Mixed Modification of the Surface Microstructure and Chemical State of Polyetheretherketone to Improve Its Antimicrobial Activity, Hydrophilicity, Cell Adhesion, and Bone Integration

Overcoming biological inertness: multifaceted strategies to optimize PEEK bioactivity for interdisciplinary clinical applications

Polyether ether ketone (PEEK), characterized by a comparable elastic modulus to human bone with high wear resistance, radiolucency, and biocompatibility, demonstrates considerable promise for clinical applications. However, due to the significant limitations in clinical applications caused by the biological inertness of PEEK, it should first be modified to meet clinical needs. Currently, the field of PEEK modifications is rapidly advancing, with a particular emphasis on enhancing its biological properties. Most of the previous reviews have separately discussed strategies like antibacterial, osteogenic, and angiogenic enhancements for PEEK. This review combines cross-domain insights to update and synthesize recent research on PEEK composites, focusing on advanced multi-component sustained release platforms that mimic postoperative biological processes. Such temporal alignment between material functionality and physiological healing phases demonstrates unprecedented potential for expanding PEEK's clinical versatility.

3D printed porous PEEK scaffolds with stable and durable gelatin composite hydrogel coating loaded Yoda1 for in vivo osseointegration

Polyetheretherketone (PEEK) has emerged as a promising material for bone substitution; however, its limited osseointegration hinders its clinical applications. This research employs a porous structural design alongside surface modification techniques to improve the osseointegration properties of PEEK. Porous PEEK scaffolds were fabricated via 3D printing technology, followed by the application of a stable coating of Yoda1-loaded methacrylated gelatin (GelMA) on their surfaces. After modification, the hydrophilicity of the PEEK scaffolds was considerably improved, and the GelMA coating facilitated the sustained release of Yoda1. In vitro experiments demonstrated that the modified surfaces promoted cell proliferation and adhesion, facilitated angiogenesis, and enhanced osteoblast differentiation and mineral deposition. Furthermore, porous PEEK scaffolds were implanted into the femoral condyles of SD rats for 6 weeks to evaluate in vivo osseointegration The results showed that the tailored three-dimensional porous structure, along with the Yoda1-loaded GelMA coating, promoted bone ingrowth and enhanced osseointegration within the scaffold. This study offers a viable strategy for enhancing PEEK osseointegration through a combination of structural design and surface modification, and introduces new avenues for the application of Yoda1 in bone tissue engineering.

Functionalizing Nonfunctional Surfaces: Creation of Metal Oxide Nanopatterns on High-Performance Polymers via Self-Assembly of PS-b-PEO

High-performance polymers are pivotal for a wide range of applications due to their excellent mechanical, chemical, and thermal properties. This work introduces, for the first time, a block copolymer (BCP) self-assembly method to modify the surfaces of different high-performance polymers. Using highly ordered poly(styrene-b-ethylene oxide) (PS-b-PEO) thin films as templates, metallic oxide nanopillars (Al2O3, Ag2O, MgO, CaO, and TiO2) with a 20 nm average diameter were fabricated. These were created on high-performance polymer substrates, specifically, polyetheretherketone (PEEK), carbon fiber-reinforced polyetheretherketone (CFPEEK), and ultrahigh molecular weight polyethylene. This method addresses the low chemical activity of these polymeric substrates, offering a cost-effective, scalable solution to produce their surface functionalization. Characterization via atomic force microscopy, scanning electron microscopy, and X-ray photoelectron spectroscopy validate the structure and composition of the nanostructured surfaces. The significance of BCP self-assembly is emphasized as an effective and versatile approach for the nanoscale tailoring of surface properties in high-performance polymers. This process offers a straightforward method with low technological and energetic costs, paving the way for the extensive surface modification of large areas. The implications of this work extend to various sectors, including biomedical devices, sensors, and electronics, showcasing the broad applicability of this nanoscale tailoring technique.

Effects of PEEK surface treatment using alumina blasting or concentrated sulfuric acid etching in combination with functional monomers on shear bond strength to adhesive cement after artificial aging

The purpose of this study is to investigate the effects of surface treatment methods using polyetheretherketone (PEEK) (with or without a functional monomer-containing primer following treatment with alumina blasting or concentrated sulfuric acid) on the shear bond strength (SBS) of resin luting material after artificial aging. The PEEK specimens were classified into five groups according to their treatment methods: untreated, alumina blasting (AB), concentrated sulfuric acid (SA), alumina blasting+primer (ABP), and concentrated SA+primer (SAP). The SBS score of each group was determined experimentally using a universal testing machine. The SBS tests revealed that the initial bond strengths of ABP and SAP were significantly higher than those of AB and SA. In addition, both SBS after 20,000 thermal cycles remained high (>15 MPa). These results suggest that the ABP and SAP groups are the best predictive methods for evaluating SBS with PEEK and resin cement.

