A new austenitic stainless steel with negligible nickel content: an in vitro and in vivo comparative investigation

Multifaceted Materials for Enhanced Osteogenesis and Antimicrobial Properties on Bioplastic Polyetheretherketone Surfaces: A Review

Implant-associated infections and the increasing number of bone implants loosening and falling off after implantation have become urgent global challenges, hence the need for intelligent alternative solutions to combat implant loosening and falling off. The application of polyetheretherketone (PEEK) in biomedical and medical therapy has aroused great interest, especially because its elastic modulus close to bone provides an effective alternative to titanium implants, thereby preventing the possibility of bone implants loosening and falling off due to the mismatch of elastic modulus. In this Review, we provide a comprehensive overview of recent advances in surface modifications to prevent bone binding deficiency and bacterial infection after implantation of bone implants, starting with inorganics for surface modification, followed by organics that can effectively promote bone integration and antimicrobial action. In addition, surface modifications derived from cells and related products of biological activity have been proposed, and there is increasing evidence of clinical potential. Finally, the advantages and future challenges of surface strategies against medical associated poor osseointegration and infection are discussed, with promising prospects for developing novel osseointegration and antimicrobial PEEK materials.

Performance of Austenitic High-Nitrogen Steels under Gross Slip Fretting Corrosion in Bovine Serum

Modular artificial hip joints are a clinical standard today. However, the release of wear products from the head-taper interface, which includes wear particles in the nm size range, as well as metal ions, have raised concerns. Depending on the loading of such taper joints, a wide variety of different mechanisms have been found by retrieval analyses. From these, this paper concentrates on analyzing the contribution of gross slip fretting corrosion at ultra-mild wear rates using a bovine calf serum solution (BCS) as the lubricant. The parameters were chosen based on biomechanical considerations, producing wear rates of some ng/m wear path. In parallel, the evolution of tribomaterial (third bodies) was analyzed as to its constituents and generation rates. It has already been shown earlier that, by an advantageous combination of wear mechanisms and submechanisms, certain constituents of the tribomaterial remain inside the contact area and act like extreme-pressure lubricant additives. For the known wear and corrosion resistance of austenitic high-nitrogen steels (AHNSs), which outperform CoCrMo alloys even under inflammatory conditions, we hypothesized that such steels will generate ultra-mild wear rates under gross slip fretting. While testing AHNSs against commercially available biomedical-grade materials of CoCrMo and TiAlV alloys, as well as zirconia-toughened alumina (ZTA) and against itself, it was found that AHNSs in combination with a Ti6Al4V alloy generated the smallest wear rate under gross slip fretting corrosion. This paper then discusses the wear behavior on the basis of ex situ analyses of the worn surfaces as to the acting wear mechanisms and submechanisms, as well as to the tribological reaction products.

Bioactivity, Cytotoxicity, and Tribological Studies of Nickel-Free Austenitic Stainless Steel Obtained via Powder Metallurgy Route

In the present study, the bioactivity, cytotoxicity, and tribological properties of a nickel-free austenitic stainless steel produced via the mechanical alloying of elemental iron, chromium, and manganese nitride powders following by hot isostatic pressing was investigated. Powders after 90 h of mechanical alloying were consolidated via hot isostatic pressing at 1150 °C (1425 K) and heat treated at 1175 °C (1448 K) for 1 h in a vacuum with furnace cooling. Tribological tests were performed to determine the resistance of the as-received nickel-free steel. It was noticed that applying heat treatment after hot isostatic pressing decreases the average friction coefficient and wear rate of the austenitic steel. An immersion test in a simulated body fluid for 28 days at 37 ± 1 °C has been used to determine the biocompatibility of the tested material. The SEM-EDS analysis allowed us to characterise the morphology of the films and the elements of the steel on the thin-film layer. Elements typical of apatite (calcium and phosphorus) were detected on the surface of the sample. Cellular toxicity tests showed no significant toxic side effects for Saos-2 human osteosarcoma cells and the number of Saos-2 human osteosarcoma cells on the nickel-free steel was greater than on the 316LV grade steel.

Mechanical Behavior of Austenitic Steel under Multi-Axial Cyclic Loading

Low-nickel austenitic steel is subjected to high-pressure torsion fatigue (HPTF) loading, where a constant axial compression is overlaid with a cyclic torsion. The focus of this work lies on investigating whether isotropic J2 plasticity or crystal plasticity can describe the mechanical behavior during HPTF loading, particularly focusing on the axial creep deformation seen in the experiment. The results indicate that a J2 plasticity model with an associated flow rule fails to describe the axial creep behavior. In contrast, a micromechanical model based on an empirical crystal plasticity law with kinematic hardening described by the Ohno-Wang rule can match the HPTF experiments quite accurately. Hence, our results confirm the versatility of crystal plasticity in combination with microstructural models to describe the mechanical behavior of materials under reversing multiaxial loading situations.

