Biocompatibility and Clinical Application of Porous TiNi Alloys Made by Self-Propagating High-Temperature Synthesis (SHS)

Advances in implants and bone graft types for lumbar spinal fusion surgery

The increasing prevalence of spinal disorders worldwide necessitates advanced treatments, particularly interbody fusion for severe cases that are unresponsive to non-surgical interventions. This procedure, especially 360° lumbar interbody fusion, employs an interbody cage, pedicle screw-and-rod instrumentation, and autologous bone graft (ABG) to enhance spinal stability and promote fusion. Despite significant advancements, a persistent 10% incidence of non-union continues to result in compromised patient outcomes and escalated healthcare costs. Innovations in lumbar stabilisation seek to mimic the properties of natural bone, with evolving implant materials like titanium (Ti) and polyetheretherketone (PEEK) and their composites offering new prospects. Additionally, biomimetic cages featuring precisely engineered porosities and interconnectivity have gained traction, as they enhance osteogenic differentiation, support osteogenesis, and alleviate stress-shielding. However, the limitations of ABG, such as harvesting morbidities and limited fusion capacity, have spurred the exploration of sophisticated solutions involving advanced bone graft substitutes. Currently, demineralised bone matrix and ceramics are in clinical use, forming the basis for future investigations into novel bone graft substitutes. Bioglass, a promising newcomer, is under investigation despite its observed rapid absorption and the potential for foreign body reactions in preclinical studies. Its clinical applicability remains under scrutiny, with ongoing research addressing challenges related to burst release and appropriate dosing. Conversely, the well-documented favourable osteogenic potential of growth factors remains encouraging, with current efforts focused on modulating their release dynamics to minimise complications. In this evidence-based narrative review, we provide a comprehensive overview of the evolving landscape of non-degradable spinal implants and bone graft substitutes, emphasising their applications in lumbar spinal fusion surgery. We highlight the necessity for continued research to improve clinical outcomes and enhance patient well-being.

Evaluation of tribological and biological properties of Ti6Al4V coated with Si3N4/ND nanoparticles for orthopedic applications: a comprehensive analysis

In this study, the biocompatibility and tribological properties of Ti6Al4V coated with silicon nitride (Si3N4)/nanodiamond using the electrophoretic deposition method were investigated. Suspensions of various aqueous and alcoholic solutions were prepared in the presence of CTAB and SDS dispersers. The most stable suspension system for the electrophoresis process was selected (aqueous media/ SDS disperser). Four different voltages (20, 30, 40 and 50 V) were applied to study the effect of voltage on the coating property. One could find that processing with 40 V obtained the best coating. The nano-composite coating was characterized using scanning electron microscopy equipped with energy dispersive spectroscopy, mapping analysis and x-ray diffraction after the coating process. The samples were then subjected to two nanoindentation and nano-scratching tests to evaluate their tribological properties. Biocompatibility was assessed in an ex vivo environment using two cell culture tests to evaluate survival and cellular adhesion. The results showed that the hardness and modulus elasticity of the coated sample increased from 85 to 124 GPa and 1.14-3.55 GPa, respectively, compared to the non-coated sample. Additionally, the MTT test results indicated that cellular survival and proliferation of MG63 cells increased from 86% for the non-coated sample to 92% for the Ti6Al4V/Si3N4/ND sample. These findings have implications for orthopedic implant applications.

Engineered Fibrous NiTi Scaffolds with Cultured Hepatocytes for Liver Regeneration in Rats

