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García-Ávila J, González-Gallegos CP, Segura-Ibarra V, Vazquez E, Garcia-Lopez E, Rodríguez CA, Vargas-Martínez A, Cuan-Urquizo E, Ramírez-Cedillo E. Dynamic topology optimization of 3D-Printed transtibial orthopedic implant using tunable isotropic porous metamaterials. J Mech Behav Biomed Mater 2024; 153:106479. [PMID: 38492502 DOI: 10.1016/j.jmbbm.2024.106479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/07/2024] [Accepted: 02/24/2024] [Indexed: 03/18/2024]
Abstract
In this paper, we introduce the design and manufacturing process of a transtibial orthopedic implant. We used medical-grade polyurethane polymer resin to fabricate a 3D porous architected implant with tunable isotropy, employing a high-speed printing method known as Continuous Liquid Interface Production (CLIP). Our objective is to enhance the weight-bearing capabilities of the bone structures in the residual limb, thereby circumventing the traditional reliance on a natural bridge. To achieve a custom-made design, we acquire the topology and morphology of the residual limb as well as the bone structure of the tibia and fibula, utilizing computed tomography (CT) and high-resolution 3D scanning. We employed a dynamic topological optimization method, informed by gait cycle data, to effectively reduce the mass of the implant. This approach, which differs from conventional static methods, enables the quantification of variations in applied forces over time. Using the Euler-Lagrange energy approach, we propose the equations of motion for a homologous multibody model with three degrees of freedom. The versatility of the Solid Isotropic Material with Penalization (SIMP) method facilitates the integration of homogenization methods for microscale porous architectures into the optimized domain. The design of these porous architectures is based on a bias-driven tuning symmetry isotropy of a Triply Periodic Minimal Surface (Schwarz Primitive surface). The internal porosity of the structure significantly reduces weight without compromising the isotropic behavior of the implant.
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Affiliation(s)
- Josué García-Ávila
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305-2004, USA
| | | | - Victor Segura-Ibarra
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Eugenio Garza Sada Sur 2501, Monterrey, Mexico
| | - Elisa Vazquez
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Eugenio Garza Sada Sur 2501, Monterrey, Mexico
| | - Erika Garcia-Lopez
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Eugenio Garza Sada Sur 2501, Monterrey, Mexico
| | - Ciro A Rodríguez
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Eugenio Garza Sada Sur 2501, Monterrey, Mexico; Laboratorio Nacional de Manufactura Aditiva y Digital (MADiT), Autopista Al Aeropuerto, Km., 9.5, Calle Alianza Norte #100, Parque PIIT, Apodaca, 66629, Mexico
| | - Adriana Vargas-Martínez
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Eugenio Garza Sada Sur 2501, Monterrey, Mexico
| | - Enrique Cuan-Urquizo
- Tecnológico de Monterrey, Institute of Advanced Materials for Sustainable Manufacturing, Monterrey, Mexico
| | - Erick Ramírez-Cedillo
- Tecnologico de Monterrey, School of Engineering and Sciences, Av. Eugenio Garza Sada Sur 2501, Monterrey, Mexico; Laboratorio Nacional de Manufactura Aditiva y Digital (MADiT), Autopista Al Aeropuerto, Km., 9.5, Calle Alianza Norte #100, Parque PIIT, Apodaca, 66629, Mexico; 3D Factory, Ramón Treviño 1109, Monterrey, Mexico.
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AlOmran AK, Alosaimi N, Alshaikhi AA, Bakhurji OM, Alzahrani KJ, Salloot BZ, Alabduladhem TO, AlMulhim AI, Alumran A. Burden of routine orthopedic implant removal a single center retrospective study. World J Orthop 2024; 15:139-146. [PMID: 38464354 PMCID: PMC10921180 DOI: 10.5312/wjo.v15.i2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures, sparking ongoing discourse over whether to retain or remove asymptomatic implants. Achieving consensus on this matter is paramount for orthopedic surgeons. This study aims to quantify the impact of routine implant removal on patients and healthcare facilities. A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University (KFHU) was conducted and subjected to statistical scrutiny. Among these cases, 44% necessitated hospitalization exceeding one day, while 56% required only a single day. Adults exhibited a 55% need for extended hospital stays, contrasting with 22.8% among the pediatric cohort. The complication rate was 6%, with all patients experiencing at least one complication. Notably, 34.1% required sick leave and 4.8% exceeded 14 d. General anesthesia was predominant (88%). Routine implant removal introduces unwarranted complications, particularly in adults, potentially prolonging hospitalization. This procedure strains hospital resources, tying up the operating room that could otherwise accommodate critical surgeries. Clearly defined institutional guidelines are imperative to regulate this practice. AIM To measure the burden of routine implant removal on the patients and hospital. METHODS This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU, a tertiary hospital in Saudi Arabia. Data were collected in the orthopedic department at KFHU from February 2016 to August 2022, which includes routine asymptomatic implant removal cases across all age categories. Nonroutine indications such as infection, pain, implant failure, malunion, nonunion, restricted range of motion, and prominent hardware were excluded. Patients who had external fixators removed or joints replaced were also excluded. RESULTS Between February 2016 and August 2022, 360 implants were retrieved; however, only 167 of those who met the inclusion criteria were included in this study. The remaining implants were rejected due to exclusion criteria. Among the cases, 44% required more than one day in the hospital, whereas 56% required only one day. 55% of adults required more than one day of hospitalization, while 22.8% of pediatric patients required more than one day of inpatient care. The complication rate was 6%, with each patient experiencing at least one complication. Sick leave was required in 34.1% of cases, with 4.8% requiring more than 14 d. The most common type of anesthesia used in the surgeries was general anesthesia (88%), and the mean (SD) surgery duration was 77.1 (54.7) min. CONCLUSION Routine implant removal causes unnecessary complications, prolongs hospital stays, depletes resources and monopolizing operating rooms that could serve more critical procedures.
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Affiliation(s)
- Ammar K AlOmran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Nader Alosaimi
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed A Alshaikhi
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Omar M Bakhurji
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Khalid J Alzahrani
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Basil Ziyad Salloot
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Tamim Omar Alabduladhem
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed I AlMulhim
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology Department, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
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Lee H, Shin DY, Bang SJ, Han G, Na Y, Kang HS, Oh S, Yoon CB, Vijayavenkataraman S, Song J, Kim HE, Jung HD, Kang MH. A strategy for enhancing bioactivity and osseointegration with antibacterial effect by incorporating magnesium in polylactic acid based biodegradable orthopedic implant. Int J Biol Macromol 2024; 254:127797. [PMID: 37949272 DOI: 10.1016/j.ijbiomac.2023.127797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
Biodegradable orthopedic implants are essential for restoring the physiological structure and function of bone tissue while ensuring complete degradation after recovery. Polylactic acid (PLA), a biodegradable polymer, is considered a promising material due to its considerable mechanical properties and biocompatibility. However, further improvements are necessary to enhance the mechanical strength and bioactivity of PLA for reliable load-bearing orthopedic applications. In this study, a multifunctional PLA-based composite was fabricated by incorporating tricalcium phosphate (TCP) microspheres and magnesium (Mg) particles homogenously at a volume fraction of 40 %. This approach aims to enhance mechanical strength, accelerate pore generation, and improve biological and antibacterial performance. Mg content was incorporated into the composite at varying values of 1, 3, and 5 vol% (referred to as PLA/TCP-1 Mg, PLA/TCP-3 Mg, and PLA/TCP-5 Mg, respectively). The compressive strength and stiffness were significantly enhanced in all composites, reaching 87.7, 85.9, and 84.1 MPa, and 2.7, 3.0, and 3.1 GPa, respectively. The degradation test indicated faster elimination of the reinforcers as the Mg content increased, resulting in accelerated pore generation to induce enhanced osseointegration. Because PLA/TCP-3 Mg and PLA/TCP-5 Mg exhibited cracks in the PLA matrix due to rapid corrosion of Mg forming corrosion byproducts, to optimize the Mg particle content, PLA/TCP-1 Mg was selected for further evaluation. As determined by in vitro biological and antibacterial testing, PLA/TCP-1 Mg showed enhanced bioactivity with pre-osteoblast cells and exhibited antibacterial properties by suppressing bacterial colonization. Overall, the multifunctional PLA/TCP-Mg composite showed improved mechanobiological performance, making it a promising material for biodegradable orthopedic implants.
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Affiliation(s)
- Hyun Lee
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea
| | - Da Yong Shin
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Seo-Jun Bang
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea
| | - Ginam Han
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea
| | - Yuhyun Na
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea
| | - Hyeong Seok Kang
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea
| | - SeKwon Oh
- Research Institute of Advanced Manufacturing & Materials Technology, Korea Institute of Industrial Technology, Incheon 21999, Republic of Korea
| | - Chang-Bun Yoon
- Department of Advanced Materials Engineering, Tech University of Korea, Siheung-si 15073, Republic of Korea
| | - Sanjairaj Vijayavenkataraman
- Division of Engineering, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Mechanical and Aerospace Engineering, Tandon School of Engineering, New York University, NY, USA
| | - Juha Song
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 70 Nanyang Drive, Singapore 637457, Singapore
| | - Hyoun-Ee Kim
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyun-Do Jung
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea
| | - Min-Ho Kang
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi-do 14662, Republic of Korea.
