Osteointegration of femoral stem prostheses with a bilayered calcium phosphate coating

Kinetic and Kinematic Gait Analyses of Dogs with Undersized Cementless Stems (Biphasic Calcium Phosphate Coated) versus Cemented in Total Hip Replacement

To use kinetic and kinematic analysis to determine whether a cementless femoral implanted with a bioactive coating can be an effective alternative to a cemented femoral stem.In the Cemented group, six dogs were implanted with a 316L stainless steel hip prosthesis. The six dogs in the Cementless group were implanted with a 316L stainless steel hip prosthesis with a biphasic calcium phosphate coating. Kinetic gait analysis was performed before the surgery and at 2, 4, 6, 8, and 12 weeks postoperatively. Kinematic analyses were carried out before the surgery and at 2, 4, 6, 8, 12, and 16 weeks.A slow and sustained improvement in kinetic parameters occurred over time. Dogs implanted with the cemented prosthesis recovered normal preoperative values for maximal hip extension angle by 4 weeks after surgery. Dogs with cementless prosthesis had not recovered normal hip extension by 4 weeks. Despite this short-term change in hip mobility, there were no significant differences in gait between the two groups over the 4-month study period.No differences in gait between cementless and cemented prosthesis were observed throughout the postoperative period to the fourth month. Additionally, compensation and adaptation with gradual recovery of kinetic and kinematic parameters were evident.

Study of biphasic calcium phosphate (BCP) ceramics of tilapia fish bones by age

Biphasic calcium phosphate (BCP), consisting of bioceramics such as HAp + β-TCP and Ca10(PO4)6(OH)2 + Ca3(PO4)2, is a popular choice for optimizing performance due to its superior biological reabsorption and osseointegration. In this study, BCP was produced by calcining the bones of tilapia fish (Oreochromis niloticus) reared in net cages and slaughtered at an age ranging from 15 to 420 days. The bones were cleaned and dried, calcined at 900 °C for 8 h, and then subjected to high-energy grinding for 3 h to produce BCP powders. After the calcination process, the crystalline phase's hydroxyapatite (HAp) and/or beta-tricalcium phosphate (β-TCP) were present in the composition of the bioceramic. The age-dependent variation in phase composition was confirmed by complementary vibrational spectroscopy techniques, revealing characteristic peaks and bands of the bioceramic. This variation was marked by an increase in HAp phase and a decrease in β-TCP phase. Thermogravimetric Analysis (TGA) and Differential Thermal Analysis (DTA) from 25 to 1400 °C showed the characteristic mass losses of the material, with a greater loss observed for younger fish, indicating the complete removal of organic components at temperatures above 600 °C. Comparison of the results obtained by X-Ray Diffraction (XRD) and Rietveld refinement with Raman spectroscopy showed excellent agreement. These results showed that with temperature and environment control and adequate fish feeding, it is possible to achieve the desired amounts of each phase by choosing the ideal age of the fish. This bioceramic enables precise measurement of HAp and β-TCP concentrations and Ca/P molar ratio, suitable for medical orthopedics and dentistry.

Preparation and Characterization of Nanofiber Coatings on Bone Implants for Localized Antimicrobial Activity Based on Sustained Ion Release and Shape-Preserving Design

Titanium (Ti), as a hard tissue implant, is facing a big challenge for rapid and stable osseointegration owing to its intrinsic bio-inertness. Meanwile, surface-related infection is also a serious threat. In this study, large-scale quasi-vertically aligned sodium titanate nanowire (SNW) arrayed coatings incorporated with bioactive Cu2+ ions were fabricated through a compound process involving acid etching, hydrothermal treatment (HT), and ion exchange (IE). A novel coating based on sustained ion release and a shape-preserving design is successfully obtained. Cu2+ substituted Na+ in sodium titanate lattice to generate Cu-doped SNW (CNW), which maintains the micro-structure and phase components of the original SNW, and can be efficiently released from the structure by immersing them in physiological saline (PS) solutions, ensuring superior long-term structural stability. The synergistic effects of the acid etching, bidirectional cogrowth, and solution-strengthening mechanisms endow the coating with higher bonding strengths. In vitro antibacterial tests demonstrated that the CNW coatings exhibited effective good antibacterial properties against both Gram-positive and Gram-negative bacteria based on the continuous slow release of copper ions. This is an exciting attempt to achieve topographic, hydrophilic, and antibacterial activation of metal implants, demonstrating a paradigm for the activation of coatings without dissolution and providing new insights into insoluble ceramic-coated implants with high bonding strengths.