The Impact of Full-Scale Substitution of Ca2+ with Ni2+ Ions on Brushite’s Crystal Structure and Phase Composition

Because the impact of the full-scale substitution of Ca2+ in brushite (CaHPO4·2H2O) with Ni2+ ions has never been systematically explored, it is the focus of this investigation, as it holds potential for use in CaxNi1−xHPO4·nH2O production. These biomaterials have many beneficial characteristics that can be modified to suit diverse applications, including bone tissue regeneration and pharmaceutics. For the present study, NaH2PO4·2H2O, Ca(NO3)2·4H2O, and Ni(NO3)2·6H2O were used in various molar concentrations to obtain the required starting solutions. Previous studies have shown that adding Ni ions in the initial solution below 20% results in the precipitation of monophasic brushite with slight changes in the crystal structure. However, this study confirms that when the Ni ions substitution increases to 20%, a mixture of phases from both brushite and hexaaquanickel(II) hydrogenphosphate monohydrate HNiP (Ni(H2O)6·HPO4·H2O) is formed. The results confirm that the full replacement (100%) of Ca ions by Ni ions results in a monophasic compound solely comprising orthorhombic HNiP nanocrystals. Therefore, a novel technique of HNiP synthesis using the precipitation method is introduced in this research work. These materials are subsequently analyzed utilizing powder X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). The obtained results confirm that the material microstructure is controlled by the Ni/Ca ratio in the starting solution and can be modified to obtain the desired characteristics of phases and crystals.

Design, Simulation and Performance Research of New Biomaterial Mg30Zn30Sn30Sr5Bi5

This study focused on the design and the preparation method of a new biomaterial, Mg30Zn30Sn30Sr5Bi5 (at%) alloy, and its simulation and property analyses. Based on the comprehensive consideration of the preparation of high-entropy alloys, the selection of biomaterial elements, and the existing research results of common Mg-based materials, the atomic percentage of various elements, that is, Mg:Zn:Sn:Sr:Bi = 30:30:30:5:5, was determined. Using the theoretical methods of thermodynamic performance analysis and solidification performance analysis, the proposed composition was simulated and analyzed. The analysis results showed that the mechanical properties of the new material can meet the design requirements, and it can be prepared in physical form. XRD, SEM, PSD, compression tests, and other experimental tests were conducted on the material, and the alloy composition and distribution law showed various characteristics, which conformed to the “chaotic” characteristics of high-entropy alloys. The elastic modulus of the material was 17.98 GPa, which is within the 0–20 GPa elastic modulus range of human bone. This means that it can avoid the occurrence of stress shielding problems more effectively during the material implantation process.

Using scaffolds as drug delivery systems to treat bone tumor

Surgery is the principal strategy to treat osteosarcoma and other types of bone tumors, but it causes bone defects that cannot be healed spontaneously. After surgery, patients still need to receive radiotherapy and/or chemotherapy to prevent tumor recurrence and metastasis, which leads to systemic side effects. Bone scaffolds exhibit the potentials to load cargos (drugs or growth factors) and act as drug delivery systems (DDSs) in the osteosarcoma postoperative treatment. This review introduces current types of bone scaffolds and highlights representative works using scaffolds as DDSs to treat osteosarcomas. Challenges and perspectives in the scaffold-based DDSs are also discussed. This review may provide references to develop effective and safe strategies for osteosarcoma postoperative treatment.

Machine Learning-Driven Biomaterials Evolution

Biomaterials is an exciting and dynamic field, which uses a collection of diverse materials to achieve desired biological responses. While there is constant evolution and innovation in materials with time, biomaterials research has been hampered by the relatively long development period required. In recent years, driven by the need to accelerate materials development, the applications of machine learning in materials science has progressed in leaps and bounds. The combination of machine learning with high-throughput theoretical predictions and high-throughput experiments (HTE) has shifted the traditional Edisonian (trial and error) paradigm to a data-driven paradigm. In this review, each type of biomaterial and their key properties and use cases are systematically discussed, followed by how machine learning can be applied in the development and design process. The discussions are classified according to various types of materials used including polymers, metals, ceramics, and nanomaterials, and implants using additive manufacturing. Last, the current gaps and potential of machine learning to further aid biomaterials discovery and application are also discussed.

Biological Safety Evaluation and Surface Modification of Biocompatible Ti-15Zr-4Nb Alloy

We performed biological safety evaluation tests of three Ti–Zr alloys under accelerated extraction condition. We also conducted histopathological analysis of long-term implantation of pure V, Al, Ni, Zr, Nb, and Ta metals as well as Ni–Ti and high-V-containing Ti–15V–3Al–3Sn alloys in rats. The effect of the dental implant (screw) shape on morphometrical parameters was investigated using rabbits. Moreover, we examined the maximum pullout properties of grit-blasted Ti–Zr alloys after their implantation in rabbits. The biological safety evaluation tests of three Ti–Zr alloys (Ti–15Zr–4Nb, Ti–15Zr–4Nb–1Ta, and Ti–15Zr–4Nb–4Ta) showed no adverse (negative) effects of either normal or accelerated extraction. No bone was formed around the pure V and Ni implants. The Al, Zr, Nb, and Ni–Ti implants were surrounded by new bone. The new bone formed around Ti–Ni and high-V-containing Ti alloys tended to be thinner than that formed around Ti–Zr and Ti–6Al–4V alloys. The rate of bone formation on the threaded portion in the Ti–15Zr–4Nb–4Ta dental implant was the same as that on a smooth surface. The maximum pullout loads of the grit- and shot-blasted Ti–Zr alloys increased linearly with implantation period in rabbits. The pullout load of grit-blasted Ti–Zr alloy rods was higher than that of shot-blasted ones. The surface roughness (Ra) and area ratio of residual Al₂O₃ particles of the Ti–15Zr–4Nb alloy surface grit-blasted with Al₂O₃ particles were the same as those of the grit-blasted Alloclassic stem surface. It was clarified that the grit-blasted Ti–15Zr–4Nb alloy could be used for artificial hip joint stems.

