Biomimetic Multispiked Connecting Ti-Alloy Scaffold Prototype for Entirely-Cementless Resurfacing Arthroplasty Endoprostheses-Exemplary Results of Implantation of the Ca-P Surface-Modified Scaffold Prototypes in Animal Model and Osteoblast Culture Evaluation

Towards the First Generation of Biomimetic Fixation for Resurfacing Arthroplasty Endoprostheses

This paper presents advances in designs of resurfacing arthroplasty endoprostheses that occurred through their historical generations. The critical characteristics of contemporary generation hip resurfacing arthroplasty endoprostheses are given and the failures resulting from the specific generation cemented and short stem fixation of the femoral component are reviewed. On the background of these failures, the critical need arises for an alternative approach to the fixation of components of resurfacing arthroplasty leading towards the first generation of biomimetic fixation for resurfacing arthroplasty endoprostheses. The state of the art of the completed bioengineering research on the first biomimetic fixation for resurfacing arthroplasty endoprostheses is presented. This new design type of completely cementless and stemless resurfacing arthroplasty endoprostheses of the hip joint (and other joints), where endoprosthesis components are embedded in the surrounding bone via the prototype biomimetic multi-spiked connecting scaffold (MSC-Scaffold), initiates the first at all generations of biomimetic endoprostheses of diarthrodial joints.

New N- and C-modified RGD-hemorphins as potential biomedical application on Ti-surface materials: synthesis, characterization and antinociceptive activity

This manuscript presented the synthesis and characterization of two new N- and C-modified analogues of VV-hemorphin-7 containing RGD (Arg-Gly-Asp) residues as potential nociceptive agents and bioactive materials. It has been shown that the addition of one or two RGD sequences to natural VV-hemorphin-7 increases its effect on acute nociception, but the reduction of the inflammatory phase depends on the concentration of the peptide. The structure-property relationship of the new peptide derivatives was highlighted by electrochemical and FT-IR methods of analysis. Because of the proven bone-structural bonds of hydroxyapatite, the simultaneous deposition of peptide/hydroxyapatite on the surface of a titanium surface was investigated. The deposition was performed in a medium of gelatin solution containing dissolved amounts of peptide and hydroxyapatite using ultrasound. SEM-EDS analyzes confirmed the presence of a layer of the studied system.

A review on in vitro/in vivo response of additively manufactured Ti-6Al-4V alloy

Bone replacement using porous and solid metallic implants, such as Ti-alloy implants, is regarded as one of the most practical therapeutic approaches in biomedical engineering. The bone is a complex tissue with various mechanical properties based on the site of action. Patient-specific Ti-6Al-4V constructs may address the key needs in bone treatment for having customized implants that mimic the complex structure of the natural tissue and diminish the risk of implant failure. This review focuses on the most promising methods of fabricating such patient-specific Ti-6Al-4V implants using additive manufacturing (AM) with a specific emphasis on the popular subcategory, which is powder bed fusion (PBF). Characteristics of the ideal implant to promote optimized tissue-implant interactions, as well as physical, mechanical/chemical treatments and modifications will be discussed. Accordingly, such investigations will be classified into 3B-based approaches (Biofunctionality, Bioactivity, and Biostability), which mainly govern native body response and ultimately the success in implantation.

Effect of Doping Element and Electrolyte’s pH on the Properties of Hydroxyapatite Coatings Obtained by Pulsed Galvanostatic Technique

Hydroxyapatite (HAp) is the most widely used calcium phosphate as a coating on metal implants due to its biocompatibility and bioactivity. The aim of this research is to evaluate the effect of the pH’s electrolyte and doping element on the morphology, roughness, chemical, and phasic composition of hydroxyapatite-based coatings obtained by pulsed galvanostatic electrochemical deposition. As doping elements, both Sr and Ag were selected due to their good osseoinductive character and antibacterial effect, respectively. The electrolytes were prepared at pH 4 and 5, in which specific concentrations of Sr, Ag, and Sr + Ag were added. In terms of morphology, all coatings consist in ribbon-like crystals, which at pH 5 appear to be a little larger. Addition of Sr did not affect the morphology of HAp, while Ag addition has led to the formation of flower-like crystals agglomeration. When both doping elements were added, the flowers like agglomerations caused by the Ag have diminished, indicating the competition between Sr and Ag. X-Ray Diffraction analysis has highlighted that Sr and/or Ag have successfully substituted the Ca in the HAp structure. Moreover, at higher pH, the crystallinity of all HAp coatings was enhanced. Thus, it can be said that the electrolyte’s pH enhances to some extent the properties of HAp-based coatings, while the addition of Sr and/or Ag does not negatively impact the obtained features of HAp, indicating that by using pulsed galvanostatic electrochemical deposition, materials with tunable features dictated by the function of the coated medical device can be designed.

