Construction of Local Drug Delivery System on Titanium-Based Implants to Improve Osseointegration

Biomimetic structural design in 3D-printed scaffolds for bone tissue engineering

The rising prevalence of bone diseases in an aging population underscores the urgent need for innovative and clinically translatable solutions in bone tissue engineering. While significant progress has been made in refining the chemical properties of biomaterials, the structural design of scaffolds-a critical determinant of repair success-remains comparatively underexplored. Structural parameters such as porosity, pore size, and interconnectivity are not only essential for achieving mechanical stability but also pivotal in regulating biological processes, including vascularization, osteogenesis, and immune modulation. This review systematically categorizes scaffold architectures documented in the literature and highlights how these design parameters can be optimized to enhance bone regeneration. Advanced fabrication technologies, particularly 3D printing, are emphasized for their transformative potential in creating precise, biomimetic scaffolds that align with the complex functional demands of native bone. Furthermore, this work synthesizes diverse findings to provide a comprehensive framework for designing next-generation scaffolds. By bridging the gap between structural innovation and clinical application, this review delivers actionable strategies and a strategic roadmap for advancing the field toward improved clinical outcomes and transformative breakthroughs in regenerative medicine.

Magnesium Infusion on Dental Implants and Its Impact on Osseointegration and Biofilm Development: A Review

Dental implants have gained global popularity as a treatment option for tooth loss. The success of dental implants depends on their optimal integration into the tissues of the alveolar bone and the periodontium. However, several factors can hinder the proper osseointegration of implants, with the growth of biofilm on the implant surface and subsequent peri-implant infections being significant concerns. To overcome this challenge, researchers have explored the incorporation of antimicrobial agents onto metallic implant surfaces to mitigate biofilm growth. Ideally these agents should promote osteogenesis while exhibiting antibacterial effects. Magnesium (Mg) has emerged as a promising dual-function implant coating due to its osteogenic and antibacterial properties. Despite several studies, the precise mechanisms behind osteoinductive and antimicrobial effect of Mg is unclear, as yet. This review aims to collate and discuss the utility of Mg as a dental implant coating, its impact on the osteogenic process, potential in mitigating microbial growth, and prospects for the future. A comprehensive literature search was conducted across several databases and the findings reveal the promise of Mg as a dual-function dental implant coating material, both as a standalone agent and in combination with other materials. The antibacterial effect of Mg is likely to be due to its (1) toxicity particularly at high concentrations, (2) the production or reactive oxygen species, and (3) pH modulation, while the osteoinductive effect is due to a complex series of cellular and biochemical pathways. Despite its potential both as a standalone and composite coating, challenges such as degradation rate, leaching, and long-term stability must be addressed. Further research is needed to understand the utility of Mg as an implant coating material, particularly in relation to its antibacterial activity, osseointegration, and longevity in the oral milieu.

A dual thermo/pH-sensitive hydrogel as 5-Fluorouracil carrier for breast cancer treatment

Intelligent hydrogels are promising in constructing scaffolds for the controlled delivery of drugs. Here, a dual thermo- and pH-responsive hydrogel called PCG [poly ( N -isopropyl acrylamide-co-itaconic acid)/chitosan/glycerophosphate (PNI/CS/GP)] was established as the carrier of 5-fluorouracil (5-FU) for triple-negative breast cancer (TNBC) treatment. The PCG hydrogel was fabricated by blending synthesized [poly ( N -isopropyl acrylamide-co-itaconic acid), pNIAAm-co-IA, PNI] with CS in the presence of GP as a crosslinking agent. The interaction between PCG hydrogel compositions was characterized by Fourier transforms infrared, NMR spectroscopy, and scanning electron microscopy. The PCG hydrogel presented an interconnected and porous structure with similar pore size, rapid swelling/deswelling rate in response to both temperature and pH change, and biocompatibility, upon which it was proposed as a great drug carrier. 5-FU had a dual thermo- and pH-responsive controlled release behavior from the PCG hydrogel and displayed an accelerated release rate in an acidic pH environment than in a neutral pH condition. The application of 5-FU-loaded PCG hydrogel exhibited a more promoted anticancer activity than 5-FU against the growth of TNBC cells both in vitro and in vivo . The outcomes suggested that the PCG hydrogel could be an excellent platform for local drug-delivery systems in the clinical therapy of TNBC.