Corrosion resistance of the nickel-free high-nitrogen steel FeCrMnMoN0.9 under simulated inflammatory conditions

Nickel-free, high-nitrogen austenitic steels (AHNS) have been introduced for biomedical applications, with encouraging results in terms of mechanical and corrosion properties. Here, we tested the corrosion resistance of a nickel-free high nitrogen steel (FeCrMnMoN0.9) in bovine serum solutions containing 0 or 3 g/L hyaluronic acid (HA), and 0, 3, or 30 mM hydrogen peroxide (H₂ O₂ ) simulating no, moderate, or strong inflammatory conditions, respectively. Nondestructive electrochemical measurements (open circuit potential [OCP], linear polarization resistance "R_P ", and electrochemical impedance spectroscopy) were run in triplicate over 10 hr. The presence of HA had no significant effect either on the stabilized OCP values, or on the corrosion resistance of FeCrMnMoN0.9. Increasing H₂ O₂ concentrations shifted the OCP to more electropositive values; the corrosion resistance decreased only at a 30 mM H₂ O₂ . Final R_P values at 0, 3, and 30 mM H₂ O₂ resulted in 1598 ± 276, 1746 ± 308, and 439 ± 47 kΩ cm² , respectively. These values were 4-14 times higher, than the R_P values measured on LC-CoCrMo in our previous study, conducted under identical conditions. While these findings are encouraging, future studies need to focus on tribocorrosive properties of the AHNS to evaluate its applicability in joint replacement.

Multifunctional Surface with Enhanced Angiogenesis for Improving Long-Term Osteogenic Fixation of Poly(ether ether ketone) Implants

Poly(ether ether ketone) (PEEK) is a biocompatible polymer, but the lack of angiogenesis makes the long-term osteogenic fixation of PEEK implants challenging, which has hampered their wider application in orthopedics. Herein, we develop a multifunctional micro-/nanostructured surface presenting hydroxyapatite (HA) nanoflowers and nickel hydroxide (Ni(OH)₂) nanoparticles on PEEK implants (sPEEK-Ni-HA) to tackle the problem. The results show that the reasonable release of Ni²⁺ from sPEEK-Ni-HA significantly facilitates the migration, tube formation, and angiogenic gene expression of human umbilical vein endothelial cells (HUVECs). In addition to angiogenesis, the sPEEK-Ni-HA displays enhanced cytocompatibility and osteogenicity in terms of cell proliferation, spreading, alkaline phosphatase activity, matrix mineralization, and osteogenesis-related gene secretion, exceeding pure and other multifunctional sPEEK samples. Importantly, in vivo evaluations employing a rabbit femoral condyle implantation model confirm that such dual decoration of Ni elements and HA nanoflowers boosts bone remodeling/osseointegration, which dramatically promotes the in vivo osteogenic fixation of implants. Therefore, this work not only sheds light on the significance of angiogenesis on the osteogenic fixation of an implant but also presents a facile strategy to empower bioinert PEEK with a well-orchestrated feature of angiogenesis and osteogenesis.

Biomechanical compatibility of high strength nickel free stainless steel bone plate under lightweight design

High nitrogen nickel-free stainless steel (HNNFSS) has excellent mechanical properties, corrosion resistance and biocompatibility, but its strength advantage is not fully used even though with one time higher than that of the conventional 316 L stainless steel. In this work, the lightweight design of HNNFSS bone plate was studied using finite element analysis, and the effect of lightweight plate fixation on histological and biomechanical behavior of healing bone were also researched on fractured rabbit femur. The finite element analysis results showed that the lightweight plate within 18.2% thickness reduction had higher bending strength and more homogeneous stress distribution compared with 316 L stainless steel plate. There was no obvious difference in radiography, histology analysis of callus and expression pattern of insulin like growth factor-1(IGF-1) of callus between the lightweight HNNFSS plate group and 316 L stainless steel plate group in animal test, and the IGF-1 concentrations of callus and the biomechanical bending test results also showed no statistical significance (p > 0.05), even though the data of the lightweight HNNFSS plate group were relatively better than that of 316 L stainless steel plate group. Therefore, the high nitrogen nickel-free stainless steel has the lightweight potential to keep good fixing function and improve bone healing compared with 316 L stainless steel plate.

Cationic Substitutions in Hydroxyapatite: Current Status of the Derived Biofunctional Effects and Their In Vitro Interrogation Methods

High-performance bioceramics are required for preventing failure and prolonging the life-time of bone grafting scaffolds and osseous implants. The proper identification and development of materials with extended functionalities addressing socio-economic needs and health problems constitute important and critical steps at the heart of clinical research. Recent findings in the realm of ion-substituted hydroxyapatite (HA) could pave the road towards significant developments in biomedicine, with an emphasis on a new generation of orthopaedic and dentistry applications, since such bioceramics are able to mimic the structural, compositional and mechanical properties of the bone mineral phase. In fact, the fascinating ability of the HA crystalline lattice to allow for the substitution of calcium ions with a plethora of cationic species has been widely explored in the recent period, with consequent modifications of its physical and chemical features, as well as its functional mechanical and in vitro and in vivo biological performance. A comprehensive inventory of the progresses achieved so far is both opportune and of paramount importance, in order to not only gather and summarize information, but to also allow fellow researchers to compare with ease and filter the best solutions for the cation substitution of HA-based materials and enable the development of multi-functional biomedical designs. The review surveys preparation and synthesis methods, pinpoints all the explored cation dopants, and discloses the full application range of substituted HA. Special attention is dedicated to the antimicrobial efficiency spectrum and cytotoxic trade-off concentration values for various cell lines, highlighting new prophylactic routes for the prevention of implant failure. Importantly, the current in vitro biological tests (widely employed to unveil the biological performance of HA-based materials), and their ability to mimic the in vivo biological interactions, are also critically assessed. Future perspectives are discussed, and a series of recommendations are underlined.