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Zheng W, Wu D, Zhang Y, Luo Y, Yang L, Xu X, Luo F. Multifunctional modifications of polyetheretherketone implants for bone repair: A comprehensive review. Biomaterials Advances 2023; 154:213607. [PMID: 37651963 DOI: 10.1016/j.bioadv.2023.213607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023]
Abstract
Polyetheretherketone (PEEK) has emerged as a highly promising orthopedic implantation material due to its elastic modulus which is comparable to that of natural bone. This polymer exhibits impressive properties for bone implantation such as corrosion resistance, fatigue resistance, self-lubrication and chemical stability. Significantly, compared to metal-based implants, PEEK implants have mechanical properties that are closer to natural bone, which can mitigate the "stress shielding" effect in bone implantation. Nevertheless, PEEK is incapable of inducing osteogenesis due to its bio-inert molecular structure, thereby hindering the osseointegration process. To optimize the clinical application of PEEK, researchers have been working on promoting its bioactivity and endowing this polymer with beneficial properties, such as antibacterial, anti-inflammatory, anti-tumor, and angiogenesis-promoting capabilities. Considering the significant growth of research on PEEK implants over the past 5 years, this review aims to present a timely update on PEEK's modification methods. By highlighting the latest advancements in PEEK modification, we hope to provide guidance and inspiration for researchers in developing the next generation bone implants and optimizing their clinical applications.
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Affiliation(s)
- Wenzhuo Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Dongxu Wu
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Yaowen Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yankun Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Lei Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiangrui Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Feng Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China; Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu 610041, China.
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Yin S, Lin S, Xu J, Yang G, Chen H, Jiang X. Dominoes with interlocking consequences triggered by zinc: involvement of microelement-stimulated MSC-derived exosomes in senile osteogenesis and osteoclast dialogue. J Nanobiotechnology 2023; 21:346. [PMID: 37741978 PMCID: PMC10518091 DOI: 10.1186/s12951-023-02085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/28/2023] [Indexed: 09/25/2023] Open
Abstract
As societal aging intensifies, senile osteoporosis has become a global public health concern. Bone microdamage is mainly caused by processes such as enhancing osteoclast activity or reducing bone formation by osteoblast-lineage cells. Compared with young individuals, extracellular vesicles derived from senescent bone marrow mesenchymal stem cells(BMSCs) increase the transient differentiation of bone marrow monocytes (BMMs) to osteoclasts, ultimately leading to osteoporosis and metal implant failure. To address this daunting problem, an exosome-targeted orthopedic implant composed of a nutrient coating was developed. A high-zinc atmosphere used as a local microenvironmental cue not only could inhibit the bone resorption by inhibiting osteoclasts but also could induce the reprogramming of senile osteogenesis and osteoclast dialogue by exosome modification. Bidirectional regulation of intercellular communication via cargoes, including microRNAs carried by exosomes, was detected. Loss- and gain-of-function experiments demonstrated that the key regulator miR-146b-5p regulates the protein kinase B/mammalian target of rapamycin pathway by targeting the catalytic subunit gene of PI3K-PIK3CB. In vivo evaluation using a naturally-aged osteoporotic rat femoral defect model further confirmed that a nutrient coating substantially augments cancellous bone remodeling and osseointegration by regulating local BMMs differentiation. Altogether, this study not only reveals the close link between senescent stem cell communication and age-related osteoporosis but also provides a novel orthopedic implant for elderly patients with exosome modulation capability.
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Affiliation(s)
- Shi Yin
- Department of Prosthodontics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- College of Stomatology, Shanghai JiaoTong University, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011 China
| | - Sihan Lin
- Department of Prosthodontics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- College of Stomatology, Shanghai JiaoTong University, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011 China
| | - Jingyi Xu
- Department of Prosthodontics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- College of Stomatology, Shanghai JiaoTong University, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011 China
| | - Guangzheng Yang
- Department of Prosthodontics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- College of Stomatology, Shanghai JiaoTong University, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011 China
| | - Hongyan Chen
- College of Stomatology, Shanghai JiaoTong University, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011 China
| | - Xinquan Jiang
- Department of Prosthodontics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- College of Stomatology, Shanghai JiaoTong University, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011 China
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Dai W, Zheng Y, Li B, Yang F, Chen W, Li Y, Deng Y, Bai D, Shu R. A 3D-printed orthopedic implant with dual-effect synergy based on MoS 2 and hydroxyapatite nanoparticles for tumor therapy and bone regeneration. Colloids Surf B Biointerfaces 2023; 228:113384. [PMID: 37320980 DOI: 10.1016/j.colsurfb.2023.113384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
Treatments for malignant bone tumors are urgently needed to be developed due to the dilemma of precise resection of tumor tissue and subsequent bone defects. Although polyether-ether-ketone (PEEK) has widely attracted attention in the orthopedic field, its bioinertness and poor osteogenic properties significantly restrict its applications in bone tumor treatment. To tackle the daunting issue, we use a hydrothermal technique to fabricate novel PEEK scaffolds modified with molybdenum disulfide (MoS2) nanosheets and hydroxyapatite (HA) nanoparticles. Our dual-effect synergistic PEEK scaffolds exhibit perfect photothermal therapeutic (PTT) property dependent on molybdous ion (Mo2+) concentration and laser power density, superior to conventional PEEK scaffolds. Under near-infrared (NIR) irradiation, the viability of MG63 osteosarcoma cells is significantly reduced by modified PEEK scaffolds, indicating a tumor-killing potential in vitro. Furthermore, the incorporation of HA nanoparticles on the surface of PEEK bolsters proliferation and adherence of MC3T3-E1 cells, boosting mineralization for further bone defect repair. The results of micro-computed tomography (micro-CT) and histological analysis of 4-week treated rat femora demonstrate the preeminent photothermal and osteogenesis capacity of 3D-printed modified scaffolds in vivo. In conclusion, the dual-effect synergistic orthopedic implant with photothermal anticancer property and osteogenic induction activity strikes a balance between tumor treatment and bone development promotion, offering a promising future therapeutic option.
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Affiliation(s)
- Wenyu Dai
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics and Paediatric Dentistry, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu 610041, China
| | - Yunfei Zheng
- Department of Orthodontics, National Center of Stomatology; National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Bin Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics and Paediatric Dentistry, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu 610041, China
| | - Fan Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics and Paediatric Dentistry, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu 610041, China
| | - Wanxi Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics and Paediatric Dentistry, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu 610041, China
| | - Yunfei Li
- Department of Biomedical Engineering, The City College of the City University of New York, New York, United States
| | - Yi Deng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics and Paediatric Dentistry, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu 610041, China; State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China; Department of Mechanical Engineering, The University of Hong Kong, Hong Kong 999077, China
| | - Ding Bai
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics and Paediatric Dentistry, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu 610041, China.
| | - Rui Shu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics and Paediatric Dentistry, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu 610041, China.
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Rahnamaee SY, Dehnavi SM, Bagheri R, Barjasteh M, Golizadeh M, Zamani H, Karimi A. Boosting bone cell growth using nanofibrous carboxymethylated cellulose and chitosan on titanium dioxide nanotube array with dual surface charges as a novel multifunctional bioimplant surface. Int J Biol Macromol 2023; 228:570-581. [PMID: 36563824 DOI: 10.1016/j.ijbiomac.2022.12.159] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
One of the most vital aspects of the orthopedic implant field has been the development of multifunctional coatings that improve bone-implant contact while simultaneously preventing bacterial infection. The present study investigates the fabrication and characterization of multifunctional polysaccharides, including carboxymethyl cellulose (CMCn) and carboxymethyl chitosan nanofibers (CMCHn), as a novel implant coating on titania nanotube arrays (T). Field emission scanning electron microscopy (FESEM) images revealed a nanofibrous morphology with a narrow diameter for CMCn and CMCHn, similar to extracellular matrix nanostructures. Compared to the T surface, the roughness of CMCn and CMCHn samples increased by over 250 %. An improved cell proliferation rate was observed on CMCHn nanofibers with a positively charged surface caused by the amino groups. Furthermore, in an antibacterial experiment, CMCn and CMCHn inhibited bacterial colony formation by 80 % and 73 %, respectively. According to the results, constructed modified CMCn and CMCHn increased osteoblast cell survival while inhibiting bacterial biofilm formation owing to their surface charge and bioinspired physicochemical properties.
