Plasma sprayed hydroxyapatite coatings on titanium substrates. Part 1: Mechanical properties and residual stress levels

Effect of bioceramic powder abrasion on different implant surfaces

PURPOSE

Bioceramic coatings have been shown to promote bone repair, which aids in the early integration of implants. This study aimed to evaluate the influence of air abrasion with a bioceramic abrasive on the surface characteristics of different implant materials and surfaces. The dissolution of the applied treatment from the surfaces over 3 weeks was also assessed.

MATERIALS AND METHODS

Discs of three alloys used for dental implants were studied and compared: two types of commercially pure titanium (CpTi)/ (CpTi SLActive) and titanium-zirconia (TiZr). The tested surfaces were: CpTi control (CpC), sandblasted (SB), sandblasted and acid-etched (SBE), and CpTi SLActive®, (TiZr) Roxolid®. Three discs from each group underwent air abrasion with apatite bioceramic powders, 95% hydroxyapatite (HA)/5% calcium oxide (CaO), and 90% hydroxyapatite (HA)/10% calcium oxide (CaO). The treated discs were surface characterized by optical profilometry to obtain surface roughness, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS) to compare element weight percentages of titanium, calcium, and phosphate. Dissolution was assessed using inductively coupled plasma optic emission spectrometry (ICP-OES).

RESULTS

Bioceramic powders were deposited on all tested surfaces leading to changes in surface characteristics. The only statistically significant differences between the material groups for surface roughness were found with 95% HA/5% CaO powder in the Sp and Rp parameters (p = 0.03 and 0.04, respectively). There were no significant differences in the Ca and P wt% between all groups and powders 95% HA/5% CaO and 90% HA/10% CaO (p = 0.14, 0.18, and p = 0.15, 0.12, respectively). A non-uniform dispersion of the treatment on the surface layer was visible on all treated surfaces. The bioceramic powder continued to dissolute from the tested surfaces for 3 weeks.

CONCLUSION

Bioceramic abrasion modifies implant surface characteristics, although the change in surface characteristics resulting from such treatment was not influenced by the implant material or surface treatment. Air abrasion with hydroxyapatite and calcium oxide bioceramics leaves powder deposits on the treated implant surfaces that could potentially influence the healing of implants affected by peri-implantitis.

Analytical review on the biocompatibility of surface-treated Ti-alloys for joint replacement applications

INTRODUCTION

With the advancement of joint replacements such as total hip replacement (THR), Titanium (Ti) and its alloys are widely used as implant materials. The bearing surface of Ti improves the longevity of implants. In this perception, researchers design a Ti-alloy that increases the wear and corrosion resistance to enhance osteogenesis and mechanical stability.

AREAS COVERED

: This paper is dedicated to finding the major causes of the failure of THR. Further, this paper provides an overview of the application of metallic alloys and their influencing factors that influence biocompatibility. The most contributing part of this paper focuses on the post-treatment impact on Ti-alloys biocompatibility.

EXPERT OPINION

This paper revealed and discussed that Ti alloys' biocompatibility for orthopedic applications mainly depends on antibacterial activities that decide tissue-implant compatibility. Therefore, performing surface treatment enhances the biocompatibility of Ti alloys. It was also observed that more water contact angle (WCA) induces bacterial growth and enhances cell adhesion. In contrast, the treated surface increases the antibacterial activities at lower WCA. Surface heat treatment with sintering or micro-arc oxidation achieves suitable antibacterial or antimicrobial activities.

Cold Spraying of Thick Biomimetic and Stoichiometric Apatite Coatings for Orthopaedic Implants

Ceramic coatings have a long history in the orthopaedic field, with plasma sprayed coatings of hydroxyapatite as leading standard in the manufacturing process; however, these coatings can contain secondary phases resulting from the decomposition of hydroxyapatite at high temperatures, which limit the lifetime of implants and their osseointegration. This work aims to produce coatings that can maximize bone osseointegration of metallic implants. In order to preserve the raw characteristics of hydroxyapatite powders that are thermally unstable, coatings were deposited by cold spray onto Ti6Al4V alloy substrates. In contrast with other thermal spray technologies, this process presents the advantage of spraying particles through a supersonic gas jet at a low temperature. On top of hydroxyapatite, carbonated nanocrystalline apatite was synthesized and sprayed. This biomimetic apatite is similar to bone minerals due to the presence of carbonates and its poor crystallinity. FTIR and XRD analyses proved that the biomimetic characteristics and the non-stoichiometric of the apatite were preserved in the cold spray coatings. The cold spray process did not affect the chemistry of the raw material. The adhesion of the coatings as well as their thicknesses were evaluated, showing values comparable to conventional process. Cold spraying appears as a promising method to preserve the characteristics of calcium phosphate ceramics and to produce coatings that offer potentially improved osseointegration.

Human Gingival Fibroblast Adhesion and Proliferation on Hydroxyapatite-Coated Zirconia Abutment Surfaces

Applying antibacterial coatings to dental implant materials seems reasonable but can have negative influences on desired cell adhesion and healing. In this study, zirconia abutment specimens interacting with gingival tissue were used. The aim was to compare the influence of machined or coated zirconia surfaces on the adhesion and proliferation of human gingival fibroblasts (HGF-1). Surface modifications were performed using atmospheric plasma coating with hydroxyapatite, zinc, and copper. Zirconia specimens were divided into four groups: hydroxyapatite, hydroxyapatite with zinc oxide (ZnO), hydroxyapatite with copper (Cu), and an untreated machined surface. After the characterization of the surface conditions, the morphology of adhered HGF-1 was determined by fluorescence staining and subjected to statistical evaluation. The visual analysis of cell morphology by SEM showed flat, polygonal, and largely adherent fibroblast cells in the untreated group, while round to partially flat cells were recorded in the groups with hydroxyapatite, hydroxyapatite + ZnO, and hydroxyapatite + Cu. The cell membranes in the hydroxyapatite + ZnO and hydroxyapatite + Cu groups appeared porous. The results show that HGF-1 adhere and proliferate well on machined zirconia, while plasma coating with hydroxyapatite or hydroxyapatite mixtures does not lead to increased adhesion or proliferation.