Design and evaluation of a multi-responsive dual-modality bone-targeted drug delivery vehicle for the treatment of osteosarcoma

The combination of chemotherapy and photothermal therapy not only improves the therapeutic effect but also limits the side effects of drugs. Herein, a multi-responsive dual-modality bone-targeted drug delivery vehicle for the treatment of osteosarcoma was designed by utilizing alendronate sodium as a bone-targeting ligand for the targeted delivery of doxorubicin (DOX) loaded polydopamine nanoparticles (PDA NPs) coated with γ-polyglutamic acid (APC@PDA/DOX NPs). The average size of spherical NPs was 140.0 nm with a zeta potential of -25.63 mV. The drug loading and encapsulation efficiency were 11.63 % and 96.44 %, respectively. The constructed NPs were responsive to acidic pH, redox conditions, and near-infrared light as the drug release rate of the system reached 70 %. Cell experiments showed that APC@PDA/DOX NPs significantly enhanced cytotoxicity in mouse K7M2 osteosarcoma cells due to PDA-induced hyperthermia and DOX-induced cytotoxicity. Compared with the free DOX solution, the area under the curve of APC@PDA/DOX NPs increased by 8.52 times, iterating the significantly prolonged circulation time of NPs in vivo that manifested in higher bioavailability. The biodistribution study showed that APC@PDA/DOX NPs enacted excellent bone targeting and tumor tissue localization. In general, APC@PDA/DOX NPs may offer a feasible and effective strategy for osteosarcoma-targeted therapy.

Silk fibroin-based hydrogels for cartilage organoids in osteoarthritis treatment

Osteoarthritis (OA) is a common joint disease characterized by cartilage degeneration. It can cause severe pain, deformity and even amputation risk. However, existing clinical treatment methods for cartilage repair present certain deficiencies. Meanwhile, the repair effect of cartilage tissue engineering is also unsatisfactory. Cartilage organoids are multicellular aggregates with cartilage-like three-dimensional structure and function. On the one hand, cartilage organoids can be used to explore the pathogenesis of OA by constructing disease models. On the other hand, it can be used as filler for rapid cartilage repair. Extracellular matrix (ECM)-like three-dimensional environment is the key to construct cartilage organoids. Silk fibroin (SF)-based hydrogels not only have ECM-like structure, but also have unique mechanical properties and remarkable biocompatibility. Therefore, SF-based hydrogels are considered as ideal biomaterials for constructing cartilage organoids. In this review, we reviewed the studies of cartilage organoids and SF-based hydrogels. The advantages of SF-based hydrogels in constructing cartilage organoids and the iterative optimization of cartilage organoids through designing hydrogels by using artificial intelligence (AI) calculation are also discussed. This review aims to provide a theoretical basis for the treatment of OA using SF-based biomaterials and cartilage organoids.

Trends and Advances in Antimicrobial Surface Modification for Orthopedic Implants (2014-2024)

The failure of orthopedic implants can significantly impact patients physiologically, psychologically, and economically. A bibliometric study of the field of surface modification for antimicrobial purposes in orthopedic implants provides insights into its developmental trajectory and offers valuable predictions for future advancements, thus playing a pivotal role in guiding research in this domain. Relevant publications on surface modification for antimicrobial purposes in orthopedic implants published between 2014 and 2024 were selected from the Web of Science (Core Collection) dataset and analyzed using VOSviewer and Citespace. The analysis encompassed 725 articles. Over the past decade, there has been a steady increase in the number of publications related to surface modification for antimicrobial purposes in orthopedic implants, with China emerging as the primary contributor. Novel antimicrobial materials development, osteogenesis, and angiogenesis have become focal areas of research interest in this domain. Surface modification for antimicrobial purposes in orthopedic implants garners increasing attention. Research in this field is anticipated to expand, with future focus likely to revolve around novel material applications, repair outcomes, and underlying mechanisms.

Engineering of Bioresorbable Polymers for Tissue Engineering and Drug Delivery Applications

Herein, the recent advances in the development of resorbable polymeric-based biomaterials, their geometrical forms, resorption mechanisms, and their capabilities in various biomedical applications are critically reviewed. A comprehensive discussion of the engineering approaches for the fabrication of polymeric resorbable scaffolds for tissue engineering, drug delivery, surgical, cardiological, aesthetical, dental and cardiovascular applications, are also explained. Furthermore, to understand the internal structures of resorbable scaffolds, representative studies of their evaluation by medical imaging techniques, e.g., cardiac computer tomography, are succinctly highlighted. This approach provides crucial clinical insights which help to improve the materials' suitable and viable characteristics for them to meet the highly restrictive medical requirements. Finally, the aspects of the legal regulations and the associated challenges in translating research into desirable clinical and marketable materials of polymeric-based formulations, are presented.