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Affiliation(s)
- Seyed Yahya Rahnamaee
- Polymeric Materials Research Group (PMRG), Department of Materials Science and Engineering, Sharif University of Technology, Tehran, Iran
| | - Seyed Mohsen Dehnavi
- Department of Life Science and Biotechnology, Shahid Beheshti University, Tehran, Iran.
| | - Reza Bagheri
- Polymeric Materials Research Group (PMRG), Department of Materials Science and Engineering, Sharif University of Technology, Tehran, Iran.
| | - Mahdi Barjasteh
- Institute for Nanoscience & Nanotechnology (INST), Sharif University of Technology, Tehran, Iran; BioTex Innovation Factory, Sharif Development of Health and Biotechnology Institute, Tehran, Iran
| | - Mortaza Golizadeh
- BioTex Innovation Factory, Sharif Development of Health and Biotechnology Institute, Tehran, Iran
| | - Hedyeh Zamani
- Department of Life Science and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Afzal Karimi
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
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Soltani-Kordshuli F, Choudhury D, Goss JA, Campbell M, Smith E, Sonntag S, Niyonshuti II, Okyere D, Smeltzer MS, Chen J, Zou M. Cartilage-inspired surface textures for improved tribological performance of orthopedic implants. J Mech Behav Biomed Mater 2023; 138:105572. [PMID: 36435033 DOI: 10.1016/j.jmbbm.2022.105572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/16/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Joint replacements have become one of the most common orthopedic procedures due to the significant demands of retaining functional mobility. While these procedures are of great value to patients, there are some limitations. Durability is the most important limitation associated with joint replacement that needs to be addressed due to the increasing number of younger patients. Titanium is a commonly used implant material which has high biocompatibility, high strength-to-density ratio, and high corrosion resistance. However, current titanium implants have poor wear resistance which shortens their lifespan. In this study, microscale dimples with four different dimple shapes (circular, triangular, square, and star) of similar sizes to the pores found in natural articular cartilage were fabricated on titanium disks to improve implant lubrication and reduce wear. Biotribology tests were performed on dimpled and non-dimpled titanium disks in a condition similar to that inside of a patient's body. It was shown that dimpling the titanium disks optimized the lubricant film formation and decreased the wear rate significantly while also reducing the coefficient of friction (COF). The star-shaped dimples had the lowest COF and almost no detectable wear after 8 h of testing. To investigate whether dimpling increased bacterial colonization due to increased surface area, and to determine whether any increase could be limited by coating with antibacterial materials, bacterial colonization with Staphylococcus aureus was tested with non-dimpled and star-shaped dimpled titanium disks with and without coating with polydopamine (PDA), silver (Ag) nanoparticles (NPs), and PDA + Ag NPs. It was found that dimpling did not increase bacterial colonization, and that coating with PDA, Ag NPs, or PDA + Ag NPs did not decrease bacterial colonization. Nevertheless, we conclude that star-shaped dimpled titanium surfaces have potential utility as more durable orthopedic implants.
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Affiliation(s)
- Firuze Soltani-Kordshuli
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, 72701, USA; Center for Advanced Surface Engineering, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Dipankar Choudhury
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, 72701, USA; Center for Advanced Surface Engineering, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Josue A Goss
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, 72701, USA; Center for Advanced Surface Engineering, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Mara Campbell
- Department of Microbiology & Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Evelyn Smith
- Department of Computer Science and Engineering, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Steven Sonntag
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, 72701, USA; Center for Advanced Surface Engineering, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Isabelle I Niyonshuti
- Center for Advanced Surface Engineering, University of Arkansas, Fayetteville, AR, 72701, USA; Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Deborah Okyere
- Center for Advanced Surface Engineering, University of Arkansas, Fayetteville, AR, 72701, USA; Materials Science and Engineering Program, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Mark S Smeltzer
- Department of Microbiology & Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Jingyi Chen
- Center for Advanced Surface Engineering, University of Arkansas, Fayetteville, AR, 72701, USA; Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Min Zou
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, 72701, USA; Center for Advanced Surface Engineering, University of Arkansas, Fayetteville, AR, 72701, USA.
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9
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Safavi S, Yu Y, Robinson DL, Gray HA, Ackland DC, Lee PVS. Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review. J Orthop Surg Res 2023; 18:42. [PMID: 36647070 DOI: 10.1186/s13018-022-03492-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Total joint replacements are an established treatment for patients suffering from reduced mobility and pain due to severe joint damage. Aseptic loosening due to stress shielding is currently one of the main reasons for revision surgery. As this phenomenon is related to a mismatch in mechanical properties between implant and bone, stiffness reduction of implants has been of major interest in new implant designs. Facilitated by modern additive manufacturing technologies, the introduction of porosity into implant materials has been shown to enable significant stiffness reduction; however, whether these devices mitigate stress-shielding associated complications or device failure remains poorly understood. METHODS In this systematic review, a broad literature search was conducted in six databases (Scopus, Web of Science, Medline, Embase, Compendex, and Inspec) aiming to identify current design approaches to target stress shielding through controlled porous structures. The search keywords included 'lattice,' 'implant,' 'additive manufacturing,' and 'stress shielding.' RESULTS After the screening of 2530 articles, a total of 46 studies were included in this review. Studies focusing on hip, knee, and shoulder replacements were found. Three porous design strategies were identified, specifically uniform, graded, and optimized designs. The latter included personalized design approaches targeting stress shielding based on patient-specific data. All studies reported a reduction of stress shielding achieved by the presented design. CONCLUSION Not all studies used quantitative measures to describe the improvements, and the main stress shielding measures chosen varied between studies. However, due to the nature of the optimization approaches, optimized designs were found to be the most promising. Besides the stiffness reduction, other factors such as mechanical strength can be considered in the design on a patient-specific level. While it was found that controlled porous designs are overall promising to reduce stress shielding, further research and clinical evidence are needed to determine the most superior design approach for total joint replacement implants.
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Roh HJ, Park J, Lee SH, Kim DH, Lee GC, Jeon H, Chae M, Lee KS, Sun JY, Lee DH, Han HS, Kim YC. Optimization of the clinically approved mg-Zn alloy system through the addition of ca. Biomater Res 2022; 26:41. [PMID: 36064494 PMCID: PMC9446879 DOI: 10.1186/s40824-022-00283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although several studies on the Mg-Zn-Ca system have focused on alloy compositions that are restricted to solid solutions, the influence of the solid solution component of Ca on Mg-Zn alloys is unknown. Therefore, to broaden its utility in orthopedic applications, studies on the influence of the addition of Ca on the microstructural, mechanical, and corrosion properties of Mg-Zn alloys should be conducted. In this study, an in-depth investigation of the effect of Ca on the mechanical and bio-corrosion characteristics of the Mg-Zn alloy was performed for the optimization of a clinically approved Mg alloy system comprising Ca and Zn. Methods The Mg alloy was fabricated by gravitational melting of high purity Mg, Ca, and Zn metal grains under an Ar gas environment. The surface and cross-section were observed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to analyze their crystallographic structures. Electrochemical and immersion tests in Hank’s balanced salt solution were used to analyze their corrosion resistance. Tensile testing was performed with universal testing equipment to investigate the impact of Ca addition. The examination of cytotoxicity for biometric determination was in line with the ISO10993 standard. Results In this study, the 0.1% Ca alloy had significantly retarded grain growth due to the formation of the tiny and well-dispersed Ca2Mg6Zn3 phase. In addition, the yield strength and elongation of the 0.1% Ca alloy were more than 50% greater than the 2% Zn alloy. The limited cell viability of the 0.3% Ca alloy could be attributed to its high corrosion rate, whereas the 0.1% Ca alloy demonstrated cell viability of greater than 80% during the entire experimental period. Conclusion The effect of the addition of Ca on the microstructure, mechanical, and corrosion characteristics of Mg-Zn alloys was analyzed in this work. The findings imply that the Mg-Zn alloy system could be optimized by adding a small amount of Ca, improving mechanical properties while maintaining corrosion rate, thus opening the door to a wide range of applications in orthopedic surgery.
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Affiliation(s)
- Hyung-Jin Roh
- Nanostructural Material Laboratory, Department of Advanced Materials, Yonsei University, Seoul, 03722, Republic of Korea.,Center for Biomaterials, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea.,Research and Development Center, U&I Corporation, Uijongbu, 480-050, Republic of Korea
| | - Jaeho Park
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea.,Department of Materials science and Engineering, Seoul National University, Seoul, 08826, Republic of Korea
| | - Sun-Hee Lee
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Do-Hyang Kim
- Nanostructural Material Laboratory, Department of Advanced Materials, Yonsei University, Seoul, 03722, Republic of Korea
| | - Gwang-Chul Lee
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Hojeong Jeon
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea.,KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Minseong Chae
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, 05505, Republic of Korea
| | - Kang-Sik Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, 05505, Republic of Korea
| | - Jeong-Yun Sun
- Department of Materials science and Engineering, Seoul National University, Seoul, 08826, Republic of Korea
| | - Dong-Ho Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, 05505, Republic of Korea. .,Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, 05505, Republic of Korea.
| | - Hyung-Seop Han
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea.
| | - Yu-Chan Kim
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea.
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11
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Khare D, Majumdar S, Krishnamurthy S, Dubey AK. An in vivo toxicity assessment of piezoelectric sodium potassium niobate [Na xK 1-xNbO 3 (x = 0.2-0.8)] nanoparticulates towards bone tissue engineering approach. Biomater Adv 2022; 140:213080. [PMID: 35985067 DOI: 10.1016/j.bioadv.2022.213080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
One of the recent challenges in the design/development of prosthetic orthopedic implants is to address the concern of local/systemic toxicity of debris particles, released due to wear or degradation. Such debris particles often lead to inflammation at the implanted site or aseptic loosening of the prosthesis which results in failure of the implant during long run. Several in vitro studies demonstrated the potentiality of piezoelectric sodium potassium niobate [NaxK1-xNbO3 (x = 0.2, 0.5, 0.8), NKN] as an emerging next-generation polarizable orthopedic implant. In this perspective, we performed an in vivo study to examine the local and systemic toxicity of NKN nanoparticulates, as a first report. In the present study, male Wistar rats were intra-articularly injected to the knee joint with 100 μl of NKN nanoparticulates (25 mg/ml in normal saline). After 7 days of exposure, the histopathological analyses demonstrate the absence of any inflammation or dissemination of nanoparticulates in vital organs such as heart, liver, kidney and spleen. The anti-inflammatory cytokines (IL-4 and IL-10) profile analyses suggest the increased anti-inflammatory response in the treated rats as compared to non-injected (control) rats, preferably for the sodium and potassium rich NKN i.e., Na0.8K0.2NbO3 and Na0.2K0.8NbO3. The biochemical analyses revealed no pathological changes in the liver and kidney of particulate treated rats. The present study is the first proof to confirm the non-toxic nature of NKN nanoparticulates which provides a step forward towards the development of prosthetic orthopedic implants using biocompatible piezoelectric NKN ceramics.