Strategies to improve the performance of polyetheretherketone (PEEK) as orthopedic implants: from surface modification to addition of bioactive materials

Polyetheretherketone (PEEK), as a high-performance polymer, is widely used for bone defect repair due to its homogeneous modulus of elasticity of human bone, good biocompatibility, excellent chemical stability and projectability. However, the highly hydrophobic surface of PEEK is biologically inert, which makes it difficult for cells and proteins to attach, and is accompanied by the development of infections that ultimately lead to failure of PEEK implants. In order to further enhance the potential of PEEK as an orthopedic implant, researchers have explored modification methods such as surface modification by physical and chemical means and the addition of bioactive substances to PEEK-based materials to enhance the mechanical properties, osteogenic activity and antimicrobial properties of PEEK. However, these current modification methods still have obvious shortcomings in terms of cost, maneuverability, stability and cytotoxicity, which still need to be explored by researchers. This paper reviews some of the modification methods that have been used to improve the performance of PEEK over the last three years in anticipation of the need for researchers to design PEEK orthopedic implants that better meet clinical needs.

An investigation of methods to enhance adhesion of conductive layer and dielectric substrate for additive manufacturing of electronics

Additive manufacturing of conductive layers on a dielectric substrate has garnered significant interest due to its promise to produce printed electronics efficiently and its capability to print on curved substrates. A considerable challenge encountered is the conductive layer's potential peeling due to inadequate adhesion with the dielectric substrate, which compromises the durability and functionality of the electronics. This study strives to facilitate the binding force through dielectric substrate surface modification using concentrated sulfuric acid and ultraviolet (UV) laser treatment. First, polyetheretherketone (PEEK) and nanoparticle silver ink were employed as the studied material. Second, the surface treatment of PEEK substrates was conducted across six levels of sulfuric acid exposure time and eight levels of UV laser scanning velocity. Then, responses such as surface morphology, roughness, elemental composition, chemical bonding characteristics, water contact angle, and surface free energy (SFE) were assessed to understand the effects of these treatments. Finally, the nanoparticle silver ink layer was deposited on the PEEK surface, and the adhesion force measured using a pull-off adhesion tester. Results unveiled a binding force of 0.37 MPa on unmodified surface, which escalated to 1.99 MPa with sulfuric acid treatment and 2.21 MPa with UV laser treatment. Additionally, cross-approach treatment investigations revealed that application sequence significantly impacts results, increasing binding force to 2.77 MPa. The analysis further delves into the influence mechanism of the surface modification on the binding force, elucidating that UV laser and sulfuric acid surface treatment methods hold substantial promise for enhancing the binding force between heterogeneous materials in the additive manufacturing of electronics.

Inflammatory tissue response in human soft tissue is caused by a higher particle load near carbon fiber-reinforced PEEK compared to titanium plates

Titanium as the leading implant material in locked plating is challenged by polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK), which became the focus of interest of researchers and manufacturers in recent years. However, data on human tissue response to these new implant materials are rare. Osteosynthesis plates and peri‑implant soft tissue samples of 16 healed proximal humerus fractures were examined (n = 8 CFR-PEEK, n = 8 titanium). Soft tissue was analyzed by immunohistochemistry and µCT. The entrapped foreign bodies were further examined for their material composition by FTIR. To gain insight into their origin and formation mechanism, explanted and new plates were evaluated by SEM, EDX, profilometry and HR-CT. In the peri‑implant soft tissue of the CFR-PEEK plates, an inflammatory tissue reaction was detected. Tissues contained foreign bodies, which could be identified as tantalum wires, carbon fiber fragments and PEEK particles. Titanium particles were also found in the peri‑implant soft tissue of the titanium plates but showed a less intense surrounding tissue inflammation in immunohistochemistry. The surface of explanted CFR-PEEK plates was rougher and showed exposed and broken carbon fibers as well as protruding and deformed tantalum wires, especially in used screw holes, whereas scratches were identified on the titanium plate surfaces. Particles were present in the peri‑implant soft tissue neighboring both implant materials and could be clearly assigned to the plate material. Particles from both plate materials caused detectable tissue inflammation, with more inflammatory cells found in soft tissue over CFR-PEEK plates than over titanium plates. STATEMENT OF SIGNIFICANCE: Osteosynthesis plates are ubiquitously used in various medical specialties for the reconstruction of bone fractures and defects and are therefore indispensable for trauma surgeons, ENT specialists and many others. The leading implant material are metals such as titanium, but recently implants made of polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK) have become increasingly popular. However, little is known about human tissue reaction and particle generation related to these new implant types. To clarify this question, 16 osteosynthesis plates (n = 8 titanium and n = 8 CFR-PEEK) and the overlying soft tissue were analyzed regarding particle occurrence and tissue inflammation. Tissue inflammation is clinically relevant for the development of scar tissue, which is discussed to cause movement restrictions and thus contributes significantly to patient outcome.