At present, the use of alternative systems to replenish the lost functions of hepatic metabolism and partial replacement of liver organ failure is relevant, due to an increase in the incidence of various liver disorders, insufficiency, and cost of organs for transplantation, as well as the high cost of using the artificial liver systems. The development of low-cost intracorporeal systems for maintaining hepatic metabolism using tissue engineering, as a bridge before liver transplantation or completely replacing liver function, deserves special attention. In vivo applications of intracorporeal fibrous nickel-titanium scaffolds (FNTSs) with cultured hepatocytes are described. Hepatocytes cultured in FNTSs are superior to their injections in terms of liver function, survival time, and recovery in a CCl₄-induced cirrhosis rats' model. 232 animals were divided into 5 groups: control, CCl₄-induced cirrhosis, CCl₄-induced cirrhosis followed by implantation of cell-free FNTSs (sham surgery), CCl₄-induced cirrhosis followed by infusion of hepatocytes (2 mL, 10⁷ cells/mL), and CCl₄-induced cirrhosis followed by FNTS implantation with hepatocytes. Restoration of hepatocyte function in the FNTS implantation with the hepatocytes group was accompanied by a significant decrease in the level of aspartate aminotransferase (AsAT) in blood serum compared to the cirrhosis group. A significant decrease in the level of AsAT was noted after 15 days in the infused hepatocytes group. However, on the 30th day, the AsAT level increased and was close to the cirrhosis group due to the short-term effect after the introduction of hepatocytes without a scaffold. The changes in alanine aminotransferase (AlAT), alkaline phosphatase (AlP), total and direct bilirubin, serum protein, triacylglycerol, lactate, albumin, and lipoproteins were similar to those in AsAT. The survival time of animals was significantly longer in the FNTS implantation with hepatocytes group. The obtained results showed the scaffolds' ability to support hepatocellular metabolism. The development of hepatocytes in FNTS was studied in vivo using 12 animals using scanning electron microscopy. Hepatocytes demonstrated good adhesion to the scaffold wireframe and survival in allogeneic conditions. Mature tissue, including cellular and fibrous, filled the scaffold space by 98% in 28 days. The study shows the extent to which an implantable "auxiliary liver" compensates for the lack of liver function without replacement in rats.

Functionalization of the Surface of Porous Nickel-Titanium Alloy with Macrocyclic Compounds

For the first time, we performed functionalization of the surface of porous titanium nickelide alloys with bambusuril[6]-based macrocyclic compounds by different methods in order to provide the basis for saturation with therapeutic agents to impart antibacterial activity and accelerate its osteogenesis. It has been shown for the first time that the vacuum modification method is preferable for bambusuril deposition, since it provides a uniform deposition of organic matter on both the outer and inner surfaces of the pores. The effect of bambusuril deposition methods on the continuity, structure, and cytocompatibility of the porous titanium nickelide surface was evaluated. In vitro tests proved high biocompatibility and low toxicity of porous TiNi treated with BU[6] under vacuum. The SEM study of the structure of the surface layer of TiNi modified with BU[6] under the vacuum method showed that BU[6] agglomerates are uniformly deposited on the inner and outer surfaces of TiNi pores, which will provide an even saturation of BU[6] cavities with various pharmaceuticals, including antibiotics and inhibitors.

RF Magnetron Sputtering of Substituted Hydroxyapatite for Deposition of Biocoatings

Functionalization of titanium (Ti)-based alloy implant surfaces by deposition of calcium phosphates (CaP) has been widely recognized. Substituted hydroxyapatites (HA) allow the coating properties to be tailored based on the use of different Ca substitutes. The formation of antibacterial CaP coatings with the incorporation of Zn or Cu by an RF magnetron sputtering is proposed. The influence of RF magnetron targets elemental composition and structure in the case of Zn-HA and Cu-HA, and the influence of substrate's grain size, the substrate's temperature during the deposition, and post-deposition heat treatment (HT) on the resulting coatings are represented. Sintering the targets at 1150 °C resulted in a noticeable structural change with an increase in cell volume and lattice parameters for substituted HA. The deposition rate of Cu-HA and Zn-HA was notably higher compared to stochiometric HA (10.5 and 10) nm/min vs. 9 ± 0.5 nm/min, respectively. At the substrate temperature below 100 °C, all deposited coatings were found to be amorphous with an atomic short-range order corresponding to the {300} plane of crystalline HA. All deposited coatings were found to be hyper-stochiometric with Ca/P ratios varying from 1.9 to 2.5. An increase in the substrate temperature to 200 °C resulted in the formation of equiaxed grain structure on both coarse-grained (CG) and nanostructured (NS) Ti. The use of NS Ti notably increased the scratch resistance of the deposited coatings from18 ± 1 N to 22 ± 2 N. Influence of HT in air or Ar atmosphere is also discussed. Thus, the deposition of Zn- or Cu-containing CaP is a complex process that could be fine-tuned using the obtained research results.

