Open-cellular metal implant design and fabrication for biomechanical compatibility with bone using electron beam melting

Powder Bed Fusion 3D Printing in Precision Manufacturing for Biomedical Applications: A Comprehensive Review

Precision manufacturing requirements are the key to ensuring the quality and reliability of biomedical implants. The powder bed fusion (PBF) technique offers a promising solution, enabling the creation of complex, patient-specific implants with a high degree of precision. This technology is revolutionizing the biomedical industry, paving the way for a new era of personalized medicine. This review explores and details powder bed fusion 3D printing and its application in the biomedical field. It begins with an introduction to the powder bed fusion 3D-printing technology and its various classifications. Later, it analyzes the numerous fields in which powder bed fusion 3D printing has been successfully deployed where precision components are required, including the fabrication of personalized implants and scaffolds for tissue engineering. This review also discusses the potential advantages and limitations for using the powder bed fusion 3D-printing technology in terms of precision, customization, and cost effectiveness. In addition, it highlights the current challenges and prospects of the powder bed fusion 3D-printing technology. This work offers valuable insights for researchers engaged in the field, aiming to contribute to the advancement of the powder bed fusion 3D-printing technology in the context of precision manufacturing for biomedical applications.

3D printing metal implants in orthopedic surgery: Methods, applications and future prospects

Background

Currently, metal implants are widely used in orthopedic surgeries, including fracture fixation, spinal fusion, joint replacement, and bone tumor defect repair. However, conventional implants are difficult to be customized according to the recipient's skeletal anatomy and defect characteristics, leading to difficulties in meeting the individual needs of patients. Additive manufacturing (AM) or three-dimensional (3D) printing technology, an advanced digital fabrication technique capable of producing components with complex and precise structures, offers opportunities for personalization.

Methods

We systematically reviewed the literature on 3D printing orthopedic metal implants over the past 10 years. Relevant animal, cellular, and clinical studies were searched in PubMed and Web of Science. In this paper, we introduce the 3D printing method and the characteristics of biometals and summarize the properties of 3D printing metal implants and their clinical applications in orthopedic surgery. On this basis, we discuss potential possibilities for further generalization and improvement.

Results

3D printing technology has facilitated the use of metal implants in different orthopedic procedures. By combining medical images from techniques such as CT and MRI, 3D printing technology allows the precise fabrication of complex metal implants based on the anatomy of the injured tissue. Such patient-specific implants not only reduce excessive mechanical strength and eliminate stress-shielding effects, but also improve biocompatibility and functionality, increase cell and nutrient permeability, and promote angiogenesis and bone growth. In addition, 3D printing technology has the advantages of low cost, fast manufacturing cycles, and high reproducibility, which can shorten patients' surgery and hospitalization time. Many clinical trials have been conducted using customized implants. However, the use of modeling software, the operation of printing equipment, the high demand for metal implant materials, and the lack of guidance from relevant laws and regulations have limited its further application.

Conclusions

There are advantages of 3D printing metal implants in orthopedic applications such as personalization, promotion of osseointegration, short production cycle, and high material utilization. With the continuous learning of modeling software by surgeons, the improvement of 3D printing technology, the development of metal materials that better meet clinical needs, and the improvement of laws and regulations, 3D printing metal implants can be applied to more orthopedic surgeries.

The translational potential of this paper

Precision, intelligence, and personalization are the future direction of orthopedics. It is reasonable to believe that 3D printing technology will be more deeply integrated with artificial intelligence, 4D printing, and big data to play a greater role in orthopedic metal implants and eventually become an important part of the digital economy. We aim to summarize the latest developments in 3D printing metal implants for engineers and surgeons to design implants that more closely mimic the morphology and function of native bone.