Cellular responses of osteoblast-like cells to 17 elemental metals

Elemental metals have been widely used to alloy metallic orthopedic implants. However, there is still insufficient research data elucidating the cell responses of osteoblastic cells to alloying elemental metals, which impedes the development of new metallic implant materials. In this study, the cellular responses of osteoblast-like cells (SaOS2) to 17 pure alloying elemental metals, that is, titanium (Ti), zirconium (Zr), hafnium (Hf), vanadium (V), niobium (Nb), tantalum (Ta), chromium (Cr), molybdenum (Mo), manganese (Mn), iron (Fe), ruthenium (Ru), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), silicon (Si), and tin (Sn) were comparatively investigated in vitro. Cellular responses including intracellular total protein synthesis and collagen content, cell adhesion, cell proliferation, and alkaline phosphatase (ALP) activity on these elemental metals were systematically assessed and compared. It was found that these elemental metals could be categorized into three groups based on the cellular functions on them. Group 1, including Ti, Zr, Hf, Nb, Ta, Cr, Ru, and Si, showed excellent cell proliferation and varied ALP activity for SaOS2 cells. Cells exposed to Group 2, including Mo and Sn, although initially attached and grew, did not proliferate over time. In contrast, Group 3, including V, Mn, Fe, Co, Ni, Cu, and Zn, showed severe cytotoxicity toward SaOS2 cells. It is vital to consider the cell responses to the elemental metals when designing a new metallic implant material and the findings of this study provide insights into the biological performance of the elemental metals. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 148-158, 2017.

Biological behaviour of human umbilical artery smooth muscle cell grown on nickel-free and nickel-containing stainless steel for stent implantation

To evaluate the clinical potential of high nitrogen nickel-free austenitic stainless steel (HNNF SS), we have compared the cellular and molecular responses of human umbilical artery smooth muscle cells (HUASMCs) to HNNF SS and 316L SS (nickel-containing austenitic 316L stainless steel). CCK-8 analysis and flow cytometric analysis were used to assess the cellular responses (proliferation, apoptosis, and cell cycle), and quantitative real-time PCR (qRT-PCR) was used to analyze the gene expression profiles of HUASMCs exposed to HNNF SS and 316L SS, respectively. CCK-8 analysis demonstrated that HUASMCs cultured on HNNF SS proliferated more slowly than those on 316L SS. Flow cytometric analysis revealed that HNNF SS could activate more cellular apoptosis. The qRT-PCR results showed that the genes regulating cell apoptosis and autophagy were up-regulated on HNNF SS. Thus, HNNF SS could reduce the HUASMC proliferation in comparison to 316L SS. The findings furnish valuable information for developing new biomedical materials for stent implantation.

The effect of CO2 laser beam welded AISI 316L austenitic stainless steel on the viability of fibroblast cells, in vitro

It has been determined by the literature research that there is no clinical study on the in vivo and in vitro interaction of the cells with the laser beam welded joints of AISI 316L biomaterial. It is used as a prosthesis and implant material and that has adequate mechanical properties and corrosion resistance characteristics. Therefore, the interaction of the CO2 laser beam welded samples and samples of the base metal of AISI 316L austenitic stainless steel with L929 fibroblast cells as an element of connective tissue under in vitro conditions has been studied. To study the effect of the base metal and the laser welded test specimens on the viability of the fibroblast cells that act as an element of connective tissues in the body, they were kept in DMEMF-12 medium for 7, 14, 28 days and 18 months. The viability study was experimentally studied using the MTT method for 7, 14, 28 days. In addition, the direct interaction of the fibroblast cells seeded on 6 different plates with the samples was examined with an inverted microscope. The MTT cell viability experiment was repeated on the cells that were in contact with the samples. The statistical relationship was analyzed using a Tukey test for the variance with the GraphPad statistics software. The data regarding metallic ion release were identified with the ICP-MS method after the laser welded and main material samples were kept in cell culture medium for 18 months. The cell viability of the laser welded sample has been detected to be higher than that of the base metal and the control based on 7th day data. However, the laser welded sample's viability of the fibroblast cells has diminished by time during the test period of 14 and 28 days and base metal shows better viability when compared to the laser welded samples. On the other hand, the base metal and the laser welded sample show better cell viability effect when compared to the control group. According to the ICP-MS results of the main material and laser welded samples which were kept in the cell culture medium for 18 months, it was determined that the Fe, Ni and Cr ion concentration released to the cell culture medium from the laser welded test sample was less than that of the main material.

Effect of cold deformation on pitting corrosion of 00Cr18Mn15Mo2N0.86 stainless steel for coronary stent application

The high nitrogen nickel-free stainless steel has offered an alternative to further improve the performance of the coronary stents, and simultaneously avoids the potential harms of nickel element. Both cold deformation and pitting corrosion are very important for coronary stents made of stainless steel. In this work, the effect of cold deformation on the pitting corrosion resistance of a high nitrogen nickel-free stainless steel (00Cr18Mn15Mo2N0.86) in 0.9% saline solution was investigated. The results showed that the pitting corrosion of the steel was nearly unchanged with increases of the cold deformation up to 50%, indicating that the higher nitrogen content can reduce the negative effect of cold deformation on the pitting corrosion resistance, which is beneficial for the long term service of coronary stents in blood vessel.

