mg. Also, culturing Mg-Sc-Sr alloy with human bone marrow-derived mesenchymal stromal cells showed a high degree of biocompatibility (>90% live cells) and a significant increase in osteoblastic differentiation in vitro shown by Alizarin red staining and alkaline phosphatase activity. Based on these results, the Mg-Sc-Sr alloy heat-treated at 400°C displayed optimal mechanical properties, corrosion rate, antibacterial efficacy, and osteoinductivity. These characteristics make the Mg-Sc-Sr alloy a promising candidate for biodegradable orthopedic implants in the fixation of bone fractures such as bone plate-screws or intramedullary nails.

Microstructural Assessment, Mechanical and Corrosion Properties of a Mg-Sr Alloy Processed by Combined Severe Plastic Deformation

The development of high-performance biodegradable alloys with controllable corrosion rates to be used for manufacturing advanced implants is a hot topic of modern materials science and biomedicine. This work features the changes in microstructure, corrosion behavior and mechanical properties of the Mg-2 wt.%Sr alloy progressively induced by equal-channel angular pressing, high-pressure torsion and annealing. We show that such processing leads to significant microstructure refinement including diminishing grain size, defect accumulation and fragmentation of the initial eutectics. We demonstrate that the application of severe plastic deformation and heat treatment is capable of considerably enhancing the mechanical and corrosion performance of a biodegradable alloy of the Mg-Sr system. The best trade-off between strength, plasticity and the corrosion resistance has been achieved by annealing of the Mg-Sr alloy subjected to combined severe plastic deformation processing.

Recent research advances on corrosion mechanism and protection, and novel coating materials of magnesium alloys: a review

Magnesium alloys have achieved a good balance between biocompatibility and mechanical properties, and have great potential for clinical application, and their performance as implant materials has been continuously improved in recent years. However, a high degradation rate of Mg alloys in a physiological environment remains a major limitation before clinical application. In this review, according to the human body's intake of elements, the current mainstream implanted magnesium alloy system is classified and discussed, and the corrosion mechanism of magnesium alloy in vivo and in vitro is described, including general corrosion, localized corrosion, pitting corrosion, and degradation of body fluid environment impact etc. The introduction of methods to improve the mechanical properties and biocorrosion resistance of magnesium alloys is divided into two parts: the alloying part mainly discusses the strengthening mechanisms of alloying elements, including grain refinement strengthening, solid solution strengthening, dislocation strengthening and precipitation strengthening etc.; the surface modification part introduces the ideas and applications of novel materials with excellent properties such as graphene and biomimetic materials in the development of functional coatings. Finally, the existing problems are summarized, and the future development direction is prospected.

Alkaline earth metals for osteogenic scaffolds: From mechanisms to applications

Regeneration of bone defects is a significant challenge today. As alternative approaches to the autologous bone, scaffold materials have remarkable features in treating bone defects; however, the various properties of current scaffold materials still fall short of expectations. Due to the osteogenic capability of alkaline earth metals, their application in scaffold materials has become an effective approach to improving their properties. Furthermore, numerous studies have shown that combining alkaline earth metals leads to better osteogenic properties than applying them alone. In this review, the physicochemical and physiological characteristics of alkaline earth metals are introduced, mainly focusing on their mechanisms and applications in osteogenesis, especially magnesium (Mg), calcium (Ca), strontium (Sr), and barium (Ba). Furthermore, this review highlights the possible cross-talk between pathways when alkaline earth metals are combined. Finally, some of the current drawbacks of scaffold materials are enumerated, such as the high corrosion rate of Mg scaffolds and defects in the mechanical properties of Ca scaffolds. Moreover, a brief perspective is also provided regarding future directions in this field. It is worth exploring that whether the levels of alkaline earth metals in newly regenerated bone differs from those in normal bone. The ideal ratio of each element in the bone tissue engineering scaffolds or the optimal concentration of each elemental ion in the created osteogenic environment still needs further exploration. The review not only summarizes the research developments in osteogenesis but also offers a direction for developing new scaffold materials.