Controlled Delivery of Ketoconazole an Antifungal Agent from Uncemented Titanium Using a Layer-by-Layer Technique

This study aims to evaluate the effectiveness of a layer-by-layer (LbL) technique for delivering ketoconazole to prevent fungi prosthetic joint infection (PJI) LbL assembly is a versatile technique for functionalizing biomaterial surfaces and engineering objects such as capsules and films through electrostatic attraction. This method involves the cyclic deposition of various materials onto substrates, allowing for the controlled growth of thin films. One of the key advantages of LbL assembly is its ability to create stable, nanoscale films with organized structures and customizable compositions on a range of substrates, which only need to carry electrostatic charges. Furthermore, the scalability and ease of fabrication of LbL coatings are significant advantages. For example, the deposition of drugs using LbL allows for a prolonged release of these drugs. In the in vivo study, ketoconazole release continued for 60 days, while in vitro release persisted for over 20 days. Moreover, 14 days after surgery, the study group showed a quicker reduction in inflammation and experienced fewer complications The evidence indicates that the LbL coating method positively affects cell viability, suggesting the potential for enhanced patient outcomes and significantly improving prophylactic strategies against fungal PJIs in joint replacement surgeries by preventing and treating fungal infections in prosthetic joints. Future research should explore the use of various antifungal agents to evaluate this approach further.

Role of immune dysregulation in peri-implantitis

Peri-implantitis, a complex condition that can lead to dental implant failure, is characterized by inflammatory destruction resulting from immune dysregulation. Oral microbial dysbiosis and foreign body stimulation are the main factors contributing to such dysregulation, impairing immune cell function and triggering an inflammatory response. Immune dysregulation plays a critical role in the pathophysiology of peri-implantitis, impacting the balance of T cell subsets, the production of inflammatory factors, and immune-related molecular signaling pathways. Understanding the relationship between immune dysregulation and peri-implantitis is crucial for developing targeted strategies for clinical diagnosis and individualized treatment planning. This review explores the similarities and differences in the immune microenvironment of oral bacterial infections and foreign body rejection, analyzes the relevant molecular signaling pathways, and identifies new key targets for developing innovative immunotherapeutic drugs and effective and personalized treatment modalities for peri-implantitis. Additionally, it addresses the challenges and potential directions for translating immunotherapy into clinical practice for peri-implantitis, offering insights that bridge the gaps in current literature and pave the way for future research.

Piezoelectric biomaterials with embedded ionic liquids for improved orthopedic interfaces through osseointegration and antibacterial dual characteristics

Orthopedic implant failures, primarily attributed to aseptic loosening and implant site infections, pose significant challenges to patient recovery and lead to revision surgeries. Combining piezoelectric materials with ionic liquids as interfaces for orthopedic implants presents an innovative approach to addressing both issues simultaneously. In this study, films of poly(vinylidene fluoride-trifluoroethylene) (P(VDF-TrFE)) incorporated with 1-ethyl-3-methylimidazolium hydrogen sulfate ([Emim][HSO4]) ionic liquid were developed. These films exhibited strong antibacterial properties, effectively reducing biofilm formation, thereby addressing implant-related infections. Furthermore, stem cell-based differentiation assays exposed the potential of the composite materials to induce osteogenesis. Interestingly, our findings also revealed the upregulation of calcium channel expression as a result of electromechanical stimulation, pointing to a mechanistic basis for the observed biological effects. This work highlights the potential of piezoelectric materials with ionic liquids to improve the longevity and biocompatibility of orthopedic implants. Offering dual-functionality for infection prevention and bone integration, these advancements hold significant potential for advancing orthopedic implant technologies and improving patient outcomes.

