An overview of translational research in bone graft biomaterials

Natural bone healing is often inadequate to treat fractures with critical size bone defects and massive bone loss. Immediate surgical interventions through bone grafts have been found to be essential on such occasions. Naturally harvested bone grafts, although are the preferred choice of the surgeons; they suffer from serious clinical limitations, including disease transmission, donor site morbidity, limited supply of graft etc. Synthetic bone grafts, on the other hand, offer a more clinically appealing approach to decode the pathways of bone repair through use of tissue engineered biomaterials. This article critically retrospects the translational research on various engineered biomaterials towards bringing transformative changes in orthopaedic healthcare. The first section of the article discusses about composition and ultrastructure of bone along with the global perspectives on statistical escalation of bone fracture surgeries requiring use of bone grafts. The next section reviews the types, benefits and challenges of various natural and synthetic bone grafts. An overview of clinically relevant biomaterials from traditionally used metallic, bioceramic, and biopolymeric biomaterials to new generation composites have been summarised. Finally, this narrative review concludes with the discussion on the emerging trends and future perspectives of the promising bone grafts.

Recent Advances in the Evaluation of Antimicrobial Materials for Resolution of Orthopedic Implant-Associated Infections In Vivo

While orthopedic implant-associated infections are rare, revision surgeries resulting from infections incur considerable healthcare costs and represent a substantial research area clinically, in academia, and in industry. In recent years, there have been numerous advances in the development of antimicrobial strategies for the prevention and treatment of orthopedic implant-associated infections which offer promise to improve the limitations of existing delivery systems through local and controlled release of antimicrobial agents. Prior to translation to in vivo orthopedic implant-associated infection models, the properties (e.g., degradation, antimicrobial activity, biocompatibility) of the antimicrobial materials can be evaluated in subcutaneous implant in vivo models. The antimicrobial materials are then incorporated into in vivo implant models to evaluate the efficacy of using the material to prevent or treat implant-associated infections. Recent technological advances such as 3D-printing, bacterial genomic sequencing, and real-time in vivo imaging of infection and inflammation have contributed to the development of preclinical implant-associated infection models that more effectively recapitulate the clinical presentation of infections and improve the evaluation of antimicrobial materials. This Review highlights the advantages and limitations of antimicrobial materials used in conjunction with orthopedic implants for the prevention and treatment of orthopedic implant-associated infections and discusses how these materials are evaluated in preclinical in vivo models. This analysis serves as a resource for biomaterial researchers in the selection of an appropriate orthopedic implant-associated infection preclinical model to evaluate novel antimicrobial materials.

Strategies for Enhancing Polyester-Based Materials for Bone Fixation Applications

Polyester-based materials are established options, regarding the manufacturing of bone fixation devices and devices in routine clinical use. This paper reviews the approaches researchers have taken to develop these materials to improve their mechanical and biological performances. Polymer blending, copolymerisation, and the use of particulates and fibre bioceramic materials to make composite materials and surface modifications have all been studied. Polymer blending, copolymerisation, and particulate composite approaches have been adopted commercially, with the primary focus on influencing the in vivo degradation rate. There are emerging opportunities in novel polymer blends and nanoscale particulate systems, to tune bulk properties, and, in terms of surface functionalisation, to optimise the initial interaction of devices with the implanted environment, offering the potential to improve the clinical performances of fracture fixation devices.

Processing and characterization of phosphate glass fiber/polylactic acid commingled yarn composites for commercial production

This study investigated the production of phosphate glass fiber/polylactic acid (PGF/PLA) commingled yarns, textiles and composites for biomedical applications. The PGF volume contents of the composites investigated were 25% and 40%. Plain weave textiles with yarn counts of 10 warp/cm and 6 weft/cm were produced using a commercial weaving machine. An orthogonal array design (OAD) was employed as a statistical method to investigate the effects of compression molding parameters (processing temperature, preheating time, compression time, and pressure) on flexural strength and porosity of PGF/PLA textile composites. Processing temperature showed the most significant effect in achieving maximum laminate flexural strength and molecular weight of PLA. Processing models were developed using regression techniques to predict the laminate flexural strength and the molecular weight of PLA. Composites with fiber contents of 25 and 40 vol% produced using optimized processing conditions identified by the processing models, provided flexural strengths of 236 MPa and 293 MPa, respectively.