In-vivo bone remodeling potential of Sr-d-Ca-P /PLLA-HAp coated biodegradable ZK60 alloy bone plate

Magnesium and its alloys are widely applied biomaterials due to their biodegradability and biocompatibility. However, rapid degradation and hydrogen gas evolution hinder its applicability on a commercial scale. In this study, we developed an Mg alloy bone plate for bone remodeling and support after a fracture. We further coated the Mg alloy plate with Sr-D-Ca-P (Sr dopped Ca-P coating) and Sr-D-Ca-P/PLLA-HAp to evaluate and compare their biodegradability and biocompatibility in both in vitro and in vivo experiments. Chemical immersion and dip coating were employed for the formation of Sr-D-Ca-P and PLLA-HAp layers, respectively. In vitro evaluation depicted that both coatings delayed the degradation process and exhibited excellent biocompatibility. MC3T3-E1cells proliferation and osteogenic markers expression were also promoted. In vivo results showed that both Sr-D-Ca-P and Sr-D-Ca-P/PLLA-HAp coated bone plates had slower degradation rate as compared to Mg alloy. Remarkable bone remodeling was observed around the Sr-D-Ca-P/PLLA-HAp coated bone plate than bare Mg alloy and Sr-D-Ca-P coated bone plate. These results suggest that Sr-D-Ca-P/PLLA-HAp coated Mg alloy bone plate with lower degradation and enhanced biocompatibility can be applied as an orthopedic implant.

Open-porous magnesium-based scaffolds withstand in vitro corrosion under cyclic loading: A mechanistic study

The successful application of magnesium (Mg) alloys as biodegradable bone substitutes for critical-sized defects may be comprised by their high degradation rate resulting in a loss of mechanical integrity. This study investigates the degradation pattern of an open-porous fluoride-coated Mg-based scaffold immersed in circulating Hanks' Balanced Salt Solution (HBSS) with and without in situ cyclic compression (30 N/1 Hz). The changes in morphological and mechanical properties have been studied by combining in situ high-resolution X-ray computed tomography mechanics and digital volume correlation. Although in situ cyclic compression induced acceleration of the corrosion rate, probably due to local disruption of the coating layer where fatigue microcracks were formed, no critical failures in the overall scaffold were observed, indicating that the mechanical integrity of the Mg scaffolds was preserved. Structural changes, due to the accumulation of corrosion debris between the scaffold fibres, resulted in a significant increase (p < 0.05) in the material volume fraction from 0.52 ± 0.07 to 0.47 ± 0.03 after 14 days of corrosion. However, despite an increase in fibre material loss, the accumulated corrosion products appear to have led to an increase in Young's modulus after 14 days as well as lower third principal strain (εp3) accumulation (−91000 ± 6361 με and −60093 ± 2414 με after 2 and 14 days, respectively). Therefore, this innovative Mg scaffold design and composition provide a bone replacement, capable of sustaining mechanical loads in situ during the postoperative phase allowing new bone formation to be initially supported as the scaffold resorbs.

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First report on in vitro cyclic loading of MgF₂ coated open-porous Mg scaffolds in HBSS simulating 2–3 months in humans.

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Fluoride-coating slows down corrosion under cyclic loading in vitro.

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Entangled scaffold structure accumulates local corrosion debris which keeps the mechanical integrity over 14 days in vitro.

Biodegradable Mg-Sc-Sr Alloy Improves Osteogenesis and Angiogenesis to Accelerate Bone Defect Restoration

Magnesium (Mg) and its alloys are considered to be biodegradable metallic biomaterials for potential orthopedic implants. While the osteogenic properties of Mg alloys have been widely studied, few reports focused on developing a bifunctional Mg implant with osteogenic and angiogenic properties. Herein, a Mg-Sc-Sr alloy was developed, and this alloy's angiogenesis and osteogenesis effects were evaluated in vitro for the first time. X-ray Fluorescence (XRF), X-ray diffraction (XRD), and metallography images were used to evaluate the microstructure of the developed Mg-Sc-Sr alloy. Human umbilical vein/vascular endothelial cells (HUVECs) were used to evaluate the angiogenic character of the prepared Mg-Sc-Sr alloy. A mix of human bone-marrow-derived mesenchymal stromal cells (hBM-MSCs) and HUVEC cell cultures were used to assess the osteogenesis-stimulating effect of Mg-Sc-Sr alloy through alkaline phosphatase (ALP) and Von Kossa staining. Higher ALP activity and the number of calcified nodules (27% increase) were obtained for the Mg-Sc-Sr-treated groups compared to Mg-treated groups. In addition, higher VEGF expression (45.5% increase), tube length (80.8% increase), and number of meshes (37.9% increase) were observed. The Mg-Sc-Sr alloy showed significantly higher angiogenesis and osteogenic differentiation than pure Mg and the control group, suggesting such a composition as a promising candidate in bone implants.