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Affiliation(s)
- Deepak Khare
- Department of Ceramic Engineering, Indian Institute of Technology (BHU) Varanasi, 221005, India
| | - Shreyasi Majumdar
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU) Varanasi, 221005, India
| | - Sairam Krishnamurthy
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU) Varanasi, 221005, India
| | - Ashutosh Kumar Dubey
- Department of Ceramic Engineering, Indian Institute of Technology (BHU) Varanasi, 221005, India.
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12
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Bohara S, Suthakorn J. Surface coating of orthopedic implant to enhance the osseointegration and reduction of bacterial colonization: a review. Biomater Res 2022; 26:26. [PMID: 35725501 PMCID: PMC9208209 DOI: 10.1186/s40824-022-00269-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/11/2022] [Indexed: 12/11/2022] Open
Abstract
The use of orthopedic implants in surgical technology has fostered restoration of physiological functions. Along with successful treatment, orthopedic implants suffer from various complications and fail to offer functions correspondent to native physiology. The major problems include aseptic and septic loosening due to bone nonunion and implant site infection due to bacterial colonization. Crucial advances in material selection in the design and development of coating matrixes an opportunity for the prevention of implant failure. However, many coating materials are limited in in-vitro testing and few of them thrive in clinical tests. The rate of implant failure has surged with the increasing rates of revision surgery creating physical and sensitive discomfort as well as economic burdens. To overcome critical pathogenic activities several systematic coating techniques have been developed offering excellent results that combat infection and enhance bone integration. This review article includes some more common implant coating matrixes with excellent in vitro and in vivo results focusing on infection rates, causes, complications, coating materials, host immune responses and significant research gaps. This study provides a comprehensive overview of potential coating technology, with functional combination coatings which are focused on ultimate clinical practice with substantial improvement on in-vivo tests. This includes the development of rapidly growing hydrogel coating techniques with the potential to generate several accurate and precise coating procedures.
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Affiliation(s)
- Smriti Bohara
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Salaya, Thailand
| | - Jackrit Suthakorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Salaya, Thailand.
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13
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Zhang S, Yu Y, Wang H, Ren L, Yang K. Study on mechanical behavior of Cu-bearing antibacterial titanium alloy implant. J Mech Behav Biomed Mater 2021; 125:104926. [PMID: 34736030 DOI: 10.1016/j.jmbbm.2021.104926] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/17/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022]
Abstract
Cu-bearing titanium alloy has been proved to have excellent antibacterial properties, which can effectively reduce the incidence of infection caused by implantation. On the other hand, the addition of Cu in the titanium alloy can also significantly improve the strength of the alloy due to the dispersed precipitation of Ti2Cu compounds in matrix, which will enhance the biomechanical safety of Cu-bearing antibacterial titanium alloys. In this study, a Ti6Al4V5Cu antibacterial titanium alloy and the ordinary Ti6Al4V titanium alloy were used to make a variety of orthopedic trauma repair implants, including bone pin, bone screw and bone plate. Through the internationally accepted test methods, the mechanical properties such as tension, torsion and bending of the implants were studied, and the difference between the implants made of two materials was analyzed. The results showed that the tensile strength of Ti6Al4V5Cu pin was 25% higher than that of Ti6Al4V pin, the torsion strength of the screw was increased up to 89%, the static bending load of the plate was increased by 67-89%, and the maximum loading force of the plate after 1 million cycles of four point dynamic bending was increased by 41-91%. The above improvements should be attributed to the strengthening effect of Cu in the antibacterial titanium alloy, indicating that the Cu-bearing antibacterial titanium alloy implant possesses both advantages of reducing the bacterial infection and improving the biomechanical safety, and a broad clinical application prospects.
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Affiliation(s)
- Shuyuan Zhang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Yachuan Yu
- Suzhou Silvan Medical Co Ltd, Suzhou 215000, China
| | - Hai Wang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Ling Ren
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China.
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14
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Wang Y, Teng W, Zhang Z, Zhou X, Ye Y, Lin P, Liu A, Wu Y, Li B, Zhang C, Yang X, Li W, Yu X, Gou Z, Ye Z. A trilogy antimicrobial strategy for multiple infections of orthopedic implants throughout their life cycle. Bioact Mater 2021; 6:1853-1866. [PMID: 33336116 PMCID: PMC7732879 DOI: 10.1016/j.bioactmat.2020.11.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 01/03/2023] Open
Abstract
Bacteria-associated infection represents one of the major threats for orthopedic implants failure during their life cycles. However, ordinary antimicrobial treatments usually failed to combat multiple waves of infections during arthroplasty and prosthesis revisions etc. As these incidents could easily introduce new microbial pathogens in/onto the implants. Herein, we demonstrate that an antimicrobial trilogy strategy incorporating a sophisticated multilayered coating system leveraging multiple ion exchange mechanisms and fine nanotopography tuning, could effectively eradicate bacterial infection at various stages of implantation. Early stage bacteriostatic effect was realized via nano-topological structure of top mineral coating. Antibacterial effect at intermediate stage was mediated by sustained release of zinc ions from doped CaP coating. Strong antibacterial potency was validated at 4 weeks post implantation via an implanted model in vivo. Finally, the underlying zinc titanate fiber network enabled a long-term contact and release effect of residual zinc, which maintained a strong antibacterial ability against both Staphylococcus aureus and Escherichia coli even after the removal of top layer coating. Moreover, sustained release of Sr2+ and Zn2+ during CaP coating degradation substantially promoted implant osseointegration even under an infectious environment by showing more peri-implant new bone formation and substantially improved bone-implant bonding strength.
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Affiliation(s)
- Yikai Wang
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Wangsiyuan Teng
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Zengjie Zhang
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Xingzhi Zhou
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Yuxiao Ye
- School of Material Science and Engineering, University of New South Wales, Sydney 2052, Australia
| | - Peng Lin
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - An Liu
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Yan Wu
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Binghao Li
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Chongda Zhang
- New York University Medical Center, New York University, New York, 10016, USA
| | - Xianyan Yang
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou 310058, PR China
| | - Weixu Li
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Xiaohua Yu
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
| | - Zhongru Gou
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou 310058, PR China
| | - Zhaoming Ye
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, PR China
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15
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Baek S, Shin MH, Kim TM, Oh KS, Lee DR, Chung SW. Metastasis of renal cell carcinoma around suture anchor implants. Clin Shoulder Elb 2021; 24:110-113. [PMID: 34078020 PMCID: PMC8181848 DOI: 10.5397/cise.2021.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/28/2021] [Indexed: 12/03/2022] Open
Abstract
We present an unusual case of bone metastases from renal cell carcinoma around orthopedic implants in a 78-year-old female with osteolytic, expansile, highly vascularized, malignant infiltration around suture anchors in the proximal humerus. The patient had undergone arthroscopic rotator cuff repair using suture anchor implants 6 years previously. After diagnosis of bone metastasis, she was successfully treated with metastasectomy and internal fixation using a plate and screws, with cement augmentation. This report is the first to document metastases around a suture anchor in a bone and suggests the vulnerability of suture anchor implants to tumor metastasis.
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Affiliation(s)
- Samuel Baek
- Department of Orthopedic Surgery, Seoul Red Cross Hospital, Seoul, Korea
| | - Myung Ho Shin
- Department of Orthopedic Surgery, CM Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Orthopedic Surgery, Yonsei Gunwoo Hospital, Seoul, Korea
| | - Kyung-Soo Oh
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Ryun Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Seok Won Chung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
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16
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Shen J, Gao P, Han S, Kao RYT, Wu S, Liu X, Qian S, Chu PK, Cheung KMC, Yeung KWK. A tailored positively-charged hydrophobic surface reduces the risk of implant associated infections. Acta Biomater 2020; 114:421-30. [PMID: 32711080 DOI: 10.1016/j.actbio.2020.07.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/18/2020] [Accepted: 07/17/2020] [Indexed: 01/10/2023]
Abstract
Implant-associated infections is one of the most challenging post-operative complications in bone-related implantations. To tackle this clinical issue, we developed a low-cost and durable surface coating for medical grade titanium implants that uses positively charged silane molecules. The in vitro antimicrobial tests revealed that the titanium surface coated with (3-aminopropyl) triethoxysilane, which has the appropriate length of hydrophobic alkyl chain and positive charged amino group, suppressed more than 90% of the initial bacterial adhesion of S. aureus, P. aeruginosa, and E. coli after 30 min of incubation. In terms of growth inhibitory rate, the treated surface was able to reduce 75.7% ± 11.9% of bacterial growth after a 24-hour culturing, thereby exhibiting superior anti-biofilm formation in the late stage. When implanted into the rat model infected by S. aureus, the treated surface eliminated the implant-associated infection through the mechanism of inhibition of bacterial adhesion on the implant surface. Additionally, the treated surface was highly compatible with mammalian cells. In general, our design demonstrated its potential for human clinical trials as a low-cost and effective antibacterial strategy to minimize post-operative implant-related bacterial infection.