A pH-Responsive Ti-Based Local Drug Delivery System for Osteosarcoma Therapy

Osteosarcoma is one of the major bone cancers, especially for youngsters. The current treatment usually requires systemic chemotherapy and the removal of bone tumors. Titanium (Ti)-based implants can be modified as local drug delivery (LDD) systems for controllable and localized chemotherapeutic drug release. In this work, a pH-responsive Ti-based LDD prototype was designed by introducing polydopamine (PDA) to release doxorubicin (DOX) around osteosarcoma cells with low pH. Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and a contact angle meter were applied for surface characterization. Both direct and indirect cell culture modes were performed for biocompatibility and biofunction assessments. The results indicate that the Ti-based LDD prototype exhibits significant pH-dependent DOX release. The cumulative release can reach up to approximately 40% at pH = 6.0 after 72 h, but only around 20% at pH = 7.4. The Ti-based LDD implant shows good biocompatibility with approximately 93% viability of MC3T3 cells after direct culture in vitro for 24 h. Both direct and indirect culture modes verify the good anti-osteosarcoma function of the LDD implant, which should be attributed to the pH-responsive release of DOX.

The effect of titanium surface treatment by application of constant potential or current on the viability of pre-osteoblast cells: an in-vitro study

Objectives

The aim of this study was to investigate the impact of electrochemical treatment of a titanium surface employing constant current and potential on the viability of the tissue cells attached to the surface and determining the safety limits for this type of treatment.

Methods

Pre-osteoblast cells (pOB) were cultured and seeded onto titanium discs. The cell-seeded discs were then exposed to a range of contant direct electrical potentials (-6V-6V) or contant direct electrical currents (-12.5 mA, -25 mA, or -50 mA) using a three-electrode system connected to a potentiostat. Cell viability was assessed using live/dead assay and fluorescence microscopy.

Results

Exposure of cells to high negative potentials caused cell detachment, while exposure to positive ones led to cell death on the cpTi surfaces. However, cellular viability was preserved when the electrical potentials were kept between -3 and +3 V. Cells retained 80% viability when subjected to -12.5 mA currents with an initial pOB cell count of 5 × 104. However, when the initial cell count was elevated to 1 × 105, the cells demonstrated the ability to withstand an even greater current (-25 mA) while preserving their vitality at the same level.

Conclusion

Treatment of a titanium dental implant surface employing constant potential or current can harm cells surrounding dental implants. However, this damage can be minimized by keeping the potential within a safety limit.

Composite Mineralized Collagen/Polycaprolactone Scaffold-Loaded Microsphere System with Dual Osteogenesis and Antibacterial Functions

Biomaterials play an important role in treating bone defects. The functional characteristics of scaffolds, such as their structure, mechanical strength, and antibacterial and osteogenesis activities, effectively promote bone regeneration. In this study, mineralized collagen and polycaprolactone were used to prepare loaded porous scaffolds with bilayer-structured microspheres with dual antibacterial and osteogenesis functions. The different drug release mechanisms of PLGA and chitosan in PLGA/CS microspheres caused differences in the drug release models in terms of the duration and rate of Pac-525 and BMP-2 release. The prepared PLGA(BMP-2)/CS(Pac-525)@MC/PCL scaffolds were analyzed in terms of physical characteristics, bioactivity, and antibacterial properties. The scaffolds with a dimensional porous structure showed similar porosity and pore diameter to cancellous bone. The release curve of the microspheres and scaffolds with high encapsulation rates displayed the two-stage release of Pac-525 and BMP-2 over 30 days. It was found that the scaffolds could inhibit S. aureus and E. coli and then promote ALP activity. The PLGA(BMP-2)/CS(Pac-525)@MC/PCL scaffold could be used as a dual delivery system to promote bone regeneration.

Anodic Production and Characterization of Biomimetic Oxide Layers on Grade 4 Titanium for Medical Applications

Biomaterials are the basis for the development of medicine because they allow safe contact with a living organism. The aim of this work was to produce innovative oxide layers with a microporous structure on the surface of commercially pure titanium Grade 4 (CpTi G4) and to characterize their properties as drug carriers. The anodization of the CpTi G4 subjected to mechanical grinding and electrochemical polishing was carried out in a solution of 1M ethylene glycol with the addition of 40 g of ammonium fluoride at a voltage of 20 V for 2, 18, 24, and 48 h at room temperature. It was found that the longer the anodization time, the greater the number of pores formed on the CpTi G4 surface as revealed using the FE-SEM method, and the greater the surface roughness determined in profilometric tests. As the anodizing time increases, the amount of the drug in the form of gentamicin sulfate incorporated into the resulting pores decreases. The most favorable drug release kinetics profile determined via UV-VIS absorption spectroscopy was found for the CpTi G4 anodized for 2 h.