Effect of pH fluctuations on the biodegradability of nanocomposite Mg-alloy in simulated bodily fluids

According to the National Institute of Health, the biodegradability, non-toxic nature, and remarkable natural and mechanical properties of magnesium and its components make them desirable choices for use in the production of supplies for biomedical implantation. Simulated bodily fluid (SBF) is used as a standard electrolyte for in vitro corrosion research. Each SBF module's independent and synergistic corrosion effects are studied in this study. Artificial pH variations increase degradation, according to the results. This experiment examined the Mg corrosion submerged in a SBF solution. The effect of pH changes on the rate of corrosion of Mg immersed in standard SBF solution was investigated. According to the previously published study, the corrosion process of Mg has been confirmed by scanning electron microscopy observations of damaged surface morphology. Because of these investigations, pH 7 was selected as the pH for bodily fluids since it is neutral.

Role of Solvent Used in Development of Graphene Oxide Coating on AZ31B Magnesium Alloy: Corrosion Behavior and Biocompatibility Analysis

Clinical applications of bio-absorbable magnesium (Mg) and its alloys can be enhanced by increasing their corrosion resistance, using surface modification and functionality. In this study, we synthesized graphene oxide (GO) through improved Hummers' method and deposited it on biodegradable AZ31B Mg alloy for further characterization. Different suspensions of GO were prepared in various solvents, like deionized water, ethanol, and acetone by ultra-sonication. Electrophoretic deposition (EPD) was used to develop GO coatings on AZ31B Mg using different GO suspensions. Effect of various solvents on corrosion behavior, as well as in vitro biocompatibility, was studied. The optimized EPD parameters were 3 volts and 90 s for coating. Different characterization techniques were used to study GO and prepared coatings. Atomic force microscopy found that the average thickness of GO was ~1 nm. Electrochemical behavior of coatings was studied through electrochemical impedance spectroscopy (EIS) and Tafel analysis in Ringer's lactate solution. Tafel analysis revealed that GO coatings deposited by GO water suspension increased corrosion protection efficiency of AZ31B Mg alloy by ~94%. After 72 h incubation in MC3T3-E1 osteoblast cells extract, in vitro analysis was performed to determine the cell viability and biocompatibility of the GO- coated and bare Mg samples. GO coatings deposited by GO water suspension demonstrated ~2× cell viability, as well as nontoxicity and better biocompatibility compared to the bare and other GO-coated Mg samples.

Development of degradable magnesium-based metal implants and their function in promoting bone metabolism (A review)

Background

Use of degradable magnesium (Mg)-based metal implants in orthopaedic surgeries can avoid drawbacks associated with subsequent removal of the non-degradable metallic implants, reducing cost and trauma of patients. Although Mg has been applied in the clinic for orthopaedic treatment, the use of Mg-based metal implants is largely in the research phase. But its application is potentially beneficial in this context as it has been shown that Mg can promote osteogenesis and inhibit osteoclast activity.

Methods

A systematic literature search about “degradable magnesium (Mg)-based metal implants” was performed in PubMed and Web of Science. Meanwhile, relevant findings have been reviewed and quoted.

Results

In this review, we summarize the latest developments in Mg-based metal implants and their role in bone regeneration. We also review the various molecular mechanisms by which Mg ions regulate bone metabolic processes, including osteogenesis, osteoclast activity, angiogenesis, immunity, and neurology. Finally, we discuss the remaining research challenges and opportunities for Mg-based implants and their applications.

Conclusion

Currently, establishment of the in vitro and in vivo biological evaluation systems and phenotypic modification improvement of Mg-based implants are still needed. Clarifying the functions of Mg-based metal implants in promoting bone metabolism is beneficial for their clinical application.