Surface Characteristics and In-Vitro Studies of TiO2 Coatings by Plasma Electrolytic Oxidation in Potassium-Phosphate Electrolyte

Plasma electrolytic oxidation (PEO) was used to produce titanium oxide (TiO2) coatings on Ti surface in potassium - phosphate electrolyte. The morphology, wettability, phase, and chemical compositions were studied as a function of processing parameters. The bioactivity of the coating was assessed by the ability to form biomimetic apatite in-vitro using cell culture medium. In-vitro studies using human mesenchymal stem cells were also conducted to evaluate cells' proliferation and viability of the treated Ti. The results revealed that the produced TiO2 coatings comprised pore features with the pore size increasing with applied current density and treatment duration due to high energy discharge channels at higher potential. The PEO treated Ti exhibited superhydrophilic characteristics with a contact angle <1°. The findings indicated that the large actual surface area produced by the PEO treatment and the presence of negatively charge P O 4 3 - are the key factors for the superhydrophilic behavior. The in-vitro studies revealed that the PEO treated groups had higher amount of biomimetic apatite formation compared to the as-polished Ti. The PEO treatment significantly enhanced the cells' adhesion and growth after 24 and 72 hrs compared to the untreated Ti. A significant difference in the bioactivity was not observed between anatase and rutile.

Bioactive Surface Modifications through Thermally Sprayed Hydroxyapatite Composite Coatings: A Review over Selective Reinforcements

Hydroxyapatite (HA) has been an excellent replacement for the natural bone in orthopedic applications, owing to its close resemblance; however, it is brittle and has low strength. Surface modification techniques...

Beneficial osseointegration effect of hydroxyapatite coating on cranial implant - FEM investigation

A firm connection of the bone-implant-fixation system is of utmost importance for patients with cranial defects. In order to improve the connection reliability, the current research focuses on finding the optimal fixation method, as well as selection of the implant manufacturing methods and the used materials. For the latter, implementation of bioactive materials such as hydroxyapatite or other calcium phosphates has also been considered in the literature. The aim of this study was to investigate the effect of gradual osseointegration on the biomechanical performance of cranial Ti6Al4V implants with a deposited HA coating as the osseointegration agent. This effect was assessed by two different computational approaches using finite element method (FEM) modeling. The values of key input parameters necessary for FEM were obtained from experimental plasma spray deposition of HA layers onto Ti6Al4V samples. Immediately upon implantation, the HA layer at the bone-implant contact area brought only a slight decrease in the values of von Mises stress in the implant and the micro-screws when compared to a non-coated counterpart; importantly, this was without any negative trade-off in other important characteristics. The major benefit of the HA coatings was manifested upon the modeled osseointegration: the results of both approaches confirmed a significant reduction of investigated parameters such as the total implant displacements (reduced from 0.050 mm to 0.012 mm and 0.002 mm while using Approach I and II, respectively) and stresses (reduced from 52 MPa to 10 MPa and 1 MPa) in the implanted components in comparison to non-coated variant. This is a very promising result for potential use of thermally sprayed HA coatings for cranial implants.

Innovative Coatings of Metallic Alloys Used as Bioactive Surfaces in Implantology: A Review

Metallic implants are widely used in the field of implantology, but there are still problems leading to implant failures due to weak osseointegration, low mechanical strength for the implant, inadequate antibacterial properties, and low patient satisfaction. Implant failure can be caused by bacterial infections and poor osteointegration. To improve the implant functionalization, many researchers focus on surface modifications to prepare the proper physical and chemical conditions able to increase biocompatibility and osteointegration between implant and bone. Improving the antibacterial performance is also a key factor to avoid the inflammation in the human body. This paper is a brief review for the types of coatings used to increase osseointegration and biocompatibility for the successful use of metal alloys in the field of implantology.

Surface engineering of biomaterials in orthopedic and dental implants: Strategies to improve osteointegration, bacteriostatic and bactericidal activities

BACKGROUND

The success of biomedical implants in orthopedic and dental applications is usually limited due to insufficient bone-implant integration, and implant-related infections. Biointerfaces are critical in regulating their interactions and the desirable performance of biomaterials in biological environment. Surface engineering has been widely studied to realize better control of the interface interaction to further enhance the desired behavior of biomaterials.

PURPOSE AND SCOPE

This review aims to investigate surface coating strategies in hard tissue applications to address insufficient osteointegration and implant-related infection problems.

SUMMARY

We first focused on surface coatings to enhance the osteointegration and biocompatibility of implants by emphasizing calcium phosphate-related, nanoscale TiO₂ -related, bioactive tantalum-based and biomolecules incorporated coatings. Different coating strategies such as plasma spraying, biomimetic deposition, electrochemical anodization and LENS are discussed. We then discussed techniques to construct anti-adhesive and bactericidal surface while emphasizing multifunctional surface coating techniques that combine potential osteointegration and antibacterial activities. The effects of nanotopography via TiO₂ coatings on antibacterial performance are interesting and included. A smart bacteria-responsive titanium dioxide nanotubes coating is also attractive and elaborated.

