Bioactive TiNbSn alloy prepared by anodization in sulfuric acid electrolytes

TiNbSn alloy plates with low Young's modulus modulates interfragmentary movement and promote osteosynthesis in rat femur

Orthopedic implants such as arthroplasty prostheses, fracture plates, and intramedullary nails often use materials like Ti6Al4V alloy and commercially pure titanium (CP-Ti), which have Young's modulus significantly higher than that of human cortical bone, potentially causing stress shielding and inhibiting effective fracture healing. TiNbSn alloy, a β-type titanium alloy with a lower Young's modulus (40-49 GPa), has shown promise in reducing stress shielding and enhancing bone healing by promoting effective load sharing with bone. This study used 5-hole plates made from TiNbSn alloy and CP-Ti to investigate their effects on bone healing in a rat femoral fracture model. Micro-CT analysis and mechanical testing were performed six weeks postoperatively to assess bone healing. Additionally, Finite element method (FEM) analysis was employed to evaluate stress shielding and interfragmentary movement (IFM) at the fracture site. Micro-CT analysis revealed significantly higher bone volume and mineral density in the TiNbSn group than in the CP-Ti group. Mechanical testing showed increased maximum load and stiffness in the TiNbSn group (77.2 ± 10.0 N for the TiNbSn alloy plate group versus 53.3 ± 8.5 N for the CP-Ti group (p = 0.002)). FEM analysis indicated that TiNbSn plates reduced stress shielding and allowed for greater displacement and strain, promoting IFM conducive to bone healing. The findings suggest that TiNbSn alloy plates are more effective than CP-Ti plates in promoting bone healing by reducing stress shielding and enhancing IFM. The lower Young's modulus of TiNbSn allows better load distribution, facilitating bone regeneration and strengthening at the fracture site.

Low Young's Modulus TiNbSn Alloy Locking Plates Accelerate Osteosynthesis in Rabbit Tibiae

A new beta TiNbSn alloy with a low Young's modulus of approximately 40 GPa has been developed to resolve the stress shielding by Young's modulus divergence. In this study, the efficacy of TiNbSn alloy locking plates on bone repair is compared to that of commercially pure titanium (CP-Ti). The TiNbSn alloy and CP-Ti, which have Young's moduli of 49.1 GPa and 107 GPa, respectively, were compared. Male Japanese white rabbits were anesthetized, and osteotomy and osteosynthesis with locking plates were performed on the right tibia. The bone repair was assessed using micro-computed tomography (CT), histomorphometry, immunohistochemistry, and mechanical testing. Micro-CT, histomorphometry, immunohistochemistry, and mechanical testing were performed four weeks after osteotomy. Six weeks after surgery, micro-CT and mechanical testing were performed. Micro-CT analysis at four weeks after surgery showed that the intramedullary fracture callus in the TiNbSn alloy group had more bone volume and numerous bridging structures compared to the CP-Ti group (CP-Ti vs. TiNbSn alloy, 34.3 ± 13.1 mm3 vs. 61.3 ± 19.6 mm3, p = 0.02; mean ± standard deviation). At four weeks post-osteotomy, the healed tibia showed significantly higher strength in the TiNbSn alloy group compared with CP-Ti (CP-Ti vs. TiNbSn alloy, 81.3 ± 31.2 N vs. 133.7 ± 46.6 N, p = 0.04). TiNbSn alloy locking plates had a more positive impact on bone formation and bone strength restoration than the CP-Ti locking plates during the early phase of bone healing.

TiNbSn stems with gradient changes of Young's modulus and stiffness reduce stress shielding compared to the standard fit-and-fill stems

BACKGROUND

The difference between Young's moduli of the femur and the stem causes stress shielding (SS). TiNbSn (TNS) stem has a low Young's modulus and strength with gradient functional properties during the change in elastic modulus with heat treatment. The aim of this study was to investigate the inhibitory effect of TNS stems on SS and their clinical outcomes compared to conventional stems.