Subchondral Bone Relative Area and Density in Human Osteoarthritic Femoral Heads Assessed with Micro-CT before and after Mechanical Embedding of the Innovative Multi-Spiked Connecting Scaffold for Resurfacing THA Endoprostheses: A Pilot Study

The multi-spiked connecting scaffold (MSC-Scaffold) prototype is the essential innovation in the fixation of components of resurfacing total hip arthroplasty (THRA) endoprostheses in the subchondral trabecular bone. We conducted the computed micro-tomography (micro-CT) assessment of the subchondral trabecular bone microarchitecture before and after the MSC-Scaffold embedding in femoral heads removed during long-stem endoprosthesis total hip arthroplasty (THA) of different bone densities from 4 patients with hip osteoarthritis (OA). The embedding of the MSC-Scaffold in subchondral trabecular bone causes the change in its relative area (BA/TA, bone area/total area ratio) ranged from 18.2% to 24.7% (translating to the calculated density ρ_B relative change 11.1–14.4%, and the compressive strength S relative change 75.3–122.7%) regardless of its initial density (before the MSC-Scaffold embedding). The densification of the trabecular microarchitecture of subchondral trabecular bone due to the MSC-Scaffold initial embedding gradually decreases with the increasing distance from the apexes of the MSC-Scaffold’s spikes while the spatial extent of this subchondral trabecular bone densification ranged from 1.5 to 2.5 mm (which is about half the height of the MSC-Scaffold’s spikes). It may be suggested, despite the limited number of examined femoral heads, that: (1) the magnitude of the effect of the MSC-Scaffold embedding on subchondral trabecular bone densification may be a factor contributing to the maintenance of the MSC-Scaffold also for decreased initial bone density values, (2) the deeper this effect of the subchondral trabecular bone densification, the better strength of subchondral trabecular bone, and as consequence, the better post-operative embedding of the MSC-Scaffold in the bone should be expected.

Bone Density Micro-CT Assessment during Embedding of the Innovative Multi-Spiked Connecting Scaffold in Periarticular Bone to Elaborate a Validated Numerical Model for Designing Biomimetic Fixation of Resurfacing Endoprostheses

Our team has been working for some time on designing a new kind of biomimetic fixation of resurfacing endoprostheses, in which the innovative multi-spiked connecting scaffold (MSC-Scaffold) that mimics the natural interface between articular cartilage and periarticular trabecular bone in human joints is the crucial element. This work aimed to develop a numerical model enabling the design of the considered joint replacement implant that would reflect the mechanics of interacting biomaterials. Thus, quantitative micro-CT analysis of density distribution in bone material during the embedding of MSC-Scaffold in periarticular bone was applied. The performed numerical studies and corresponding mechanical tests revealed, under the embedded MSC-Scaffold, the bone material densification affecting its mechanical properties. On the basis of these findings, the built numerical model was modified by applying a simulated insert of densified bone material. This modification led to a strong correlation between the re-simulation and experimental results (FVU = 0.02). The biomimetism of the MSC-Scaffold prototype that provided physiological load transfer from implant to bone was confirmed based on the Huber–von Mises–Hencky (HMH) stress maps obtained with the validated finite element (FE) model of the problem. The micro-CT bone density assessment performed during the embedding of the MSC-Scaffold prototype in periarticular bone provides insight into the mechanical behaviour of the investigated implant-bone system and validates the numerical model that can be used for the design of material and geometric features of a new kind of resurfacing endoprostheses fixation.

Native Osseous CaP Biomineral Coating on a Biomimetic Multi-Spiked Connecting Scaffold Prototype for Cementless Resurfacing Arthroplasty Achieved by Combined Electrochemical Deposition

The multi-spiked connecting scaffold (MSC-Scaffold) prototype with spikes mimicking the interdigitations of articular subchondral bone is an essential innovation in surgically initiated fixation of resurfacing arthroplasty (RA) endoprosthesis components. This paper aimed to present a determination of the suitable range of conditions for the calcium phosphate (CaP) potentiostatic electrochemical deposition (ECD_V=const) on the MSC-Scaffold prototype spikes to achieve a biomineral coating with a native Ca/P ratio. The CaP ECD_V=const process on the MSC-Scaffold Ti4Al6V pre-prototypes was investigated for potential V_ECDfrom −9 to −3 V, and followed by 48 h immersion in a simulated body fluid. An acid–alkaline pretreatment (AAT) was applied for a portion of the pre-prototypes. Scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD) studies of deposited coatings together with coatings weight measurements were performed. Themost suitable V_ECD range, from −5.25 to −4.75 V, was determined as the native biomineral Ca/P ratio of coatings was achieved. AAT increases the weight of deposited coatings (44% for V_ECD = −5.25 V, 9% for V_ECD = −5.00 V and 15% for V_ECD = −4.75 V) and the coverage degree of the lateral spike surfaces (40% for V_ECD = −5.25 V, 14% for V_ECD = −5.00 V and 100% for V_ECD = −4.75 V). XRD confirmed that the multiphasic CaP coating containing crystalline octacalcium phosphate is produced on the lateral surface of the spikes of the MSC-Scaffold. ECD_V=const preceded by AAT prevents micro-cracks on the bone-contacting surfaces of the MSC-Scaffold prototype, increases its spikes’ lateral surface coverage, and results in the best modification effect at V_ECD = −5.00 V. To conclude, the biomimetic MSC-Scaffold prototype with desired biomineral coating of native Ca/P ratio was obtained for cementless RA endoprostheses.