CONCLUSION

Developing multifunctional surface coatings combining osteogenesis and antimicrobial activity is the current trend. Surface engineering methods are usually combined to obtain hierarchical multiscale surface structures with better biofunctionalization outcomes.

Calcium Phosphate Based Bioactive Ceramic Layers on Implant Materials Preparation, Properties, and Biological Performance

Calcium phosphate based bioactive ceramics (CPCs) can be successfully applied as implant coatings since they are chemically similar to the inorganic constituent of hard tissues (bones, teeth). Nowadays, in orthopedic surgeries, it is still common to use metallic implants. However, the biological response of the human body to these foreign materials can be adverse, causing the failure of implant materials. This disadvantage can be avoided by bioactive coatings on the surface of implants. CPCs can be prepared by different routes that provide coatings of different quality and properties. In our paper, we compared the morphological, chemical, and biological properties of CPC coatings prepared by the pulse current electrochemical method. The size and thickness of the pulse current deposited platelets largely depended on the applied parameters such as the length of ton and the current density. The decrease in the ton/toff ratio resulted in thinner, more oriented platelets, while the increase in current density caused a significant decrease in grain size. The higher pH value and the heat treatment favored the phase transformation of CPCs from monetite to hydroxyapatite. The contact angle measurements showed increased hydrophilicity of the CPC sample as well as better biocompatibility compared to the uncoated implant material.

Thermal Oxide Layer Enhances Crystallinity and Mechanical Properties for Plasma-Sprayed Hydroxyapatite Biomedical Coatings

The stability of plasma-sprayed hydroxyapatite (HA) coatings on metallic implants in vivo remains a significant challenge for load-bearing orthopedic implants despite their excellent mechanical and osteoconductive properties. This study focuses on oxide layer formation on the surface of Ti6Al4V samples through furnace heating at 600, 700, and 800 °C for 10 min for optimization of the most effective oxide layer to increase plasma coating crystallinity and improve plasma coating bond strength with the metal surface. The 800 °C heat treatment shows an effective oxide layer which increases coating crystallinity from 64 to 75% and coating adhesive bond strength from 25.9 ± 2.3 to 30.7 ± 1.1 MPa, while simultaneously reducing the dissolution rate of HA coatings. The addition of biologically relevant dopants, MgO and SiO2, show negligible effects on crystallinity and adhesive bond strength on plasma-sprayed HA coatings and additionally show an enhancement effect on osteoblast proliferation and differentiation. Moreover, the inclusion of these additivess shows an increase in osteogenesis in a rat distal femur model after 6 and 10 weeks of implantation. Overall, this study provides a direct solution to improve the crystallinity, adhesive bond strength, and osteogenic properties of plasma-sprayed HA coatings on orthopedic implants that is more manufacturable and translational from research to an industrial scale.

Pulsed laser deposition temperature effects on strontium-substituted hydroxyapatite thin films for biomedical implants

Substituting small molecule drugs with abundant and easily affordable ions may have positive effects on the way countless disease treatments are approached. The interest in strontium cation in bone therapies soared in the wake of the success of strontium ranelate in the treatment of osteoporosis. A new method for producing thin strontium-containing hydroxyapatite (Sr-HA, Ca₉Sr(PO₄)₆(OH)₂) films as coatings that render bioinert titanium implant bioactive is reported here. The method is based on the combination of a mechanochemical synthesis of Sr-HA targets and their deposition in form of thin films on top of titanium with the use of laser ablation at low pressure. The films were 1-2 μm in thickness and their formation was studied at different temperatures, including 25, 300, and 500 °C. Highly crystalline Sr-HA target transformed during pulsed laser deposition to a fully amorphous film, whose degree of long-range order recovered with temperature. Particle edges became somewhat sharper and surface roughness moderately increased with temperature, but the (Ca+Sr)/P atomic ratio, which increased 1.5 times during the film formation, remained approximately constant at different temperatures. Despite the mostly amorphous structure of the coatings, their affinity for capturing atmospheric carbon dioxide and accommodating it as carbonate ions that replace both phosphates and hydroxyls of HA was confirmed in an X-ray photoelectron spectroscopic analysis. As the film deposition temperature increased, the lattice voids got reduced in concentration and the structure gradually "closed," becoming more compact and entailing a linear increase in microhardness with temperature, by 0.03 GPa/°C for the entire 25-500 °C range. Biocompatibility and bioactivity of Sr-HA thin films deposited on titanium were confirmed in an interaction with dental pulp stem cells, suggesting that these coatings, regardless of the processing temperature, may be viable candidates for the surface components of metallic bone implants.

Developing highly nanoporous titanate structures via wet chemical conversion of DC magnetron sputtered titanium thin films

Titanate structures have been widely investigated as biomedical component surfaces due to their bioactive, osteoinductive and antibacterial properties. However, these surfaces are limited to Ti and its alloys, due to the nature of the chemical conversion employed. The authors present a new method for generating nanoporous titanate structures on alternative biomaterial surfaces, such as other metals/alloys, ceramics and polymers, to produce bioactive and/or antibacterial properties in a simple yet effective way. Wet chemical (NaOH; 5 M; 60 °C; 24 h) conversion of DC magnetron sputtered Ti surfaces on 316L stainless steel were investigated to explore effects of microstructure on sodium titanate conversion. It was found that the more equiaxed thin films (B/300) generated the thickest titanate structures (ca. 1.6 μm), which disagreed with the proposed hypothesis of columnar structures allowing greater NaOH ingress. All film parameters tested ultimately generated titanate structures, as confirmed via EDX, SEM, XPS, XRD, FTIR and Raman analyses. Additionally, the more columnar structures (NB/NH & B/NH) had a greater quantity of Na (ca. 26 at.%) in the top portion of the films, as confirmed via XPS, however, on average the Na content was consistent across the films (ca. 5-9 at.%). Film adhesion for the more columnar structures (ca. 42 MPa), even on polished substrates, were close to that of the FDA requirement for plasma-sprayed HA coatings (ca. 50 MPa). This study demonstrates the potential of these surfaces to be applied onto a wide variety of material types, even polymeric materials, due to the lower processing temperatures utilised, with the vision to generate bioactive and/or antibacterial properties on a plethora of bioinert materials.