Creep, recovery, and stress relaxation behavior of nanostructured bioactive calcium phosphate glass-POSS/polymer composites for bone implants studied under simulated physiological conditions

The creep and recovery and the stress relaxation behaviors of poly(butylene adipate-co-terephthalate) (PBAT) and polyhydroxyalkanoates (PHA) binary blends incorporating 30 wt % of a mixture of trisilanolisobutyl polyhedral oligomeric silsesquioxanes (POSS) and calcium phosphate glass (CaP-g) were investigated under simulated physiological and human body temperature conditions. The synergistic effect of PHA and CaP-g/POSS filler remarkably improved the creep behavior of the PBAT matrix and decreased its residual strain, consequently enhancing its elastic recovery. A considerable increase of the relaxation modulus of the hybrid materials was also observed upon incorporation of PHA and CaP-g/POSS. The relaxation modulus of the neat PBAT sample increased from ~60 MPa to ~1600 MPa after addition of 30 wt % CaP-g/POSS and 70 wt % PHA. However, after exposure of the composites to the simulated human body conditions for 14 days, a drop of dynamic mechanical properties of the studied material systems was observed along with formation of a desirable calcium phosphate phase on the material surface. The long-term (i.e., up to 7 × 10⁵  s) viscoelastic behavior of the studied materials was successfully predicted using the time-temperature superposition principle and the obtained creep strain and the relaxation modulus master curves were satisfactorily fitted to the Findley power law equation and the generalized Maxwell model, respectively. This study demonstrates a facile method for tailoring CaP-g/POSS bioactive glasses composition for bone-like apatite formation on biopolymer surfaces. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2419-2432, 2019.

Multiple shape memory behavior of highly oriented long-chain-branched poly(lactic acid) and its recovery mechanism

The shape memory effect of highly oriented long-chain-branched poly(lactic acid) (LCB-PLA) prepared through solid-phase die drawing technology was studied by comparison with PLA. When the recovery temperature increased from 60°C to 120°C, for PLA, only one-step recovery at about 80°C can be observed and the recovery ratio was below 21.5%, while, for LCB-PLA, multiple recovery behavior with high recovery ratio of 78.8% can be achieved. For oriented PLA, the recovery curve of the final sample showed the same trend with that of sample suffering just free drawing; while for oriented LCB-PLA, the recovery curve of the final sample showed the same trend with that of sample suffering just die drawing. After shape recovery, the mechanical properties of LCB-PLA showed a linear downward trend with the recovery temperature. Together with amorphous phase, the oriented mesomorphic phase, which formed during solid die drawing, can act as switching domains. And thus, upon heating, the chain segment of amorphous phase relaxed at first and triggered the first macroscopical shape recovery, leading to the decrease of long period (L_ac) and the thickness of the amorphous layer (L_a ). Then, with further increasing temperature, the oriented mesomorphic phase gradually relaxed resulting subsequently multi-shape recovery, and the L_ac and the L_a further decreased. Therefore, by regulating the recovery temperature of oriented LCB-PLA, the shape recovery ratio and mechanical strength can be controlled effectively, and thus the self-reinforced and self-fastening effect can be achieved simultaneously for PLA as bone fixation material. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 872-883, 2019.

Effects of Fe2O3 addition and annealing on the mechanical and dissolution properties of MgO-and CaO-containing phosphate glass fibres for bio-applications

This paper investigated the preparation of phosphate glass fibres (PGFs) in the following systems: i) 45P2O5-5B2O3-5Na2O-(29-x)CaO-16MgO-(x)Fe2O3 and ii) 45P2O5-5B2O3-5Na2O-24CaO-(21-x)MgO-(x)Fe2O3 (where x = 5, 8 and 11 mol%) for biomedical applications. Continuous fibres of 23 ± 1 μm diameter were prepared via a meltdraw spinning process. Compositions with higher Fe2O3 content and higher MgO/CaO ratio required higher melting temperature and longer heating time to achieve glass melts for fibre pulling. The effects of Fe2O3 addition and annealing treatment on mechanical properties and degradation behaviours were also investigated. Adding Fe2O3 was found to increase the tensile strength from 523 ± 63 (Ca-Fe5) to 680 ± 75 MPa (Ca-Fe11), improve the tensile modulus from72 ± 4 (Ca-Fe5) to 78 ± 3 GPa (Ca-Fe11) and decrease the degradation rate from 4.0 (Mg-Fe5) to 1.9 × 10−6 kg m−2 s−1 (Mg-Fe11). The annealing process reduced the fibre tensile strength by 46% (Ca-Fe5), increased the modulus by 19.6%(Ca-Fe8) and decreased the degradation rate by 89.5% (Mg-Fe11) in comparison to the corresponding as drawn fibres. Additionally, the annealing process also impeded the formation of precipitate shells and revealed coexistence of the precipitation and the pitting corrosion as fibre degradation behaviours.