A review on in vitro/in vivo response of additively manufactured Ti-6Al-4V alloy

Bone replacement using porous and solid metallic implants, such as Ti-alloy implants, is regarded as one of the most practical therapeutic approaches in biomedical engineering. The bone is a complex tissue with various mechanical properties based on the site of action. Patient-specific Ti-6Al-4V constructs may address the key needs in bone treatment for having customized implants that mimic the complex structure of the natural tissue and diminish the risk of implant failure. This review focuses on the most promising methods of fabricating such patient-specific Ti-6Al-4V implants using additive manufacturing (AM) with a specific emphasis on the popular subcategory, which is powder bed fusion (PBF). Characteristics of the ideal implant to promote optimized tissue-implant interactions, as well as physical, mechanical/chemical treatments and modifications will be discussed. Accordingly, such investigations will be classified into 3B-based approaches (Biofunctionality, Bioactivity, and Biostability), which mainly govern native body response and ultimately the success in implantation.

Cubic multi-ions-doped Na2TiO3 nanorod-like coatings: Structure-stable, highly efficient platform for ions-exchanged release to immunomodulatory promotion on vascularized bone apposition

The dissolution-derived release of bioactive ions from ceramic coatings on metallic implants, despite improving osseointegration, renders a concern on the interfacial breakdown of the metal/coating/bone system during long-term service. Consequently, persistent efforts to seek alternative strategies instead of dissolution-derived activation are pressingly carrying out. Inspired by bone mineral containing ions as Ca²⁺, Mg²⁺, Sr²⁺ and Zn²⁺, here we hydrothermally grew the quadruple ions co-doped Na₂TiO₃ nanorod-like coatings. The co-doped ions partially substitute Na⁺ in Na₂TiO₃, and can be efficiently released from cubic lattice via exchange with Na⁺ in fluid rather than dissolution, endowing the coatings superior long-term stability of structure and bond strength. Regulated by the coatings-conditioned extracellular ions, TLR4-NFκB signalling is enhanced to act primarily in macrophages (MΦs) at 6 h while CaSR-PI3K-Akt1 signalling is potentiated to act predominately since 24 h, triggering MΦs in a M1 response early and then in a M2 response to sequentially secrete diverse cytokines. Acting on endothelial and mesenchymal stem cells with the released ions and cytokines, the immunomodulatory coatings greatly promote Type-H (CD31^hiEmcn^hi) angiogenesis and osteogenesis in vitro and in vivo, providing new insights into orchestrating insoluble ceramics-coated implants for early vascularized osseointegration in combination with long-term fixation to bone.

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Co-doped Ca²⁺, Mg²⁺, Sr²⁺ and Zn²⁺ in Na₂TiO₃ efficiently release via ion exchange.

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QID elevates extracellular concentrations of the ions and MΦ intracellular [Ca²⁺].

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Co-doped Na₂TiO₃ coatings promote immunomodulatory apposition of vascularized bone.