Evaluation of bioactivity and antibacterial properties of Ti6Al4V-based green biocomposite implant encompassing TiO2 nanotube arrays and garlic extract

This study involved the incorporation of an antibacterial garlic extract into titanium oxide nanotubes (TNTs) formed via the anodization of Ti6Al4V implants. The garlic extract, obtained through low-temperature extraction aided by ultrasound waves, was loaded into the nanotubes. The presence of the nanotubes was confirmed through X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDS), and scanning electron microscopy (SEM). Fourier-transform infrared spectroscopy (FT-IR) and gas chromatography-mass spectrometry (GC-MS) were used to investigate the presence of bioactive compounds, particularly sulfur compounds responsible for garlic's antibacterial effects. The impact of loading two concentrations (0.1 and 0.2 g per milliliter) of garlic extract on Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria was examined. Results indicated a decrease in the growth range of S. aureus from 109 to 106 (CFU/ml) and E. coli from 1011 to 109 (CFU/ml) upon treatment. Additionally, cell adhesion and viability tests conducted on MG63 cells revealed an 8% increase in cell viability with the 0.1 g per milliliter concentration and a 35% decrease with the 0.2 g per milliliter concentration of garlic extract after 72 h of incubation (They have been evaluated by Microculture tetrazolium (MTT) assay). GC-MS analysis identified the presence of diethyl phthalate compounds in the garlic extract, suggesting a potential correlation with cellular toxicity observed in the sample with the higher concentration (0.2 g per milliliter) of garlic extract. Overall, the TNTs loaded with 0.1 g per milliliter of garlic extract simultaneously demonstrated antibacterial activity, cell viability, adhesion, and growth enhancement.

Harnessing exosomes for targeted therapy: strategy and application

Exosomes, nanoscopic extracellular vesicles produced by cells, are pivotal in mediating intracellular communication by transporting nucleic acids, proteins, lipids, and other bioactive molecules, thereby influencing physiological and pathological states. Their endogenous origin and inherent diversity confer distinct advantages over synthetic vehicles like liposomes and nanoparticles in diagnostic and therapeutic applications. Despite their potential, the clinical utility of exosomes is hampered by challenges such as limited storage stability, yield, purity, and targeting efficiency. This review focuses on exosomes as targeted therapeutic agents, examining their biogenesis, classification, isolation, and characterisation, while also addressing the current limitations in yield, purity, and targeting. We delve into the literature to propose optimisation strategies that can enhance their therapeutic efficacy and accelerate the translation of exosome-based therapies into clinical practice.

Active osseointegration in an ex vivo porcine bone model

Achieving osseointegration is a fundamental requirement for many orthopaedic, oral, and craniofacial implants. Osseointegration typically takes three to 6 months, during which time implants are at risk of loosening. The aim of this study was to investigate whether osseointegration could be actively enhanced by delivering controllable electromechanical stimuli to the periprosthetic bone. First, the osteoconductivity of the implant surface was confirmed using an in vitro culture with murine preosteoblasts. The effects of active treatment on osseointegration were then investigated in a 21-day ex vivo model with freshly harvested cancellous bone cylinders (n = 24; Ø10 mm × 5 mm) from distal porcine femora, with comparisons to specimens treated by a distant ultrasound source and static controls. Cell viability, proliferation and distribution was evident throughout culture. Superior ongrowth of tissue onto the titanium discs during culture was observed in the actively stimulated specimens, with evidence of ten-times increased mineralisation after 7 and 14 days of culture (p < 0.05) and 2.5 times increased expression of osteopontin (p < 0.005), an adhesive protein, at 21 days. Moreover, histological analyses revealed increased bone remodelling at the implant-bone interface in the actively stimulated specimens compared to the passive controls. Active osseointegration is an exciting new approach for accelerating bone growth into and around implants.