Effects of combined modification of sulfonation, oxygen plasma and silane on the bond strength of PEEK to resin

OBJECTIVE

This study aimed to evaluate the combined effects of sulfonation, non-thermal oxygen plasma and silane on the shear bond strength (SBS) of PEEK to resin materials.

MATERIALS AND METHODS

Two hundred and eighty specimens were randomly divided into four groups: (A) untreated; (B) sulfonation for 60 s; (C) oxygen plasma for 20 min; (D) sulfonation for 60 s and oxygen plasma for 20 min. According to the instructions, 120 samples (N = 30) were coated with silane, adhesive, and resin composites. Each group of bonding specimens was divided into two subgroups (n = 15) to measure immediate and post-aging SBS. The surface morphology and the interface between the samples and adhesive were analyzed through SEM. Physicochemical characteristics of the surface and mechanical properties were determined through XPS, FTIR, light interferometry, contact angle measurement, and three-point bending tests.

RESULTS

Sulfonation produced a porous layer of approximately 20 µm thickness on the surface, and the oxygen plasma increased the O/C ratio and oxygen-containing groups of the sample surface. After coating with silane, the SBS values of sulfonated PEEK and plasma-treated PEEK increased (9.96 and 10.72 MPa, respectively), and dual-modified PEEK exhibited the highest SBS value (20.99 MPa), which was significantly higher than that of blank group (p > 0.01). After 10,000 thermal cycles, the dual-modified PEEK still displayed a favorable SBS (18.68 MPa).

SIGNIFICANCE

Sulfonation strengthened the mechanical interlocking between PEEK and the resin while oxygen plasma established a chemical bonding between silane and PEEK. This dual modification of the surface microstructure and chemical state synergistically improved the bond strength of PEEK to resin and resulted in considerable long-term effects.

Methods to improve antibacterial properties of PEEK: A review

As a thermoplastic and bioinert polymer, polyether ether ketone (PEEK) serves as spine implants, femoral stems, cranial implants, and joint arthroplasty implants due to its mechanical properties resembling the cortical bone, chemical stability, and radiolucency. Although there are standards and antibiotic treatments for infection control during and after surgery, the infection risk is lowered but can not be eliminated. The antibacterial properties of PEEK implants should be improved to provide better infection control. This review includes the strategies for enhancing the antibacterial properties of PEEK in four categories: immobilization of functional materials and functional groups, forming nanocomposites, changing surface topography, and coating with antibacterial material. The measuring methods of antibacterial properties of the current studies of PEEK are explained in detail under quantitative, qualitative, andin vivomethods. The mechanisms of bacterial inhibition by reactive oxygen species generation, contact killing, trap killing, and limited bacterial adhesion on hydrophobic surfaces are explained with corresponding antibacterial compounds or techniques. The prospective analysis of the current studies is done, and dual systems combining osteogenic and antibacterial agents immobilized on the surface of PEEK are found the promising solution for a better implant design.

Dual aldehyde cross-linked hyaluronic acid hydrogels loaded with PRP and NGF biofunctionalized PEEK interfaces to enhance osteogenesis and vascularization

Polyetheretherketone (PEEK) material has become a potential bone replacement material due to its elastic modulus, which is close to that of human bone, and stable chemical properties. However, its biological inertness has hindered its clinical application. To improve the biological inertia of PEEK material, a hyaluronic acid (HA) hydrogel coating loaded with platelet-rich plasma (PRP) and nerve growth factor (NGF) was constructed on the surface of PEEK material in this study. After the hybrid hydrogel coating was constructed, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), Fourier transform infrared spectroscopy (FT-IR), degradation tests, and enzyme-linked immunosorbent assays (ELISAs) were used to evaluate its characteristics and biological properties. The osteogenic and angiogenic potentials were also investigated in vitro and in vivo. Our results showed that the HA hydrogel loaded with RPP and NGF on the PEEK surface degraded slowly and could sustainably release various growth factors, including NGF. The results of in vitro tests showed that the hybrid hydrogel on the surface of PEEK effectively promoted osteogenesis and angiogenesis. The in vivo experiment also confirmed that the PEEK surface hydrogel could promote osseointegration of the implant and the integration of new bone and neovascularization. Our results suggest that the cross-linked hyaluronic acid hydrogel loaded with PRP and NGF can significantly improve the biological inertia of PEEK material, endowing PEEK material with good osteogenic and angiogenic ability.