Compositional dependency on dissolution rate and cytocompatibility of phosphate-based glasses: Effect of B2O3 and Fe2O3 addition

The unique property of phosphate-based glasses and fibres to be completely dissolved in aqueous media is largely dependent on the glass composition. This article focuses on investigating the effect of replacing Na₂O with 3 and 5 mol% Fe₂O₃ on cytocompatibility, thermal and dissolution properties of P₂O₅–CaO–Na₂O–MgO–B₂O₃ glass system, where P₂O₅ content was fixed at 45 mol%. The effect of increasing Fe₂O₃ from 3 to 5 mol% on P₂O₅–CaO–Na₂O–MgO glasses was also evaluated. The glass transition temperature, onset of crystallisation temperature and liquidus temperature were found to decrease with increasing Fe₂O₃ content and the addition of B₂O₃, while the thermal expansion values were found to decrease. The density of the glasses decreased with increasing Fe₂O₃ content. However, an increase in the density was observed by the addition of 5 mol% B₂O₃. The dissolution properties and mode of bulk glass and fibres were also examined which were found to decrease with increasing B₂O₃ and Fe₂O₃. However, it was found that the dissolution properties of the glasses containing both B₂O₃ and Fe₂O₃ were lower than only Fe₂O₃ containing glasses. The in vitro cell culture studies using human osteoblast like (MG63) cell lines revealed that the glasses containing both B₂O₃ and Fe₂O₃ maintained and showed higher cell viability as compared to the only Fe₂O₃ containing glasses. Glasses containing both B₂O₃ and Fe₂O₃ showed a pronounced effect on the dissolution rate of the glasses, which eventually improved the cytocompatibility properties of the glasses investigated.

Near-Infrared Spectroscopic Evaluation of the Water Content of Molded Polylactide under the Effect of Crystallization

During melt processing, the moisture inside polylactide (PLA) easily induces hydrolysis, which deteriorates the mechanical and thermal properties of the product. The state of dryness of resin pellets must be monitored to prevent PLA hydrolysis. In this study, near-infrared (NIR) spectroscopy was applied to measure water content in PLA. In addition, the shape of the NIR spectrum is also affected by crystallization, which could lead to a reduction in the accuracy of evaluating the water content. The objective of this research is to construct a robust model for estimating the water content with varying dispersive extents of crystallization. Two methods for estimating water content measured during a drying process were conducted: the integration of absorbance and partial least squares (PLS) regression were conducted to estimate the water contents in PLA considering the effect of crystallization. The slope of the calibration line of the water content obtained from integrating absorbance varied between PLA with different crystallinities. This is due to the overlap between the NIR band of water and that of PLA crystal in the range of 5100-5400 cm^-1. We found that the shape of the NIR spectrum was changed by crystallization, and the crystallinity, compared to the thickness of lamellae, was the dominant factor determining such a change of NIR spectra. The PLS model of water content constructed from only amorphous PLA showed large error of estimation in crystallized PLA. In contrast, the PLS model constructed from both amorphous and crystallized PLA estimated the water contents with lower errors. This was because latent variables obtained from both amorphous and crystallized PLA cancelled the effect of crystallization on NIR spectra.

Cytocompatibility, mechanical and dissolution properties of high strength boron and iron oxide phosphate glass fibre reinforced bioresorbable composites