Biomechanical evaluation of a new intramedullary nail compared with proximal femoral nail antirotation and InterTAN for the management of femoral intertrochanteric fractures

Purpose: Surgical treatment is the main treatment method for femoral intertrochanteric fractures (FIFs), however, there are lots of implant-related complications after surgery. Our team designed a new intramedullary nail (NIN) to manage such fractures. The purpose of this study was to introduce this new implant and compare it with proximal femoral nail antirotation (PFNA) and InterTAN for treating FIFs. Methods: An AO/OTA 31-A1.3 FIF model was built and three fixation models were created via finite element method, comprising PFNA, InterTAN, and the NIN. Vertical, anteroposterior (A-P) bending, and torsional loads were simulated and applied to the three fixation models. Displacement and stress distribution were monitored. In order to compare PFNA and the NIN deeply, finite element testing was repeated for five times in vertical load case. Results: The finite element analysis (FEA) data indicated that the NIN possessed the most outstanding mechanical properties among the three fixation models. The NIN model had lower maximal stress at implants compared to PFNA and InterTAN models under three load conditions. The trend of maximal stress at bones was similar to that of maximal stress at implants. Besides, the NIN model showed smaller maximal displacement compared with PFNA and InterTAN models under vertical, A-P bending, and torsional load cases. The trend for maximal displacement of fracture surface (MDFS) was almost identical with that of maximal displacement. In addition, there was significant difference between the PFNA and NIN groups in vertical load case (p < 0.05). Conclusion: Compared with PFNA and InterTAN, the NIN displayed the best mechanical properties for managing FIFs, including the lowest von Mises stress at implants and bones, and the smallest maximal displacement and MDFS under vertical, A-P bending, and torsional load cases. Therefore, this study might provide a new choice for patients with FIFs.

A personalized biomimetic dual-drug delivery system via controlled release of PTH1-34 and simvastatin for in situ osteoporotic bone regeneration

Patients with osteoporosis often encounter clinical challenges of poor healing after bone transplantation due to their diminished bone formation capacity. The use of bone substitutes containing bioactive factors that increase the number and differentiation of osteoblasts is a strategy to improve poor bone healing. In this study, we developed an in situ dual-drug delivery system containing the bone growth factors PTH1-34 and simvastatin to increase the number and differentiation of osteoblasts for osteoporotic bone regeneration. Our system exhibited ideal physical properties similar to those of natural bone and allowed for customizations in shape through a 3D-printed scaffold and GelMA. The composite system regulated the sustained release of PTH1-34 and simvastatin, and exhibited good biocompatibility. Cell studies revealed that the composite system reduced osteoblast death, and promoted expression of osteoblast differentiation markers. Additionally, by radiographic analysis and histological observation, the dual-drug composite system demonstrated promising bone regeneration outcomes in an osteoporotic skull defect model. In summary, this composite delivery system, comprising dual-drug administration, holds considerable potential for bone repair and may serve as a safe and efficacious therapeutic approach for addressing bone defects in patients with osteoporosis.

The application of custom 3D-printed prostheses with ultra-short stems in the reconstruction of bone defects: a single center analysis

Objective: Considering the advantages and widespread presence of 3D-printing technology in surgical treatments, 3D-printed porous structure prostheses have been applied in a wide range of the treatments of bone tumor. In this research, we aimed to assess the application values of the 3D-printed custom prostheses with ultra-short stems for restoring bone defects and maintaining arthrosis in malignant bone tumors of lower extremities in children. Methods: Seven cases of pediatric patients were included in this study. In all cases, the prostheses were porous titanium alloy with ultra-short stems. MSTS 93 (Musculoskeletal Tumor Society) scores were recorded for the functional recovery of the limbs. VAS (Visual analogue scale) scores were utilized to assess the degree of painfulness for the patients. X-ray and MRI (magnetic resonance imaging) were applied to evaluate the bone integration, prostheses aseptic loosening, prostheses fracture, wound healing, and tumor recurrence during follow-up. Results: During follow-up, none of the patients developed any postoperative complications, including prostheses aseptic loosening, prostheses fracture, or tumor recurrence. Radiological examinations during the follow-up showed that prostheses implanted into the residual bone were stably fitted and bone defects were effectively reconstructed. The MSTS 93 scores were 24.9 ± 2.9 (20-28). VAS scores were decreased to 5.8 ± 1.2 (4.0-7.0). No statistically significant differences in leg length discrepancy were observed at the time of the last follow-up. Conclusion: 3D-printing technology can be effectively applied throughout the entire surgical treatment procedures of malignant bone tumors, offering stable foundations for the initial stability of 3D-printed prostheses with ultra-short stems through preoperative design, intraoperative precision operation, and personalized prosthesis matching. With meticulous postoperative follow-up, close monitoring of postoperative complications was ensured. These favorable outcomes indicate that the utilization of 3D-printed custom prostheses with ultra-short stems is a viable alternative for reconstructing bone defects. However, further investigation is warranted to determine the long-term effectiveness of the 3D-printing technique.