A Review on Biphasic Calcium Phosphate Materials Derived from Fish Discards

This review summarizes the results reported on the production of biphasic calcium phosphate (BCP) materials derived from fish wastes (i.e., heads, bones, skins, and viscera), known as fish discards, and offers an in-depth discussion on their promising potential for various applications in many fields, especially the biomedical one. Thus, considerable scientific and technological efforts were recently focused on the capability of these sustainable materials to be transformed into economically attractive and highly valuable by-products. As a consequence of using these wastes, plenty of beneficial social effects, with both economic and environmental impact, will arise. In the biomedical field, there is a strong and continuous interest for the development of innovative solutions for healthcare improvement using alternative materials of biogenic origin. Thus, the orthopedic field has witnessed a significant development due to an increased demand for a large variety of implants, grafts, and/or scaffolds. This is mainly due to the increase of life expectancy and higher frequency of bone-associated injuries and diseases. As a consequence, the domain of bone-tissue engineering has expanded to be able to address a plethora of bone-related traumas and to deliver a viable and efficient substitute to allografts or autografts by combining bioactive materials and cells for bone-tissue ingrowth. Among biomaterials, calcium phosphate (CaP)-based bio-ceramics are widely used in medicine, in particular in orthopedics and dentistry, due to their excellent bioactive, osteoconductive, and osteointegrative characteristics. Recently, BCP materials (synthetic or natural), a class of CaP, which consist of a mixture of two phases, hydroxyapatite (HA) and beta tricalcium phosphate (β-TCP), in different concentrations, gained increased attention due to their superior overall performances as compared to single-phase formulations. Moreover, the exploitation of BCP materials from by-products of fish industry was reported to be a safe, cheap, and simple procedure. In the dedicated literature, there are many reviews on synthetic HA, β-TCP, or BCP materials, but to the best of our knowledge, this is the first collection of results on the effects of processing conditions on the morphological, compositional, structural, mechanical, and biological properties of the fish discard-derived BCPs along with the tailoring of their features for various applications.

Biogenic Calcium Phosphate from Fish Discards and By-Products

Every year, millions of tons of fish waste are generated from fishing activities, and a similar amount is discarded and returned to the sea as unwanted catches. This material can be used as a biological source for many potential new added-value products, such asobtaining hyaluronic acid from fish eyeballs or extracting collagen from fish skin, but there are not many utilities for fish bones yet. This work tackles the transformation of fish discards into calcium phosphates. Discards from scorpionfish (Scorpaena scrofa) and Atlantic horse mackerel (Trachurus trachurus), as well as by-products generated from aquaculture activities (heads and trimmings frames) of salmon (Salmon salar), were used to obtain calcium phosphate. Biphasic carbonated hydroxyapatite (HA) /beta-tricalcium phosphate (TCP) material was obtained. The biphasic HA-TCP material has a promising range of applications in the biomedical field based on its similarity to calcium phosphates found in human bones in terms of crystallite size and carbonate content. The presence of Na, Mg, Sr, and K ions in the HA-TCP material is very beneficial, since they contribute to bone metabolism and cell adhesion.

Corrosion Protection of Nano-biphasic Calcium Phosphate Coating on Titanium Substrate

Background:

Increasing the bioactivity of metallic implants is necessary for biomaterial applications where hydroxyapatite (HA) is used as a surface coating. In industry, HA is currently coated by plasma spraying, but this technique has a high cost and produces coating with short-term stability.

Objectives:

In the present study, electrophoretic deposition (EPD) was used to deposit nano-biphasic calcium phosphate compound (β-tri-calcium phosphate (β-TCP) /hydroxyapatite (HA)) bio-ceramics on the titanium surface. The microstructural, chemical compositions and bioactivity of the β- TCP/HA coatings were studied in a simulated body fluid solution (SBF).

Methods:

Scanning electron microscopy (SEM) equipped with energy-dispersive X-ray spectroscopy (EDX) and Fourier transform infrared spectroscopy (FTIR) were used. Additionally, the antibacterial effect was studied by the agar diffusion method. The corrosion behavior of the β-TCP/HA coating on titanium surface (Ti) in the SBF solution at 37oC was investigated by means of electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization tests.

Results:

The Ti surface modification increased its biocompatibility and corrosion resistance in the simulated body fluid. The antibacterial inhibition activity of the β-TCP/HA bio-ceramic was enhanced by electroless silver deposition. The enhanced properties could be attributed to the use of nano-sized biphasic calcium phosphates in a low-temperature EPD process.

