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The general trend of increasing life expectancy will consistently drive the demand for orthopedic prostheses. In addition to the elderly, the younger population is also in urgent need of orthopedic devices, as bone fractures are a relatively common injury type; it is important to treat the patient quickly, painlessly, and eliminate further health complications. In the field of traumatology and orthopedics, metals and their alloys are currently the most commonly used materials. In this context, numerous scientists are engaged in the search for new implant materials and coatings. Among the various coating techniques, plasma electrolytic oxidation (PEO) (or micro-arc oxidation—MAO) occupy a distinct position. This method offers a cost-effective and environmentally friendly approach to modification of metal surfaces. PEO can effectively form porous, corrosion-resistant, and bioactive coatings on light alloys. The porous oxide surface structure welcomes organic molecules that can significantly enhance the corrosion resistance of the implant and improve the biological response of the body. The review considers the most crucial aspects of new combined PEO-organic coatings on metal implants, in terms of their potential for implantation, corrosion resistance, and biological activity in vitro and in vivo. [ABSTRACT FROM AUTHOR]

Purpose: The presence of metal implants can produce artifacts and distort Hounsfield units (HU) in patient computed tomography (CT) images. The purpose of this work was to characterize a novel metal artifact reduction (MAR) algorithm for reconstruction of CBCT images obtained by the HyperSight imaging system. Methods: Three tissue‐equivalent phantoms were fitted with materials commonly used in medical applications. The first consisted of a variety of metal samples centered within a solid water block, the second was an Advanced Electron Density phantom with metal rods, and the third consisted of hip prostheses positioned within a water tank. CBCT images of all phantoms were acquired and reconstructed using the MAR and iCBCT Acuros algorithms on the HyperSight system. The signal‐to‐noise ratio (SNR), artifact index (AI), structural similarity index measure (SSIM), peak signal‐to‐noise ratio (PSNR), and mean‐square error (MSE) were computed to assess the image quality in comparison to artifact‐free reference images. The mean HU at various VOI positions around the cavity was calculated to evaluate the artifact dependence on distance and angle from the center of the cavity. The artifact volume of the phantom (excluding the cavity) was estimated by summing the volume of all voxels with HU values outside the 5th and 95th percentiles of the phantom CBCT with no artifact. Results: The SNR, AI, SSIM, PSNR, and MSE metrics demonstrated significantly higher similarity to baseline when using MAR compared to iCBCT Acuros for all high‐density materials, except for aluminum. Mean HU returned to expected solid water background at a shorter distance from metal sample in the MAR images, and the standard deviation remained lower for the MAR images at all distances from the insert. The artifact volume decreased using the novel MAR algorithm for all metal samples excluding aluminum (p < 0.001) and all hip prostheses (p < 0.05). Conclusion: Varian's HyperSight MAR reconstruction algorithm shows a reduction in metal artifact metrics, motivating the use of MAR reconstruction for patients with metal implants. [ABSTRACT FROM AUTHOR]

Bone formation on implant surfaces occurs via distance and contact osteogenesis, with osseointegration influenced by the implant's surface topography and coating. However, the traditional mechanisms of osseointegration around metal implant surfaces may not fully encompass the ultimate outcomes of using medical-grade polycaprolactone β-tricalcium phosphate calcium phosphate coated (mPCL-TCP-CaP) scaffolds for the reconstruction of large bone defects. Using histology, immunohistochemical (IHC) and scanning electron microscopy (SEM) analyses our studies on large bone defects using mPCL-TCP-CaP scaffolds show osteogenic cells forming a fibrous connective matrix around these scaffolds. Despite extensive research, the in vivo mechanisms of osseointegration of CaP-coated mPCL-TCP-CaP scaffolds remain unclear. This study investigates the structural details and spatial organization of the mPCL-TCP-CaP scaffold's interface, providing insights into the histodynamic processes involved in their osseointegration with CaP coatings. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions For patients with metal implants, computed tomography (CT) imaging results suffer from metal artifacts, which seriously affect image evaluation and even lead to misdiagnosis. Because spectral CT technology has the advantage of quantitative imaging, basis material decomposition, and so on, the current metal artifact reduction methods are utilizing spectral information to reduce metal artifacts with good results. However, they usually require projection data from multiple spectra or energy‐windows, which is difficult to realize in conventional CT.To satisfy the status quo, the aim of this work is to propose a metal artifact reduction (MAR) method based on single spectral CT (MARSS). By incorporating prior information, the average density of some base materials, and a constrained image reconstruction model is established. It forces the solution spaces of the materials to be discrete and finite, making the model easier to solve.The MARSS method uses the idea of discrete tomography to establish a constrained reconstruction model. By incorporating priori knowledge, the constraint forces the solution spaces of some materials to be discrete, which can effectively downsize the solution space and reduce the ill‐posedness of this problem. Then, an iteration algorithm is developed to solve this model. This algorithm iterates alternately between reconstruction and discretization. It ensures that the solution spaces are discrete while the polychromatic projection of the reconstructed image converges to that of the scanned object.The MRASS method significantly reduces artifacts and restores structures near metal to a large extent. Unlike the comparison MAR methods, it effectively prevents the introduction of new artifacts and distortion of the structure.The MARSS method can achieve MAR based on single spectral CT. Subjective and quantitative evaluation of the results show that the method significantly improves image quality compared to competing methods. [ABSTRACT FROM AUTHOR]