Reliable Methods for Classification, Characterization, and Design of Cellular Structures for Patient-Specific Implants

In our research, our goal was to develop a characterization method that can be universally applied to periodic cell structures. Our work involved the accurate tuning of the stiffness properties of cellular structure components that can significantly reduce the number of revision surgeries. Up to date porous, cellular structures provide the best possible osseointegration, while stress shielding and micromovements at the bone-implant interface can be reduced by implants with elastic properties equivalent to bone tissue. Furthermore, it is possible to store a drug inside implants with a cellular structure, for which we have also prepared a viable model. In the literature, there is currently no established uniform stiffness sizing procedure for periodic cellular structures but also no uniform designation to identify the structures. A uniform marking system for cellular structures was proposed. We developed a multi-step exact stiffness design and validation methodology. The method consists of a combination of FE (Finite Element) simulations and mechanical compression tests with fine strain measurement, which are finally used to accurately set the stiffness of components. We succeeded in reducing the stiffness of test specimens designed by us to a level equivalent to that of bone (7-30 GPa), and all of this was also validated with FE simulation.

3D printed electronics with nanomaterials

A large variety of printing, deposition and writing techniques have been incorporated to fabricate electronic devices in the last decades. This approach, printed electronics, has gained great interest in research and practical applications and is successfully fuelling the growth in materials science and technology. On the other hand, a new player is emerging, additive manufacturing, called 3D printing, introducing a new capability to create geometrically complex constructs with low cost and minimal material waste. Having such tremendous technology in our hands, it was just a matter of time to combine advances of printed electronics technology for the fabrication of unique 3D structural electronics. Nanomaterial patterning with additive manufacturing techniques can enable harnessing their nanoscale properties and the fabrication of active structures with unique electrical, mechanical, optical, thermal, magnetic and biological properties. In this paper, we will briefly review the properties of selected nanomaterials suitable for electronic applications and look closer at the current achievements in the synergistic integration of nanomaterials with additive manufacturing technologies to fabricate 3D printed structural electronics. The focus is fixed strictly on techniques allowing as much as possible fabrication of spatial 3D objects, or at least conformal ones on 3D printed substrates, while only selected techniques are adaptable for 3D printing of electronics. Advances in the fabrication of conductive paths and circuits, passive components, antennas, active and photonic components, energy devices, microelectromechanical systems and sensors are presented. Finally, perspectives for development with new nanomaterials, multimaterial and hybrid techniques, bioelectronics, integration with discrete components and 4D-printing are briefly discussed.

Numerical analysis of the influence of triply periodic minimal surface structures morphometry on the mechanical response

BACKGROUND AND OBJECTIVE

Design of bone scaffolds requires a combination of material and geometry to fulfil requirements of mechanical properties, porosity and pore size. Triply Periodic Minimal Surface (TPMS) structures have gained attention due to their similarities to cancellous bone. In this work, we aim at exploring relationships between morphometry and mechanical properties for TPMS configurations.

METHODS

Eight TPMS structures are defined considering six porosity levels and their morphometry is characterized. The stiffness matrix of each structure is assessed and related to morphometry through a statistical analysis.

RESULTS

An orthotropic mechanical behavior has been derived from the numerical homogenization. Properties decay exponentially for decreasing volume fraction. Through volume fraction variation, TPMS mechanical properties can be selected to match bone properties in a range of 0.2% to 70% of the bulk material properties.

CONCLUSIONS

The comparison between cancellous bone and TPMS morphometry, considering a unit cell size of 1.5 mm, reveals that the configurations analyzed in this work match the requirements of volume fraction, mean thickness and pore size. However, the TPMS studied in this work differ from cancellous bone anisotropy. The results in this paper provide a framework to select the proper TPMS configuration and its geometry for patient-specific applications.

Biocompatibility and osseointegration properties of a novel high strength and low modulus β- Ti10Mo6Zr4Sn3Nb alloy