Conclusions:

The β-TCP/HA and β-TCP/HA/Ag coatings well protect Ti from the corrosion in SBF and endow Ti with biocompatibility. The β-4-TCP/HA/Ag/Ti substrate shows good antibacterial activity.

HA-hybrid matrix composite coating on Ti-Cp for biomedical application

Calcium phosphate coatings have been applied to titanium metal substrates and their alloys as a synergistic alternative capable of combining the mechanical properties of metals and the excellent bioactive properties provided by ceramic materials. However, the unsatisfactory adhesion of hydroxyapatite coatings on metallic substrates, as well as their limitation when subjected to mechanical stresses have been reported as a limitation. Biofunctional coatings have been proposed as an alternative to single ceramic coatings, aiming at optimizing the long-term clinical success of biomaterials such as Ti. This work aims at evaluating the morphological properties and biological behavior of Ti-cp coated with matrix composite coating hydroxyapatite-containing hybrid. The hybrid matrix was obtained from TEOS and MTES silicon precursors, with dispersed hydroxyapatite suspended by dip coating. For the morphological characterization FTIR, SEM/FEG, AFM and contact angle measurement were used. Biological behavior was evaluated for toxicity, cell viability and the osteogenic differentiation capacity of mesenchymal stem cells. The composite coatings obtained showed regular dispersion of hydroxyapatite particles in the hybrid matrix, with uniform coating adhering to the Ti-Cp substrate. Nevertheless, although they provided similar viability behavior of mesenchymal stem cells to the Ti-Cp substrate, the evaluated coatings did not present osteoinductive properties. This result is probably due to the pronounced hydrophobic behavior caused by the incorporation of HA.

Effects of Nanotopography Regulation and Silicon Doping on Angiogenic and Osteogenic Activities of Hydroxyapatite Coating on Titanium Implant

Background

Angiogenic and osteogenic activities are two major problems with biomedical titanium (Ti) and other orthopedic implants used to repair large bone defects.

Purpose

The aim of this study is to prepare hydroxyapatite (HA) coatings on the surface of Ti by using electrochemical deposition (ED), and to evaluate the effects of nanotopography and silicon (Si) doping on the angiogenic and osteogenic activities of the coating in vitro.

Materials and Methods

HA coating and Si-doped HA (HS) coatings with varying nanotopographies were fabricated using two ED modes, ie, the pulsive current (PC) and cyclic voltammetry (CV) methods. The coatings were characterized through scanning electron microscope (SEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), X-ray photoelectron spectrometer (XPS), and atomic force microscopy (AFM), and their in vitro bioactivity and protein adsorption were assessed. Using MC3T3-E1 pre-osteoblasts and HUVECs as cell models, the osteogenic and angiogenic capabilities of the coatings were evaluated through in vitro cellular experiments.

Results

By controlling Si content in ~0.8 wt.%, the coatings resulting from the PC mode (HA-PC and HS-PC) and CV mode (HA-CV and HS-CV) had nanosheet and nanorod topographies, respectively. At lower crystallinity, higher ionic dissolution, smaller contact angle, higher surface roughness, and more negative zeta potential, the HS and PC samples exhibited quicker apatite deposition and higher BSA adsorption capacity. The in vitro cell study showed that Si doping was more favorable for enhancing the viability of the MC3T3-E1 cells, but nanosheet coating increased the area for cell spreading. Of the four coatings, HS-PC with Si doping and nanosheet topography exhibited the best effect in terms of up-regulating the expressions of the osteogenic genes (ALP, Col-I, OSX, OPN and OCN) in the MC3T3-E1 cells. Moreover, all leach liquors of the surface-coated Ti disks promoted the growth of the HUVECs, and the HS samples played a more significant role in promoting cell migration and tube formation than the HA samples. Of the four leach liquors, only the two HS samples up-regulated NO content and expressions of the angiogenesis-related genes (VEGF, bFGF and eNOS) in the HUVECs, and the HS-PC yielded a better effect.