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17
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Safaei M, Meneghini RM, Anton SR. Compartmental force and contact location sensing in instrumented total knee replacements. Med Eng Phys 2020; 83:64-72. [PMID: 32807349 DOI: 10.1016/j.medengphy.2020.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/04/2020] [Accepted: 07/18/2020] [Indexed: 11/20/2022]
Abstract
For the past three decades, total knee replacement has become the main solution for progressed knee injuries and diseases. Due to a lack of postoperative in vivo data, a universal correlation between intra- and postoperative soft tissue balance in the knee joint has not been established. In this work, an instrumented knee implant design with six piezoelectric transducers embedded in the tibial bearing is proposed. The aim of the presented device is to measure the total and compartmental forces as well as to track the location of contact points on the medial and lateral compartments of the bearing. A numerical analysis using finite element software is first performed to obtain the best sensory system arrangement inside the bearing. The chosen design is then used to fabricate a prototype of the device. Several experiments are designed and performed using the prototype, and the ability of the proposed system to track the location and magnitude of applied compartmental forces on the bearing is evaluated. The experimental results show that the instrumented knee bearing is able to accurately measure the compartmental force quantities with a maximum error of 2.6% of the peak axial load, and the contact point locations with a maximum error of less than 1 mm.
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18
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Huo SC, Yue B. Approaches to promoting bone marrow mesenchymal stem cell osteogenesis on orthopedic implant surface. World J Stem Cells 2020; 12:545-561. [PMID: 32843913 PMCID: PMC7415248 DOI: 10.4252/wjsc.v12.i7.545] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
Bone marrow-derived mesenchymal stem cells (BMSCs) play a critical role in the osseointegration of bone and orthopedic implant. However, osseointegration between the Ti-based implants and the surrounding bone tissue must be improved due to titanium’s inherent defects. Surface modification stands out as a versatile technique to create instructive biomaterials that can actively direct stem cell fate. Here, we summarize the current approaches to promoting BMSC osteogenesis on the surface of titanium and its alloys. We will highlight the utilization of the unique properties of titanium and its alloys in promoting tissue regeneration, and discuss recent advances in understanding their role in regenerative medicine. We aim to provide a systematic and comprehensive review of approaches to promoting BMSC osteogenesis on the orthopedic implant surface.
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Affiliation(s)
- Shi-Cheng Huo
- Department of Bone and Joint Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bing Yue
- Department of Bone and Joint Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Jahanmard F, Croes M, Castilho M, Majed A, Steenbergen MJ, Lietaert K, Vogely HC, van der Wal BCH, Stapels DAC, Malda J, Vermonden T, Amin Yavari S. Bactericidal coating to prevent early and delayed implant-related infections. J Control Release 2020; 326:38-52. [PMID: 32580041 DOI: 10.1016/j.jconrel.2020.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/22/2020] [Accepted: 06/14/2020] [Indexed: 01/01/2023]
Abstract
The occurrence of an implant-associated infection (IAI) with the formation of a persisting bacterial biofilm remains a major risk following orthopedic biomaterial implantation. Yet, progress in the fabrication of tunable and durable implant coatings with sufficient bactericidal activity to prevent IAI has been limited. Here, an electrospun composite coating was optimized for the combinatorial and sustained delivery of antibiotics. Antibiotics-laden poly(ε-caprolactone) (PCL) and poly`1q`(lactic-co glycolic acid) (PLGA) nanofibers were electrospun onto lattice structured titanium (Ti) implants. In order to achieve tunable and independent delivery of vancomycin (Van) and rifampicin (Rif), we investigated the influence of the specific drug-polymer interaction and the nanofiber coating composition on the drug release profile and durability of the polymer-Ti interface. We found that a bi-layered nanofiber structure, produced by electrospinning of an inner layer of [PCL/Van] and an outer layer of [PLGA/Rif], yielded the optimal combinatorial drug release profile. This resulted in markedly enhanced bactericidal activity against planktonic and adherent Staphylococcus aureus for 6 weeks as compared to single drug delivery. Moreover, after 6 weeks, synergistic bacterial killing was observed as a result of sustained Van and Rif release. The application of a nanofiber-filled lattice structure successfully prevented the delamination of the multi-layer coating after press-fit cadaveric bone implantation. This new lattice design, in conjunction with the multi-layer nanofiber structure, can be applied to develop tunable and durable coatings for various metallic implantable devices. This is particularly appealing to tune the release of multiple antimicrobial agents over a period of weeks to prevent early and delayed onset IAI.
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Affiliation(s)
- F Jahanmard
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M Croes
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M Castilho
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - A Majed
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M J Steenbergen
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - K Lietaert
- 3D Systems - LayerWise NV, Leuven, Belgium; Department of Metallurgy and Materials Engineering, KU Leuven, Leuven, Belgium
| | - H C Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B C H van der Wal
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - D A C Stapels
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Malda
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - T Vermonden
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - S Amin Yavari
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands.
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Jia B, Yang H, Han Y, Zhang Z, Qu X, Zhuang Y, Wu Q, Zheng Y, Dai K. In vitro and in vivo studies of Zn-Mn biodegradable metals designed for orthopedic applications. Acta Biomater 2020; 108:358-372. [PMID: 32165194 DOI: 10.1016/j.actbio.2020.03.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 12/24/2022]
Abstract
In recent years, Zn-based materials provide a new option as biodegradable metals for orthopedic applications. To improve the low strength and brittle nature of pure Zn, small amounts of alloying element Mn (0.1, 0.4 and 0.8 wt.%) were added into Zn to fabricate binary Zn-Mn alloys. An extremely high elongation (83.96 ± 2.36%) was achieved in the resulting Zn-0.8 wt.%Mn alloy. Moreover, Zn-Mn alloys displayed significantly improved cytocompatibility as compared to pure Zn, according to cell proliferation and morphology analyses. More importantly, a significantly improved osteogenic activity was verified after adding Mn regarding ALP activity and osteogenic expression. Furthermore, Zn-0.8 wt.%Mn alloy scaffolds were implanted into the rat femoral condyle for repairing bone defects with pure Ti as control. Enhanced osteogenic activities were confirmed for Zn-0.8Mn alloy in contrast to pure Ti based on Micro-CT and histological results, and favorable in vivo biosafety of Zn-0.8Mn alloy was verified by H&E staining and blood tests. The exceptional mechanical performance and favorable osteogenic capability render Zn-Mn alloy a promising candidate material in the treatment of bone defects or fracture repair. STATEMENT OF SIGNIFICANCE: The element Mn, on the one hand, as an essential trace element in the human body, promotes cell proliferation, adhesion, spreading, and regulates bone metabolism; on the other hand, it could significantly improve the ductility of Zn alloys. Here, we systematically reported the biocompatibility and biofunctionality of binary biodegradable Zn-Mn alloys in the bone environment. The Zn-Mn alloys promoted MC3T3-E1 cell proliferation, adhesion, spreading, and osteogenic differentiation in vitro. Furthermore, a rat femoral condyle defect model was established; porous Zn-Mn alloy scaffolds were manufactured to repair the bone defects. Significant bone regenerations, considerable bone ingrowth, and desirable biosafety were confirmed in vivo. Therefore, biodegradable Zn-Mn with promising osteogenic properties may become new options for orthopedic implant materials.
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Dwivedi A, Mazumder A, Nasongkla N. Layer-by-layer nanocoating of antibacterial niosome on orthopedic implant. Int J Pharm 2018; 547:235-243. [PMID: 29864515 DOI: 10.1016/j.ijpharm.2018.05.075] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/05/2018] [Accepted: 05/31/2018] [Indexed: 02/05/2023]
Abstract
The major clinical hindrance of orthopedic implants is the bacterial infection, which can lead to biofilm formation and ultimately results in implant rejection. In this research, layer-by-layer nanocoating consists of vancomycin/PLA/vancomycin-loaded niosomes was designed. Vancomycin-loaded niosomes were formulated by thin film hydration method and the attributes of niosomes in terms of size, zeta potential, drug loading and EE, were assessed. The size was 340.5 ± 2.95 nm with the zeta potential and %EE was 45.4 ± 0.77 mV and 50.47 ± 3.66% respectively. The dip coating technique was used to deposit a thin film, which was characterized morphologically under FE-SEM. Drug release from coated bone plates with and without vancomycin-loaded niosomes was also studied and results suggested that bone plates coated with vancomycin-loaded niosomes have accumulated more vancomycin than the control group and hence aided in the prolonged release up to two weeks. These niosomes-coated bone plates demonstrated superior antibacterial activity for longer time period, without exhibiting any cytotoxic effects towards normal cells (L929). These findings offer a promising approach to control the bacterial colonization and biofilms formation. This thin film nano-coating can also be utilized in coating of other medical devices, which are prone to infections.
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Affiliation(s)
- Anupma Dwivedi
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakorn Pathom 73170 Thailand
| | - Anisha Mazumder
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakorn Pathom 73170 Thailand
| | - Norased Nasongkla
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakorn Pathom 73170 Thailand.