Introduction: Ti6Al4V titanium alloy is widely used in producing orthopedic and maxillofacial implants, but drawbacks include high elastic modulus, poor osseointegration performance, and toxic elements. A new medical titanium alloy material with better comprehensive performance is urgently needed in the clinic. Methods: Ti10Mo6Zr4Sn3Nb titanium alloy (referred to as Ti-B12) is a unique medical ß titanium alloy material developed by us. The mechanical properties of Ti-B12 depict that it has advantages, such as high strength, low elastic modulus, and fatigue resistance. In our study, the biocompatibility and osseointegration properties of Ti-B12 titanium alloy are further studied to provide theoretical guidance for its clinical transformation. Results and Discussion: The titanium alloy Ti-B12 displays no significant effect on MC3T3-E1 cell morphology, proliferation, or apoptosis in vitro. Neither Ti-B12 titanium alloy nor Ti6Al4V titanium alloy depicts a significant difference (p > 0.05); Ti-B12 material extract injected into the abdominal cavity of mice does not cause acute systemic toxicity. The skin irritation test and intradermal irritation test reveal that Ti-B12 does not cause skin allergic reactions in rabbits. Compared to Ti6Al4V, Ti-B12 titanium alloy material has more advantages in promoting osteoblast adhesion and ALP secretion (p < 0.05). Although there is no significant difference in OCN and Runx2 gene expression between the three groups on the 7th and 14th days of differentiation induction (p > 0.05), the expression of Ti-B12 group is higher than that of Ti6Al4V group and blank control group. Furthermore, the rabbit in vivo test present that 3 months after the material is implanted in the lateral epicondyle of the rabbit femur, the Ti-B12 material fuses with the surrounding bone without connective tissue wrapping. This study confirms that the new β-titanium alloy Ti-B12 not only has low toxicity and does not cause rejection reaction but also has better osseointegration performance than the traditional titanium alloy Ti6Al4V. Therefore, Ti-B12 material is expected to be further promoted in clinical practice.

Complex geometry and integrated macro-porosity: Clinical applications of electron beam melting to fabricate bespoke bone-anchored implants

The last decade has witnessed rapid advancements in manufacturing technologies for biomedical implants. Additive manufacturing (or 3D printing) has broken down major barriers in the way of producing complex 3D geometries. Electron beam melting (EBM) is one such 3D printing process applicable to metals and alloys. EBM offers build rates up to two orders of magnitude greater than comparable laser-based technologies and a high vacuum environment to prevent accumulation of trace elements. These features make EBM particularly advantageous for materials susceptible to spontaneous oxidation and nitrogen pick-up when exposed to air (e.g., titanium and titanium-based alloys). For skeletal reconstruction(s), anatomical mimickry and integrated macro-porous architecture to facilitate bone ingrowth are undoubtedly the key features of EBM manufactured implants. Using finite element modelling of physiological loading conditions, the design of a prosthesis may be further personalised. This review looks at the many unique clinical applications of EBM in skeletal repair and the ground-breaking innovations in prosthetic rehabilitation. From a simple acetabular cup to the fifth toe, from the hand-wrist complex to the shoulder, and from vertebral replacement to cranio-maxillofacial reconstruction, EBM has experienced it all. While sternocostal reconstructions might be rare, the repair of long bones using EBM manufactured implants is becoming exceedingly frequent. Despite the various merits, several challenges remain yet untackled. Nevertheless, with the capability to produce osseointegrating implants of any conceivable shape/size, and permissive of bone ingrowth and functional loading, EBM can pave the way for numerous fascinating and novel applications in skeletal repair, regeneration, and rehabilitation. STATEMENT OF SIGNIFICANCE: Electron beam melting (EBM) offers unparalleled possibilities in producing contaminant-free, complex and intricate geometries from alloys of biomedical interest, including Ti6Al4V and CoCr. We review the diverse range of clinical applications of EBM in skeletal repair, both as mass produced off-the-shelf implants and personalised, patient-specific prostheses. From replacing large volumes of disease-affected bone to complex, multi-material reconstructions, almost every part of the human skeleton has been replaced with an EBM manufactured analog to achieve macroscopic anatomical-mimickry. However, various questions regarding long-term performance of patient-specific implants remain unaddressed. Directions for further development include designing personalised implants and prostheses based on simulated loading conditions and accounting for trabecular bone microstructure with respect to physiological factors such as patient's age and disease status.

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.