The effects of bone implants' coating mechanical properties on osseointegration: In vivo, in vitro, and histological investigations

The main goal of this work was to investigate the effects of implants coatings' mechanical properties and morphology on the osseointegration. In order to produce different mechanical properties of coatings, two thermal spray techniques, high velocity oxy-fuel (HVOF) and air plasma spray (APS) were employed. Titanium pins were coated and implanted into the distal femurs and proximal tibias of fifteen New Zealand white rabbits, equally distributed in three study groups, and a total of 20 pins implanted in each group. Eight weeks after insertion, the rabbits were euthanized and the femur samples were taken out for biomechanical tests and tibia samples for histological evaluations of osseointegration. Scanning electron microscopy results showed enhanced density and a better morphology of HVOF coatings, compared to APS samples, and X-ray diffraction characterized an enhanced crystallinity of HVOF coatings. Nanoindentation tests revealed greater hardness and elastic modulus of HVOF coatings, whereas greater tensile residual stress and more pronounced creep was observed for APS coatings. Neither in biomechanical tests, nor in the histological analyses, a significant difference was observed between HVOF and APS coated samples (p > 0.05, and p > 0.05, respectively). The lack of significant difference between the HVOF and APS coated implants' osseointegration rejected our hypothesis to have a more enhanced osseointegration due to a better morphology, as well as stronger mechanical properties of HA coatings. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2679-2691, 2018.

X-ray diffraction analysis of hydroxyapatite-coated in different plasma gas atmosphere on Ti and Ti-6Al-4V

Objective:

The aim is to study the effect of plasma working gas on composition, crystallinity, and microstructure of hydroxyapatite (HA) coated on Ti and Ti-6Al-4V metal substrates.

Materials and Methods:

Ti and Ti-6Al-4V metal substrates were coated with HA by plasma spray using four plasma gas atmospheres of argon, argon/hydrogen, nitrogen, and nitrogen/hydrogen. The degree of crystallinity, the phases present, and microstructure of HA coating were characterized using X-ray diffraction and scanning electron microscopy.

Results:

Variation in crystallinity and the microstructure of HA coating on plasma gas atmosphere was observed. Micro-cracks due to thermal stresses and shift in the 2θ angle of HA compared to feedstock was seen.

Conclusion:

Plasma gas atmosphere has a significant influence on composition, crystallinity, and micro-cracks of HA-coated dental implants.

Bioactive Glass and Silicate-Based Ceramic Coatings on Metallic Implants: Open Challenge or Outdated Topic?

The overall success and long-term life of the medical implants are decisively based on the convenient osseointegration at the hosting tissue-implant interface. Therefore, various surface modifications and different coating approaches have been utilized to the implants to enhance the bone formation and speed up the interaction with the surrounding hosting tissues, thereby enabling the successful fixation of implants. In this review, we will briefly present the main metallic implants and discuss their biocompatibility and osseointegration ability depending on their chemical and mechanical properties. In addition, as the main goal of this review, we explore the main properties of bioactive glasses and silica-based ceramics that are used as coating materials for both orthopedic and dental implants. The current review provides an overview of these bioactive coatings, with a particular emphasis on deposition methods, coating adhesion to the substrates and apatite formation ability tested by immersion in Simulated Body Fluid (SBF). In vitro and in vivo performances in terms of biocompatibility, biodegradability and improved osseointegration are examined as well.

Bioinspired surface modification of orthopedic implants for bone tissue engineering

Biomedical implants have been widely used in various orthopedic treatments, including total hip arthroplasty, joint arthrodesis, fracture fixation, non-union, dental repair, etc. The modern research and development of orthopedic implants have gradually shifted from traditional mechanical support to a bioactive graft in order to endow them with better osteoinduction and osteoconduction. Inspired by structural and mechanical properties of natural bone, this review provides a panorama of current biological surface modifications for facilitating the interaction between medical implants and bone tissue and gives a future outlook for fabricating the next-generation multifunctional and smart implants by systematically biomimicking the physiological processes involved in formation and functioning of bones.

Mechanical and biological properties of ZnO, SiO2, and Ag2O doped plasma sprayed hydroxyapatite coating for orthopaedic and dental applications