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Li G, Zhang L, Wang L, Yuan G, Dai K, Pei J, Hao Y. Dual modulation of bone formation and resorption with zoledronic acid-loaded biodegradable magnesium alloy implants improves osteoporotic fracture healing: An in vitro and in vivo study. Acta Biomater 2018; 65:486-500. [PMID: 29079514 DOI: 10.1016/j.actbio.2017.10.033] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/02/2017] [Accepted: 10/23/2017] [Indexed: 01/08/2023]
Abstract
Osteoporotic fracture (OPF) remains a major clinical challenge for skeletal regeneration. Impaired osteogenesis and excessive remodeling result in prolonged and poor quality of fracture healing. To augment bone formation and inhibit excessive resorption simultaneously, we constructed a biodegradable magnesium-based implant integrated with the anti-catabolic drug zoledronic acid (ZA); this implant exhibits controllable, sustained release of magnesium degradation products and ZA in vitro. The extracts greatly stimulate the osteogenic differentiation of rat-bone marrow-derived mesenchymal stem cells (rBMSCs), while osteoclastogenesis is inhibited by ZA. Implantation of intramedullary nails to fix femur fracture in ovariectomy-induced osteoporotic rats for up to 12 weeks demonstrates magnesium implants alone can enhance OPF repair through promoting callus formation compared to conventional stainless steel, while the combinatory treatment with local ZA release from implant coating further increases bone regeneration rate and callus size, remarkably improves bone quality and mechanical strength and suppresses osteoclasts and bone remodeling, due to the synergistic effect of both agents. The slow and uniform degradation of the implant ensures a steady decrease in bending force, which meets clinical requirements. In summary, biodegradable magnesium-based implants can locally co-deliver magnesium degradation products and zoledronic acid in a controlled manner, and can be superior alternatives for the reconstruction of osteoporosis-related fracture. STATEMENT OF SIGNIFICANCE Management of osteoporotic fracture has posed a major challenge in orthopedics, as the imbalance between diminished osteogenesis and excessive bone remodeling often leads to delayed and compromised fracture repair. Among various efforts expended on augmenting osteoporotic fracture healing, herein we reported a new strategy by engineering and utilizing a biodegradable magnesium-based implant integrated with local drug delivery, specifically, zoledronic acid (ZA)-loaded polylactic acid/brushite bilayer coating on a biodegradable Mg-Nd-Zn-Zr alloy (denoted as Mg/ZA/CaP), aiming to combine the favorable properties of Mg and zoledronic acid for simultaneous modulation of bone formation and bone resorption. In vitro and in vivo studies demonstrated its superior treatment efficacy along with adequate degradation. It stimulated new bone formation while suppressing remodeling, ascribed to the local release of magnesium degradation products and zoledronic acid. To our knowledge, the enhanced fracture repair capability of Mg-based implants was for the first time demonstrated in an osteoporotic fracture animal model. This innovative biodegradable Mg-based orthopedic implant presents great potential as a superior alternative to current internal fixation devices for treating osteoporotic fracture.
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Affiliation(s)
- Guoyuan Li
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Lei Zhang
- National Engineering Research Center of Light Alloy Net Forming & State Key Laboratory of Metal Matrix Composite, Shanghai 200240, People's Republic of China
| | - Lei Wang
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloy Net Forming & State Key Laboratory of Metal Matrix Composite, Shanghai 200240, People's Republic of China
| | - Kerong Dai
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Jia Pei
- National Engineering Research Center of Light Alloy Net Forming & State Key Laboratory of Metal Matrix Composite, Shanghai 200240, People's Republic of China.
| | - Yongqiang Hao
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.
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Sonamuthu J, Samayanan S, Jeyaraman AR, Murugesan B, Krishnan B, Mahalingam S. Influences of ionic liquid and temperature on the tailorable surface morphology of F-apatite nanocomposites for enhancing biological abilities for orthopedic implantation. Mater Sci Eng C Mater Biol Appl 2017. [PMID: 29519448 DOI: 10.1016/j.msec.2017.11.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This report has approached for the green synthesis of morphological controlled novel metal-doped fluorinated apatite/polymeric nanocomposites. The synthesized nanocomposites have investigated for hard tissue engineering and bone substitute applications. The selected fluoro ionic liquid explored the dual performances as fluorine precursor and as a soft template for the morphological development of apatite nanocomposite synthesis. The structural and surface studies (XRD, FTIR, FE-SEM, EDS, AFM, HR-TEM & SAED) confirmed the crystalline and morphological changes of synthesized fluorohydroxyapatite nanostructures at two different reaction temperatures. The fluorinated apatite nanocomposites doped with silver for metal-doped composites, which have effective antibacterial efficacy and favorable biocompatibility. The silver-doped nanocomposites showed excellent antibacterial ability against Staphylococcus aureus and Escherichia coli bacterial pathogens with the uniform release of silver and fluorine ions. These antibacterial performances have systematically tested by the quantitative and qualitative methods. The rod-like fluorinated apatite nanocrystals promote cell adhesion and viability of human osteosarcoma (MG-63) cell lines and these studies compared with the sheet-like apatite nanocomposites. This type of biomedical apatite materials may be a promising material for orthopedic implant and regeneration applications.
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Affiliation(s)
- Jegatheeswaran Sonamuthu
- Advanced Green Chemistry Lab, Department of Industrial Chemistry, School of Chemical Sciences, Alagappa University, Karaikudi 630003, Tamil Nadu, India
| | - Selvam Samayanan
- Laser and Sensor Application Laboratory, Pusan National University, Busan 609735, South Korea
| | - Anandha Raj Jeyaraman
- Functional Materials Division, CSIR - Central Electrochemical Research Institute, Karaikudi 630006, Tamilnadu, India
| | - Balaji Murugesan
- Advanced Green Chemistry Lab, Department of Industrial Chemistry, School of Chemical Sciences, Alagappa University, Karaikudi 630003, Tamil Nadu, India
| | - Bama Krishnan
- Advanced Green Chemistry Lab, Department of Industrial Chemistry, School of Chemical Sciences, Alagappa University, Karaikudi 630003, Tamil Nadu, India
| | - Sundrarajan Mahalingam
- Advanced Green Chemistry Lab, Department of Industrial Chemistry, School of Chemical Sciences, Alagappa University, Karaikudi 630003, Tamil Nadu, India.
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Johansson L, Hailer NP, Rahme H. High incidence of periprosthetic joint infection with propionibacterium acnes after the use of a stemless shoulder prosthesis with metaphyseal screw fixation - a retrospective cohort study of 241 patients. BMC Musculoskelet Disord 2017; 18:203. [PMID: 28526023 PMCID: PMC5438499 DOI: 10.1186/s12891-017-1555-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A stemless shoulder prosthesis with humeral metaphyseal screw fixation was introduced in order to save bone-stock and to facilitate reconstruction of biomechanics (Eclipse®). The aim of this study was to analyze whether the risk of infection is different with this implant compared to conventional shoulder prosthesis. METHODS Two hundred and forty-one patients (54.8% females) were operated with a shoulder arthroplasty and followed for median 2.0 (0.1-5.7) years. One hundred and two (42.3%) had received an Eclipse® prosthesis, the remaining patients were operated with other implants. There was an overrepresentation of males in the Eclipse® group (63.7% males) when compared with the control group (31.7% males). RESULTS In the Eclipse® group 10 (9.8%) patients developed a periprosthetic joint infection, as opposed to 1 (0.7%) in the control group. The most common bacteria was Propionibacterium acnes. Unadjusted infection-free survival after 4 years was 88.8% (CI 82.5-95.7) for Eclipse® patients and 95.7% (CI 87.7-100.0) for controls (p = 0.002). After adjustment for age, gender, diagnosis, and type of shoulder prosthesis (total or hemi), the risk ratio for revision due to infection was 4.3 (CI 0.5-39.1) for patients with the Eclipse® prosthesis. CONCLUSIONS Deep infections seem to be more common after the use of the metaphyseally fixed Eclipse® prosthesis than after conventional shoulder implants, but a predominance of male gender and younger age in the Eclipse group may have biased our findings. Future studies on larger cohorts and in vitro investigations on bacterial adherence and biofilm formation are needed. TRIAL REGISTRATION The study was conducted in accordance with the Helsinki Declaration. The local ethics board (Regionala Etikprövningsnämnden Stockholm) approved the study (Approval number 2015/1590-31, date of issue 2015-10-14). Retrospectively registered.
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Affiliation(s)
- Lisa Johansson
- Institute of Surgical Sciences, Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden.
| | - Nils P Hailer
- Institute of Surgical Sciences, Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - Hans Rahme
- Institute of Surgical Sciences, Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
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25
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Li Y, Munir KS, Lin J, Wen C. Titanium-niobium pentoxide composites for biomedical applications. Bioact Mater 2016; 1:127-131. [PMID: 29744401 PMCID: PMC5883992 DOI: 10.1016/j.bioactmat.2016.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022] Open
Abstract
The strength of titanium scaffolds with the introduction of high porosity decreases dramatically and may become inadequate for load bearing in biomedical applications. To simultaneously meet the requirements of biocompatibility, low elastic modulus and appropriate strength for orthopedic implant materials, it is highly desirable to develop new biocompatible titanium based materials with enhanced strength. In this study, we developed a niobium pentoxide (Nb2O5) reinforced titanium composite via powder metallurgy for biomedical applications. The strength of the Nb2O5 reinforced titanium composites (Ti-Nb2O5) is significantly higher than that of pure titanium. Cell culture results revealed that the Ti-Nb2O5 composite exhibits excellent biocompatibility and cell adhesion. Human osteoblast-like cells grew and spread healthily on the surface of the Ti-Nb2O5 composite. Our study demonstrated that Nb2O5 reinforced titanium composite is a promising implant material by virtue of its high mechanical strength and excellent biocompatibility. Developed novel Ti-Nb2O5 composites by powder metallurgy for biomedical applications. The Ti-Nb2O5 composite shows significantly higher strength than pure titanium. The Ti-Nb2O5 composite exhibits excellent biocompatibility and cell adhesion. The Ti-Nb2O5 composite is a promising implant material.