The most common technologies in tissue engineering include growth factor therapies; metal implants, such as titanium; 3D bioprinting; nanoimprinting for ceramic/polymer scaffolds; and cell therapies, such as mesenchymal stem cells (MSCs). Cell therapy is a promising alternative to organ grafts and transplants in the treatment of numerous musculoskeletal diseases. MSCs have increasingly been used in generative medicine due to their specialized self‐renewal, immunomodulation, multiplication, and differentiation properties. To further expand the potential of these cells in tissue repair, significant efforts are currently dedicated to the production of biomaterials with desirable short‐ and long‐term biophysical properties that can aid the differentiation and expansion of MSCs. Biomaterials support MSC differentiation by modulating their characteristics, such as composition, mechanical properties, porosity, and topography. This review aimed to describe recent MSC approaches, including those associated with biomaterials, from experimental, clinical, and preclinical studies with sheep models. [ABSTRACT FROM AUTHOR]

Objective: Subtraction angiographies are calculated using a native and a contrast-enhanced 3D angiography images. This minimizes both bone and metal artifacts and results in a pure image of the vessels. However, carrying out the examination twice means double the radiation dose for the patient. With the help of generative AI, it could be possible to simulate subtraction angiographies from contrast-enhanced 3D angiographies and thus reduce the need for another dose of radiation without a cutback in quality. We implemented this concept by using conditional generative adversarial networks. Methods: We selected all 3D subtraction angiographies from our PACS system, which had performed between 01/01/2018 and 12/31/2022 and randomly divided them into training, validation, and test sets (66%:17%:17%). We adapted the pix2pix framework to work on 3D data and trained a conditional generative adversarial network with 621 data sets. Additionally, we used 158 data sets for validation and 164 for testing. We evaluated two test sets with (n = 72) and without artifacts (n = 92). Five (blinded) neuroradiologists compared these datasets with the original subtraction dataset. They assessed similarity, subjective image quality, and severity of artifacts. Results: Image quality and subjective diagnostic accuracy of the virtual subtraction angiographies revealed no significant differences compared to the original 3D angiographies. While bone and movement artifact level were reduced, artifact level caused by metal implants differed from case to case between both angiographies without one group being significant superior to the other. Conclusion: Conditional generative adversarial networks can be used to simulate subtraction angiographies in clinical practice, however, new artifacts can also appear as a result of this technology. [ABSTRACT FROM AUTHOR]

The article discusses the development of a low-cost, computing-powered whole-body MRI scanner operating at 0.05 Tesla, aiming to improve MRI accessibility in healthcare. The scanner utilizes deep learning techniques for image reconstruction, enhancing image quality and providing a more affordable option compared to high-field MRI scanners. The technology offers advantages such as open scanning environment, less noise, and improved patient comfort, with potential applications in cancer detection and other medical fields. Future research is needed to further advance ULF MRI technology and evaluate its clinical efficacy in various healthcare settings. [Extracted from the article]