Highly hydrophilic and dispersed TiO2 nano-system with enhanced photocatalytic antibacterial activities and accelerated tissue regeneration under visible light

Titanium dioxide (TiO2)-based photodynamic antibacterial (PDA) agents present a novel approach for addressing drug-resistant bacterial infections and the associated tissue damage. However, the suboptimal dispersibility, negative charge, and weak photocatalytic activity under visible light of TiO2 hinder its practical applications. This study aimed to address these limitations by developing a highly hydrophilic and dispersed Zn-TiO2/reduced graphene oxide (rGO) (HTGZ) nano-system with exceptional visible light catalytic activity and tissue repair ability. HTGZ produced an antibacterial ratio over 98% within a short time, likely due to the enhanced production of reactive oxygen species under visible light. After being co-cultured for 4 days, L929 cells and BMSCs maintained over 90% activity, indicating that HTGZ had no significant cytotoxicity. Furthermore, the transcriptomic and metabolic analyses revealed that the antibacterial mechanism mainly came from the destruction of cell membranes and the disruption of various metabolic processes, such as purine metabolism and fatty acid biosynthesis. Critically, results of in vivo experiments had authenticated that HTGZ significantly promoted infected tissue regeneration by slaughtering bacteria and release Zn2+. After 14 days, the wound area was only one-third that of the control group. Overall, the enhanced antibacterial efficacy and wound-healing potential position HTGZ as a promising nano-antibacterial medication for the clinical treatment of infectious bacterial diseases.

Ion Bombardment-Induced Nanoarchitectonics on Polyetheretherketone Surfaces for Enhanced Nanoporous Bioactive Implants

In spite of the biocompatible, nontoxic, and radiolucent properties of polyetheretherketone (PEEK), its biologically inert surface compromises its use in dental, orthopedic, and spine fusion industries. Many efforts have been made to improve the biological performance of PEEK implants, from bioactive coatings to composites using titanium alloys or hydroxyapatite and changing the surface properties by chemical and physical methods. Directed plasma nanosynthesis (DPNS) is an atomic-scale nanomanufacturing technique that changes the surface topography and chemistry of solids via low-energy ion bombardment. In this study, PEEK samples were nanopatterned by using argon ion irradiation by DPNS to yield active nanoporous biomaterial surface. PEEK surfaces modified with two doses of low and high fluence, corresponding to 1.0 × 1017 and 1.0 × 1018 ions/cm2, presented pore sizes of 15-25 and 60-90 nm, respectively, leaving exposed PEEK fibers and an increment of roughness of nearly 8 nm. The pores per unit area were closely related for high fluence PEEK and low fluence PEEK surfaces, with 129.11 and 151.72 pore/μm2, respectively. The contact angle significantly decreases in hydrophobicity-hydrophilicity tests for the irradiated PEEK surface to ∼46° from a control PEEK value of ∼74°. These super hydrophilic substrates had 1.6 times lower contact angle compared to the control sample revealing a rough surface of 20.5 nm only at higher fluences when compared to control and low fluences of 12.16 and 14.03 nm, respectively. These super hydrophilic surfaces in both cases reached higher cell viability with ∼13 and 34% increase, respectively, compared to unmodified PEEK, with an increased expression of alkaline phosphatase at 7 days on higher fluences establishing a higher affinity for preosteblasts with increased cellular activity, thus revealing successful and improved integration with the implant material, which can potentially be used in bone tissue engineering.

Polyetheretherketone development in bone tissue engineering and orthopedic surgery

Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.