Conclusion

The results show that Si doping while regulating the topography of the coating can help enhance the bone regeneration and vascularization of HA-coated Ti implants.

Intraosseous metal implants in orthopedics: A review

Metal implants are biomaterials widely used in orthopedics. They are both used in osteosynthesis and arthroplasty. Their mechanical properties, biocompatibility and resistance to corrosion make them a widely used option in orthopedics. Alloys are the most commonly used metals in orthopedics. As far as physical traumas are concerned, implants such as screws, plates and/or nails are used for osteosynthesis as they ensure the stability of the fractured area and contribute to bone healing. Prostheses are used in arthroplasty to restore joint function for as long as possible. Contact between bone and the prosthesis induces bone remodeling at the interface between metal and bone even if the metal is recognized as biocompatible. Upon time, the interface between the metal implant and the bony tissue is continuously modified and adapted. Hip prosthesis is a typical example of intraosseous metal implant whose bone/implant interface has been extensively studied. Metal can be altered in vivo by different mechanisms including corrosion and fretting. An altered torque friction leads to wear debris that accumulate in the peri-prosthetic tissues causing metallosis.

Hydoxyapatite/beta-tricalcium phosphate biphasic ceramics as regenerative material for the repair of complex bone defects

Bone is a composite material composed of collagen and calcium phosphate (CaP) mineral. The collagen gives bone its flexibility while the inorganic material gives bone its resilience. The CaP in bone is similar in composition and structure to the mineral hydroxyapatite (HA) and is bioactive, osteoinductive and osteoconductive. Therefore synthetic versions of bone apatite (BA) have been developed to address the demand for autologous bone graft substitutes. Synthetic HA (s-HA) are stiff and strong, but brittle. These lack of physical attributes limit the use of synthetic apatites in situations where no physical loading of the apatite occurs. s-HA chemical properties differ from BA and thus change the physical and mechanical properties of the material. Consequently, s-HA is more chemically stable than BA and thus its resorption rate is slower than the rate of bone regeneration. One solution to this problem is to introduce a faster resorbing CaP, such as β-tricalcium phosphate (β-TCP), when synthesizing the material creating a biphasic (s-HA and β-TCP) formulation of calcium phosphate (BCP). The focus of this review is to introduce the major differences between BCP and biological apatites and how material scientists have overcome the inadequacies of the synthetic counterparts. Examples of BCP performance in vitro and in vivo following structural and chemical modifications are provided as well as novel ultrastructural data. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2493-2512, 2018.

Preparation and in vitro evaluation of a biomimetic nanoscale calcium phosphate coating on a polyethylene terephthalate artificial ligament

In the present study, a polyethylene terephthalate (PET) artificial ligament was coated with an organic layer-by-layer (LBL) self-assembled template of chitosan and hyaluronic acid, and then incubated in a calcium phosphate (CaP) solution to prepare a biomimetic CaP coating. The surface characterization of the ligament was examined using scanning electron microscopy, atomic force microscopy and energy-dispersive X-ray spectroscopy. The effects of CaP coatings on the osteogenic activity of MC3T3 E1 mouse osteoblastic cells were investigated by evaluating their attachment, proliferation and the relative expression levels of alkaline phosphatase. The results revealed that the organic LBL template on the PET artificial ligament was effective for CaP apatite formation. Following incubation for 72 h, numerous nanoscale CaP apatites were deposited on the PET ligament fibers. In addition, the results of the in vitro culture of MC3T3-E1 mouse osteoblastic cells demonstrated that the CaP coating had a good biocompatibility for cell proliferation and adhesion, and the CaP-coated group had a significantly higher alkaline phosphatase activity compared with the uncoated control group after seven days of cell culture. Collectively, these results demonstrated that the biomimetic nanoscale CaP-coated PET artificial ligaments have potential in bone-tissue engineering.