The biodegradability of magnesium (Mg) metal implants necessitates surface modification to mitigate the high corrosion rate in the body's physiological environment. This study focuses on synthesizing and applying a nanocomposite coating of polydimethylsiloxane-nanosized bioactive glass (PDMS-nBG) on the surface of a plasma electrolytic oxidation (PEO)-modified AZ91 Mg alloy. The PDMS-1 wt% nBG nanocomposite coating was deposited on the PEO-treated substrate using the dip-coating method. Surface and cross-sectional morphologies of the nanocomposite coatings were examined using field emission scanning electron microscopy (FESEM). Corrosion behavior of the AZ91 substrate, PEO coating, and double-layer PEO/PDMS-nBG coating was investigated using electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (PDP) tests. Results showed that the corrosion resistance and corrosion current density of Mg substrates increased and decreased from 4815 Ω.cm2 and 8.96 µA.cm− 2 to 18 MΩ.cm2 and 0.00016 µA.cm− 2 for AZ91 and PEO/PDMS-nBG coating, respectively. Additionally, the morphology and adhesion of cultured human mesenchymal cells on the PEO-modified AZ91 substrates with a single PDMS polymer coating and a PDMS-nBG nanocomposite coating were investigated using fluorescent light microscopy and FESEM. The PEO/PDMS-nBG bilayer coating effectively addressed the limitations of magnesium alloys and holds potential for biomedical applications, particularly in orthopedic implants, due to the enhanced biocompatibility and bioactivity of Mg alloys. [ABSTRACT FROM AUTHOR]

In the past decade, the transfibular approach to Total Ankle Replacement (TAR) has emerged as an alternative to anterior approach with reduced bone resection. The purpose of this systematic review is to report survival, complications, and reoperation rates of transfibular TAR. We conducted a systematic search of studies that evaluated complications, reoperations, and survival of transfibular TAR following PRISMA guidelines across PubMed, Scopus and Web of Science. Our review included data from 12 cohorts, comprising 919 patients across 7 countries, with an average age of 62 years (59% posttraumatic). Over an average follow-up period of 3 years, adverse events occurred in 23% of cases, with 18% requiring surgical reintervention, mostly due to hardware removal. The survival rate of the transfibular TAR metal components was 97% at the final follow-up. Transfibular TAR demonstrates a 97% survival rate at a 3-year follow-up. Level II [ABSTRACT FROM AUTHOR]

Background: Metal implants may affect the image quality, iodine concentration (IC), and CT Hounsfield unit (HU) quantification accuracy. Purpose: To investigate the quantitative accuracy of IC and HU from dual-layer spectral detector (DLCT) in the presence of metal artifacts. Material and Methods: An experimental cylindrical phantom containing eight iodine inserts and two metal inserts was designed. The phantom underwent scanning at three radiation dose levels and two tube voltage settings. A set of conventional images (CIs), virtual monoenergetic images (VMIs), and iodine concentration maps (ICMs) were generated and measured for all the eight iodine inserts. Quantitative indicators of mean absolute percentage error (MAPE), artifact index (AI), contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and standard deviation (SD) on CIs and VMIs were calculated for IC and HU. Subjective score evaluation was also conducted. Results: The MAPEiodine values of all regions of interest across different scanning configurations were all <5%. Almost all APEiodine values were <5%, indicating that metal artifacts had little impact on IC measurements. When the tube voltage was fixed, the SD value of attenuation decreased with the increase of the tube current; this is also true when the tube current was fixed. The middle energy reconstructions seemed to give a good balance between reducing artifacts and improving contrast. Conclusion: VMIs from DLCT can reduce metal artifacts, the accuracy of IC quantification is not sensitive to imaging parameters. In summary, metal implants exhibit minimal impact on image quality and IC quantification accuracy in reconstructed images from DLCT. [ABSTRACT FROM AUTHOR]