Single-cell RNA sequencing in osteoarthritis

Osteoarthritis is a progressive and heterogeneous joint disease with complex pathogenesis. The various phenotypes associated with each patient suggest that better subgrouping of tissues associated with genotypes in different phases of osteoarthritis may provide new insights into the onset and progression of the disease. Recently, single-cell RNA sequencing was used to describe osteoarthritis pathogenesis on a high-resolution view surpassing traditional technologies. Herein, this review summarizes the microstructural changes in articular cartilage, meniscus, synovium and subchondral bone that are mainly due to crosstalk amongst chondrocytes, osteoblasts, fibroblasts and endothelial cells during osteoarthritis progression. Next, we focus on the promising targets discovered by single-cell RNA sequencing and its potential applications in target drugs and tissue engineering. Additionally, the limited amount of research on the evaluation of bone-related biomaterials is reviewed. Based on the pre-clinical findings, we elaborate on the potential clinical values of single-cell RNA sequencing for the therapeutic strategies of osteoarthritis. Finally, a perspective on the future development of patient-centred medicine for osteoarthritis therapy combining other single-cell multi-omics technologies is discussed. This review will provide new insights into osteoarthritis pathogenesis on a cellular level and the field of applications of single-cell RNA sequencing in personalized therapeutics for osteoarthritis in the future.

Biomechanical evaluation of three implants for treating unstable femoral intertrochanteric fractures: finite element analysis in axial, bending and torsion loads

Purpose: How to effectively enhance the mechanical stability of intramedullary implants for unstable femoral intertrochanteric fractures (UFIFs) is challenging. The authors developed a new implant for managing such patients. Our aim was to enhance the whole mechanical stability of internal devices through increasing antirotation and medial support. We expected to reduce stress concentration in implants. Each implant was compared to proximal femoral nail antirotation (PFNA) via finite element method. Methods: Adult AO/OTA 31-A2.3 fracture models were constructed, and then the new intramedullary system (NIS), PFNA, InterTan nail models were assembled. We simulated three different kinds of load cases, including axial, bending, and torsion loads. For further comparison of PFNA and the NIS, finite element analysis (FEA) was repeated for five times under axial loads of 2100 N. Two types of displacement and stress distribution were assessed. Results: Findings showed that the NIS had the best mechanical stability under axial, bending, and torsion load conditions compared to PFNA and InterTan. It could be seen that the NIS displayed the best properties with respect to maximal displacement while PFNA showed the worst properties for the same parameter in axial loads of 2100 N. In terms of maximal stress, also the NIS exhibited the best properties while PFNA showed the worst properties in axial loads of 2100 N. For bending and torsion load cases, it displayed a similar trend with that of axial loads. Moreover, under axial loads of 2100 N, the difference between the PFNA group and the NIS group was statistically significant (p < 0.05). Conclusion: The new intramedullary system exhibited more uniform stress distribution and better biomechanical properties compared to the PFNA and InterTan. This might provide a new and efficacious device for managing unstable femoral intertrochanteric fractures.

BMP-2 releasing mineral-coated microparticle-integrated hydrogel system for enhanced bone regeneration

Introduction: Large bone defects (LBD) caused by trauma, infection, and tumor resection remain a significant clinical challenge. Although therapeutic agents such as bone morphogenetic protein-2 (BMP-2), have shown substantial potency in various clinical scenarios, their uncontrollable release kinetics has raised considerable concern from the clinical viewpoint. Mineral-coated microparticle (MCM) has shown its excellent biologics loading and delivery potential due to its superior protein-binding capacity and controllable degradation behaviors; thus, it is conceivable that MCM can be combined with hydrogel systems to enable optimized BMP-2 delivery for LBD healing. Methods: Herein, BMP-2 was immobilized on MCMs via electrostatic interaction between its side chains with the coating surface. Subsequently, MCM@BMP-2 is anchored into a hydrogel by the crosslinking of chitosan (CS) and polyethylene glycol (PEG). Results and Discussion: This microparticle-hydrogel system exhibits good biocompatibility, excellent vascularization, and the sustained release of BMP-2 in the bone defect. Furthermore, it is observed that this microsphere-hydrogel system accelerates bone formation by promoting the expression of osteogenesis-related proteins such as RUNX2, osteopontin, and osteocalcin in bone marrow mesenchymal stem cells (BMSCs). Thus, this newly developed multifunctional microparticle-hydrogel system with vascularization, osteogenesis, and sustained release of growth factor demonstrates an effective therapeutic strategy toward LBD.