Low-Temperature Printed Hierarchically Porous Induced-Biomineralization Polyaryletherketone Scaffold for Bone Tissue Engineering

Polyetheretherketone (PEEK) as a popular orthopaedic implant is usually fabricated into a hierarchically porous structure for improving osteogenic activity. However, the applications are limited due to the excessively high processing temperature and uncontrollably tedious modification routes. Here, an amorphous polyaryletherketone with carboxyl groups (PAEK-COOH) is synthesized and fabricated to the hierarchically controllable porous scaffolds via a low-temperature 3D-printing process. The prepared PAEK-COOH scaffolds present controllable porous structures ranging from nano- to micro-scale, and their mechanical strengths are comparable to that of trabecular bone. More importantly, the in vitro experiments show that the nanoporous surface is conducive to promoting cellular adhesion, and carboxyl groups can induce hydroxyapatite mineralization via electrostatic interaction. The in vivo experiments demonstrate that the PAEK-COOH scaffolds offer much better osseointegration without additional active ingredients, compared to that of PEEK. Therefore, this work will not only develop a promising candidate for bone tissue engineering, but provide a viable method to design PAEK biomaterials.

Treatment methods toward improving the anti-infection ability of poly(etheretherketone) implants for medical applications

Due to its favorable chemical stability, biocompatibility, and mechanical properties, Poly(etheretherketone) (PEEK) is a promising material for repairing bone and dental hard tissue defects. However, there are critical disadvantages: PEEK is biologically and chemically inert, which influences osseointegration of implants and bonding strength of prostheses, and its mechanical properties still cannot meet the requirements for some medical applications. Furthermore, bacterial infections and inflammatory reactions often accompany bone defects caused by trauma or inflammation or teeth loss caused by periodontitis. Previous studies mainly focused on enhancing PEEK's bioactivity and mechanical performance, but PEEK also lacks effective anti-infection ability. Thus, it is necessary to improve its anti-infection ability, and this is considered in this paper from two aspects. The first is to inhibit the attachment and growth of bacteria on the material, and the second is to endow the material with immunoregulatory ability, which means mobilizing the host immune system to protect tissue from inflammation. In this review, we analyze and discuss the existing treatment methods to improve the antibacterial and immunomodulatory abilities of PEEK addressing their limitations, relevant future challenges, and required research efforts.

Surface Modification of Poly(ether ether ketone) by Simple Chemical Grafting of Strontium Chondroitin Sulfate to Improve its Anti-Inflammation, Angiogenesis, Osteogenic Properties

Besides inducing osteogenic differentiation, the surface modification of poly(ether ether ketone) (PEEK) is highly expected to improve its angiogenic activity and reduce the inflammatory response in the surrounding tissue. Herein, strontium chondroitin sulfate is first attempted to be introduced into the surface of sulfonated PEEK (SPEEK-CS@Sr) based on the Schiff base reaction between PEEK and ethylenediamine (EDA) and the amidation reaction between EDA and chondroitin sulfate (CS). The surface characteristics of SPEEK-CS@Sr implant are systematically investigated, and its biological properties in vitro and in vivo are also evaluated. The results show that the surface of SPEEK-CS@Sr implant exhibits a 3D microporous structure and good hydrophilicity, and can steadily release Sr ions. Importantly, the SPEEK-CS@Sr not only displays excellent biocompatibility, but also can remarkably promote cell adhesion and spread, improve osteogenic activity and angiogenic activity, and reduce the inflammatory response compared to the original PEEK. Therefore, this study presents the surface modification of PEEK material by simple chemical grafting of strontium chondroitin sulfate to improve its angiogenesis, anti-inflammation, and osteogenic properties, and the as-fabricated SPEEK-CS@Sr has the potential to serve as a promising orthopedic implant in bone tissue engineering.

Immobilization of Collagen on the Surface of a PEEK Implant with Monolayer Nanopores

Polyetheretherketone (PEEK) is the only polymer material that can replace titanium implants in the field of orthopedics. This is because the mechanical properties of PEEK are similar to those of bone, and PEEK has natural radiolucency, chemical stability, and sterilization resistance. Despite these advantages, PEEK has a disadvantage—that it is bio-inert. Therefore, many studies have attempted to change the bio-inertness of PEEK into bioactivity. Among them, a method of forming pores by acid treatment is attracting attention. In this study, an attempt was made to form pores on the surface of PEEK implant using a mixed acid of sulfuric acid and nitric acid. As a result, it was found that the condition when the PEEK surface is in contact with the acid is very important. That is, it was possible to form single-layered nanopores on the surface by contacting PEEK with a mixed acid under ultrasound. Additionally, by immobilizing type I collagen on the porous PEEK surface through dopamine coating, it was possible to obtain collagen-immobilized porous PEEK (P-PEEK-Col) with high compatibility with osteoblasts. This P-PEEK-Col has high potential for use as a bone substitute that promotes bone formation.