The Translational potential of this article

All current reviews on Mg-based implants are mainly concerned with the improvement of Mg alloy properties or the progress of applications. However, there are few reviews that provides a systematic narrative on the effect of Mg on bone metabolism. This review summarized the latest developments in Mg-based metal implants and various molecular mechanisms of Mg ions regulating bone metabolism, which is beneficial to further promote the translation of Mg based implants in the clinic and is able to provide a strong basis for the clinical application of Mg based implants.

3D-printed NIR-responsive shape memory polyurethane/magnesium scaffolds with tight-contact for robust bone regeneration

Patients with bone defects suffer from a high rate of disability and deformity. Poor contact of grafts with defective bones and insufficient osteogenic activities lead to increased loose risks and unsatisfied repair efficacy. Although self-expanding scaffolds were developed to enhance bone integration, the limitations on the high transition temperature and the unsatisfied bioactivity hindered greatly their clinical application. Herein, we report a near-infrared-responsive and tight-contacting scaffold that comprises of shape memory polyurethane (SMPU) as the thermal-responsive matrix and magnesium (Mg) as the photothermal and bioactive component, which fabricated by the low temperature rapid prototyping (LT-RP) 3D printing technology. As designed, due to synergistic effects of the components and the fabrication approach, the composite scaffold possesses a homogeneously porous structure, significantly improved mechanical properties and stable photothermal effects. The programmed scaffold can be heated to recover under near infrared irradiation in 60s. With 4 wt% Mg, the scaffold has the balanced shape fixity ratio of 93.6% and shape recovery ratio of 95.4%. The compressed composite scaffold could lift a 100 g weight under NIR light, which was more than 1700 times of its own weight. The results of the push-out tests and the finite element analysis (FEA) confirmed the tight-contacting ability of the SMPU/4 wt%Mg scaffold, which had a signficant enhancement compared to the scaffold without shape memory effects. Furthermore, The osteopromotive function of the scaffold has been demonstrated through a series of in vitro and in vivo studies. We envision this scaffold can be a clinically effective strategy for robust bone regeneration.

In Vitro Degradation and In Vivo Biocompatibility of Strontium-Doped Magnesium Phosphate-Reinforced Magnesium Composites

Magnesium is projected for use as a degradable orthopedic biomaterial. However, its fast degradation in physiological media is considered as a significant challenge for its successful clinical applications. Bioactive reinforcements containing Mg-based composites constitute one of the promising approaches for developing degradable metallic implants because of their adjustable mechanical behaviors, corrosion resistance, and biological response. Strontium is a trace element known for its role in enhancing osteoblast activity. In this study, bioactive SrO-doped magnesium phosphate (MgP)-reinforced Mg composites containing 1, 3, and 5 wt % MgP were developed through the casting route. The influence of the SrO-doped MgP reinforcement on degradation behaviors of the composites along with its cell-material interactions and in vivo biocompatibility was investigated. The wt % and distribution of MgP particles significantly improved the mechanical properties of the composite. HBSS immersion study indicated the least corrosion rate (0.56 ± 0.038 mmpy) for the Mg-3MgP composite. The higher corrosion resistance of Mg-3MgP leads to a controlled release of Sr-containing bioactive reinforcement, which eventually enhanced the cytotoxicity as measured using MG-63 cell-material interactions. The in vivo biocompatibility of the composite was evaluated using the rabbit femur defect model. Micro-computed tomography (μ-CT) and histological analysis supported the fact that Mg-3MgP maintained its structural integrity and enhanced osteogenesis (50.36 ± 2.03%) after 2 months of implantation. The results indicated that the Mg-MgP composite could be used as a degradable internal fracture fixation device material.

Development of biodegradable Zn-Mn-Li and CaP coatings on Zn-Mn-Li alloys and cytocompatibility evaluation for bone graft

Zn-based alloys are considered as new kind of potential biodegradable implanted biomaterials recently. The difficulty of metal implanted biomaterials and bone tissue integration seriously affects the applications of metal implanted scaffolds in bone tissue-related fields. Herein, we self-designed Zn0.8Mn and Zn0.8Mn0.1Li alloys and CaP coated Zn0.8Mn and Zn0.8Mn0.1Li alloys, then evaluated the degradation property and cytocompatibility. The results demonstrated that the Zn0.8Mn0.1Li alloys had profoundly modified the degradation property and cytocompatibility, but Zn0.8Mn0.1Li alloys had particularly adverse effects on the surface morphology of osteoblasts. The results furtherly showed that the CaP-coated Zn0.8Mn and Zn0.8Mn0.1Li alloys scaffold had better biocompatibility, which would further guarantee the biosafety of this new kind of biodegradable Zn-based alloys implants for future clinical applications.