A biodegradable 3D woven magnesium-based scaffold for orthopedic implants

Porous Magnesium (Mg) is a promising biodegradable scaffold for treating critical-size bone defects, and as an essential element for human metabolism, Mg has shown sufficient biocompatibility. Its elastic moduli and yield strengths are closer to those of cortical bone than common, inert metallic implants, effectively reducing stress concentrations around host tissue as well as stress shielding. More importantly, Mg can degrade and be absorbed in the human body in a safe and controlled manner, thereby reducing the need for second surgeries to remove implants. The development of porous Mg scaffolds via conventional selective laser melting (SLM) techniques has been limited due to Mg’s low boiling point, high vapor pressures, high reactivity, and non-ideal microstructures in additively manufactured parts. Here we present an exciting alternative to conventional additive techniques: 3D weaving with Mg wires that have controlled chemistries and microstructures. The weaving process offers high throughput manufacturing as well as porous architectures that can be optimized for stiffness and porosity with topology optimization. Once woven, we dip-coat the weaves with polylactic acid (PLA) to enhance their strength and corrosion resistance. Following fabrication, we characterize their mechanical properties, corrosion behavior, and cell compatibility in vitro, and we use an intramuscular implantation model to evaluate their in vivo corrosion behavior and tissue response.

Reconstruction of maxillofacial bone defects using patient-specific long-lasting titanium implants

The objective of this retrospective study is to verify the effectiveness and safety of patient-specific titanium implants on maxillofacial bones, with a long-term follow-up. Total 16 patients with various maxillofacial defects underwent reconstruction using patient-specific titanium implants. Titanium implants, manufactured by electron beam melting, selective laser sintering, or milling, were inserted into the maxilla, mandible, or zygoma. Long-term follow‐up (36.7 ± 20.1 months) was conducted after the surgery. Bone fusion of the titanium implant body, postoperative infection, implant malunion, functional results, patient satisfaction, subsidence, osteolysis around the implants, and complications were recorded and analyzed at the last follow-up. Of the 28 implants, only one failed to unite with the bone; therefore, revision surgery was performed. No osteolysis or subsidence around the titanium implants nor adverse events were observed; the mean VAS score for satisfaction was 9. All patients enrolled in this trial were esthetically and functionally satisfied with their surgical results, and fixation failure and esthetic dissatisfaction complications were well resolved. Patient-specific titanium showed satisfactory outcomes when used to treat various oral and maxillofacial defects. A 3D printed titanium implant can be effectively used in the reconstruction of the zygoma and mandible instead of autogenous bone without donor site morbidity.

Main Applications and Recent Research Progresses of Additive Manufacturing in Dentistry

In recent ten years, with the fast development of digital and engineering manufacturing technology, additive manufacturing has already been more and more widely used in the field of dentistry, from the first personalized surgical guides to the latest personalized restoration crowns and root implants. In particular, the bioprinting of teeth and tissue is of great potential to realize organ regeneration and finally improve the life quality. In this review paper, we firstly presented the workflow of additive manufacturing technology. Then, we summarized the main applications and recent research progresses of additive manufacturing in dentistry. Lastly, we sketched out some challenges and future directions of additive manufacturing technology in dentistry.

A state-of-the-art review of the fabrication and characteristics of titanium and its alloys for biomedical applications

Abstract

Commercially pure titanium and titanium alloys have been among the most commonly used materials for biomedical applications since the 1950s. Due to the excellent mechanical tribological properties, corrosion resistance, biocompatibility, and antibacterial properties of titanium, it is getting much attention as a biomaterial for implants. Furthermore, titanium promotes osseointegration without any additional adhesives by physically bonding with the living bone at the implant site. These properties are crucial for producing high-strength metallic alloys for biomedical applications. Titanium alloys are manufactured into the three types of α, β, and α + β. The scientific and clinical understanding of titanium and its potential applications, especially in the biomedical field, are still in the early stages. This review aims to establish a credible platform for the current and future roles of titanium in biomedicine. We first explore the developmental history of titanium. Then, we review the recent advancement of the utility of titanium in diverse biomedical areas, its functional properties, mechanisms of biocompatibility, host tissue responses, and various relevant antimicrobial strategies. Future research will be directed toward advanced manufacturing technologies, such as powder-based additive manufacturing, electron beam melting and laser melting deposition, as well as analyzing the effects of alloying elements on the biocompatibility, corrosion resistance, and mechanical properties of titanium. Moreover, the role of titania nanotubes in regenerative medicine and nanomedicine applications, such as localized drug delivery system, immunomodulatory agents, antibacterial agents, and hemocompatibility, is investigated, and the paper concludes with the future outlook of titanium alloys as biomaterials.