In this study, we explored a ternary dopant system utilizing 0.25 wt% ZnO to induce osteogenesis, 0.5 wt% SiO₂ to induce angiogenesis, and 2.0 wt% Ag₂O to provide secondary infection control within a plasma assisted hydroxyapatite coating for orthopaedic or dental applications. The objective of this study was to understand the effects of ZnO, SiO₂, and Ag₂O dopants on the mechanical and biological properties of hydroxyapatite (HA) coatings on titanium (Ti). Coatings were deposited using a 30 kW plasma spray system equipped with a supersonic nozzle to produce above standard coating bond strengths of 24 ± 2 MPa on Ti6Al4V and 22 ± 1 MPa on commercially pure Ti substrates. Antibacterial properties were revealed in vitro against E. coli and S. aureus. The ternary dopant system was implanted in 18 male Sprague-Dawley rats with timepoints of 5 and 10 weeks. By week 5, ZnSiAg-HA produced 32% bone mineralization of 68% total bone formation compared to only 11% bone mineralization of 55% total bone formation in the undoped coating. This system can be employed for replacement surgeries and revision surgeries to reduce healing time and enhance osseointegration. STATEMENT OF SIGNIFICANCE: Total hip replacements increased 124% from 2000 to 2010 with an ever-increasing rate due to the rise in average life span and an escalation in surgeries for young patients. Replacement surgeries come with the risk of rejection, poor integration, and infection. This study incorporates biologically relevant metallic oxides of ZnO, SiO₂, and Ag₂O within a hydroxyapatite coating on titanium deposited using a radio frequency induction plasma spray. A ternary dopant system has not been explored in the current literature and little is known about these particular dopants in vivo. This proposed system can be employed for replacement surgeries to lower healing time and enhance osseointegration between implant and host tissue.

On Coating Techniques for Surface Protection: A Review

A wide variety of coating methods and materials are available for different coating applications with a common purpose of protecting a part or structure exposed to mechanical or chemical damage. A benefit of this protective function is to decrease manufacturing cost since fabrication of new parts is not needed. Available coating materials include hard and stiff metallic alloys, ceramics, bio-glasses, polymers, and engineered plastic materials, giving designers a variety freedom of choices for durable protection. To date, numerous processes such as physical/chemical vapor deposition, micro-arc oxidation, sol–gel, thermal spraying, and electrodeposition processes have been introduced and investigated. Although each of these processes provides advantages, there are always drawbacks limiting their application. However, there are many solutions to overcome deficiencies of coating techniques by using the benefits of each process in a multi-method coating. In this article, these coating methods are categorized, and compared. By developing more advanced coating techniques and materials it is possible to enhance the qualities of protection in the future.

In Vitro Characterizations of Si4+ and Zn2+ Doped Plasma Sprayed Hydroxyapatite Coatings Using Osteoblast and Osteoclast Coculture

Osteoporosis is one of the most commonly identified bone disorders, which leads to an enhanced risk of bone fracture, especially for the older population. Hydroxyapatite (HA) coated titanium (Ti) alloys have been used widespread for load bearing applications like hip or knee replacements owing to their compositional similarity to natural bone; however, incorporation of osteoinductivity is still a challenge. The objective of this study is to evaluate the effects of SiO₂ and ZnO as dopants in HA coated Ti alloys on cellular osteoporotic conditions mimicked by an in vitro osteoblast and osteoclast coculture model. HA, Si-HA, and Zn-HA coatings showed adhesive bond strengths of 25.7 ± 1.9 MPa, 23.8 ± 2.3 MPa, and 22.9 ± 3.5 MPa, respectively. To study the effects of doped HA coatings on the simulated osteoporotic cellular condition, human mesenchymal stem cells (hMSCs) and monocytes (THP-1) were seeded simultaneously in a ratio of 1:4, respectively. Gene expressions studies were carried out with marker genes showing that the presence of the dopants in the HA coating enhanced osteoblast proliferation along with diminishing cell growth of osteoclasts. This study demonstrates the promising effects of SiO₂ and ZnO in plasma sprayed HA coatings on alleviating osteoporosis cellular conditions, which can potentially be used for load-bearing implants in aging patients whose bone resorption is more dominant than bone formation.

Compositionally graded doped hydroxyapatite coating on titanium using laser and plasma spray deposition for bone implants

Plasma sprayed hydroxyapatite (HA) coating is known to improve the osteoconductivity of metallic implants. However, the adhesive bond strength of the coating is affected due to a mismatch in coefficients of thermal expansion (CTE) between the metal and HA ceramic. In this study, a gradient HA coating was prepared on Ti6Al4V by laser engineered net shaping (LENS™) followed by plasma spray deposition. In addition, 1 wt% MgO and 2 wt% Ag2O were mixed with HA to improve the biological and antibacterial properties of the coated implant. Results showed that the presence of an interfacial layer by LENS™ enhanced adhesive bond strength from 26 ± 2 MPa for just plasma spray coating to 39 ± 4 MPa for LENS™ and plasma spray coatings. Presence of MgO and Ag2O did not influence the adhesive bond strength. Also, Ag+ ions release dropped by 70% less with a gradient HA LENS™ layer due to enhanced crystallization of the HA layer. In vitro human osteoblast cell culture revealed presence of Ag2O had no deleterious effect on proliferation and differentiation when compared to pure HA as control and provided antibacterial properties against E. coli and S. aureus bacterial strands. This study presents an innovative way to improve interfacial mechanical and antibacterial properties of plasma sprayed HA coating for load-bearing orthopedic as well as dental implants. STATEMENT OF SIGNIFICANCE: Implants are commonly composed of metals that lack osteoconductivity. Osteoconductivity is a property where bone grows on the surface meaning the material is compatible with the surrounding bone tissue. Plasma sprayed hydroxyapatite (HA) coating improves the osteoconductivity of metallic implants, however, the adhesive bond strength can be weak. This study incorporates a gradient HA coating by using an additive manufacturing technique, laser engineered net shaping (LENS™), followed by plasma spray deposition to enhance the adhesive bond strength by incorporating a thermal barrier. The proposed system has not been well studied in the current literature and the results presented bring forth an innovative way to improve the interfacial mechanical and antibacterial properties of plasma sprayed HA coating for load-bearing orthopedic implants.