Magnesium for Implants: A Review on the Effect of Alloying Elements on Biocompatibility and Properties

An attempt is made to cover the whole of the topic of biodegradable magnesium (Mg) alloys with a focus on the biocompatibility of the individual alloying elements, as well as shed light on the degradation characteristics, microstructure, and mechanical properties of most binary alloys. Some of the various work processes carried out by researchers to achieve the alloys and their surface modifications have been highlighted. Additionally, a brief look into the literature on magnesium composites as also been included towards the end, to provide a more complete picture of the topic. In most cases, the chronological order of events has not been particularly followed, and instead, this work is concentrated on compiling and presenting an update of the work carried out on the topic of biodegradable magnesium alloys from the recent literature available to us.

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.

High-strength biodegradable zinc alloy implants with antibacterial and osteogenic properties for the treatment of MRSA-induced rat osteomyelitis

Implant-related infections caused by drug-resistant bacteria remain a major challenge faced by orthopedic surgeons. Furthermore, ideal prevention and treatment methods are lacking in clinical practice. Here, based on the antibacterial and osteogenic properties of Zn alloys, Ag and Li were selected as alloying elements to prepare biodegradable Zn-Li-Ag ternary alloys. Li and Ag addition improved the mechanical properties of Zn-Li-Ag alloys. The Zn-0.8Li-0.5Ag alloy exhibited the highest ultimate tensile strength (>530 MPa). Zn-Li-Ag alloys showed strong bactericidal effects on methicillin-resistant Staphylococcus aureus (MRSA) in vitro. RNA sequencing revealed two MRSA-killing mechanisms exhibited by the Zn-0.8Li-0.5Ag alloy: cellular metabolism disturbance and induction of reactive oxygen species production. To verify that the therapeutic potential of the Zn-0.8Li-0.5Ag alloy is greater than that of Ti intramedullary nails, X-ray, micro-computed tomography, microbiological, and histological analyses were conducted in a rat femoral model of MRSA-induced osteomyelitis. Treatment with Zn-0.8Li-0.5Ag alloy implants resulted in remarkable infection control and favorable bone retention. The in vivo safety of this ternary alloy was confirmed by evaluating vital organ functions and pathological morphologies. We suggest that, with its good antibacterial and osteogenic properties, Zn-0.8Li-0.5Ag alloy can serve as an orthopedic implant material to prevent and treat orthopedic implant-related infections.

Investigation on Mechanical, Biocorrosion, and Biocompatibility Behavior of HAp-Assisted Sr-Based Mg Composites

Numerous biodegradable Mg-based biomaterials have been developed in recent years because of their outstanding biocompatibility, biodegradation, and mechanical properties. The Mg-based composite is an appropriate candidate for orthopedic implants, such as supporting the fractured bone due to its superb biocompatibility and biodegradation properties. In the present work, a Mg-based biomaterial is developed by incorporating low wt % of alloying elements such as Zn, Ca, Mn, and Sr and ceramic powders such as HAp to improve the biocompatibility and biodegradebility and strengthen the mechanical properties. In this study, the Mg-4Zn-3Ca-1HAp-0.5Mn and Mg-4Zn-2.9Ca-1HAp-0.5Mn-0.1Sr composites are prepared, and the mechanical, microstructure, and in vitro degradation behavior of these composites are studied. The Mg-4Zn-2.9Ca-1HAp-0.5Mn-0.1Sr composite has good mechanical properties and a low uniform in vitro degradation rate (0.587 mm/year). From the dynamic mechanical analysis, it is found that the composites have better damping characteristics than the pure Mg. The composites are chosen for further evaluation. All the composites show no cytotoxicity to MG63 cells. The composite having Sr with PVA/ZrO₂ coating showed the highest cell viability. On the basis of the above observation, the viability of the Mg-4Zn-3Ca-1HAp-0.5Mn and Mg-4Zn-2.9Ca-1HAp-0.5Mn-0.1Sr composites is discussed systematically for the use as an orthopedic implant. This investigation delivers a new idea for the evolution of a high-performance Sr-based Mg composite having excellent mechanical and corrosion properties while successfully reducing the cytotoxicity effect.