Graphic abstract

Porous tantalum structure integrated on Ti6Al4V base by Laser Powder Bed Fusion for enhanced bony-ingrowth implants: In vitro and in vivo validation

Despite the widespread application of Ti6Al4V and tantalum (Ta) in orthopedics, bioinertia and high cost limit their further applicability, respectively, and tremendous efforts have been made on the Ti6Al4V-Ta alloy and Ta coating to address these drawbacks. However, the scaffolds obtained are unsatisfactory. In this study, novel high-interface-strength Ti6Al4V-based porous Ta scaffolds were successfully manufactured using Laser Powder Bed Fusion for the first time, in which porous Ta was directly manufactured on a solid Ti6Al4V substrate. Mechanical testing revealed that the novel scaffolds were biomechanically compatible, and the interfacial bonding strength was as high as 447.5 MPa. In vitro biocompatibility assay, using rat bone marrow mesenchymal stem cells (r-BMSCs), indicated that the novel scaffolds were biocompatible. Alkaline phosphatase and mineralized nodule determination demonstrated that the scaffolds favored the osteogenic differentiation of r-BMSCs. Moreover, scaffolds were implanted into rabbits with femur bone defects, and imaging and histological evaluation identified considerable new bone formation and bone ingrowth, suggesting that the scaffolds were well integrated with the host bone. Overall, these results demonstrated good mechanical compatibility, biocompatibility, and osteointegration performance of the novel Ti6Al4V-based porous Ta scaffold, which possesses great potential for orthopedic clinical applications.

Bone Conduction Capacity of Highly Porous 3D-Printed Titanium Scaffolds Based on Different Pore Designs

In porous titanium scaffolds manufactured via 3D printing, the differences in bone formation according to pore design and implantation period were studied. Titanium scaffolds with three types of different pore structures (Octadense, Gyroid, and Dode) were fabricated via 3D printing using the selective laser melting method. Mechanical properties of scaffolds were investigated. Prepared specimens were inserted into both femurs of nine rabbits and their clinical characteristics were observed. Three animals were sacrificed at the 2nd, 4th, and 6th weeks, and the differences in bone formation were radiologically and histologically analyzed. The percentage of new bone and surface density in the pore structure were observed to be approximately 25% and 8 mm²/mm³, respectively. There was no difference in the amount of newly formed bone according to the pore design at 2, 4, and 6 weeks. In addition, no differences in the amount of newly formed bone were observed with increasing time within the same pore design for all three designs. During the 6-week observation period, the proportion of new bones in the 3D-printed titanium scaffold was approximately 25%. Differences in bone formation according to the pore design or implantation period were not observed.

Advances in powder bed fusion 3D printing in drug delivery and healthcare

Powder bed fusion (PBF) is a 3D printing method that selectively consolidates powders into 3D objects using a power source. PBF has various derivatives; selective laser sintering/melting, direct metal laser sintering, electron beam melting and multi-jet fusion. These technologies provide a multitude of benefits that make them well suited for the fabrication of bespoke drug-laden formulations, devices and implants. This includes their superior printing resolution and speed, and ability to produce objects without the need for secondary supports, enabling them to precisely create complex products. Herein, this review article outlines the unique applications of PBF 3D printing, including the main principles underpinning its technologies and highlighting their novel pharmaceutical and biomedical applications. The challenges and shortcomings are also considered, emphasising on their effects on the 3D printed products, whilst providing a forward-thinking view.

Additively manufactured titanium scaffolds and osteointegration - meta-analyses and moderator-analyses of in vivo biomechanical testing

Introduction

Maximizing osteointegration potential of three-dimensionally-printed porous titanium (3DPPT) is an ongoing focus in biomaterial research. Many strategies are proposed and tested but there is no weighted comparison of results.

Methods

We systematically searched Pubmed and Embase to obtain two pools of 3DPPT studies that performed mechanical implant-removal testing in animal models and whose characteristics were sufficiently similar to compare the outcomes in meta-analyses (MAs). We expanded these MAs to multivariable meta-regressions (moderator analysis) to verify whether statistical models including reported scaffold features (e.g., “pore-size”, “porosity”, “type of unit cell”) or post-printing treatments (e.g., surface treatments, adding agents) could explain the observed differences in treatment effects (expressed as shear strength of bone-titanium interface).