Biocompatibility Characteristics of Titanium Coated with Multi Walled Carbon Nanotubes-Hydroxyapatite Nanocomposites

Multi walled carbon nanotubes-hydroxyapatite (MWCNTs-HA) with various contents of MWCNTs was synthesized using the sol-gel method. MWCNTs-HA composites were characterized by X-ray diffraction (XRD) and transmission electron microscopy (TEM). HA particles were generated on the surface of MWCNT. Produced MWCNTs-HA nanocomposites were coated on pure titanium (PT). Characteristic of the titanium coated MWCNTs-HA was evaluated by field-emission scanning electron microscopy (FE-SEM) and XRD. The results show that the titanium surface was covered with MWCNTs-HA nanoparticles and MWCNTs help form the crystalized hydroxyapatite. Furthermore, the MWCNTs-HA coated titanium was investigated for in vitro cellular responses. Cell proliferation and differentiation were improved on the surface of MWCNT-HA coated titanium.

Characterization and influence of hydroxyapatite nanopowders on living cells

Nanomaterials, such as hydroxyapatite nanoparticles show a great promise for medical applications due to their unique properties at the nanoscale. However, there are concerns about the safety of using these materials in biological environments. Despite a great number of published studies of nanoobjects and their aggregates or agglomerates, the impact of their physicochemical properties (such as particle size, surface area, purity, details of structure and degree of agglomeration) on living cells is not yet fully understood. Significant differences in these properties, resulting from different manufacturing methods, are yet another problem to be taken into consideration. The aim of this work was to investigate the correlation between the properties of nanoscale hydroxyapatite from different synthesis methods and biological activity represented by the viability of four cell lines: A549, CHO, BEAS-2B and J774.1 to assess the influence of the nanoparticles on immune, reproductive and respiratory systems.

Acetabular Debonding: An Investigation of Porous Coating Delamination in Hip Resurfacing Arthroplasty

Background

To date, there have been no published investigations on the cause of acetabular debonding, a rare failure phenomenon in metal-on-metal hip resurfacing where the acetabular porous coating delaminates from the implant while remaining well fixed to the pelvic bone.

Purposes

This study aims to summarize the current understanding of acetabular debonding and to investigate the discrepancy in rate of debonding between two implant systems.

Patients and Methods

To elucidate potential causes of debonding, we retrospectively analyzed a single-surgeon cohort of 839 hip resurfacing cases. Specifically, we compared rate of debonding and manufacturing processes between two implant systems.

Results

Group 1 experienced significantly more cases of debonding than Group 2 cases (4.0% versus 0.0%, p value<0.0001). Implant manufacturing processes differed in surface coating, heat treatment, postmanufacturing treatment, and apex thickness. Debonded implants were more likely to have missed RAIL guidelines (p=0.04).

Conclusions

We identified implant system, postoperative time, and acetabular component placement as variables contributing to rate of debonding. We recommend minimizing acetabular inclination angle according to RAIL guidelines. Further, we evaluated manufacturing differences between the two implant systems but did not have access to proprietary data to identify the cause of debonding. Both implants met ASTM standards, yet only the Group 1 implant debonded. This suggests the second implant had greater fatigue shear strength. Because the Group 2 implant achieved a more durable interface that did not debond, we suggest the ASTM F1160 standard for fatigue shear strength be increased to that achieved by its manufacturer.

Level of Evidence II

A retrospective evaluation of prospectively collected data.

Enhancement of osteoblast activity on nanostructured NiTi/hydroxyapatite coatings on additive manufactured NiTi metal implants by nanosecond pulsed laser sintering

Background

The osteoinductive behaviors of nitinol (NiTi)-based metal implants for bone regeneration are largely dependent on their surface composition and topology. Continuous-mode laser sintering often results in complete melting of the materials and aggregation of particles, which lack control of heat transfer, as well as microstructural changes during sintering of the nanocomposite materials.

Methods

In the current study, in situ direct laser deposition was used to additively manufacture three-dimensional NiTi structures from Ni and Ti powders. The mechanical property of NiTi has been shown to be similar to bone. Nanosecond pulsed laser sintering process was then utilized to generate a nanoporous composite surface with NiTi alloy and hydroxyapatite (HA) by ultrafast laser heating and cooling of Ni, Ti, and HA nanoparticles mixtures precoated on the 3D NiTi substrates; HA was added in order to improve the biocompatibility of the alloy. We then studied the underlying mechanism in the formation of NiTi/HA nanocomposite, and the synergistic effect of the sintered HA component and the nanoporous topology of the composite coating. In addition, we examined the activity of bone-forming osteoblasts on the NiTi/HA surfaces. For this, osteoblast cell morphology and various biomarkers were examined to evaluate cellular activity and function.

Results

We found that the nanoscale porosity delivered by nanosecond pulsed laser sintering and the HA component positively contributed to osteoblast differentiation, as indicated by an increase in the expression of collagen and alkaline phosphatase, both of which are necessary for osteoblast mineralization. In addition, we observed topological complexities which appeared to boost the activity of osteoblasts, including an increase in actin cytoskeletal structures and adhesion structures.

Conclusion

These findings demonstrate that the pulsed laser sintering method is an effective tool to generate biocompatible coatings in complex alloy-composite material systems with desired composition and topology. Our findings also provide a better understanding of the osteoinductive behavior of the sintered nanocomposite coatings for use in orthopedic and bone regeneration applications.