Nickel doped nanohydroxyapatite: vascular endothelial growth factor inducing biomaterial for bone tissue engineering

Biomaterial induced activation of vascular endothelial growth factor (VEGF) pathway for angiogenesis is now gaining recognition as an effective option for tissue engineering.

Study of biocompatibility of medical grade high nitrogen nickel-free austenitic stainless steel in vitro

Adverse effects of nickel ions being released into the living organism have resulted in development of high nitrogen nickel-free austenitic stainless steels for medical applications. Nitrogen not only replaces nickel for austenitic structure stability but also improves steel properties. The cell cytocompatibility, blood compatibility and cell response of high nitrogen nickel-free austenitic stainless steel were studied in vitro. The mechanical properties and microstructure of this stainless steel were compared to the currently used 316L stainless steel. It was shown that the new steel material had comparable basic mechanical properties to 316L stainless steel and preserved the single austenite organization. The cell toxicity test showed no significant toxic side effects for MC3T3-E1 cells compared to nitinol alloy. Cell adhesion testing showed that the number of MC3T3-E1 cells was more than that on nitinol alloy and the cells grew in good condition. The hemolysis rate was lower than the national standard of 5% without influence on platelets. The total intracellular protein content and ALP activity and quantification of mineralization showed good cell response. We conclude that the high nitrogen nickel-free austenitic stainless steel is a promising new biomedical material for coronary stent development.

Effect of cold working on biocompatibility of Ni-free high nitrogen austenitic stainless steels using Dalton's Lymphoma cell line

The aims of the present work are to explore the effect of cold working on in-vitro biocompatibility of indigenized low cost Ni-free nitrogen containing austenitic stainless steels (HNSs) and to compare it with conventionally used biomedical grade, i.e. AISI 316L and 316LVM, using Dalton's Lymphoma (DL) cell line. The MTT assay [3-(4,5-dimethythiazol 2-yl)-2,5-diphenyltetrazolium bromide] was performed on DL cell line for cytotoxicity evaluation and cell adhesion test. As a result, it was observed that the HNS had higher cell proliferation and cell growth and it increases by increasing nitrogen content and degree of cold working. The surface wettability of the alloys was also investigated by water contact angle measurements. The value of contact angles was found to decrease with increase in nitrogen content and degree of cold working. This indicates that the hydrophilic character increases with increasing nitrogen content and degree of cold working which further attributed to enhance the surface free energy (SFE) which would be conducive to cell adhesion which in turn increases the cell proliferation.

An overview of recent advances in designing orthopedic and craniofacial implants

Great deal of research is still going on in the field of orthopedic and craniofacial implant development to resolve various issues being faced by the industry today. Despite several disadvantages of the metallic implants, they continue to be used, primarily because of their superior mechanical properties. In order to minimize the harmful effects of the metallic implants and its by-products, several modifications are being made to these materials, for instance nickel-free stainless steel, cobalt-chromium and titanium alloys are being introduced to eliminate the toxic effects of nickel being released from the alloys, introduce metallic implants with lower modulus, reduce the cost of these alloys by replacing rare elements with less expensive elements etc. New alloys like tantalum, niobium, zirconium, and magnesium are receiving attention given their satisfying mechanical and biological properties. Non-oxide ceramics like silicon nitride and silicon carbide are being currently developed as a promising implant material possessing a combination of properties such as good wear and corrosion resistance, increased ductility, good fracture and creep resistance, and relatively high hardness in comparison to alumina. Polymer/magnesium composites are being developed to improve mechanical properties as well as retain polymer's property of degradation. Recent advances in orthobiologics are proving interesting as well. This paper thus deals with the latest improvements being made to the existing implant materials and includes new materials being introduced in the field of biomaterials.

Quantitative biocompatibility evaluation of nickel-free high-nitrogen stainless steel in vitro/in vivo

Coronary stents must not provoke an inflammatory response; however, some kinds of ions that are released from biometals induce biological reaction. In the present study, we quantitatively evaluated biological reaction of nickel-free high-nitrogen stainless steel (HNS) by endothelial cell culture, and a bioimaging system using NF-κB/luciferase transgenic mice to confirm the potential of HNS for the application of coronary stent. Endothelialization was greater with HNS than with commercial stainless steel (SUS316L). In vivo inflammatory response of HNS was lower than that of SUS316L. These differences may be related to the amounts of nickel ion eluted from the stents, as HNS did not elute nickel ion. These data suggest that HNS may be useful as a material for coronary artery stents.

A review on nickel-free nitrogen containing austenitic stainless steels for biomedical applications

The field of biomaterials has become a vital area, as these materials can enhance the quality and longevity of human life. Metallic materials are often used as biomaterials to replace structural components of the human body. Stainless steels, cobalt-chromium alloys, commercially pure titanium and its alloys are typical metallic biomaterials that are being used for implant devices. Stainless steels have been widely used as biomaterials because of their very low cost as compared to other metallic materials, good mechanical and corrosion resistant properties and adequate biocompatibility. However, the adverse effects of nickel ions being released into the human body have promoted the development of "nickel-free nitrogen containing austenitic stainless steels" for medical applications. Nitrogen not only replaces nickel for austenitic structure stability but also much improves steel properties. Here we review the harmful effects associated with nickel and emphatically the advantages of nitrogen in stainless steel, as well as the development of nickel-free nitrogen containing stainless steels for medical applications. By combining the benefits of stable austenitic structure, high strength, better corrosion and wear resistance and superior biocompatibility in comparison to the currently used austenitic stainless steel (e.g. 316L), the newly developed nickel-free high nitrogen austenitic stainless steel is a reliable substitute for the conventionally used medical stainless steels.