Results

“Animal type” (species of animal in which the 3DPPT was implanted) and “type of post-treatment” (treatment performed after 3D printing) were moderators providing statistically significant models for differences in mechanical removal strength. An interaction model with covariables “pore-size” and “porosity” in a rabbit subgroup analysis (the most reported animal model) was also significant. Impact of other moderators (including “time” and “location of implant”) was not statistically significant.

Discussion/conclusion

Our findings suggest a stronger effect from porosity in a rat than in a sheep model. Additionally, adding a calcium-containing layer does not improve removal strength but the other post-treatments do. Our results provide overview and new insights, but little narrowing of existing value ranges. Consequent reporting of 3DPPT characteristics, standardized comparison, and expression of porosity in terms of surface roughness could help tackle these existing dilemmas.

Graphical abstract

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

Microstructure Evolution and Mechanical Property Response of 3D-Printed Scalmalloy with Different Heat-Treatment Times at 325 °C

According to the material nature, aluminum alloys are widely applied in aerospace, construction, and automotive applications due to their characteristics of being lightweight, having good formability, and having good corrosion resistance. To further improve the degree of the lightweight quality, introducing a new material with high specific strength and a structure with a lightweight design would be efficient. Scalmalloy (Al-4.49Mg-0.71Sc-0.51Mn-0.27Zr-0.07Fe-0.03Si alloy), which exhibits high specific strength and is made by a 3D printing process with less design limitation, has huge application potential. In this study, the selective laser melting (SLM) process was introduced for sample preparation. Through XRD, EBSD, and TEM, the microstructure of the heat-treated samples at 325 °C with different heat-treatment times was analyzed to evaluate the optimized heat-treatment parameter for 3D printed Scalmalloy. The relationship between the mechanical properties and the variation of precipitation size and volume fraction is discussed in detail in this study.

Orthopaedic osseointegration: Implantology and future directions

Osseointegration (OI) is the direct anchorage of a metal implant into bone, allowing for the connection of an external prosthesis to the skeleton. Osseointegration was first discovered in the 1960s based on the microscopic analysis of titanium implant placed into host bone. New bone was observed to attach directly to the metal surface. Following clinical investigations into dentistry applications, OI was adapted to treat extremity amputations. These bone anchored implants, which penetrate the skin and soft tissues, eliminate many of the challenges of conventional prosthetic sockets, such as poor fit and suspension, skin breakdown, and pain. Osseointegrated implants show promise to improve prosthesis use, pain, and function for amputees. The successful process of transcutaneous metal integration into host bone requires three synergistic systems: the host bone, the metal implant, and the skin-implant interface. All three systems must be optimized for successful incorporation and longevity of the implant. Osseointegration begins during surgical implantation of the metal components through a complex interplay of cellular mechanisms. While implants can vary in design-including the original screw, press fit implants, and compressive osseointegration-they face common challenges to successful integration and maintenance of fixation within the host bone. Overcoming these challenges requires the understanding of the complex interactions between each element of OI. This review outlines (a) the basic components of OI, (b) the science behind both the bone-implant and the skin-implant interfaces, (c) the current challenges of OI, and (d) future opportunities within the field.

Development of AM Technologies for Metals in the Sector of Medical Implants

Additive manufacturing (AM) processes have undergone significant progress in recent years, having been implemented in sectors as diverse as automotive, aerospace, electrical component manufacturing, etc. In the medical sector, different devices are printed, such as implants, surgical guides, scaffolds, tissue engineering, etc. Although nowadays some implants are made of plastics or ceramics, metals have been traditionally employed in their manufacture. However, metallic implants obtained by traditional methods such as machining have the drawbacks that they are manufactured in standard sizes, and that it is difficult to obtain porous structures that favor fixation of the prostheses by means of osseointegration. The present paper presents an overview of the use of AM technologies to manufacture metallic implants. First, the different technologies used for metals are presented, focusing on the main advantages and drawbacks of each one of them. Considered technologies are binder jetting (BJ), selective laser melting (SLM), electron beam melting (EBM), direct energy deposition (DED), and material extrusion by fused filament fabrication (FFF) with metal filled polymers. Then, different metals used in the medical sector are listed, and their properties are summarized, with the focus on Ti and CoCr alloys. They are divided into two groups, namely ferrous and non-ferrous alloys. Finally, the state-of-art about the manufacture of metallic implants with AM technologies is summarized. The present paper will help to explain the latest progress in the application of AM processes to the manufacture of implants.