Preparation of spherical calcium phosphate granulates suitable for the biofunctionalization of active brazed titanium alloy coatings

Titanium-based alloys can be actively brazed onto bio-inert ceramics and potentially be used as biocompatible coatings. To further improve their bioactivity in vivo, introduction of calcium phosphate (CaP)-based granulates onto their surface layer is possible. For this, mechanically stable CaP-based granulates need to be able to withstand the demand of the brazing process. In this study, spherical granulates, made of a calcium phosphate composite composed primarily of β-tricalcium phosphate and hydroxyapatite, a bioactive glass, and a mixture of the previous two, were manufactured by spray drying. The influence of organic additives (Dolapix CE64, trisodium citrate) and solids content (30-80 wt%) in the slurry on the physical characteristics of granulates was investigated. X-ray diffraction, Brunauer, Emmett, Teller specific surface area standard method, scanning electron microscopy, granulate size analysis, and single granule strength were performed. Our results showed that trisodium citrate permitted the production of granulates with regular morphology, high density, and increased failure stress values. The strong granules also withstood the brazing process. These results show that CaP bioactive agents can be generated and be integrated during the demanding metallurgical processes, allowing for one-step bioactivation of metal brazes.

Significance of calcium phosphate coatings for the enhancement of new bone osteogenesis--a review

A systematic analysis of results available from in vitro, in vivo and clinical trials on the effects of biocompatible calcium phosphate (CaP) coatings is presented. An overview of the most frequently used methods to prepare CaP-based coatings was conducted. Dense, homogeneous, highly adherent and biocompatible CaP or hybrid organic/inorganic CaP coatings with tailored properties can be deposited. It has been demonstrated that CaP coatings have a significant effect on the bone regeneration process. In vitro experiments using different cells (e.g. SaOS-2, human mesenchymal stem cells and osteoblast-like cells) have revealed that CaP coatings enhance cellular adhesion, proliferation and differentiation to promote bone regeneration. However, in vivo, the exact mechanism of osteogenesis in response to CaP coatings is unclear; indeed, there are conflicting reports of the effectiveness of CaP coatings, with results ranging from highly effective to no significant or even negative effects. This review therefore highlights progress in CaP coatings for orthopaedic implants and discusses the future research and use of these devices. Currently, an exciting area of research is in bioactive hybrid composite CaP-based coatings containing both inorganic (CaP coating) and organic (collagen, bone morphogenetic proteins, arginylglycylaspartic acid etc.) components with the aim of promoting tissue ingrowth and vascularization. Further investigations are necessary to reveal the relative influences of implant design, surgical procedure, and coating characteristics (thickness, structure, topography, porosity, wettability etc.) on the long-term clinical effects of hybrid CaP coatings. In addition to commercially available plasma spraying, other effective routes for the fabrication of hybrid CaP coatings for clinical use still need to be determined and current progress is discussed.

Modified cementless total coxofemoral prosthesis: development, implantation and clinical evaluation

The aim of this study was to modify canine coxofemoral prostheses and the clinical evaluation of the implantation. Fifteen canine hips and femora of cadavers were used in order to study the surface points of modification in prostheses and develop a perforation guide. Femoral stems and acetabular components were perforated and coated with biphasic calcium phosphate layer. Twelve young adult male mongrel dogs were implanted with coxofemoral prostheses. Six were operated upon and implanted with cemented canine modular hip prostheses, establishing the control group. The remaining six were implanted with a novel design of cementless porous tricalcic phosphate-hydroxyapatite coated hip prostheses. Clinical and orthopedic performance, complications, and thigh muscular hypotrophy were assessed up to the 120th post-operatory day. After 120 days, animals with cementless prostheses had similar clinical and orthopedic performance compared to the cemented group despite the increased pain thigh hypotrophy. Animals that underwent cementless hip prosthesis evidenced more pain, compared to animals with cemented hip prosthesis that required longer recuperation time. No luxations, two fractures and two isquiatic neurapraxies were identified in the course of the study. Using both the cemented and the bioactive coated cementless model were suitable to dogs, showing clinical satisfactory results. Osseointegration and biological fixation were observed in the animals with the modified cementless hip prosthesis.