METHODS

This study was a clinical trial. Primary THA was performed using a TNS stem from April 2016 to September 2017 for patients in the TNS group. Unilateral THA was performed using a Ti6Al4V alloy stem from January 2007 to February 2011 for patients in the control group. The TNS and Ti6Al4V stems were matched in shape. Radiographs were obtained at the 1- and 3-year follow-ups. Two surgeons independently checked the SS grade and appearance of cortical hypertrophy (CH). The Japanese Orthopaedic Association (JOA) scores before and 1 year after surgery were assessed as clinical scores.

RESULTS

None of the patients in the TNS group had grade 3 or 4 SS. In contrast, in the control group, 24% and 40% of patients had grade 3 and 4 SS at the 1- and 3-year follow-ups, respectively. The SS grade was lower in the TNS group than in the control group at the 1- and 3-year follow-ups (p < 0.001). The frequencies of CH in both groups were no significant difference at the 1- and 3-year follow-ups. The JOA scores of the TNS group significantly improved at 1 year after surgery and were comparable to control group.

CONCLUSION

The TNS stem reduced SS at 1 and 3 years after THA compared to the proximal-engaging cementless stem, although the shapes of the stems matched. The TNS stem could reduce SS, stem loosening, and periprosthetic fractures.

TRIAL REGISTRATION

Current Controlled Trials. ISRCTN21241251. https://www.isrctn.com/search?q=21241251 . The date of registration was October 26, 2021. Retrospectively registered.

Antimicrobial Properties of TiNbSn Alloys Anodized in a Sulfuric Acid Electrolyte

TiNbSn alloy is a high-performance titanium alloy which is biosafe, strong, and has a low Young's modulus. TiNbSn alloy has been clinically applied as a material for orthopedic prosthesis. Anodized TiNbSn alloys with acetic and sulfuric acid electrolytes have excellent biocompatibility for osseointegration. Herein, TiNbSn alloy was anodized in a sulfuric acid electrolyte to determine the antimicrobial activity. The photocatalytic activities of the anodic oxide alloys were investigated based on their electronic band structure and crystallinity. In addition, the cytotoxicity of the anodized TiNbSn alloy was evaluated using cell lines of the osteoblast and fibroblast lineages. The antimicrobial activity of the anodic oxide alloy was assessed according to the ISO 27447 using methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Escherichia coli. The anodic oxide comprised rutile and anatase titanium dioxide (TiO₂) and exhibited a porous microstructure. A well-crystallized rutile TiO₂ phase was observed in the anodized TiNbSn alloy. The methylene blue degradation tests under ultraviolet illumination exhibited photocatalytic activity. In antimicrobial tests, the anodized TiNbSn alloy exhibited robust antimicrobial activities under ultraviolet illumination for all bacterial species, regardless of drug resistance. Therefore, the anodized TiNbSn alloy can be used as a functional biomaterial with low Young's modulus and excellent antimicrobial activity.

A Review of Anodized TiNbSn Alloys for Improvement in Layer Quality and Application to Orthopedic Implants

Titanium alloys are useful for application in orthopedic implants. However, complications, such as prosthetic infections and aseptic loosening, often occur after orthopedic devices are implanted. Therefore, innovation in surface modification techniques is essential to develop orthopedic materials with optimal properties at the biomaterial–bone interface. In this review, we present recent research on the improvement in the osteoconductivity and antibacterial effect of the Ti-33.6% Nb-4% Sn (TiNbSn) alloy by anodic oxidation and other related studies. TiNbSn alloys are excellent new titanium alloys with a low Young’s modulus, high tensile strength, and with gradient functional properties such as a thermally adjustable Young’s modulus and strength. Titanium dioxide (TiO₂), when obtained by the anodic oxidation of a TiNbSn alloy, improves bone affinity and provides antibacterial performance owing to its photocatalytic activity. The safety of TiO₂ and its strong bonding with metal materials make its method of preparation a promising alternative to conventional methods for improving the surface quality of orthopedic implants. Implementing anodization technology for TiNbSn alloys may alleviate orthopedic surgery-related complications, such as loosening, stress shielding, and infection after arthroplasty.