Subject-specific finite element analysis of a lumbar cage produced by electron beam melting

The aim of this study was the analysis of the mechanical behaviour of a partially porous lumbar custom-made cage by means of a subject-specific finite element analysis (FEA). The cage, made of Ti6Al4V ELI alloy, was produced via electron beam melting (EBM) process and surgically implanted in a female subject, 50 years old. The novelty of this study was the customized design of the cage and of its internal structure, which is impossible to obtain with the traditional production techniques. The 3D model of the spine was obtained from the computed tomography (CT) of the patient. Moreover, high-resolution industrial CT was also used to reconstruct a 3D model of the cage, with its real (as-produced) features, such as superficial roughness, morphology of the bulk and of the porous structure. The workflow was divided in several steps: the main finite element analyses were non-linear and quasi-static regarding: the rhombic dodecahedron (RD) unit cell of the porous structure; the device; the whole L4-L5 motion segment with the implanted cage. Stress distribution was calculated under compression load for all models. For the RD unit cell, the maximum stress appeared at the connected cross nodes, where notch effect was present. For the cage subjected to a load of 1 kN, the porous structure did not present any functional failure. For the whole biomechanical system subjected to a physiological load of 360 N, the calculated stress in the bone was smaller than its yield strength value. On the axial view, a zone with higher compressive stresses was present on the L5 vertebral body. This was due to the contact stress between the cage and the vertebra. From the comparison between FE results and the CT images of the spine, bone remodelling was supposed, with the formation of new bone. Graphical abstract Workflow showing the phases of the research.

Comparison of 3D-printed porous tantalum and titanium scaffolds on osteointegration and osteogenesis

Metals such as Ta (tantalum) and Ti (titanium) have been popularly used as a bone substitute or implants in orthopedic surgery and dentistry, since they have excellent corrosion. For manufacturing porous implants with precise structure, SLM (Selective laser melting), which is one of the 3D (three-dimensional) printing techniques, is always be chosen. To compare biological performances between porous Ta and Ti implants, we designed them with the same porosity, pore shape, pore size, and pore distribution via CAD (computer aided design), and then produced them by SLM. It was shown that the equivalent stress of porous Ta and Ti were 393.62 ± 1.39 MPa and 139.75 ± 14.50 MPa, and their Young's modulus were 3.10 ± 0.03GPa and 5.42 ± 0.07GPa, respectively. Meanwhile, we investigated their biological performance with hBMMSCs (human Bone marrow mesenchymal stem cells) in vitro. The results revealed that both two scaffolds were in favor of hBMMSCs proliferation and osteogenic differentiation. In addition, porous scaffolds were implanted in the femur bone defects rabbits in vivo showed the both porous scaffolds were beneficial to the bone ingrowth and bone-implant fixation. In summary, porous Ta has an equivalent biological performance as traditional porous Ti implants in small bone defect repair. Taken together, porous Ta is a promising material for bone regeneration.

Mechanical performance of additively manufactured meta-biomaterials

Additive manufacturing (AM) (=3D printing) and rational design techniques have enabled development of meta-biomaterials with unprecedented combinations of mechanical, mass transport, and biological properties. Such meta-biomaterials are usually topologically ordered and are designed by repeating a number of regular unit cells in different directions to create a lattice structure. Establishing accurate topology-property relationships is of critical importance for these materials. In this paper, we specifically focus on AM metallic meta-biomaterials aimed for application as bone substitutes and orthopaedic implants and review the currently available evidence regarding their mechanical performance under quasi-static and cyclic loading conditions. The topology-property relationships are reviewed for regular beam-based lattice structures, sheet-based lattice structures including those based on triply periodic minimal surface, and graded designs. The predictive models used for establishing the topology-property relationships including analytical and computational models are covered as well. Moreover, we present an overview of the effects of the AM processes, material type, tissue regeneration, biodegradation, surface bio-functionalization, post-manufacturing (heat) treatments, and loading profiles on the quasi-static mechanical properties and fatigue behavior of AM meta-biomaterials. AM meta-biomaterials exhibiting unusual mechanical properties such as negative Poisson's ratios (auxetic meta-biomaterials), shape memory behavior, and superelasitcity as well as the potential applications of such unusual behaviors (e.g. deployable implants) are presented too. The paper concludes with some suggestions for future research. STATEMENT OF SIGNIFICANCE: Additive manufacturing enables fabrication of meta-biomaterials with rare combinations of topological, mechanical, and mass transport properties. Given that the micro-scale topological design determines the macro-scale properties of meta-biomaterials, establishing topology-property relationships is the central research question when rationally designing meta-biomaterials. The interest in understanding the relationship between the topological design and material type on the one hand and the mechanical properties and fatigue behavior of meta-biomaterials on the other hand is currently booming. This paper presents and critically evaluates the most important trends and findings in this area with a special focus on the metallic biomaterials used for skeletal applications to enable researchers better understand the current state-of-the-art and to guide the design of future research projects.