Reduction of in-stent restenosis risk on nickel-free stainless steel by regulating cell apoptosis and cell cycle

High nitrogen nickel-free austenitic stainless steel (HNNF SS) is one of the biomaterials developed recently for circumventing the in-stent restenosis (ISR) in coronary stent applications. To understand the ISR-resistance mechanism, we have conducted a comparative study of cellular and molecular responses of human umbilical vein endothelial cells (HUVECs) to HNNF SS and 316L SS (nickel-containing austenitic 316L stainless steel) which is the stent material used currently. CCK-8 analysis and flow cytometric analysis were used to assess the cellular responses (proliferation, apoptosis, and cell cycle), and quantitative real-time PCR (qRT-PCR) was used to analyze the gene expression profile of HUVECs exposed to HNNF SS and 316L SS, respectively. Flow cytometry analysis revealed that 316L SS could activate the cellular apoptosis more efficiently and initiate an earlier entry into the S-phase of cell cycle than HNNF SS. At the molecular level, qRT-PCR results showed that the genes regulating cell apoptosis and autophagy were overexpressed on 316L SS. Further examination indicated that nickel released from 316L SS triggered the cell apoptosis via Fas-Caspase8-Caspase3 exogenous pathway. These molecular mechanisms of HUVECs present a good model for elucidating the observed cellular responses. The findings in this study furnish valuable information for understanding the mechanism of ISR-resistance on the cellular and molecular basis as well as for developing new biomedical materials for stent applications.

In vitro electrochemical corrosion and cell viability studies on nickel-free stainless steel orthopedic implants

The corrosion and cell viability behaviors of nanostructured, nickel-free stainless steel implants were studied and compared with AISI 316L. The electrochemical studies were conducted by potentiodynamic polarization and electrochemical impedance spectroscopic measurements in a simulated body fluid. Cytocompatibility was also evaluated by the adhesion behavior of adult human stem cells on the surface of the samples. According to the results, the electrochemical behavior is affected by a compromise among the specimen's structural characteristics, comprising composition, density, and grain size. The cell viability is interpreted by considering the results of the electrochemical impedance spectroscopic experiments.

Promotion of initial cell adhesion on trisuccinimidyl citrate-modified nickel-free high-nitrogen stainless steel

The surface of nickel-free high-nitrogen stainless steel (HNS) was modified with a citric acid-based cross-linker, trisuccinimidyl citrate (TSC), to promote initial cell adhesion in external skeletal fixation pins. The remaining active ester groups on TSC-immobilized HNS reacted with the amino groups of serum proteins. The immobilized serum proteins formed cell recognition sites to promote the initial cell adhesion immediately after cell seeding. The amount of fibronectin, which is a typical cell adhesion protein, immobilized on the TSC-immobilized HNS surface was threefold greater than on the original HNS after only 15 min. The fibroblastic cell culture experiments showed that the initial cell adhesion was significantly enhanced on the TSC-immobilized HNS compared with the original HNS at 3 h. Furthermore, the cell adhesion activity of the TSC-immobilized HNS continued to promote cell proliferation even at 7 days. Therefore, TSC-immobilized HNS may enable the rapid integration of soft tissues through its reaction with the patient's serum proteins and extracellular proteins around the surgical site.

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.

Cytocompatibility of medical biomaterials containing nickel by osteoblasts: a systematic literature review

The present review is based on a survey of 21 studies on the cytocompatibility of medical biomaterials containing nickel, as assessed by cell culture of human and animal osteoblasts or osteoblast-like cells. Among the biomaterials evaluated were stainless steel, NiTi alloys, pure Ni, Ti, and other pure metals. The materials were either commercially available, prepared by the authors, or implanted by various techniques to generate a protective layer of oxides, nitrides, acetylides. The observation that the layers significantly reduced the initial release of metal ions and increased cytocompatibility was confirmed in cell culture experiments. Physical and chemical characterization of the materials was performed. This included, e.g., surface characterization (roughness, wettability, corrosion behavior, quantity of released ions, microhardness, and characterization of passivation layer). Cytocompatibility tests of the materials were conducted in the cultures of human or animal osteoblasts and osteoblast-like cells. The following assays were carried out: cell proliferation and viability test, adhesion test, morphology (by fluorescent microscopy or SEM). Also phenotypic and genotypic markers were investigated. In the majority of works, it was found that the most cytocompatible materials were stainless steel and NiTi alloy. Pure Ni was rendered and less cytocompatible. All the papers confirmed that the consequence of the formation of protective layers was in significant increase of cytocompatibility of the materials. This indicates the possible further modifications of the manufacturing process (formation of the passivation layer).

Corrosion behaviour and biocompatibility of a novel Ni-free intermetallic coating growth on austenitic steel by hot dipping in an Al-12.6%Si alloy

Commercial 316 LVM austenitic stainless steel samples have been coated by immersion in a bath of molten Al-12.6%Si alloy for 120 s. The coating consists of the Al(12)(Fe,Cr)(3)Si(2) intermetallic. In vitro corrosion behaviour has been evaluated in the Ringer's solution by means of potentiodynamic curves and electrochemical impedance spectroscopy. The results reveal that the coated specimens exhibit lower susceptibility to localised corrosion with respect to the substrate. XPS analysis suggests that the ennoblement of the pitting potential is due to the formation of a chromium oxyhydroxide containing passive layer. The intermetallic coating shows a good biocompatibility, as demonstrated by culturing human mesenchymal stem cells isolated from bone marrow which attached, grew and differentiated to the osteoblastic lineage to a similar extent on coated and bare steels. In summary, this study proposes a method that generates Ni-free coatings of the stainless steel with useful properties for biomedical applications.