Porous amorphous nitinol synthesized by argon injection: a molecular dynamics study

Porous crystalline nitinol is widely applied in various fields of science and technology due to the unique combination of physical and mechanical properties as well as biocompatibility. Porous amorphous nitinol is characterized by improved mechanical properties compared to its crystalline analogues. Moreover, this material is more promising from the point of view of fundamental study and practical application. The production of porous amorphous nitinol is a difficult task requiring rapid cooling protocol and optimal conditions to form a stable porous structure. In the present work, based on the results of molecular dynamics simulations, we show that porous nitinol with the amorphous matrix can be obtained by injection of argon into a liquid melt followed by rapid cooling of the resulting mixture. We find that the porosity of the system increases exponentially with increasing fraction of injected argon. It has been established that the system should contain about∼18%-23% argon for obtain an open porous structure, while the system is destroyed by overheated inert gas when the argon fraction is more than∼23%. It is shown that the method of argon injection makes it possible to obtain a highly porous system with the porosity∼70% consisting the spongy porous structure similar to aerogels and metallic foams.

In Vitro Bio-Testing Comparative Analysis of NiTi Porous Alloys Modified by Heat Treatment

The present work is aimed at studying the surface cytocompatibility of porous NiTi obtained by self-propagating high temperature synthesis (SHS), and then annealed in air at 500–1000 °C. Using cytotoxicity tests in vitro, it was found that the cells had attached to the oxidized surface in the amount sufficient for their growth and proliferation on the substrate. The surfaces of the annealed samples and the control sample were studied by XRD, SEM and optical microscopy. It was found that there is a correlation between cell hemolysis and nickel-containing phases on the surface. Thus, annealing at 500–700 °C worsens cytocompatibility compared to the control sample, but annealing at 800–1000 °C improves cytocompatibility.

Repair of huge thoracic defect combined with hernia after multimodality treatment of breast cancer

A case of the successful reconstruction of an extensive chest wall defect combined with a ventral hernia in a patient after multimodality treatment of breast cancer complicated by sternal and costal osteomyelitis is presented. To recover the chest mechanics, with emphasis on the supporting function, and to repair the hernial defect, customized reinforced “sandwich” TiNi rib endografts and knitted TiNi surgical mesh were used. A five-year follow-up indicated no recurrence of osteomyelitis or ventral hernia, and no failure/migration of the implants or instability of the thorax. Excellent clinical and functional outcomes were achieved pursuant to the Enneking score.

Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors

In this study, we assessed the outcomes after surgical treatment of thoracic post-excision defects in 15 patients, using TiNi knitted surgical meshes and customized artificial TiNi-based ribs. Methods: Eight patients were diagnosed with advanced non-small cell lung cancer (NSCLC) invading the chest wall, of which five patients were T₃N₀M₀, two were T₃N₁M₀, and one was T₃N₂M₀. Squamous cell carcinoma was identified in three of these patients and adenocarcinoma in five. In two cases, chest wall resection and repair were performed for metastases of kidney cancer after radical nephrectomy. Three-dimensional CT reconstruction and X-ray scans were used to plan the surgery and customize the reinforcing TiNi-based implants. All patients received TiNi-based devices and were prospectively followed for a few years. Results: So far, there have been no lethal outcomes, and all implanted devices were consistent in follow-up examinations. Immediate complications were noted in three cases (ejection of air through the pleural drains, paroxysm of atrial fibrillation, and pleuritis), which were conservatively managed. In the long term, no complications, aftereffects, or instability of the thoracic cage were observed. Conclusion: TiNi-based devices used for extensive thoracic lesion repair in this context are promising and reliable biomaterials that demonstrate good functional, clinical, and cosmetic outcomes.