Additively manufactured porous metallic biomaterials

Additively manufactured (AM, =3D printed) porous metallic biomaterials with topologically ordered unit cells have created a lot of excitement and are currently receiving a lot of attention given their great potential for improving bone tissue regeneration and preventing implant-associated infections.

Experimental Characterization of the Primary Stability of Acetabular Press-Fit Cups with Open-Porous Load-Bearing Structures on the Surface Layer

Background: Nowadays, hip cups are being used in a wide range of design versions and in an increasing number of units. Their development is progressing steadily. In contrast to conventional methods of manufacturing acetabular cups, additive methods play an increasingly central role in the development progress. Method: A series of eight modified cups were developed on the basis of a standard press-fit cup with a pole flattening and in a reduced version. The surface structures consist of repetitive open-pore load-bearing textural elements aligned right-angled to the cup surface. We used three different types of unit cells (twisted, combined and combined open structures) for constructing of the surface structure. All cups were manufactured using selective laser melting (SLM) of titanium powder (Ti6Al4V). To evaluate the primary stability of the press fit cups in the artificial bone cavity, pull-out and lever-out tests were conducted. All tests were carried out under exact fit conditions. The closed-cell polyurethane (PU) foam, which was used as an artificial bone cavity, was characterized mechanically in order to preempt any potential impact on the test results. Results and conclusions: The pull-out forces as well as the lever moments of the examined cups differ significantly depending on the elementary cells used. The best results in pull-out forces and lever-out moments are shown by the press-fit cups with a combined structure. The results for the assessment of primary stability are related to the geometry used (unit cell), the dimensions of the unit cell, and the volume and porosity responsible for the press fit. Corresponding functional relationships could be identified. The findings show that the implementation of reduced cups in a press-fit design makes sense as part of the development work.

Development and in vitro validation of a simplified numerical model for the design of a biomimetic femoral stem

BACKGROUND

Dense and stiff metallic femoral stems implanted into femurs for total hip arthroplasties produce a stress shielding effect since they modify the original load sharing path in the bony structure. Consequently, in the long term, the strain adaptive nature of bones leads to bone resorption, implant loosening, and the need for arthroplasty revision. The design of new cementless femoral stems integrating open porous structures can reduce the global stiffness of the stems, allowing them a better match with that of bones and provide their firm fixation via bone ingrowth, and, thus reduce the risk of implantation failure.

METHODS

This paper aims to develop and validate a simplified numerical model of stress shielding, which calculates the levels of bone resorption or formation by comparing strain distributions on the surface of the intact and the implanted femurs subjected to a simulated biological loading. Two femoral stems produced by laser powder-bed fusion using Ti-6Al-4V alloy are employed: the first is fully dense, while the second features a diamond cubic lattice structure in its core. The validation consists of a comparison of the numerically calculated force-displacement diagrams, and displacement and strain fields with their experimental equivalents obtained using the digital image correlation technique.

RESULTS AND CONCLUSIONS

The numerical models showed reasonable agreement between the force-displacement diagrams. Also, satisfactory results for the correlation analyses of the total displacement and equivalent strain fields were obtained. The stress shielding effect of the implant was assessed by comparing the equivalent strain fields of the implanted and intact femurs. The results obtained predicted less bone resorption in the femur implanted with the porous stem than with its dense counterpart.