In this study, Polylactic acid (PLA)/phosphate glass fibres (PGF) composites were prepared by compression moulding. Fibres produced from phosphate based glasses P2O5-CaO-MgO-Na2O (P45B0), P2O5-CaO-MgO-Na2O-B2O3 (P45B5), P2O5-CaO-MgO-Na2O-Fe2O3 (P45Fe3) and P2O5-CaO-MgO-Na2O-B2O3-Fe2O3 (P45B5Fe3) were used to reinforce the bioresorbable polymer PLA. Fibre mechanical properties and degradation rate were investigated, along with the mechanical properties, degradation and cytocompatibility of the composites. Retention of the mechanical properties of the composites was evaluated during degradation in PBS at 37°C for four weeks. The fibre volume fraction in the composite varied from 19 to 23%. The flexural strength values (ranging from 131 to 184MPa) and modulus values (ranging from 9.95 to 12.29GPa) obtained for the composites matched those of cortical bone. The highest flexural strength (184MPa) and modulus (12.29GPa) were observed for the P45B5Fe3 composite. After 28 days of immersion in PBS at 37°C, ~35% of the strength profile was maintained for P45B0 and P45B5 composites, while for P45Fe3 and P45B5Fe3 composites ~40% of the initial strength was maintained. However, the overall wet mass change of P45Fe3 and P45B5Fe3 remained significantly lower than that of the P45B0 and P45B5 composites. The pH profile also revealed that the P45B0 and P45B5 composites degraded quicker, correlating well with the degradation profile. From SEM analysis, it could be seen that after 28 days of degradation, the fibres in the fractured surface of P45B5Fe3 composites remain fairly intact as compared to the other formulations. The in vitro cell culture studies using MG63 cell lines revealed both P45Fe3 and P45B5Fe3 composites maintained and showed higher cell viability as compared to the P45B0 and P45B5 composites. This was attributed to the slower degradation rate of the fibres in P45Fe3 and P45B5Fe3 composites as compared with the fibres in P45B0 and P45B5 composites.

Are Biodegradable Osteosyntheses Still an Option for Midface Trauma? Longitudinal Evaluation of Three Different PLA-Based Materials

The aim was to evaluate three different biodegradable polylactic acid- (PLA-) based osteosynthesis materials (OM). These OM (BioSorb, LactoSorb, and Delta) were used in 64 patients of whom 55 (85.9%) had fractures of the zygoma, five (7.8%) in the LeFort II level, two of the frontal bone (3.1%), and two of the maxillary sinus wall (3.1%). In addition to routine follow-up (FU) at 3, 6, and 12 months (m) (T1, T2, and T3) all patients were finally evaluated at a mean FU after 14.1 m for minor (e.g., nerve disturbances, swelling, and pain) and major (e.g., infections and occlusal disturbances) complications. Out of all 64 patients 38 presented with complications; of these 28 were minor (43.8%) and 10 major (15.6%) resulting in an overall rate of 59.4%. Differences in minor complications regarding sensibility disturbance at T1 and T3 were statistically significant (P = 0.04). Differences between the OM were not statistically significant. Apart from sufficient mechanical stability for clinical use of all tested OM complications mostly involved pain and swelling probably mainly related to the initial bulk reaction attributable to the drop of pH value during the degradation process. This paper includes a review of the current aspects of biodegradable OM.

Biodegradable Materials for Bone Repair and Tissue Engineering Applications

This review discusses and summarizes the recent developments and advances in the use of biodegradable materials for bone repair purposes. The choice between using degradable and non-degradable devices for orthopedic and maxillofacial applications must be carefully weighed. Traditional biodegradable devices for osteosynthesis have been successful in low or mild load bearing applications. However, continuing research and recent developments in the field of material science has resulted in development of biomaterials with improved strength and mechanical properties. For this purpose, biodegradable materials, including polymers, ceramics and magnesium alloys have attracted much attention for osteologic repair and applications. The next generation of biodegradable materials would benefit from recent knowledge gained regarding cell material interactions, with better control of interfacing between the material and the surrounding bone tissue. The next generations of biodegradable materials for bone repair and regeneration applications require better control of interfacing between the material and the surrounding bone tissue. Also, the mechanical properties and degradation/resorption profiles of these materials require further improvement to broaden their use and achieve better clinical results.

Biodegradable poly-lactic acid based-composite reinforced unidirectionally with high-strength magnesium alloy wires

Biodegradable poly-lactic acid (PLA)--based composites reinforced unidirectionally with high-strength magnesium alloy wires (MAWs) are fabricated by a heat-compressing process and the mechanical properties and degradation behavior are studied experimentally and theoretically. The composites possess improved strengthening and toughening properties. The bending strength and impact strength of the composites with 40 vol% MAWs are 190 MPa and 150 kJ/m(2), respectively, although PLA has a low viscosity and an average molecular weight of 60,000 g/mol. The mechanical properties of the composites can be further improved by internal structure modification and interface strengthening and a numerical model incorporating the equivalent section method (ESM) is proposed for the bending strength. Micro arc oxidization (MAO) of the MAWs is an effective interfacial strengthening method. The composites exhibit high strength retention during degradation and the PLA in the composite shows a smaller degradation rate than pure PLA. The novel biodegradable composites have large potential in bone fracture fixation under load-bearing conditions.