Study on tensile, bending, fatigue, and in vivo behavior of porous SHS-TiNi alloy used as a bone substitute

Intermetallic porous SHS-TiNi alloys exhibit tangled and specific stress-strain characteristics. This article aims to evaluate the findings emanating from experiments using standard and proprietary instruments. Fatigue testing under repeated complex loading was used to measure the total number of load cycles before failure of the SHS-TiNi samples occurred. Of the tested samples, seventy percent passed through 10⁶ cycles without failure due to the reversible martensite transformation in the TiNi phase, one of the prevailing constituents of a multiphase matrix. The fractured surfaces were analyzed using scanning electron microscopy and confocal laser scanning instruments. Microscopy studies showed that the entire surface of the sample is concealed by miscellaneous strata that result from the SHS processand effectively protect the porous alloy in a corrosive environment. Numerous non-metallic inclusions, which are also attributed to the SHS reaction, do not have a significant impact on the deformation behavior and fatigue performance. In this context, the successful in vivo functioning of porous grafts assessed in a canine rib-plasty model allows the bone substitute to be congruentially deformed in the body without rejection or degradation; it thus has a long operational life, often greater than 17 ×10⁶ (22 × 60 × 24 × 540) cycles. It acknowledges the potential benefits of SHS-TiNi as a superior osteoplastic material and its high resistance to corrosion fatigue.

Synthesis of core-shell Ti@Ni-P spherical powder by Ni electroless plating

Ni-P plated Ti powders with core-shell structure were prepared by Ni electroless plating. The micromorphology and growth mechanism of core-shell Ti@Ni-P powders were analyzed by field emission scanning electron microscopy (FESEM) with an energy dispersive spectrometer (EDS). The results show the overall uniformity of Ni-P coated Ti powders is improved by two pretreatments, namely NaOH preprocessing and alkaline electroless preplating, compared with a single alkaline electroless pretreatment. The surface morphology of the Ni-P plated powders is a typical spaced spherical nodular structure. Meanwhile, the growth mechanism of the Ni-P coated Ti powder is illuminated in detail.

Development of tantalum with highly hydrophilic surface and antimicrobial properties obtained by micro-arc oxidation process

Tantalum (Ta) and its application in biomaterials has been attracting more and more attention recently. It can be considered as a material for hard tissue implants. This study focuses on antimicrobial and surface characterization of micro-arc oxidized (MAO) nanocrystalline Ta compared with its microcrystalline equivalent. For the purposes of the investigation, x-ray diffractometry (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), wetting analysis, optical profilometry, corrosion resistance measurement, and antimicrobial tests were performed. Nanocrystalline Ta was fabricated using high-energy ball milling (HEBM) and pulse plasma sintering (PPS). The MAO process done at 250 V results in the formation of a porous oxide surface. An XRD analysis confirmed the presence of a Ta₂ O₅ oxide layer. Based on the SEM pictures, the obtained oxide layer was approximately 3-4 μm thick for nanocrystalline Ta substrate. For microcrystalline Ta, the oxide layer was thinner, in the range of 0.3-0.6 μm. The analysis of polarization curves showed a significant improvement of corrosion resistance for MAO nanocrystalline Ta (2.62 × 10^-8 A/cm² ) versus not oxidized nanocrystalline Ta (1.20 × 10^-5 A/cm² ). The surface roughness of MAO nanocrystalline Ta proved to be several times higher than that of unoxidized Ta. Wetting analysis showed that the oxide layer on the nanocrystalline substrate is hydrophilic. This research provides detailed information about MAO microcrystalline and MAO nanocrystalline Ta antimicrobial activity against Staphylococcus aureus and Pseudomonas aeruginosa. A significant decrease of S. aureus for MAO nanocrystalline Ta (control 10,435 ± 981 vs. sample 3,453 ± 130) was noticed. No significant difference was noticed for MAO microcrystalline and nanocrystalline Ta tested for P. aeruginosa.