Evaluation of biological properties of electron beam melted Ti6Al4V implant with biomimetic coating in vitro and in vivo

Background

High strength porous titanium implants are widely used for the reconstruction of craniofacial defects because of their similar mechanical properties to those of bone. The recent introduction of electron beam melting (EBM) technique allows a direct digitally enabled fabrication of patient specific porous titanium implants, whereas both their in vitro and in vivo biological performance need further investigation.

Methods

In the present study, we fabricated porous Ti6Al4V implants with controlled porous structure by EBM process, analyzed their mechanical properties, and conducted the surface modification with biomimetic approach. The bioactivities of EBM porous titanium in vitro and in vivo were evaluated between implants with and without biomimetic apatite coating.

Results

The physical property of the porous implants, containing the compressive strength being 163 - 286 MPa and the Young’s modulus being 14.5–38.5 GPa, is similar to cortical bone. The in vitro culture of osteoblasts on the porous Ti6Al4V implants has shown a favorable circumstance for cell attachment and proliferation as well as cell morphology and spreading, which were comparable with the implants coating with bone-like apatite. In vivo, histological analysis has obtained a rapid ingrowth of bone tissue from calvarial margins toward the center of bone defect in 12 weeks. We observed similar increasing rate of bone ingrowth and percentage of bone formation within coated and uncoated implants, all of which achieved a successful bridging of the defect in 12 weeks after the implantation.

Conclusions

This study demonstrated that the EBM porous Ti6Al4V implant not only reduced the stress-shielding but also exerted appropriate osteoconductive properties, as well as the apatite coated group. The results opened up the possibility of using purely porous titanium alloy scaffolds to reconstruct specific bone defects in the maxillofacial and orthopedic fields.

Corrosion fatigue of biomedical metallic alloys: mechanisms and mitigation

Cyclic stresses are often related to the premature mechanical failure of metallic biomaterials. The complex interaction between fatigue and corrosion in the physiological environment has been subject of many investigations. In this context, microstructure, heat treatments, plastic deformation, surface finishing and coatings have decisive influence on the mechanisms of fatigue crack nucleation and growth. Furthermore, wear is frequently present and contributes to the process. However, despite all the effort at elucidating the mechanisms that govern corrosion fatigue of biomedical alloys, failures continue to occur. This work reviews the literature on corrosion-fatigue-related phenomena of Ti alloys, surgical stainless steels, Co-Cr-Mo and Mg alloys. The aim was to discuss the correlation between structural and surface aspects of these materials and the onset of fatigue in the highly saline environment of the human body. By understanding such correlation, mitigation of corrosion fatigue failure may be achieved in a reliable scientific-based manner. Different mitigation methods are also reviewed and discussed throughout the text. It is intended that the information condensed in this article should be a valuable tool in the development of increasingly successful designs against the corrosion fatigue of metallic implants.

Enhanced osteointegration of orthopaedic implant gradient coating composed of bioactive glass and nanohydroxyapatite

We conducted histologic and histomorphometric studies to evaluate the osteointegration of gradient coatings composed of bioactive glass and nanohydroxyapatite (BG-nHA) on titanium-alloy orthopaedic implants and surrounding bone tissue in vivo. Titanium-alloy implants with a gradient coating (gradient coating group), uncoated implants (uncoated group), and implants with a conventional hydroxyapatite (HA) coating (HA coating group) were randomly implanted in bilateral femoral condyles of 36 male New Zealand rabbits. The bone-implant contact at 12 and 24 weeks and the new bone volume in the notch created for observing bone ingrowth at 4, 12, and 24 weeks were found greater in the gradient coating group than those in both the uncoated group and the HA coating group (p < 0.05). Fluorescence micrographs showed active osteogenesis in the gradient coating group at 4 weeks after implantation. These findings indicated that BG-nHA gradient coatings could enhance the osteointegration of orthopaedic implant.