Core/Clad Phosphate Glass Fibres Containing Iron and/or Titanium

Phosphate glasses are novel amorphous biomaterials due to their fully resorbable characteristics, with controllable degradation profiles. In this study, phosphate glasses containing titanium and/or iron were identified to exhibit sufficiently matched thermal properties (glass transition temperature, thermal expansion coefficient and viscosity) which enabled successful co-extrusion of glass billets to form a core/clad preform. The cladding composition for the core/clad preforms were also reversed. Fe clad and Ti clad fibres were successfully drawn with an average diameter of between 30~50 μm. The average cladding annular thickness was estimated to be less than 2 μm. Annealed core/clad fibres were degraded in PBS for a period of 27 days. The strength of the Fe clad fibres appeared to increase from 303 ± 73 MPa to 386 ± 45 MPa after nearly 2 weeks in the dissolution medium (phosphate buffered solution) before decreasing by day 27. The strength of the Ti clad fibres revealed an increase from 236 ± 53 MPa to 295 ± 61 MPa when compared at week 3. The tensile modulus measured for both core/clad fibres ranged between 51 GPa to 60 GPa. During the dissolution study, Fe clad fibres showed a peeling mechanism compared to the Ti clad fibres.

Mechanical and thermal property characterization of poly-l-lactide (PLLA) scaffold developed using pressure-controllable green foaming technology

Poly-l-lactide (PLLA) is one of the most promising biological materials used for tissue engineering scaffolds (TES) because of their excellent biodegradability and tenability. Here, microcellular PLLA foams were fabricated by pressure-controllable green foaming technology. Scanning electron microscopy (SEM), dynamic mechanical analysis (DMA), differential scanning calorimetry (DSC), wide angle X-ray diffraction measurement (WAXRD), thermogravimetric (TG) analysis, reflection-Fourier transform infrared (FTIR) analysis, enzymatic degradation study and MTT assay were used to analyze the scaffolds' morphologies, structures and crystallinities, mechanical and biodegradation properties, as well as their cytotoxicity. The results showed that PLLA foams with pore sizes from 8 to 103μm diameters were produced when the saturation pressure decreased from 7.0 to 4.0MPa. Through a combination of StepScan DSC (SSDSC) and WAXRD approaches, it was observed in PLLA foams that the crystallinity, highly-oriented metastable state and rigid amorphous phase increased with the increasing foaming pressure. It was also found that both the glass transition temperature and apparent enthalpy of PLLA significantly increased after the foaming process, which suggested that the changes of microcellular structure could provide PLLA scaffolds better thermal stability and elasticity. Moreover, MTT assessments suggested that the smaller pore size should benefit cell attachment and growth in the scaffold. The results of current work will give us better understanding of the mechanisms involved in structure and property changes of PLLA at the molecular level, which enables more possibilities for the design of PLLA scaffold to satisfy various requirements in biomedical and green chemical applications.

Τhe effect of silica nanoparticles on the thermomechanical properties and degradation behavior of polylactic acid

In this work a series of polylactic acid/SiO2 nanocomposites have been prepared by a melt mixing procedure. The dispersion quality was examined by scanning electron microscopy. To study the degradation behavior of the polylactic acid/nanocomposites prepared, the samples were immersed in a buffer solution at a temperature of 37℃ with a pH of 7.4 for a time period of up to 23 weeks. These conditions simulate those in the human body, appropriate in medical applications. In order to assess their suitability in biomedical applications, we investigated the biocompatibility of these materials in terms of cell viability, growth, and morphology. A good initial cell adhesion has been detected, supporting their potential use in bone tissue engineering applications. The hydrolytic degradation of polylactic acid, under the prescribed conditions, was studied by the molecular weight reduction in terms of size exclusion chromatography, whereas the progress of thermal stability of polylactic acid and polylactic acid/nanocomposites during aging was tested by thermogravimetric analysis. The evolution of the materials' thermomechanical properties during aging was studied by differential scanning calorimetry, dynamic mechanical analysis, and tensile testing. The crystallization behavior in polylactic acid and the way it is affected by the presence of nanofillers during degradation procedure has been studied and values of 44% crystallinity increment have been found. At the specific aging conditions studied, silica nanoparticles accelerate the degradability of polylactic acid, having a higher impact on Young's modulus, under the specified aging conditions, for 7 weeks and hereafter this acceleration is retarded, due to the crystallinity increment, as a result of the molecular weight reduction.