Discovering an unknown territory using atom probe tomography: Elemental exchange at the bioceramic scaffold/bone tissue interface

Here we report the first atom probe study to reveal the atomic-scale composition of in vivo bone formed in a bioceramic scaffold (strontium-hardystonite-gahnite) after 12-month implantation in a large bone defect in sheep tibia. The composition of the newly formed bone tissue differs to that of mature cortical bone tissue, and elements from the degrading bioceramic implant, particularly aluminium (Al), are present in both the newly formed bone and in the original mature cortical bone tissue at the perimeter of the bioceramic implant. Atom probe tomography confirmed that the trace elements are released from the bioceramic and are actively transported into the newly formed bone. NanoSIMS mapping, as a complementary technique, confirmed the distribution of the released ions from the bioceramic into the newly formed bone tissue within the scaffold. This study demonstrated the combined benefits of atom probe and nanoSIMS in assessing nanoscopic chemical composition changes at precise locations within the tissue/biomaterial interface. Such information can assist in understanding the interaction of scaffolds with surrounding tissue, hence permitting further iterative improvements to the design and performance of biomedical implants, and ultimately reducing the risk of complications or failure while increasing the rate of tissue formation. STATEMENT OF SIGNIFICANCE: The repair of critical-sized load-bearing bone defects is a challenge, and precisely engineered bioceramic scaffold implants is an emerging potential treatment strategy. However, we still do not understand the effect of the bioceramic scaffold implants on the composition of newly formed bone in vivo and surrounding existing mature bone. This article reports an innovative route to solve this problem, the combined power of atom probe tomography and nanoSIMS is used to spatially define elemental distributions across bioceramic implant sites. We determine the nanoscopic chemical composition changes at the Sr-HT Gahnite bioceramic/bone tissue interface, and importantly, provide the first report of in vivo bone tissue chemical composition formed in a bioceramic scaffold.

Exogenous Protein Delivery of Ionic Liquid-Mediated HMGB1 Coating on Titanium Implants

Strategies for modifying titanium (Ti) implant surfaces are becoming increasingly popular to enhance osseointegration during acute and inflammatory healing stages. In this study, two dicationic imidazolium-based ionic liquids (IonLs) containing phenylalanine and methionine anions (IonL-Phe(1,10-bis(3-methylimidazolium-1-yl)decane diphenylalanine) and IonL-Met(1,10-bis(3-methylimidazolium-1-yl)decane dimethionine)) were investigated to stably deliver exogenous proteins on Ti to promote osseointegration. The protein selected for this study is High-Mobility Group Box 1 (HMGB1), which recruits inflammatory and mesenchymal stem cells to the implantation site, contributing to healing. To explore IonL-Ti interactions and HMGB1 stability on the IonL-coated surface, experimental characterization techniques including X-ray photoelectron spectroscopy, scanning electron microscopy, dynamic scanning calorimetry (DSC), and liquid chromatography mass spectrometry (LC-MS) were used along with molecular dynamics (MD) computer simulations to provide a detailed molecular level description. Results show well-structured IonL molecules on the Ti surface that impact protein crystallization and coating morphology. IonL cations and anions were found to bind strongly to oppositely charged residues of the protein. LC-MS/MS reveals that HMGB1 B-box lysine residues bind strongly to the IonLs. Stronger interactions of HMGB1 with Ion-Phe in contrast to IonL-Met results in greater retention capacity of HMGB1 in the IonL-Phe coating. Overall, this study provides evidence that the selected IonLs strongly interact with HMGB1, which can be a potential surface treatment for bone-implantable Ti devices.

Special Issue: Tissue Engineered Biomaterials and Drug Delivery Systems

Current advances in biomaterials processing and engineering for drug delivery have allowed interesting progressed in biomedical field [...].