The thermal stability of hydroxyapatite in biphasic calcium phosphate ceramics

Biphasic calcium phosphate ceramics (BCP) comprising a mix of non-resorbable hydroxyapatite (HA) and resorbable beta-tricalcium phosphate (beta-TCP) are particularly suitable materials for synthetic bone substitute applications. In this study, HA synthesised by solid state reaction was mechanically mixed with beta-TCP, then sintered to form a suite of BCP materials with a wide range of HA/beta-TCP phase content ratios. The influence of sintering temperature and composition on the HA thermal stability was quantified by X-ray diffraction (XRD). The pre-sinter beta-TCP content was found to strongly affect the post-sinter HA/beta-TCP ratio by promoting the thermal decomposition of HA to beta-TCP, even at sintering temperatures as low as 850 degrees C. For BCP material with pre-sinter HA/beta-TCP = 40/60 wt%, approximately 80% of the HA decomposed to beta-TCP during sintering at 1000 degrees C. Furthermore, the HA content appeared to influence the reverse transformation of alpha-TCP to beta-TCP expected upon gradual cooling from sintering temperatures greater than 1125 degrees C. Because the HA/beta-TCP ratio dominantly determines the rate and extent of BCP resorption in vivo, the possible thermal decomposition of HA during BCP synthesis must be considered, particularly if high temperature treatments are involved.

Effect of bone sialoprotein and collagen coating on cell attachment to TICER and pure titanium implant surfaces

To improve integration between implants and biological tissues, this study compared bone sialoprotein (BSP) as a surface-coating material against the major organic and inorganic components of bone, collagen type I and hydroxyapatite (TICER). The expression of osteocalcin, osteonectin and transforming growth factor ss was evaluated using immunohistochemical staining procedures. The distribution patterns of osteoblasts on the surface of pure titanium with a smooth machined surface and a rough surface (TICER) were determined by image processing using confocal laser scanning microscopy. The results compared to uncoated control materials showed that, at all times investigated, the number of cells on the surface of the TICER and pure titanium samples differed significantly (P<0.1), demonstrating the superiority of TICER over pure titanium in this respect. For pure titanium implants, collagen-precoated surfaces were not beneficial for the attachment of bone-derived cells with the exception of day 3 in vitro (P<0.01). BSP-precoated implant surfaces displayed non-significantly higher numbers of settled cells. BSP-precoated implant surfaces were beneficial for osteoinduction as revealed by osteocalcin and osteonectin expression. BSP precoating of the rough TICER implant surface enhanced the osteoinductive effect much more than did collagen precoating. These results contribute to the consideration of at least two distinct pathways of osseointegration.

An electrodeposition method of calcium phosphate coatings on titanium alloy

Calcium phosphates coatings were deposited onto titanium alloy discs via en electrodeposition method. Titanium alloy discs were blasted with calcium phosphate particles, then etched in a mixture of nitric and fluoric acids and rinsed in demineralized water. The titanium alloy disc (cathode) and platinum mesh (anode) were immersed in a supersaturated calcium phosphate electrolyte buffered at pH 7.4 and connected to a current generator. The microstructure, chemical composition and crystallinity of the electrodeposited coatings were studied as function of time 10-120 min, temperature 25-80 degrees C, current density 8-120 mA/cm(2), magnesium and hydrogen carbonate amounts (0.1-1 mM). Uniform calcium phosphate coatings were obtained in 30 min but coating thickness increased with deposition time. Raising the temperature of electrolyte resulted in more uniform coatings as ionic mobility increased. Low current density was preferable due to hydrogen gas evolving at the cathode, which disturbed the deposition of calcium phosphate crystals on titanium. The amounts of magnesium and hydrogen carbonate ions affected both the homogeneity and morphology of the coatings. This study showed that the electrodeposition method is efficient for coating titanium with osteoconductive calcium phosphate layers.