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Affiliation(s)
- Yuncang Li
- School of Engineering, RMIT University, Melbourne, Victoria 3001, Australia
| | - Khurram S Munir
- School of Engineering, RMIT University, Melbourne, Victoria 3001, Australia
| | - Jixing Lin
- Department of Materials Science and Engineering, Jilin University, Changchun, Jilin 130025, China.,Advanced Material Research and Development Center, Zhejiang Industry & Trade Vocational College, Wenzhou, Zhejiang 325003, China
| | - Cuie Wen
- School of Engineering, RMIT University, Melbourne, Victoria 3001, Australia
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26
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Zhang W, Liu J, Shi H, Yang K, Wang P, Wang G, Liu N, Wang H, Ji J, Chu PK. Communication between nitric oxide synthase and positively-charged surface and bone formation promotion. Colloids Surf B Biointerfaces 2016; 148:354-362. [PMID: 27619187 DOI: 10.1016/j.colsurfb.2016.08.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/30/2016] [Accepted: 08/27/2016] [Indexed: 12/11/2022]
Abstract
Despite the effects on physiology of bone marrow mesenchymal stem cells (BMSCs) and bone tissue, biological signal communication between bone implants and them is seldom employed as a guidance to create an osteo-inductive interface. Herein, the positively-charged surface is constructed on bone implant from the perspective of mediation of nitric oxide synthase (NOS) expression to signal BMSCs osteo-differentiation. In vitro and in vivo results indicate that the proper surface potential on the positively-charged surface affects NOS to express a high level of inducible nitric oxide synthase (iNOS) in three NOS isoforms of the contacted BMSCs, upregulates their osteogenetic expression, and ultimately foster new bone growth. However, an excessively high surface potential produces substantial immunomodulatory effects thereby offsetting the aforementioned advantages. This study demonstrates that fine-tuning of the positively-charged surface and proper utilization of the communication between NOS and bone implants promote bone formation.
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Affiliation(s)
- Wei Zhang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China.
| | - Jun Liu
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Haigang Shi
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Kun Yang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Pingli Wang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Gexia Wang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Na Liu
- Stomatology Department of the General Hospital of Chinese PLA, 28 FuXing Road, Beijing 100853, China
| | - Huaiyu Wang
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, Guangdong, China
| | - Junhui Ji
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China.
| | - Paul K Chu
- Department of Physics & Materials Science, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
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Guillot R, Pignot-Paintrand I, Lavaud J, Decambron A, Bourgeois E, Josserand V, Logeart-Avramoglou D, Viguier E, Picart C. Assessment of a polyelectrolyte multilayer film coating loaded with BMP-2 on titanium and PEEK implants in the rabbit femoral condyle. Acta Biomater 2016; 36:310-22. [PMID: 26965394 DOI: 10.1016/j.actbio.2016.03.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/29/2016] [Accepted: 03/06/2016] [Indexed: 01/14/2023]
Abstract
UNLABELLED The aim of this study was to evaluate the osseointegration of titanium implants (Ti-6Al-4V, noted here TA6V) and poly(etheretherketone) PEEK implants induced by a BMP-2-delivering surface coating made of polyelectrolyte multilayer films. The in vitro bioactivity of the polyelectrolyte film-coated implants was assessed using the alkaline phosphatase assay. BMP-2-coated TA6V and PEEK implants with a total dose of 9.3μg of BMP-2 were inserted into the femoral condyles of New Zealand white rabbits and compared to uncoated implants. Rabbits were sacrificed 4 and 8weeks after implantation. Histomorphometric analyses on TA6V and PEEK implants and microcomputed tomography on PEEK implants revealed that the bone-to-implant contact and bone area around the implants were significantly lower for the BMP-2-coated implants than for the bare implants. This was confirmed by scanning electron microscopy imaging. This difference was more pronounced at 4weeks in comparison to the 8-week time point. However, bone growth inside the hexagonal upper hollow cavity of the screws was higher in the case of the BMP-2 coated implants. Overall, this study shows that a high dose of BMP-2 leads to localized and temporary bone impairment, and that the dose of BMP-2 delivered at the surface of an implant needs to be carefully optimized. STATEMENT OF SIGNIFICANCE The presentation of growth factors from material surfaces currently presents significant challenges in academia, clinics and industry. Applying osteoinductive factors to different types of implants, made of metals or polymers, may improve bone repair in difficult situations. Here, we show the effects of an osteoinductive coating made of polyelectrolyte multilayer films on two widely used materials, titanium TA6V alloys and PEEK implants, which were implanted in the rabbit femoral condyle. We show that a too high dose of BMP-2 delivered from the screw surface has a negative short-term effect on bone regeneration in close vicinity of the screw surface. In contrast, bone formation was increased at early times in the empty spaces around the screw. These results highlight the need for future dose-dependence studies on bone formation in response to osteoinductive coatings.
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Zhao C, Pan F, Zhang L, Pan H, Song K, Tang A. Microstructure, mechanical properties, bio-corrosion properties and cytotoxicity of as-extruded Mg-Sr alloys. Mater Sci Eng C Mater Biol Appl 2017; 70:1081-8. [PMID: 27772708 DOI: 10.1016/j.msec.2016.04.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/21/2016] [Accepted: 04/04/2016] [Indexed: 11/23/2022]
Abstract
In this study, as-extruded Mg-Sr alloys were studied for orthopedic application, and the microstructure, mechanical properties, bio-corrosion properties and cytotoxicity of as-extruded Mg-Sr alloys were investigated by optical microscopy, scanning electron microscopy with an energy dispersive X-ray spectroscopy, X-ray diffraction, tensile and compressive tests, immersion test, electrochemical test and cytotoxicity test. The results showed that as-extruded Mg-Sr alloys were composed of α-Mg and Mg17Sr2 phases, and the content of Mg17Sr2 phases increased with increasing Sr content. As-extruded Mg-Sr alloy with 0.5wt.% Sr was equiaxed grains, while the one with a higher Sr content was long elongated grains and the grain size of the long elongated grains decreased with increasing Sr content. Tensile and compressive tests showed an increase of both tensile and compressive strength and a decrease of elongation with increasing Sr content. Immersion and electrochemical tests showed that as-extruded Mg-0.5Sr alloy exhibited the best anti-corrosion property, and the anti-corrosion property of as-extruded Mg-Sr alloys deteriorated with increasing Sr content, which was greatly associated with galvanic couple effect. The cytotoxicity test revealed that as-extruded Mg-0.5Sr alloy did not induce toxicity to cells. These results indicated that as-extruded Mg-0.5Sr alloy with suitable mechanical properties, corrosion resistance and good cytocompatibility was potential as a biodegradable implant for orthopedic application.
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29
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Metsemakers WJ, Emanuel N, Cohen O, Reichart M, Potapova I, Schmid T, Segal D, Riool M, Kwakman PHS, de Boer L, de Breij A, Nibbering PH, Richards RG, Zaat SAJ, Moriarty TF. A doxycycline-loaded polymer-lipid encapsulation matrix coating for the prevention of implant-related osteomyelitis due to doxycycline-resistant methicillin-resistant Staphylococcus aureus. J Control Release 2015; 209:47-56. [PMID: 25910578 DOI: 10.1016/j.jconrel.2015.04.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/17/2015] [Accepted: 04/19/2015] [Indexed: 11/19/2022]
Abstract
Implant-associated bone infections caused by antibiotic-resistant pathogens pose significant clinical challenges to treating physicians. Prophylactic strategies that act against resistant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), are urgently required. In the present study, we investigated the efficacy of a biodegradable Polymer-Lipid Encapsulation MatriX (PLEX) loaded with the antibiotic doxycycline as a local prophylactic strategy against implant-associated osteomyelitis. Activity was tested against both a doxycycline-susceptible (doxy(S)) methicillin-susceptible S. aureus (MSSA) as well as a doxycycline-resistant (doxy(R)) methicillin-resistant S. aureus (MRSA). In vitro elution studies revealed that 25% of the doxycycline was released from the PLEX-coated implants within the first day, followed by a 3% release per day up to day 28. The released doxycycline was highly effective against doxy(S) MSSA for at least 14days in vitro. A bolus injection of doxycycline mimicking a one day release from the PLEX-coating reduced, but did not eliminate, mouse subcutaneous implant-associated infection (doxy(S) MSSA). In a rabbit intramedullary nail-related infection model, all rabbits receiving a PLEX-doxycycline-coated nail were culture negative in the doxy(S) MSSA-group and the surrounding bone displayed a normal physiological appearance in both histological sections and radiographs. In the doxy(R) MRSA inoculated rabbits, a statistically significant reduction in the number of culture-positive samples was observed for the PLEX-doxycycline-coated group when compared to the animals that had received an uncoated nail, although the reduction in bacterial burden did not reach statistical significance. In conclusion, the PLEX-doxycycline coating on titanium alloy implants provided complete protection against implant-associated MSSA osteomyelitis, and resulted in a significant reduction in the number of culture positive samples when challenged with a doxycycline-resistant MRSA.
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Affiliation(s)
- Willem-Jan Metsemakers
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland
| | - Noam Emanuel
- PolyPid Ltd., 18 Hasivim St., Petach-Tikva 4959376, Israel
| | - Or Cohen
- PolyPid Ltd., 18 Hasivim St., Petach-Tikva 4959376, Israel
| | - Malka Reichart
- PolyPid Ltd., 18 Hasivim St., Petach-Tikva 4959376, Israel
| | - Inga Potapova
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland
| | - Tanja Schmid
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland
| | - David Segal
- PolyPid Ltd., 18 Hasivim St., Petach-Tikva 4959376, Israel
| | - Martijn Riool
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Paulus H S Kwakman
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Leonie de Boer
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Anna de Breij
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Peter H Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - R Geoff Richards
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland
| | - Sebastian A J Zaat
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - T Fintan Moriarty
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland.