Antibacterial Activity of an Anodized TiNbSn Alloy Prepared in Sodium Tartrate Electrolyte

In this study, we anodized a TiNbSn alloy with low Young’s modulus in an electrolyte of sodium tartrate with and without hydrogen peroxide (H2O2). The photo-induced characteristics of the anodized alloy were analyzed for crystallinity and electrochemical conditions with comparisons to the effect with the addition of H2O2. The antibacterial activity was evaluated using methicillin-resistant Staphylococcus aureus and other pathogenic bacteria according to ISO 27447, and time decay antibacterial tests were also conducted. The anodized oxide had a porous microstructure with anatase- and rutile-structured titanium dioxide (TiO2). In contrast, the peaks of rutile-structured TiO2 were accelerated in the anodized TiNbSn alloy with H2O2. The formation of hydroxyl radicals and methylene blue breaching performance under ultraviolet irradiation was confirmed in the anodic oxide on TiNbSn alloy with and without H2O2. The anodic oxide on TiNbSn alloy had a robust antibacterial activity, and no significant difference was detected with or without H2O2. We conclude that anodized TiNbSn alloy with sodium tartrate electrolyte may be a functional biomaterial with a low Young’s modulus and an antibacterial function.

Mid-term results of a new femoral prosthesis using Ti-Nb-Sn alloy with low Young's modulus

Background

This study was performed to investigate the mid-term results of Ti-Nb-Sn (TNS) alloy stem with a low Young’s modulus.

Methods

This study was a multicenter prospective cohort study. A total of 40 primary total hip arthroplasties performed between April 2016 and September 2017 was enrolled in this study. With the unique functional gradient properties by heating treatment, the strength of the proximal portion was enhanced, while the distal portion maintained a low Young’s modulus. The surgeries were performed through the posterolateral approach using the TNS alloy stems. Radiographs were taken from immediately after surgeries until 3 years, and stress shielding and subsidence of the stems were evaluated. The incidences of the stem breakage were also assessed. Clinical assessments were performed using Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores.

Results

Among the 40 enrolled patients, 36 patients were female and 4 were male. At 3 years after surgery, there were no radiologic signs of loosening, subsidence, or breakage of the stem. Stress shielding was observed in 26 hips (65%). Of 26 hips, 16 hips (40%) were grade 1 and 10 hips (25%) were grade 2. There was no advanced stress shielding. The JOA and JHEQ scores significantly improved compared with the preoperative scores.

Conclusion

The current study using a new TNS alloy femoral stem showed good clinical outcomes at 3-year follow-up. Radiologically, there was no loosening or subsidence of the stem. The mild stress shielding was observed in 65% of patients.

Trial registration

Current Controlled Trials ISRCTN21241251.

The date of registration was October 26, 2021.

Retrospectively registered.

Acceleration of Fracture Healing in Mouse Tibiae Using Intramedullary Nails Composed of β-Type TiNbSn Alloy with Low Young's Modulus

The optimal Young's modulus of material of orthopedic devices for fracture treatment is still unknown. The purpose of present study was to evaluate the impacts of intramedullary nails composed of a titanium alloy with low Young's modulus, on accelerating fracture healing compared with stainless steel with high Young's modulus. A β-type TiNbSn alloy with a low Young's modulus close to that of human cortical bone was developed for clinical application. TiNbSn alloy with a Young's modulus of 45 GPa and stainless steel with a Young's modulus of 205 GPa were compared, with respect to the impacts on fracture healing. Fracture and fixation using intramedullary nail were performed on the right tibiae of C57BL/6 mice. The assessment of bone healing was performed via micro-computed tomography, histomorphometry, and quantitative reverse transcription polymerase chain reaction. In micro-computed tomography, larger bone volumes were observed in the fracture callus treated with TiNbSn alloy in comparison with those treated with stainless steel. Histological assessments confirmed accelerated cartilage absorption and new bone formation in the TiNbSn alloy group compared with the stainless steel group. The expression of Col1a1, Runx2, Dkk1, and Acp5 was higher in the TiNbSn alloy group, while that of Col2a1 and Col10a1 was lower in the late phase. The present study demonstrated that the fixation by intramedullary nails with TiNbSn alloy offered an accelerated fracture healing with promotion of bone formation via increased Runx2 expression. TiNbSn alloy might be a promising material for fracture treatment devices.