The Role of Surface Chemistry in the Osseointegration of PEEK Implants

Poly(etheretherketone) (PEEK) implants suffer from poor osseointegration because of chronic inflammation. In this study, we hypothesized that adding NH₂ and COOH groups to the surface of PEEK could modulate macrophage responses by altering protein adsorption and improve its osseointegration. NH₂ and COOH-functionalized PEEK surfaces induced pro- and anti-inflammatory macrophage responses, respectively, and differences in protein adsorption patterns on these surfaces were related to the varied inflammatory responses. The macrophage responses to NH₂ surfaces significantly reduced the osteogenic differentiation of mesenchymal stem cells (MSCs). MSCs cultured on NH₂ surfaces differentiated less than those on COOH surfaces even though NH₂ surfaces promoted the most mineralization in simulated body fluid solutions. After 14 days in rat tibia unicortical defects, the bone around NH₂ surfaces had thinner trabeculae and higher specific bone surface than the bone around unmodified implants; surprisingly, the NH₂ implants significantly increased bone-binding over the unmodified implants, while COOH implants only showed a trend for increasing bone-binding. Taken together, these results suggest that both mineral-binding and immune responses play a role in osseointegration, and PEEK implant integration may be improved with mixtures of these two functional groups to harness the ability to reduce inflammation and bind bone strongly.

Photoinduced immobilization of 2-methacryloyloxyethyl phosphorylcholine polymers with different molecular architectures on a poly(ether ether ketone) surface

Poly(ether ether ketone) (PEEK) has seen increasing use in biomedical fields as a replacement for metal implants. Accordingly, the surface functionalities of PEEK are important for the development of medical devices. We have focused on the application of photoinduced reactions in PEEK to immobilize a functional polymer via radical generation on the surface, which can react with hydrocarbon groups. In this study, we used zwitterionic copolymers comprising 2-methacryloyloxyethyl phosphorylcholine (MPC) units and n-butyl methacrylate (BMA) units with various molecular architectures for surface modification. A random copolymer (poly(MPC-co-BMA) (r-PMB)), an AB-type diblock copolymer (di-PMB), and an ABA-type triblock copolymer (tri-PMB) (A segment: poly(BMA); B segment: poly(MPC)) were synthesized with the same monomer compositions. All PMBs were successfully immobilized on the PEEK surface via UV irradiation after the dip-coating process, regardless of their molecular structure. In this reaction, the alkyl group of the BMA unit functioned as a photoreactive site on the PEEK surface. This indicates that the molecular structure differences affect the surface properties. For example, compared to r-PMB and tri-PMB, di-PMB-modified surfaces exhibited an extremely low water contact angle of approximately 10°. The findings of this study demonstrate that this surface functionalization method does not require a low-molecular-weight compound, such as an initiator, and can be applied to the surface of inert PEEK through a simple photoreaction under room temperature, atmospheric pressure, and dry state conditions.

Arg-Gly-Asp peptide functionalized poly-amino acid/ poly (p-benzamide) copolymer with enhanced mechanical properties and osteogenicity

Poly-amino acid (PAA) is a promising biomaterial in biomedical engineering due to its similar amide bond structure to collagen and excellent biocompatibility, but the lack of osteogenic activity and inferior mechanical strength limit its long-term application in orthopedics. In this study, a poly-amino acid/poly (p-benzamide) (PAA-PBA) copolymer with high mechanical strength was designed and fabricated by the method of solution polymerization. The chain structures, thermal properties and mechanical properties of these polymers were evaluated and results showed that PBA greatly promoted the mechanical properties of PAA, and the copolymer performed the maximum mechanical strengths with compressive strength, bending strength and tensile strength of 123 MPa, 107 MPa and, 95 MPa, respectively. To increase the bioactivity of surface, a bioactive coating that consists of poly-(dopamine) (PDA) nanolayers and tripeptide Arginine-Glycine-Aspartic acid (RGD) on sulfonated PAA-PBA copolymer was created. A porous structure appeared on the surface after modification, the surface roughness and hydrophilicity of copolymer has been improved obviously after introducing PDA and RGD peptide coating. The in vitro bioactivity evaluation demonstrated that the RGD-functionalized sample showed a significantly improved ability to promote bone apatite mineralization, cell adhesion, proliferation and osteogenic differentiation. In a word, such a strategy of material synthesis and surface modification method shows a great potential for broadening the use of PAA in the application of load-bearing bone substitute biomaterials.