Nickel-free austenitic stainless steels for medical applications

The adverse effects of nickel ions being released into the human body have prompted the development of high-nitrogen nickel-free austenitic stainless steels for medical applications. Nitrogen not only replaces nickel for austenitic structure stability but also much improves steel properties. Here we review the harmful effects associated with nickel in medical stainless steels, the advantages of nitrogen in stainless steels, and emphatically, the development of high-nitrogen nickel-free stainless steels for medical applications. By combining the benefits of stable austenitic structure, high strength and good plasticity, better corrosion and wear resistances, and superior biocompatibility compared to the currently used 316L stainless steel, the newly developed high-nitrogen nickel-free stainless steel is a reliable substitute for the conventional medical stainless steels.

Histological and clinical survey of polylactic-polyglycolic acid and dextrane copolymer in maxillary sinus lift: a pilot in vivo study

Of various proposed alternatives to autogenous bone, a synthetic, degradable copolymer of PLA-GLA and dextrane seems to be a promising biomaterial for maxillary sinus lift. Consecutive partially edentulous patients showing severe monolateral posterior maxillary atrophy were treated via sinus lift using PLA-GLA-dextrane copolymer as the sole filler. Delayed implant positioning was performed and cores of regenerated tissues and native bone controls were retrieved and evaluated by light and electron microscopy, histomorphometry, microhardness and qualitative X-ray analysis. Seven sinuses in 7 patients were augmented with PLA-GLA-dextrane copolymer. Six to nine months after the copolymer 'graft', 17 bone cores were retrieved: all histological sections contained newly synthesized, mineralized material and new bone in various stages of development. Histomorphometry revealed average Trabecular Bone Volume (TBV) values ranging from 51% (6 months) to 77% (9 months). Backscattered scanning electron microscopy (BSE) in experimental and control samples confirmed histology findings. Microhardness values suggested newly formed bone at nine months was not as hard as native bone. Ca and P content was similar in 9-month regenerated and native bone. Seventeen implants were inserted in the second stage of surgery: resulting Implant Success (SR) and Cumulative Success (CSR) up to 3 years were 100% following Albrektssons criteria. Sinus lift augmentation using PLA-GLA-dextrane copolymer as the sole filler resulted in uneventful surgeries. New bone formation was evident histologically and its maturation was still in progress after 9 months. Successful, staged implant positioning was achieved in regenerated tissue.

Uptake of nickel from 316L stainless steel into contacting osteoblastic cells and metal ion interference with BMP-2-induced alkaline phosphatase

Bone cells contacting nickel (Ni)-containing implant materials may be affected by Ni species via disturbed signaling pathways involved in bone cell development. Here we analyze effects of the Ni-containing steel 316L and major metal constituents thereof on bone morphogenetic protein-2 (BMP-2)-induced alkaline phosphatase (ALP) of MC3T3-E1 cells. While cells grew normally on 316L, cellular Ni content increased 10-fold vs. control within 4 days. With respect to the major components of 316L, Ni2+ (3-50 microM) was most inhibitory to BMP-2-induced ALP, whereas even 50 microM Fe3+, Cr3+, Mo5+, or Mn2+ had no such effect. In line with this, BMP-2-induced ALP was significantly reduced in cells on 316L. This effect was not prevented by the metal ion chelator diethylenetriaminepentaacetic acid (DTPA). Instead, DTPA abolished the stimulatory effect of BMP-2 on ALP, pointing to chelatable metal ions involved. Zn2+, as one possible candidate, antagonized the Ni2+ inhibition of BMP-2-induced ALP in both MC3T3-E1 and human bone marrow stromal cells. Results show that cells contacting 316L steel are exposed to increased concentrations of Ni which suffice to impair BMP-2-induced ALP activity. Zn2+, as a competitor of this inhibition, may help to restore normal osteoblastic function and bone development under these conditions.

Surface mechanical properties, corrosion resistance, and cytocompatibility of nitrogen plasma-implanted nickel-titanium alloys: a comparative study with commonly used medical grade materials

Stainless steel and titanium alloys are the most common metallic orthopedic materials. Recently, nickel-titanium (NiTi) shape memory alloys have attracted much attention due to their shape memory effect and super-elasticity. However, this alloy consists of equal amounts of nickel and titanium, and nickel is a well known sensitizer to cause allergy or other deleterious effects in living tissues. Nickel ion leaching is correspondingly worse if the surface corrosion resistance deteriorates. We have therefore modified the NiTi surface by nitrogen plasma immersion ion implantation (PIII). The surface chemistry and corrosion resistance of the implanted samples were studied and compared with those of the untreated NiTi alloys, stainless steel, and Ti-6Al-4V alloy serving as controls. Immersion tests were carried out to investigate the extent of nickel leaching under simulated human body conditions and cytocompatibility tests were conducted using enhanced green fluorescent protein mice osteoblasts. The X-ray photoelectron spectroscopy results reveal that a thin titanium nitride (TiN) layer with higher hardness is formed on the surface after nitrogen PIII. The corrosion resistance of the implanted sample is also superior to that of the untreated NiTi and stainless steel and comparable to that of titanium alloy. The release of nickel ions is significantly reduced compared with the untreated NiTi. The sample with surface TiN exhibits the highest amount of cell proliferation whereas stainless steel fares the worst. Compared with coatings, the plasma-implanted structure does not delaminate as easily and nitrogen PIII is a viable way to improve the properties of NiTi orthopedic implants.