The most significant and protracted phase of the installation of a dental prosthesis is osseointegration of a metal implant with bone tissue. It is important to accelerate this process, for example, by the use of extracorporeal shock wave therapy. The objective of this study is to investigate numerically the conditions for osseointegration of the implant in the dental region employing a poroelastic model implemented in the movable cellular automaton method. The mandibular segment under consideration includes a spongy tissue covered with a cortical layer 600 μm thick and a gum 400 μm thick. Additionally, the second premolar and second molar exhibited periodontal membranes of their roots, while the implant of the first molar was situated within a shell of soft fibrous tissue. The obtained fields of hydrostatic pressure and interstitial fluid pressure were analyzed according to the mechanobiological principles. The results obtained have indicated that shock wave therapy has a beneficial impact on the creation of conditions conducive to the differentiation and transfer of bone tissue cells along the main volume of the fibrous tissue surrounding the implant during the initial osseointegration stage. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) around metal implants has been challenging due to magnetic susceptibility differences between metal implants and adjacent tissues, resulting in image signal loss, geometric distortion, and loss of fat suppression. These artifacts can compromise the diagnostic accuracy and the evaluation of surrounding anatomical structures. As the prevalence of total joint replacements continues to increase in our aging society, there is a need for proper radiological assessment of tissues around metal implants to aid clinical decision-making in the management of post-operative complaints and complications. Various techniques for reducing metal artifacts in musculoskeletal imaging have been explored in recent years. One approach focuses on improving hardware components. High-density multi-channel radiofrequency (RF) coils, parallel imaging techniques, and gradient warping correction enable signal enhancement, image acquisition acceleration, and geometric distortion minimization. In addition, the use of susceptibility-matched implants and low-field MRI helps to reduce magnetic susceptibility differences. The second approach focuses on metal artifact reduction sequences such as view-angle tilting (VAT) and slice-encoding for metal artifact correction (SEMAC). Iterative reconstruction algorithms, deep learning approaches, and post-processing techniques are used to estimate and correct artifact-related errors in reconstructed images. This article reviews recent developments in clinically applicable metal artifact reduction techniques as well as advances in MR hardware. The review provides a better understanding of the basic principles and techniques, as well as an awareness of their limitations, allowing for a more reasoned application of these methods in clinical settings. [ABSTRACT FROM AUTHOR]

3D multi-spectral imaging (MSI) of metal implants necessitates relatively long scan times. We implemented a fast isotropic 3D MSI technique at 3 T and compared its image quality and clinical utility to non-isotropic MSI in the evaluation of hip implants. Two musculoskeletal radiologists scored images from coronal proton density-weighted conventional MAVRIC-SL and an isotropic MAVRIC-SL sequence accelerated with robust-component-analysis on a 3-point scale (3: diagnostic, 2: moderately diagnostic, 1: non-diagnostic) for overall image quality, metal artifact, and visualization around femoral and acetabular components. Grades were compared using a signed Wilcoxon test. Images were evaluated for effusion, synovitis, osteolysis, loosening, pseudotumor, fracture, and gluteal tendon abnormalities. Reformatted axial and sagittal images for both sequences were subsequently generated and compared for image quality with the Wilcoxon test. Whether these reformats increased diagnostic confidence or revealed additional pathology, including findings unrelated to arthroplasty that may contribute to hip pain, was also compared using the McNemar test. Inter-rater agreement was measured by Cohen's kappa. 39 symptomatic patients with a total of 59 hip prostheses were imaged (mean age, 70 years ±9, 14 males, 25 females). Comparison scores between coronal images showed no significant difference in image quality, metal artifact, or visualization of the femur and acetabulum. Except for loosening, reviewers identified more positive cases of pathology on the original coronally-acquired isotropic sequence. In comparison of reformatted axial and sagittal images, the isotropic sequence scored significantly (p < 0.01) higher for overall image quality (3.0 vs 2.0) and produced significantly (p < 0.01) more cases of increased diagnostic confidence (42.4% vs 7.6%) or additional diagnoses (50.8% vs 22.9%). Inter-rater agreement was substantial (k = 0.798) for image quality. Mean scan times were 4.2 mins (isotropic) and 7.1 mins (non-isotropic). Compared to the non-isotropic sequence, isotropic 3D MSI was acquired in less time while maintaining diagnostically acceptable image quality. It identified more pathology, including postoperative complications and potential pain-generating pathology unrelated to arthroplasty. This fast isotropic 3D MSI sequence demonstrates promise for improving diagnostic evaluation of symptomatic hip prostheses at 3 T while simultaneously reducing scan time. • Accelerated isotropic 3D MSI at 3 T is clinically feasible in hip implants. • Accelerated isotropic 3D MSI has good visualization of postoperative complications. • This technique can facilitate formation of fast MRI protocol for hip implant patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the equivalence of computed tomography (CT)–based synthetic T1-weighted imaging (T1WI) to conventional T1WI for the quantitative assessment of brain morphology. Materials and methods: This prospective study examined 35 adult patients undergoing brain magnetic resonance imaging (MRI) and CT scans. An image synthesis method based on a deep learning model was used to generate synthetic T1WI (sT1WI) from CT data. Two senior radiologists used sT1WI and conventional T1WI on separate occasions to independently measure clinically relevant brain morphological parameters. The reliability and consistency between conventional and synthetic T1WI were assessed using statistical consistency checks, comprising intra-reader, inter-reader, and inter-method agreement. Results: The intra-reader, inter-reader, and inter-method reliability and variability mostly exhibited the desired performance, except for several poor agreements due to measurement differences between the radiologists. All the measurements of sT1WI were equivalent to that of T1WI at 5% equivalent intervals. Conclusion: This study demonstrated the equivalence of CT-based sT1WI to conventional T1WI for quantitatively assessing brain morphology, thereby providing more information on imaging diagnosis with a single CT scan. Clinical relevance statement: Real-time synthesis of MR images from CT scans reduces the time required to acquire MR signals, improving the efficiency of the treatment planning system and providing benefits in the clinical diagnosis of patients with contraindications such as presence of metal implants or claustrophobia. Key Points: • Deep learning–based image synthesis methods generate synthetic T1-weighted imaging from CT scans. • The equivalence of synthetic T1-weighted imaging and conventional MRI for quantitative brain assessment was investigated. • Synthetic T1-weighted imaging can provide more information per scan and be used in preoperative diagnosis and radiotherapy. [ABSTRACT FROM AUTHOR]