Mechanical, degradation and cytocompatibility properties of magnesium coated phosphate glass fibre reinforced polycaprolactone composites

Retention of mechanical properties of phosphate glass fibre reinforced degradable polyesters such as polycaprolactone and polylactic acid in aqueous media has been shown to be strongly influenced by the integrity of the fibre/polymer interface. A previous study utilising ‘single fibre’ fragmentation tests found that coating with magnesium improved the fibre and matrix interfacial shear strength. Therefore, the aim of this study was to investigate the effects of a magnesium coating on the manufacture and characterisation of a random chopped fibre reinforced polycaprolactone composite. Short chopped strand non-woven phosphate glass fibre mats were sputter coated with degradable magnesium to manufacture phosphate glass fibre/polycaprolactone composites. The degradation behaviour (water uptake, mass loss and pH change of the media) of these polycaprolactone composites as well as of pure polycaprolactone was investigated in phosphate buffered saline. The Mg coated fibre reinforced composites revealed less water uptake and mass loss during degradation compared to the non-coated composites. The cations released were also explored and a lower ion release profile for all three cations investigated (namely Na+, Mg2+ and Ca2+) was seen for the Mg coated composite samples. An increase of 17% in tensile strength and 47% in tensile modulus was obtained for the Mg coated composite samples. Both flexural and tensile properties were investigated and a higher retention of mechanical properties was obtained for the Mg coated fibre reinforced composite samples up to 10 days immersion in PBS. Cytocompatibility study showed both composite samples (coated and non-coated) had good cytocompatibility with human osteosarcoma cell line.

Effect of boron oxide addition on fibre drawing, mechanical properties and dissolution behaviour of phosphate-based glass fibres with fixed 40, 45 and 50 mol% P2O5

Previous studies investigating manufacture of phosphate-based glass fibres from glasses fixed with P2O5 content less than 50 mol% showed that continuous manufacture without breakage was very difficult. In this study, nine phosphate-based glass formulations from the system P2O5-CaO-Na2O-MgO-B2O3 were prepared with P2O5 contents fixed at 40, 45 and 50 mol%, where Na2O was replaced by 5 and 10 mol% B2O3 and MgO and CaO were fixed to 24 and 16 mol%, respectively. The effect of B2O3 addition on the fibre drawing, fibre mechanical properties and dissolution behaviour was investigated. It was found that addition of 5 and 10 mol% B2O3 enabled successful drawing of continuous fibres from glasses with phosphate (P2O5) contents fixed at 40, 45 and 50 mol%. The mechanical properties of the fibres were found to significantly increase with increasing B2O3 content. The highest tensile strength (1200 ± 130 MPa) was recorded for 45P2O5-16CaO-5Na2O-24MgO-10B2O3 glass fibres. The fibres were annealed, and a comparison of the mechanical properties and mode of degradation of annealed and non-annealed fibres were investigated. A decrease in tensile strength and an increase in tensile modulus were observed for the annealed fibres. An assessment of the change in mechanical properties of both the annealed and non-annealed fibres was performed in phosphate-buffered saline (PBS) at 37℃ for 28 and 60 days, respectively. Initial loss of mechanical properties due to annealing was found to be recovered with degradation. The B2O3-containing glass fibres were found to degrade at a much slower rate as compared to the non-B2O3-containing fibres. Both annealed and non-annealed fibres exhibited a peeling effect of the fibre's outer layer during degradation.

Cytocompatibility assessment of chemical surface treatments for phosphate glass to improve adhesion between glass and polyester

Fully resorbable phosphate glass fiber reinforced polymer composites have shown real potential for replacing some of the existing metallic bone fracture fixation devices. However, some of these composites have not provided suitable mechanical strength profiles over the required healing period for bone. Typically, it has been seen that these composites can lose up to 50% or more of their strength within the first week of degradation. Functionalizing the glass surface to promote polymer adhesion or to introduce hydrophobicity at the glass surface could potentially introduce control over the mechanical properties of the composite and their retention. In this study eight chemical agents namely, Glycerol 2-phosphate disodium salt; 3-phosphonopropionic acid; 3-aminopropyltriethoxy silane; etidronic acid; hexamethylene diisocyanate; sorbitol/sodium ended PLA oligomers and amino phosphonic acid, were selected to functionalise the bulk phosphate glass surface. Selected chemical agents had one functional group (-OH or O C N) to react with the glass and another functionality (either -OH, NH2, or Na) to react with the polymer matrix and/or produce hydrophobicity at the fiber surface. Bulk phosphate glass surface-treated with the above agents were assessed for the cytotoxicity of degradation products cell-material interaction in short- and long-term direct cytocompatibility studies. Results obtained from these cytocompatibility studies (using human osteosarcoma (MG63) and primary human osteoblast cell lines) revealed no cytotoxicity from the degradation products and a response comparable to controls in terms of cell functions (attachment, viability, metabolic activity, proliferation, and differentiation) and morphology.