Functional outcomes before and after implant removal in patients with posttraumatic shoulder stiffness and healed proximal humerus fractures: does implant material (PEEK vs. titanium) have an impact? - a pilot study

Background

Posttraumatic shoulder stiffness remains a problem after proximal humerus fracture (PHF) despite good healing rates. The aim of this pilot study was to determine whether the implant material and overlying soft tissue have an effect on shoulder range of motion (ROM) before and after implant removal (IR).

Methods

16 patients (mean age 55.2 ± 15.3 (SD) years; 62.5% female) were included who underwent operative treatment with locking plates of either carbon fiber reinforced Polyetheretherketone (PEEK) (PEEKPower® humeral fracture plate, Arthrex, Naples, Florida, USA, n = 8) or titanium alloy (Ti) (Philos®, DePuy Synthes, Johnson & Johnson Medical, Raynham, Massachusetts, USA, n = 8) for PHF. All patients presented with a limited ROM and persistent pain in everyday life after the fracture had healed, whereupon IR was indicated. ROM before and after IR were compared as well as the Constant Score (CS) and the CS compared to the contralateral shoulder (%CS) 1 year after IR.

Results

In group PEEK, elevation was 116.3° ± 19.2° pre- and 129.4° ± 23.7° post-IR (p = 0.027). External rotation was 35.0° ± 7.6° pre- and 50.6° ± 21.8° post-IR (p = 0.041). External rotation with the humerus abducted 90° was 38.8° ± 18.1° pre- and 52.5° ± 25.5° post-IR (p = 0.024). In group Ti, elevation was 110.0° ± 34.6° pre- and 133.8° ± 31.1° post-IR (p = 0.011). External rotation with the humerus at rest was 33.8° ± 23.1° pre- and 48.8° ± 18.7° post-IR (p = 0.048). External rotation with the humerus abducted 90° was 40.0° ± 31.6° pre- and 52.5° ± 22.5° post-IR (p = 0.011). Comparison of the two implant materials showed no significant difference. The overall CS was 90.3 ± 8.8, the %CS was 91.8% ± 14.7%.

Conclusion

There was no significant difference in ROM, CS and %CS with respect to plate materials, although lower cell adhesion is reported for the hydrophobic PEEK. However, all patients showed improved functional outcomes after IR in this pilot study. In patients with shoulder stiffness following locked plating for PHF, implants should be removed and open arthrolysis should be performed, independently from the hardware material.

Level of evidence

II

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05061-x.

Immunomodulatory Properties and Osteogenic Activity of Polyetheretherketone Coated with Titanate Nanonetwork Structures

Polyetheretherketone (PEEK) is a potential substitute for conventional metallic biomedical implants owing to its superior mechanical and chemical properties, as well as biocompatibility. However, its inherent bio-inertness and poor osseointegration limit its use in clinical applications. Herein, thin titanium films were deposited on the PEEK substrate by plasma sputtering, and porous nanonetwork structures were incorporated on the PEEK surface by alkali treatment (PEEK-TNS). Changes in the physical and chemical characteristics of the PEEK surface were analyzed to establish the interactions with cell behaviors. The osteoimmunomodulatory properties were evaluated using macrophage cells and osteoblast lineage cells. The functionalized nanostructured surface of PEEK-TNS effectively promoted initial cell adhesion and proliferation, suppressed inflammatory responses, and induced macrophages to anti-inflammatory M2 polarization. Compared with PEEK, PEEK-TNS provided a more beneficial osteoimmune environment, including increased levels of osteogenic, angiogenic, and fibrogenic gene expression, and balanced osteoclast activities. Furthermore, the crosstalk between macrophages and osteoblast cells showed that PEEK-TNS could provide favorable osteoimmunodulatory environment for bone regeneration. PEEK-TNS exhibited high osteogenic activity, as indicated by alkaline phosphatase activity, osteogenic factor production, and the osteogenesis/osteoclastogenesis-related gene expression of osteoblasts. The study establishes that the fabrication of titanate nanonetwork structures on PEEK surfaces could extract an adequate immune response and favorable osteogenesis for functional bone regeneration. Furthermore, it indicates the potential of PEEK-TNS in implant applications.