In the biomedical field, the commonly used metal implant materials are prone to "stress shielding" because of their mechanical properties and elastic modulus are very different from human bone. The mechanical properties of metal materials are often difficult to maintain in corrosive media and release harmful ions. Nor can it reliably establish a sufficient combination with human bones, resulting in a service life that does not reach the desired goal. Researchers in this field propose to combine the superior mechanical properties of metals with bioactive materials, such as bioactive ceramics and the emerging ferrous glass, and achieve this through surface modification techniques. The laser cladding technique is of great interest for its low dilution rate, high bond strength and fine organisation. This review paper describes the development of common medical metal materials and the research progress of laser cladding surface modification technology. [ABSTRACT FROM AUTHOR]

Temporary metal implants, made from materials like titanium (Ti) or stainless steel, can cause metabolic issues, raise toxicity levels within the body, and negatively impact the patient's long-term health. This necessitates a subsequent operation to extract these implants once the healing process is complete or when they are outgrown by the patient. In contrast, medical devices fabricated from absorbable alloys have the advantage of being biodegradable, allowing them to be naturally absorbed by the body once they have fulfilled their role in facilitating tissue healing. Among the various absorbable alloy systems studied, magnesium (Mg) alloys stand out due to their biocompatibility, mechanical properties, and corrosion behavior. The existing literature on absorbable Mg alloys highlights the effectiveness of silicon (Si) and zinc (Zn) additions in improving mechanical properties and controlling corrosion susceptibility; however, there is a lack of comprehensive quantitative morphological analysis of the intermetallic phases within these alloy systems. The quantification of the complex morphology of intermetallic particles is a challenging task and has significant implications for the micromechanical properties of the alloys. This study, therefore, aims to introduce a robust set of morphometric parameters for evaluating the morphology of intermetallic phases within two as-cast Mg alloys with Si and Zn additions. X-ray Computed Tomography (XCT) was used to capture the 3D tomographic data of the alloys, and a novel pair of morphological parameters (ratio of convex hull to particle volume and convex hull sphericity) was applied to the 3D tomographic data to assess the MgZn phase formed in the two alloys. In addition to the impact of composition, the effect of solidification rate on the morphological parameters was also studied. Furthermore, Scanning Electron Microscopy (SEM) and Energy-Dispersive Spectroscopy (EDS) were employed to gather detailed 2D microstructural and compositional information on the intermetallics. The comprehensive characterization reveals that the morphological complexity and size distribution of the MgZn phase are influenced by both compositional changes and the solidification rate. However, the change in MgZn intermetallic particle morphology with size was found to follow a predictable trend, which was relatively agnostic of the chosen casting conditions. [ABSTRACT FROM AUTHOR]