Potential bioactive coating system for high-performance absorbable magnesium bone implants

Magnesium alloys are considered the most suitable absorbable metals for bone fracture fixation implants. The main challenge in absorbable magnesium alloys is their high corrosion/degradation rate that needs to be controlled. Various coatings have been applied to magnesium alloys to slow down their corrosion rates to match their corrosion rate to the regeneration rate of the bone fracture. In this review, a bioactive coating is proposed to slow down the corrosion rate of magnesium alloys and accelerate the bone fracture healing process. The main aim of the bioactive coatings is to enhance the direct attachment of living tissues and thereby facilitate osteoconduction. Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are six bioactive agents that show high potential for developing a bioactive coating system for high-performance absorbable magnesium bone implants. In addition to coating, the substrate itself can be made bioactive by alloying magnesium with calcium, zinc, copper, and manganese that were found to promote bone regeneration.

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Bioactive-coated magnesium implant could accelerate bone fracture healing time to match with magnesium degradation.

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Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are high potential bioactive coating materials.

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The incorporation of Ca, Zn, Cu, Sr, and Mn in Mg base-metal could further enhance bone formation.

A review on properties of magnesium-based alloys for biomedical applications

With changing lifestyles, the demand for bone implantation has been increasing day by day. The deficiency of nutritious elements within the human body results in certain diseases like osteoporosis, rickets, and other skeletal disorders; lack of physical activities; and the increasing number of accidents are the primary reasons for bone damage/fracture. Metallic implants made up of chrome steel, cobalt-based alloys, and titanium-based alloys are being majorly used worldwide owing to their high strength and high corrosion resistance which makes them permanent orthopedic bioimplant materials, however, they display a stress-shielding effect and it also requires an implant removal surgery. Thus, these problems can be addressed through the employment of biodegradable materials. Among the available biodegradable metallic materials, Mg alloys have been identified as a prospective orthopedic implant material. These alloys are biodegradable as well as biocompatible, however, they experience a relatively higher rate of degradation limiting their usability as implant material. This study attempts to comprehensively assess the effects of various alloying elements such as Ca, Zn, Sn, Mn, Sr and Rare earth elements (REEs) on the mechanical and degradation behavior (bothin vivoandin vitro) of Mg alloys. Since the microstructure, mechanical properties and degradation response of the Mg alloys are dependent on the processing route, hence detailed processing- property database of different Mg alloys is provided in this paper.

Corrosion Behavior in Magnesium-Based Alloys for Biomedical Applications

Magnesium alloys exhibit superior biocompatibility and biodegradability, which makes them an excellent candidate for artificial implants. However, these materials also suffer from lower corrosion resistance, which limits their clinical applicability. The corrosion mechanism of Mg alloys is complicated since the spontaneous occurrence is determined by means of loss of aspects, e.g., the basic feature of materials and various corrosive environments. As such, this study provides a review of the general degradation/precipitation process multifactorial corrosion behavior and proposes a reasonable method for modeling and preventing corrosion in metals. In addition, the composition design, the structural treatment, and the surface processing technique are involved as potential methods to control the degradation rate and improve the biological properties of Mg alloys. This systematic representation of corrosive mechanisms and the comprehensive discussion of various technologies for applications could lead to improved designs for Mg-based biomedical devices in the future.

A review of current challenges and prospects of magnesium and its alloy for bone implant applications

Medical application materials must meet multiple requirements, and the designed implant must mimic the bone structure in shape and support the formation of bone tissue (osteogenesis). Magnesium (Mg) alloys, as a "smart" biodegradable material and as "the green engineering material in the twenty-first century", have become an outstanding bone implant material due to their natural degradability, smart biocompatibility, and desirable mechanical properties. Magnesium is recognised as the next generation of orthopaedic appliances and bioresorbable scaffolds. At the same time, improving the mechanical properties and corrosion resistance of magnesium alloys is an urgent challenge to promote the application of magnesium alloys. Nevertheless, the excessively quick deterioration rate generally results in premature mechanical integrity disintegration and local hydrogen build-up, resulting in restricted clinical bone restoration applicability. The condition of Mg bone implants is thoroughly examined in this study. The relevant approaches to boost the corrosion resistance, including purification, alloying treatment, surface coating, and Mg-based metal matrix composite, are comprehensively revealed. These characteristics are reviewed to assess the progress of contemporary Mg-based biocomposites and alloys for biomedical applications. The fabricating techniques for Mg bone implants also are thoroughly investigated. Notably, laser-based additive manufacturing fabricates customised forms and complicated porous structures based on its distinctive additive manufacturing conception. Because of its high laser energy density and strong controllability, it is capable of fast heating and cooling, allowing it to modify the microstructure and performance. This review paper aims to provide more insight on the present challenges and continued research on Mg bone implants, highlighting some of the most important characteristics, challenges, and strategies for improving Mg bone implants.