Bioresorbable composite screws manufactured via forging process: pull-out, shear, flexural and degradation characteristics

Bioresorbable screws have the potential to overcome some of the complications associated with metallic screws currently in use. Removal of metallic screws after bone has healed is a serious issue which can lead to refracture due to the presence of screw holes. Poly lactic acid (PLA), fully 40 mol% P(2)O(5) containing phosphate unidirectional (P40UD) and a mixture of UD and short chopped strand random fibre mats (P40 70%UD/30%RM) composite screws were prepared via forging composite bars. Water uptake and mass loss for the composite screws manufactured increased significantly to ∼1.25% (P=0.0002) and ∼1.1% (P<0.0001), respectively, after 42 days of immersion in PBS at 37 °C. The initial maximum flexural load for P40 UD/RM and P40 UD composite screws was ∼60% (P=0.0047) and ∼100% (P=0.0037) higher than for the PLA screws (∼190 N), whilst the shear load was slightly higher in comparison to PLA (∼2.2 kN). The initial pull-out strengths for the P40 UD/RM and PLA screws were similar whereas that for P40 UD screws was ∼75% higher (P=0.022). Mechanical properties for the composite screws decreased initially after 3 days of immersion and this reduction was ascribed to the degradation of the fibre/matrix interface. After 3 days interval the mechanical properties (flexural, shear and pull-out) maintained their integrity for the duration of the study (at 42 days). This property retention was attributed to the chemical durability of the fibres used and stability of the matrix properties during the degradation process. It was also deemed necessary to enhance the fibre/matrix interface via use of a coupling agent in order to maintain the initial mechanical properties acquired for the required period of time. Lastly, it is also suggested that the degrading reinforcement fibres may have the potential to buffer any acidic products released from the PLA matrix.

Cytocompatibility and Mechanical Properties of Short Phosphate Glass Fibre Reinforced Polylactic Acid (PLA) Composites: Effect of Coupling Agent Mediated Interface

In this study three chemical agents Amino-propyl-triethoxy-silane (APS), sorbitol ended PLA oligomer (SPLA) and Hexamethylene diisocyanate (HDI) were identified to be used as coupling agents to react with the phosphate glass fibre (PGF) reinforcement and the polylactic acid (PLA) polymer matrix of the composite. Composites were prepared with short chopped strand fibres (l = 20 mm, ϕ = 20 µm) in a random arrangement within PLA matrix. Improved, initial composite flexural strength (~20 MPa) was observed for APS treated fibres, which was suggested to be due to enhanced bonding between the fibres and polymer matrix. Both APS and HDI treated fibres were suggested to be covalently linked with the PLA matrix. The hydrophobicity induced by these coupling agents (HDI, APS) helped to resist hydrolysis of the interface and thus retained their mechanical properties for an extended period of time as compared to non-treated control. Approximately 70% of initial strength and 65% of initial modulus was retained by HDI treated fibre composites in contrast to the control, where only ~50% of strength and modulus was retained after 28 days of immersion in PBS at 37 °C. All coupling agent treated and control composites demonstrated good cytocompatibility which was comparable to the tissue culture polystyrene (TCP) control, supporting the use of these materials as coupling agent’s within medical implant devices.

Bioresorbable screws reinforced with phosphate glass fibre: manufacturing and mechanical property characterisation

Use of bioresorbable screws could eliminate disadvantages associated with metals such as removal operations, corrosion, MRI interference and stress shielding. Mechanical properties of bioresorbable polymers alone are insufficient for load bearing applications application as screws. Thus, reinforcement is necessary to try and match or surpass the mechanical properties of cortical bone. Phosphate based glass fibres were used to reinforce polylactic acid (PLA) in order to produce unidirectionally aligned (UD) and unidirectionally plus randomly distributed (UD/RM) composite screws (P40 UD and P40 UD/RM). The maximum flexural and push-out properties for the composite screws (P40 UD and P40 UD/RM) increased by almost 100% in comparison with the PLA screws. While the pull-out strength and stiffness of the headless composite screws were ∼80% (strength) and ∼130% (stiffness) higher than for PLA, those with heads exhibited properties lower than those for PLA alone as a result of failure at the heads. An increase in the maximum shear load and stiffness for the composite screws (∼30% and ∼40%) in comparison to the PLA screws was also seen. Maximum torque for the PLA screws was ∼1000 mN m, while that for the composite screws were slightly lower. The SEM micrographs for P40 UD and P40 UD/RM screws revealed small gaps around the fibres, which were suggested to be due to buckling of the UD fibres during the manufacturing process.