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Evans NT, Torstrick FB, Lee CSD, Dupont KM, Safranski DL, Chang WA, Macedo AE, Lin ASP, Boothby JM, Whittingslow DC, Carson RA, Guldberg RE, Gall K. High-strength, surface-porous polyether-ether-ketone for load-bearing orthopedic implants. Acta Biomater 2015; 13:159-67. [PMID: 25463499 DOI: 10.1016/j.actbio.2014.11.030] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/26/2014] [Accepted: 11/17/2014] [Indexed: 12/19/2022]
Abstract
Despite its widespread clinical use in load-bearing orthopedic implants, polyether-ether-ketone (PEEK) is often associated with poor osseointegration. In this study, a surface-porous PEEK material (PEEK-SP) was created using a melt extrusion technique. The porous layer was 399.6±63.3 μm thick and possessed a mean pore size of 279.9±31.6 μm, strut spacing of 186.8±55.5 μm, porosity of 67.3±3.1% and interconnectivity of 99.9±0.1%. Monotonic tensile tests showed that PEEK-SP preserved 73.9% of the strength (71.06±2.17 MPa) and 73.4% of the elastic modulus (2.45±0.31 GPa) of as-received, injection-molded PEEK. PEEK-SP further demonstrated a fatigue strength of 60.0 MPa at one million cycles, preserving 73.4% of the fatigue resistance of injection-molded PEEK. Interfacial shear testing showed the pore layer shear strength to be 23.96±2.26 MPa. An osseointegration model in the rat revealed substantial bone formation within the pore layer at 6 and 12 weeks via microcomputed tomography and histological evaluation. Ingrown bone was more closely apposed to the pore wall and fibrous tissue growth was reduced in PEEK-SP when compared to non-porous PEEK controls. These results indicate that PEEK-SP could provide improved osseointegration while maintaining the structural integrity necessary for load-bearing orthopedic applications.
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Affiliation(s)
- Nathan T Evans
- School of Materials Science and Engineering, 771 Ferst Drive, J. Erskine Love Building, Georgia Institute of Technology, Atlanta, GA 30332, USA.
| | - F Brennan Torstrick
- George W. Woodruff School of Mechanical Engineering, 801 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA; Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | | | - Kenneth M Dupont
- MedShape, Inc., 1575 Northside Drive, NW, Suite 440, Atlanta, GA 30318, USA
| | - David L Safranski
- MedShape, Inc., 1575 Northside Drive, NW, Suite 440, Atlanta, GA 30318, USA
| | - W Allen Chang
- Vertera, Inc., 311 Ferst Drive NW Suite L1328, Atlanta, GA 30332, USA
| | - Annie E Macedo
- Wallace H. Coulter Department of Biomedical Engineering, 313 Ferst Drive, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
| | - Angela S P Lin
- George W. Woodruff School of Mechanical Engineering, 801 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA; Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Jennifer M Boothby
- Wallace H. Coulter Department of Biomedical Engineering, 313 Ferst Drive, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
| | - Daniel C Whittingslow
- Wallace H. Coulter Department of Biomedical Engineering, 313 Ferst Drive, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
| | - Robert A Carson
- George W. Woodruff School of Mechanical Engineering, 801 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Robert E Guldberg
- George W. Woodruff School of Mechanical Engineering, 801 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA; Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Ken Gall
- School of Materials Science and Engineering, 771 Ferst Drive, J. Erskine Love Building, Georgia Institute of Technology, Atlanta, GA 30332, USA; George W. Woodruff School of Mechanical Engineering, 801 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA; Parker H. Petit Institute for Bioengineering and Bioscience, 315 Ferst Drive, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Zou YF, Chu B, Wang CB, Hu ZY. Evaluation of MR issues for the latest standard brands of orthopedic metal implants: plates and screws. Eur J Radiol 2014; 84:450-457. [PMID: 25544555 DOI: 10.1016/j.ejrad.2014.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE The study was performed to evaluate magnetic resonance (MR) issues for the latest standard brands of plates and screws used in orthopedic surgery at a 1.5-T MR system, including the safety and metallic artifacts. METHODS The plates and screws (made of titanium alloy and stainless steel materials, according to the latest standard brands) were assessed for displacement in degrees, MRI-related heating and artifacts at a 1.5-T MR system. The displacement in degrees of the plates and screws was evaluated on an angel-measurement instrument at the entrance of the MR scanner. The MRI-related heating was assessed on a swine leg fixed with a plate by using a "worst-case" pulse sequence. A rectangular water phantom was designed to evaluate metallic artifacts of a screw on different sequences (T1/T2-weighted FSE, STIR, T2-FSE fat saturation, GRE, DWI) and then artifacts were evaluated on T2-weighted FSE sequence by modifying the scanning parameters including field of view (FOV), echo train length (ETL) and bandwidth to identify the influence of parameters on metallic artifacts. 15 volunteers with internal vertebral fixation (titanium alloy materials) were scanned with MR using axial and sagittal T2-FSE, sagittal T2-FSE fat suppression and STIR with conventional and optimized parameters, respectively. Then all images were graded by two experienced radiologists having the experience of more than 7 years under double-blind studies that is neither of them knew which was conventional parameter group and optimized parameter group. RESULTS The average deflection angle of titanium alloy and stainless steel implants were 4.3° and 7.7°, respectively, (less than 45°) which indicated that the magnetically induced force was less than the weight of the object. The deflection angle of the titanium alloy implants was less than the stainless steel one (t=9.69, P<0.001). The average temperature changes of titanium alloy before and after the scan was 0.48°C and stainless steel implants was 0.74°C, respectively, with the background temperature changes of 0.24°C. The water phantom test indicated that the DWI sequence produced largest artifacts, while FSE pulse sequence produced smallest artifacts. And T2-weighted FSE fat saturation sequence produced larger artifacts than STIR sequence. The influence of the scanning parameters on metallic artifacts was verified that metallic artifacts increased with longer echo train length and bigger FOV, while decreased with larger bandwidth. The interreader agreement was good or excellent for each set of images graded with Cohen's Kappa statistic. Image grading of axial and sagittal T2-FSE with optimized parameters were significantly superior to that with conventional parameters (grade, 3.3±0.5 vs 2.7±0.6, P=0.003; 3.2±0.4 vs 1.9±0.7, P=0.001) and image of STIR sequence received a better grade than T2-FSE FS sequence (grade, 3.4±0.5 vs 1.7±0.6, P<0.001). CONCLUSIONS The latest standard plates and screws used in orthopedic surgery do not pose an additional hazard or risk to patients undergoing MR imaging at 1.5-T or less. Though artifacts caused by them cannot be ignored because of their relatively large size, it is possible to be minimized by choosing appropriate pulse sequences and optimizing scanning parameters, such as FSE and STIR sequence with large bandwidth, small FOV and appropriate echo train length.
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Affiliation(s)
- Yue-Fen Zou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China.
| | - Bin Chu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China.
| | - Chuan-Bing Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China.
| | - Zhi-Yi Hu
- Department of Spine Surgery, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China.
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Beiki D, Yousefi G, Fallahi B, Tahmasebi MN, Gholamrezanezhad A, Fard-Esfahani A, Erfani M, Eftekhari M. (99m)tc-Ubiquicidin [29-41], a Promising Radiopharmaceutical to Differentiate Orthopedic Implant Infections from Sterile Inflammation. Iran J Pharm Res 2013; 12:347-53. [PMID: 24250609 PMCID: PMC3813225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ubiquicidin (UBI) [29-41] is a synthetic cationic antimicrobial peptide that preferentially binds to bacterial cell membrane at the site of infection. We aimed to assess diagnostic value of (99m)Tc-UBI [29-41] as a radiopharmaceutical in differentiation of bacterial infection from sterile inflammation in suspected orthopedic implants. Nine patients suspected for orthopedic implant infection, all males with the mean age of 41.6 ± 20.9 years, were studied. A dose of 10 MBq/Kg (range : 555-740 MBq) (99m)Tc-UBI [29-41] was injected intravenously. A dynamic study followed by static whole body imaging at 30, 60 and 120 min post-radiotracer injection was acquired. Periprosthetic tissue culture was considered the closest test to a gold standard for diagnosing infections and scintigraphic scans were categorized as true- or false-positive and true- or false-negative, considering the bacterial culture as the gold standard. No adverse reaction was observed during or after the radiotracer injection days. There were five true positive, four true negative and no false positive and false negative scans. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were all calculated as 100%. We found a high diagnostic accuracy for (99m)Tc-UBI [29-41] scintigraphy in differentiation of bacterial infection from sterile inflammation in suspected orthopedic implants. Therefore, (99m)Tc-UBI [29-41] scintigraphy might be potentially recommended as a safe and promising imaging modality in these settings. However, further studies on a larger number of patients and different pathologies are still needed.
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Affiliation(s)
- Davood Beiki
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gholamali Yousefi
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Babak Fallahi
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding author: E-mail:
| | - Mohammad Naghi Tahmasebi
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Gholamrezanezhad
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Armaghan Fard-Esfahani
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Erfani
- Nuclear Science Research School, Nuclear Sciences and Technology Research Institute, Atomic Energy Organization of Iran, Tehran, Iran.
| | - Mohammad Eftekhari
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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