First Biomimetic Fixation for Resurfacing Arthroplasty: Investigation in Swine of a Prototype Partial Knee Endoprosthesis

Resurfacing hip and knee endoprostheses are generally embedded in shallow, prepared areas in the bone and secured with cement. Massive cement penetration into periarticular bone, although it provides sufficient primary fixation, leads to the progressive weakening of peri-implant bone and results in failures. The aim of this paper was to investigate in an animal model the first biomimetic fixation of components of resurfacing arthroplasty endoprostheses by means of the innovative multispiked connecting scaffold (MSC-Scaffold). The partial resurfacing knee arthroplasty (RKA) endoprosthesis working prototype with the MSC-Scaffold was designed for biomimetic fixation investigations using reverse engineering methods and manufactured by selective laser melting. After Ca-P surface modification of bone contacting surfaces of the MSC-Scaffold, the working prototypes were implanted in 10 swines. Radiological, histopathological, and micro-CT examinations were performed on retrieved bone-implant specimens. Clinical examination confirmed very good stability (4 in 5-point Likert scale) of the operated knee joints. Radiological examinations showed good implant fixation (radiolucency less than 2 mm) without any signs of migration. Spaces between the MSC-Scaffold spikes were penetrated by bone tissue. The histological sections showed newly formed trabecular bone tissue between the spikes, and the trabeculae of periscaffold bone were seen in contact with the spikes. The micro-CT results showed the highest percentage of bone tissue ingrowths into the MSC-Scaffold at a distance of 2.5÷3.0 mm from the spikes bases. The first biomimetic fixation for resurfacing arthroplasty was successfully verified in 10 swines investigations using RKA endoprosthesis working prototypes. The performed research shows that the MSC-Scaffold allows for cementless and biomimetic fixation of resurfacing endoprosthesis components in periarticular cancellous bone.

Numerical studies of the influence of various geometrical features of a multispiked connecting scaffold prototype on mechanical stresses in peri-implant bone

The multispiked connecting scaffold (MSC-scaffold) prototype is an essential innovation in the fixation of components of resurfacing arthroplasty (RA) endoprostheses, providing their entirely non-cemented and bone-tissue-preserving fixation in peri-articular bone. An FE study is proposed to evaluate the influence of geometrical features of the MSC-scaffold on the transfer of mechanical load in peri-implant bone. For this study, an FE model of Ti-Alloy MSC-scaffold prototype embedded in a bilinear elastic, transversely isotropic bone material was built. For the compressive load on the MSC-scaffold, maps of Huber-Mises-Hencky (HMH) stress in peri-implant bone were determined. The influence of the distance between the bases of neighbouring spikes, the apex angle of spikes, and the height of the spherical cup of spikes of the MSC-scaffold were analysed. It was found that the changes in the distance between the bases of neighbouring spikes from 0.2 to 0.5 mm cause the HMH stress to increase in bone material by 32%. The changes of the apex angle of spikes from 2° to 4° decrease the HMH stress in bone material by 39%. The changes of height of the spherical cup of spikes from 0 to 0.12 mm increase the HMH stress in bone material by 24%. In conclusion, the spikes' apex angle and the distance between the bases of spikes of the MSC-scaffold are the key geometrical features determining the appropriate MSC-scaffold prototype design. The built FE model was found to be useful in bioengineering design of the novel fixation system for RA endoprostheses by means of the MSC-scaffold.

Antimicrobial and Osseointegration Properties of Nanostructured Titanium Orthopaedic Implants

The surface design of titanium implants influences not only the local biological reactions but also affects at least the clinical result in orthopaedic application. During the last decades, strong efforts have been made to improve osteointegration and prevent bacterial adhesion to these surfaces. Following the rule of “smaller, faster, cheaper”, nanotechnology has encountered clinical application. It is evident that the hierarchical implant surface micro- and nanotopography orchestrate the biological cascades of early peri-implant endosseous healing or implant loosening. This review of the literature gives a brief overview of nanostructured titanium-base biomaterials designed to improve osteointegration and prevent from bacterial infection.