In Vitro Biocompatibility of a New High Nitrogen Nickel Free Austenitic Stainless Steel

The in vitro blood compatibility of a new nickel free high nitrogen austenitic stainless steel Fe-Cr-Mn-Mo-N (BIOSSN4) was studied by the kinetic clotting time test and the platelet rich plasma adhesion test in this paper. In comparison with 316L stainless steel, the kinetic clotting time of BIOSSN4 steel are longer, and only causes less activation of platelets in platelet adhesion test, which was indicated by their morphology and low spreading. The experimental results reveals that the BIOSSN4 stainless steel has better blood compatibility, the blood compatibility mechanism of steels was analyzed based on surface tension and interfacial tension between the steels and blood.

Corrosion degradation and prevention by surface modification of biometallic materials

Metals, in addition to ceramics and polymers, are important class of materials considered for replacement of non-functional parts in the body. Stainless steel 316, titanium and titanium alloys, Co-Cr, and nitinol shape memory alloys are the most frequently used metallic materials. These alloys are prone to corrosion in various extents. This review briefly discusses the important biomaterials, their properties, and the physiological environment to which these materials are exposed. Corrosion performance of currently used metallic materials has been assessed and threat to the biocompatibility from corrosion products/metal ions is discussed. The possible preventive measures to improve corrosion resistance by surface modification and to increase the bioactivity of the metallic surfaces have also been discussed. Importance of the formation of oxide layers on the metal surface, another aspect of corrosion process, has been correlated with the host response. The gap areas and future direction of research are also outlined in the paper.

Soft tissue response to a new austenitic stainless steel with a negligible nickel content

This study evaluates the soft tissue response to a new austenitic stainless steel with a low nickel content (P558) in comparison with a conventional stainless steel (SSt)and a titanium alloy (Ti6Al4V). Previous findings showed its in vitro biocompatibility by culturing P558 with healthy and osteoporotic osteoblasts and its in vivo effectiveness as bone implant material. Regarding its use as a material in osteosynthesis,P558 biocompatibility when implanted in soft tissues, as subcutis and muscle, was assessed. Disks and rods of these metals were implanted in rat subcutis and in rabbit muscle, respectively. Four and twelve weeks post surgery implants with surrounding tissue were retrieved for histologic and histomorphometric analysis: fibrous capsule thickness and new vessel formation were measured. Around all implanted materials, light microscopy highlighted a reactive and fibrous capsule formation coupled with ongoing neoangiogenesis both in rats and in rabbits. Histomorphometric measurements revealed a stronger inflammatory response,in terms of capsule thickness,surrounding SSt implants (9.8% Ni content) both in rat subcutis and in rabbit muscle independently of shape and site of implantation. A progressive decrease in capsule thickness around P558 (<0.02% Ni content) and Ti6Al4V, respectively, was seen. Regarding new vessel density, the data showed a different response dependent on the site of implantation. However,in the light of the previous and present studies, P558 is a good material, instead of titanium alloys, in orthopedic research.

No genotoxicity of a new nickel-free stainless steel

Stainless steel is a metallic alloy largely employed in orthopedics, maxillofacial surgery and orthodontic therapy. However, the presence in its composition of a high quantity of nickel, an agent known to trigger toxic, allergic and cancerogenous responses in humans, is cause of some concern. In this study, we have investigated the in vitro mutagenicity and genotoxicity of a new nickel-free stainless steel, namely P558, in comparison to the conventional stainless steel AISI 316L. The cytogenetic effects were evaluated by studying the frequency of Sister Chromatid Exchanges (SCE) and chromosomal aberrations. Ames test was performed to detect the mutagenic activity. Both P558 and AISI 316L did not cause any significant increase in the average number of SCE and in chromosomal aberrations, either with or without metabolic activation. Furthermore, the Ames test showed that the extracts of both P558 and of AISI 316L are not mutagenic. Overall, these findings prove that P558 is devoid of genotoxicity and mutagenicity. The present results, together with other previous interesting observations that P558 promotes osseointegration, suggest that this new nickel-free stainless steel can represent a better alternative to other conventional steel alloys.

Quantitative assessment of the response of osteoblast- and macrophage-like cells to particles of Ni-free Fe-base alloys

In the present study, the effect of mechanically alloyed particles of new FeAlCr alloys developed for potential applications as surgical implants has been tested on osteoblast- and macrophage-like cells and compared to particles of the Ti6Al4V alloy, for which there is a good clinical experience. After microstructural characterisation of the particles, cells were cultured with particles for 24-48 h using three different concentrations of particles, and the response of cells was quantified by assessment of viability, proliferation, and morphology. Mineralisation by osteoblasts was verified after 21 days. The amount of aluminium and chromium ions in the culture medium of macrophages was measured by graphite furnace atomic absorption and phagocytosis of particles assessed by light microscopy. Viability and proliferation of osteoblast- and macrophage-like cells were substantially unaffected by the presence of particles of the new alloys, which were phagocytosed according to their size. Aluminium and chromium ions were released in the culture medium, but no direct correlation with the cell behaviour was found. In vitro mineralisation was achieved by osteoblasts in due time. The new alloys are well tolerated in in vitro systems, and, due to their chemical and mechanical characteristics, they are under development for surgical implants.