Adhesion and mechanical properties of nanocrystalline hydroxyapatite coating obtained by conversion of atomic layer-deposited calcium carbonate on titanium substrate

The purpose of this study was to evaluate the mechanical properties of nanocrystalline hydroxyapatite coating by tensile adhesion testing and scratch testing. The coating was manufactured on titanium substrate by converting atomic layer-deposited (ALD) calcium carbonate thin film in dilute phosphate solution. The tensile adhesion testing was performed with hydraulic testing device in accordance with ISO 4624 and ISO 16276-1. Scratch testing was done according to SFS-EN 13523-12 with spherical 10 µm scratching tip. Characterization of the samples was done with light and electron microscopy after which they were stained with alizarin red and the failure modes and loadings were analyzed. The highest obtained tensile adhesion value was 6.71 MPa produced with 4000 ALD cycles, converted to hydroxyapatite in alkaline solution, and annealed for 30 min in 700 °C. The annealing improved the adhesion values by approximately 0.8 MPa, but examining the samples with electron microscopy showed intact coating in both annealed and non-annealed samples. Samples produced with 4000 cycles performed better in testing than 2000 cycle samples, and better adhesion was also achieved with alkaline conversion solution compared to neutral solution.

Application of fluoridated hydroxyapatite thin film coatings using KrF pulsed laser deposition

Fluoridated hydroxyapatite (FHA) was investigated for application as an implant coating for titanium bone substitute materials in dental implants. A KrF pulsed excimer deposition technique was used for film preparation on a titanium plate. The compacts were ablated by laser irradiation at an energy density of 1 J/cm² on an area 1×1 mm² with the substrate at room temparature. Energydispersive spectrometric analysis of the FHA film revealed peaks of fluorine in addition to calcium and phosphorus. X-ray diffraction revealed the presence of crystalline FHA on the FHA film after a 10 h post annealing treatment at 450°C. The FHA film coating exhibited significant dissolution resistance to sodium phosphate buffer for up to 21 days, and favorable cell attachment of human mesenchymal stem cells compared with HA film. The results of this study suggest that FHA coatings are suitable for real-world implantation applications.

Effects of MgO and SiO2 on Plasma-Sprayed Hydroxyapatite Coating: An in Vivo Study in Rat Distal Femoral Defects

Plasma-sprayed hydroxyapatite (HA)-coated titanium implants have been widely used in orthopedic applications due to their inheritance of an excellent mechanical property from titanium and great osteoconductivity from HA. However, the lack of osteoinductivity limits their further applications. In this study, 1 wt % MgO and 0.5 wt % SiO₂ were mixed with HA for making plasma-sprayed coatings on titanium implants. Plasma-sprayed HA- and MgO/SiO₂-HA-coated titanium implants showed adhesive bond strengths of 25.73 ± 1.92 and 23.44 ± 2.89 MPa, respectively. The presence of MgO and SiO₂ significantly increased the osteogenesis, osseointegration, and bone mineralization of HA-coated titanium implants by the evaluation of their histomorphology after 6, 10, and 14 weeks of implantation in rat distal femoral defects. Implant pushout tests also showed a shear modulus of 149.83 ± 3.69 MPa for MgO/SiO₂-HA-coated implants after 14 weeks of implantation, compared to 52.68 ± 10.41 MPa for uncoated implants and 83.92 ± 3.68 MPa for pure HA-coated implants; These are differences in the shear modulus of 96% and 56.4%, respectively. This study assesses for the first time the quality of the bone-implant interface of induction plasma-sprayed MgO and SiO₂ binary-doped HA coatings on load-bearing implants compared to bare titanium and pure HA coatings in a quantitative manner. Relating the osseointegration and interface shear modulus to the quality of implant fixation is critical to the advancement and implementation of HA-coated orthopedic implants.

Alumina-fluorapatite composite coating deposited by atmospheric plasma spraying: An agent of cohesion between bone and prostheses

In order to remedy the poor biological and tribological properties of 316L stainless steel (SS), plasma sprayed bio-ceramic coatings have been widely investigated. In the present study, a small amount of fluorapatite (Fap) was introduced into alumina in order to enhance its bioactivity. The powder feedstock was sprayed on 316L substrate by Atmospheric Plasma Spraying (APS) technology. The roughness profiles and average roughness values were determined using 3D profilometry. The cross sectional morphologies of the coatings were examined by scanning electron microscopy (SEM). Adhesive strength, micro-hardness and tribological properties were also examined. Experimental results revealed that Al₂O₃/Fap coating showed a good microhardness property revealing that the calcium aluminates were quite effective in improving the Fap mechanical behavior. The tribological characteristics of both alumina and alumina-Fap coating were also compared to those of classical hydroxyapatite (Hap) coatings as reported in the literature. The main finding of this work was that Fap coating can contribute to the cohesion between bone and prostheses and thus ensure a more durable and reliable prostheses.

Influence of Post-deposition Heating Time and the Presence of Water Vapor on Sputter-coated Calcium Phosphate Crystallinity

Extensive research suggested that calcium phosphate (CaP) coatings on titanium implants are essential for early bone response. However, the characterization of CaP crystallinity and the means to control coating crystallinity are not well-established. In this study, the effect of a 400°C heat treatment for 1, 2, or 4 hours, and in the presence or absence of water vapor, on CaP crystallinity was investigated. Scanning electron microscopy indicated dense as-sputtered coatings. Increase in coating crystallinity was observed to be consistent with the increasing number of PO4 peaks observed as a result of different heat treatments. In addition, x-ray diffraction analyses indicated amorphous as-sputtered coatings, whereas crystalline CaP coatings in the range of 0-85% were observed after different post-deposition heat treatments. It was concluded that the presence of water vapor and post-deposition heat treatment time significantly affect the crystallinity of CaP coatings, which may ultimately affect bone healing.