Effect of Extreme Ultraviolet (EUV) Radiation and EUV Induced, N2 and O2 Based Plasmas on a PEEK Surface's Physico-Chemical Properties and MG63 Cell Adhesion

Polyetheretherketone (PEEK), due to its excellent mechanical and physico-chemical parameters, is an attractive substitute for hard tissues in orthopedic applications. However, PEEK is hydrophobic and lacks surface-active functional groups promoting cell adhesion. Therefore, the PEEK surface must be modified in order to improve its cytocompatibility. In this work, extreme ultraviolet (EUV) radiation and two low-temperature, EUV induced, oxygen and nitrogen plasmas were used for surface modification of polyetheretherketone. Polymer samples were irradiated with 100, 150, and 200 pulses at a 10 Hz repetition rate. The physical and chemical properties of EUV and plasma modified PEEK surfaces, such as changes of the surface topography, chemical composition, and wettability, were examined using atomic force microscopy (AFM), scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and goniometry. The human osteoblast-like MG63 cells were used for the analysis of cell viability and cell adhesion on all modified PEEK surfaces. EUV radiation and two types of plasma treatment led to significant changes in surface topography of PEEK, increasing surface roughness and formation of conical structures. Additionally, significant changes in the chemical composition were found and were manifested with the appearance of new functional groups, incorporation of nitrogen atoms up to ~12.3 at.% (when modified in the presence of nitrogen), and doubling the oxygen content up to ~25.7 at.% (when modified in the presence of oxygen), compared to non-modified PEEK. All chemically and physically changed surfaces demonstrated cyto-compatible and non-cytotoxic properties, an enhancement of MG63 cell adhesion was also observed.

Vascular cell behavior on heparin-like polymers modified silicone surfaces: The prominent role of the lotus leaf-like topography

Vascular cell behavior on material surfaces, such as heparin-like polymers, can be affected by the surface chemical composition and surface topological structure. In this study, the effects of heparin-like polymers and lotus leaf-like topography on surface vascular cell behavior are considered. By combining multicomponent thermo-curing and replica molding, a polydimethylsiloxane surface containing bromine (PDMS-Br) with lotus leaf-like topography is obtained. Heparin-like polymers with different chemical compositions are grafted onto PDMS-Br surfaces using visible-light-induced graft polymerization. Compared with unmodified PDMS-Br, surfaces modified by sulfonate-containing polymers are more friendly to vascular cells, while those modified by a glyco-polymer are much more resistant to vascular cells. The introduction of lotus leaf-like topography results in different degrees of decrease in cell density on different heparin-like polymer-modified surfaces. In addition, the combination of heparin-like polymers and lotus leaf-like topography results in the change in protein adsorption, indicating that the two factors may affect the surface vascular cell behavior by affecting the adsorption of relative proteins. The combination of bionic surface topography and different chemical components of heparin-like polymers on material surfaces suggests a new way of engineering cell-material interactions.

Biologically Modified Polyether Ether Ketone as Dental Implant Material

Polyether ether ketone (PEEK) is a non-toxic polymer with elastic modulus close to human bone. Compared with metal implants, PEEK has advantages such as evasion of stress shielding effect, easy processing, and similar color as teeth, among others. Therefore, it is an excellent substitute material for titanium dental orthopedic implants. However, PEEK's biological inertia limits its use as an implant. To change PEEK's biological inertia and increase its binding ability with bone tissue as an implant, researchers have explored a number of modification methods to enhance PEEK's biological activities such as cellular compatibility, osteogenic activity, and antibacterial activity. This review summarizes current biological activity modification methods for PEEK, including surface modification and blending modification, and analyzes the advantages and disadvantages of each modification method. We believe that modified PEEK will be a promising dental and orthopedic implant material.

Preparation of Poly(ether-ether-ketone)/Nanohydroxyapatite Composites with Improved Mechanical Performance and Biointerfacial Affinity

Poly(ether-ether-ketone) (PEEK) displays promising potential in hard tissue repair and orthopedic surgery due to its adaptable mechanical performance, good chemical resistance, and bioinertness. However, the low biointerfacial affinity of pure PEEK implants and the decrease of mechanical strength after processing greatly limit their clinical applications. In this work, the influences on mechanical performance and biointerfacial affinity of the PEEK/nanohydroxyapatite (nHA) composites are systematically investigated. Results show that the mechanical performance of PEEK/nHA composites was improved by adjusting the nHA content. The maximum values of the tensile, compressive, bending, and impact strength of the composites were increased by approximately 16.2, 25, 54, and 21%, respectively, when compared with that of pure PEEK. Studies in vitro show that PEEK/nHA composites display good cytocompatibility and promote the biomimic formation of HA, adhesion, and proliferation of L929 cells on the surface. Studies in vivo demonstrate that, compared to the pure PEEK, PEEK/nHA composites exhibit higher biointerfacial affinity, including the adhesion and encapsulation of muscle tissues on the surface of the implants and the suppression of inflammatory reaction around the implants. Our findings could pave the way for extensive applications of PEEK/nHA composites in hard tissue repair, particularly orthopedic surgery.