Finite element modelling of the flexural performance of resorbable phosphate glass fibre reinforced PLA composite bone plates

A finite element method is presented to predict the flexural properties of resorbable phosphate glass fibre reinforced PLA composite bone plates. A novel method for meshing discontinuous fibre architectures is presented, which removes many of the limitations imposed by conventional finite element approaches. The model is used to understand the effects of increasing the span-to-thickness ratio for different fibre architectures used for PBG/PLA composites. A span-to-thickness ratio of 16:1 is found to be appropriate for materials with randomly orientated fibres, which agrees well with the test standard. However, for highly aligned materials the model indicates that a span-to-thickness ratio of 80:1 is required, in order to minimise the effects of shear deflection. The model is validated against flexural stiffness data from the literature for a range of polymers, fibres and fibre volume fractions. Generally there is less than 10% error between the FE predictions and experimental values. The model is subsequently used to perform a parametric study to understand what material developments are required to match the properties of PGF/PLA composites to cortical bone. It is concluded that alignment of the fibre is necessary to exceed the 20 GPa target, since the current manufacturing methods limit the fibre length to ∼10 mm, which consequently restricts the flexural modulus to ∼19 GPa (at 50% volume fraction).

Investigating the use of coupling agents to improve the interfacial properties between a resorbable phosphate glass and polylactic acid matrix

Eight different chemicals were investigated as potential candidate coupling agents for phosphate glass fibre reinforced polylactic acid composites. Evidence of reaction of the coupling agents with phosphate glass and their effect on surface wettability and glass degradation were studied along with their principle role of improving the interface between glass reinforcement and polymer matrix. It was found that, with an optimal amount of coupling agent on the surface of the glass/polymer, interfacial shear strength improved by a factor of 5. Evidence of covalent bonding between agent and glass was found for three of the coupling agents investigated, namely: 3-aminopropyltriethoxysilane; etidronic acid and hexamethylene diisocyanate. These three coupling agents also improved the interfacial shear strength and increased the hydrophobicity of the glass surface. It is expected that this would provide an improvement in the macroscopic properties of full-scale composites fabricated from the same materials which may also help to retain these properties for the desired length of time by retarding the breakdown of the fibre/matrix interface within these composites.

In vitro degradation, flexural, compressive and shear properties of fully bioresorbable composite rods

Several studies have investigated self-reinforced polylactic acid (SR-PLA) and polyglycolic acid (SR-PGA) rods which could be used as intramedullary (IM) fixation devices to align and stabilise bone fractures. This study investigated totally bioresorbable composite rods manufactured via compression moulding at ~100 °C using phosphate glass fibres (of composition 50P(2)O(5)-40CaO-5Na(2)O-5Fe(2)O(3) in mol%) to reinforce PLA with an approximate fibre volume fraction (v(f)) of 30%. Different fibre architectures (random and unidirectional) were investigated and pure PLA rods were used as control samples. The degradation profiles and retention of mechanical properties were investigated and PBS was selected as the degradation medium. Unidirectional (P50 UD) composite rods had 50% higher initial flexural strength as compared to PLA and 60% higher in comparison to the random mat (P50 RM) composite rods. Similar initial profiles for flexural modulus were also seen comparing the P50 UD and P50 RM rods. Higher shear strength properties were seen for P50 UD in comparison to P50 RM and PLA rods. However, shear stiffness values decreased rapidly (after a week) whereas the PLA remained approximately constant. For the compressive strength studies, P50 RM and PLA rods remained approximately constant, whilst for the P50 UD rods a significantly higher initial value was obtained, which decreased rapidly after 3 days immersion in PBS. However, the mechanical properties decreased after immersion in PBS as a result of the plasticisation effect of water within the composite and degradation of the fibres. The fibres within the random and unidirectional composite rods (P50 RM and P50 UD) degraded leaving behind microtubes as seen from the SEM micrographs (after 28 days degradation) which in turn created a porous structure within the rods. This was the main reason attributed for the increase seen in mass loss and water uptake for the composite rods (~17% and ~16%, respectively).