Magnesium-Based Alloys Used in Orthopedic Surgery

Magnesium (Mg)-based alloys have become an important category of materials that is attracting more and more attention due to their high potential use as orthopedic temporary implants. These alloys are a viable alternative to nondegradable metals implants in orthopedics. In this paper, a detailed overview covering alloy development and manufacturing techniques is described. Further, important attributes for Mg-based alloys involved in orthopedic implants fabrication, physiological and toxicological effects of each alloying element, mechanical properties, osteogenesis, and angiogenesis of Mg are presented. A section detailing the main biocompatible Mg-based alloys, with examples of mechanical properties, degradation behavior, and cytotoxicity tests related to in vitro experiments, is also provided. Special attention is given to animal testing, and the clinical translation is also reviewed, focusing on the main clinical cases that were conducted under human use approval.

High-Efficient Vacuum Ultraviolet-Ozone Assist-Deposited Polydopamine for Poly(lactic-co-glycolic acid)-Coated Pure Zn toward Biodegradable Cardiovascular Stent Applications

Zinc is a prospective metal for biodegradable cardiovascular stent applications, but the excessively released Zn²⁺ during degradation remains a huge challenge in biocompatibility. Considerable efforts have been made to develop a high-efficient surface modification method, while maintaining adhesion strength, mechanical support, and vascular compatibility. Biomimetic polydopamine (PDA) can adhere to Zn tightly, subsequently achieving robust chemical bonds with poly(lactic-co-glycolic acid) (PLGA) coating. However, the deposition of PDA on Zn depends on the controlled conditions such as a sensitive pH and a long period of time. Herein, we introduce vacuum ultraviolet-ozone (VUV/O₃) assist-deposition technology to accelerate the polymerization of PDA on pure Zn, which shortens the process to 40 min at a moderate pH of 8.5 and improves the deposition rate by 1-2 orders of magnitude under sufficient active oxygen species (ROS). Additionally, PLGA/PDA coating enhances the corrosion resistance, and their effective protection maintains the mechanical properties after long-term corrosion. Moreover, the controlled Zn²⁺ release contributes to the superior in vitro biocompatibility, which inhibits the hemolysis rate and smooth muscle cell (SMC) proliferation. The enhanced endothelial cell (EC) proliferation is promising to promote the re-endothelialization, avoiding in-stent restenosis and neointimal hyperplasia. Such modified Zn might be a viable candidate for the treatment of cardiovascular diseases.

The Application of Tannic Acid in Orthopedics

Tannic acid (TA) is a naturally occurring polyphenol compound commonly found in tea, wine, and fruits. Because of the excellent structural and functional properties afforded by TA, materials based on the structure of polyhydroxyphenols have great value, particularly for orthopedic transplantation. This compound, for example, can form a strong interaction with metals and can form a stable coating on their surfaces, thus, improving the physical and chemical properties of bone–implant surfaces and boosting implantation success rates. TA can also inhibit the activity of osteoclasts, thus, playing a potential role in the treatment of osteoporosis. Furthermore, if the body becomes polluted with heavy metals, TA can chelate the ions to protect bone morphology and structure. It also has a significant antibacterial effect and can reduce infections caused by surgical implantation and inhibit a variety of tumor cells, thereby promoting its potential application in spinal metastasis surgery. Furthermore, it can also slow the corrosion caused by magnesium alloys, thereby greatly improving the development of degradable orthopedic metal fixatives. Importantly, TA is cheap and easy to obtain, making it extremely valuable for use in orthopedics. This review focuses on the research status and practical applications of TA, and prospects for its future application for orthopedics (Figure 1).