Preparation and Characterization of Electrodeposited Calcium Phosphate/Chitosan Coating on Ti6Al4V Plates

Electrolytically deposited carbonate apatite coating demonstrates higher strength but weaker support for bone marrow stromal cell attachment than do biomimetically deposited coatings. It is hypothesized that the incorporation of chitosan will increase the biocompatibility of electrolytic coating while maintaining its original strength. To verify this hypothesis, we formed a hybrid calcium phosphate/chitosan coating through electrodeposition. We found that the incorporation of chitosan influenced calcium phosphate formation and crystallization. Moreover, coating thickness and surface roughness decreased with increasing chitosan concentration. Hybrid coating exhibited an increased dissolution rate in both acidic and neutral simulated physiologic solution, whereas no significant difference on adhesive strength was found between the hybrid and original coatings (P > 0.05). Most importantly, the calcium phosphate/chitosan coating proved to be a more favorable surface for goat bone marrow stromal cell attachment than an unincorporated coating (P < 0.01). Considering its economic and simple production, a hybrid calcium phosphate/chitosan coating is thought to be an attractive candidate for future applications.

Real-Time Protein and Cell Binding Measurements on Hydroxyapatite Coatings

Although a lot of in vitro and in vivo assays have been performed during the last few decades years for hydroxyapatite bioactive coatings, there is a lack of exploitation of real-time in vitro interaction measurements. In the present work, real-time interactions for a plasma sprayed hydroxyapatite coating were measured by a Multi-Parametric Surface Plasmon Resonance (MP-SPR), and the results were compared with standard traditional cell viability in vitro assays. MP-SPR is proven to be suitable not only for measurement of molecule-molecule interactions but also molecule-material interaction measurements and cell interaction. Although SPR is extensively utilized in interaction studies, recent research of protein or cell adsorption on hydroxyapatite coatings for prostheses applications was not found. The as-sprayed hydroxyapatite coating resulted in 62.4% of crystalline phase and an average thickness of 24 ± 6 μm. The MP-SPR was used to measure lysozyme protein and human mesenchymal stem cells interaction to the hydroxyapatite coating. A comparison between the standard gold sensor and Hydroxyapatite (HA)-plasma coated sensor denoted a clearly favourable cell attachment on HA coated sensor as a significantly higher signal of cell binding was detected. Moreover, traditional cell viability and proliferation tests showed increased activity with culture time indicating that cells were proliferating on HA coating. Cells show homogeneous distribution and proliferation along the HA surface between one and seven days with no significant mortality. Cells were flattened and spread on rough surfaces from the first day, with increasing cytoplasmatic extensions during the culture time.

Surface Assembly Configurations and Packing Preferences of Fibrinogen Mediated by the Periodicity and Alignment Control of Block Copolymer Nanodomains

The ability to control the specific adsorption and packing behaviors of biomedically important proteins by effectively guiding their preferred surface adsorption configuration and packing orientation on polymeric surfaces may have utility in many applications such as biomaterials, medical implants, and tissue engineering. Herein, we investigate the distinct adhesion configurations of fibrinogen (Fg) proteins and the different organization behaviors between single Fg molecules that are mediated by the changes in the periodicity and alignment of chemically alternating nanodomains in thin films of polystyrene-block-poly(methyl methacrylate) (PS-b-PMMA) block copolymer (BCP). Specifically, the adsorption characteristics of individual Fg molecules were unambiguously resolved on four different PS-b-PMMA templates of dsa PS-b-PMMA, sm PS-b-PMMA, com PS-b-PMMA, and PS-r-PMMA. By direct visualization through high resolution imaging, the distinct adsorption and packing configurations of both isolated and interacting Fg molecules were determined as a function of the BCP template-specific nanodomain periodicity, domain alignment (random versus fully aligned), and protein concentration. The three dominant Fg adsorption configurations, SP∥, SP⊥, and TP, were observed and their occurrence ratios were ascertained on each PS-b-PMMA template. During surface packing, the orientation of the protein backbone was largely governed by the periodicity and alignment of the underlying PS-b-PMMA nanodomains whose specific direction was explicitly resolved relative to the polymeric nanodomain axis. The use of PS-b-PMMA with a periodicity much smaller than (and comparable to) the length of Fg led to a Fg scaffold with the protein backbone aligned parallel (and perpendicular) to the nanodomain major axis. In addition, we have successfully created fully Fg-decorated BCP constructs analogous to two-dimensional Fg crystals in which aligned protein molecules are arranged either side-on or end-on, depending on the BCP template. Our results demonstrate that the geometry and orientation of the protein can be effectively guided during Fg self-assembly by controlling the physical dimensions and orientations of the underlying BCP templates. Finally, the biofunctionality of the BCP surface-bound Fg was assessed and the Fg/BCP construct was successfully used in the Ca-P nanoparticle nucleation/growth and microglia cell activation.

Adhesive strength of bioactive oxide layers fabricated on TNTZ alloy by three different alkali-solution treatments

Bioactive oxide layers were fabricated on Ti-29Nb-13Ta-4.6Zr alloy (TNTZ) by three different alkali solution treatments: hydrothermal (H), electrochemical (E), and hydrothermal-electrochemical (HE). The adhesive strength of the oxide layer to the TNTZ substrate was measured to determine whether this process achieves sufficient adhesive strength for implant materials. Samples subjected to the HE process, in which a current of 15mA/cm(2) was applied at 90°C for 1h (HE90-1h), exhibited a comparatively higher adhesive strength of approximately 18MPa while still maintaining a sufficiently high bioactivity. Based on these results, an oxide layer fabricated on TNTZ by HE90-1h is considered appropriate for practical biomaterial application, though thicker oxide layers with many cracks can lead to a reduced adhesive strength.