Purpose: Fluid‐sensitive turbo spin echo (TSE) MRI with short‐TI inversion‐recovery preparation for fat suppression (STIR) plays a critical role in the diagnostics of the musculoskeletal system (e.g., close to metal implants). Potential advantages of 3D acquisitions, however, are difficult to exploit due to long acquisition times. Shortening the TR incurs a signal loss, and a driven‐equilibrium (DE) extension reduces fluid signal even further. Methods: The phase of the flip‐back pulse was changed by 180° relative to the conventional implementation (i.e., 90° along the positive x‐axis (90°x) instead of −90°x). After signal modeling and numerical simulations, the modification was implemented in STIR‐TSE sequences and tested on a clinical 3T system. Imaging was performed in the lumbar spine, and long‐TR images without DE were acquired as reference. CSF SNR and fluid‐muscle contrast were measured and compared between the sequences. Imaging was repeated in a metal implant phantom. Results: A shortening of TR by 43%–57% reduced the CSF SNR by 39%–59%. A conventional DE module further reduced SNR to 26%–40%, whereas the modified DE recovered SNR to 59%–108% compared with the long‐TR acquisitions. Fluid‐tissue contrast was increased by about 340% with the modified DE module compared with the conventional extension. Similar results were obtained in implant measurements. Conclusions: The proposed DE element for TSE‐STIR sequences has the potential to accelerate the acquisition of fluid‐sensitive images. DE‐STIR may work most efficiently for 3D acquisitions, in which no temporo‐spatial interleaving of inversion and imaging pulses is possible. [ABSTRACT FROM AUTHOR]

This work aimed to characterize a dedicated phantom for assessing the dose near metal implants for radiotherapy with photons and protons. A dosimetry audit phantom was redesigned to position a Gafchromic EBT-3 film within a bisected titanium pedicle screw (6.5 mm diameter). The mass density and the water equivalent thickness (WET) of the phantom material were determined. The phantom was irradiated using a photon arc and a horizontal proton beam in combination with a couch rotation of 20°, with three repeated measurements each. Treatment plans utilizing a single field covering the screw and the EBT-3 film were optimized to deliver a physical dose of 2 Gy using a collapsed cone and Monte Carlo dose engine for photons and protons, respectively. The mass density and the WET of the phantom were determined as (1.033 ± 0.010) gcm-3 and (1.022 ± 0.013), respectively. Ionisation chamber measurements agreed within 1% (photons) and 0.5% (protons) with the calculated dose values. Relative photon dosimetry measurements using EBT-3 films revealed an agreement between measured and calculated horizontal profiles within the confidence interval for areas beyond 5 mm from the center. For photon plans, significant deviations of more than 10% were found at the interfaces between phantom material and screw. The proton measurements showed a gradual decrease of 3% across both profiles. In contrast to photon plans, no dose increase was measured within the screw, but significant dose fluctuations (>5%) in the beam's exit region. This study showed that the behavior of dose engine is affected by metal implants and thus dosimetric measurements are highly recommended. The presented phantom can serve as foundation for dedicated end-2-end phantoms. [ABSTRACT FROM AUTHOR]

Background: Computed tomography (CT) is widely in clinics and is affected by metal implants. Metal segmentation is crucial for metal artifact correction, and the common threshold method often fails to accurately segment metals. Purpose: This study aims to segment metal implants in CT images using a diffusion model and further validate it with clinical artifact images and phantom images of known size. Methods: A retrospective study was conducted on 100 patients who received radiation therapy without metal artifacts, and simulated artifact data were generated using publicly available mask data. The study utilized 11,280 slices for training and verification, and 2,820 slices for testing. Metal mask segmentation was performed using DiffSeg, a diffusion model incorporating conditional dynamic coding and a global frequency parser (GFParser). Conditional dynamic coding fuses the current segmentation mask and prior images at multiple scales, while GFParser helps eliminate high-frequency noise in the mask. Clinical artifact images and phantom images are also used for model validation. Results: Compared with the ground truth, the accuracy of DiffSeg for metal segmentation of simulated data was 97.89% and that of DSC was 95.45%. The mask shape obtained by threshold segmentation covered the ground truth and DSCs were 82.92% and 84.19% for threshold segmentation based on 2500 HU and 3000 HU. Evaluation metrics and visualization results show that DiffSeg performs better than other classical deep learning networks, especially for clinical CT, artifact data, and phantom data. Conclusion: DiffSeg efficiently and robustly segments metal masks in artifact data with conditional dynamic coding and GFParser. Future work will involve embedding the metal segmentation model in metal artifact reduction to improve the reduction effect. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to compare the surgical and non-operative management of displaced radial head fractures via a network meta-analysis of randomised controlled trials (RCTs). Methods: RCTs comparing management of isolated, displaced radial head fractures in adults were included in our review and statistical analysis. A systematic review of electronic databases (Medline, Embase and Cochrane Library) were screened for comparative RCTs reporting on the management of displaced radial head fractures in August 2021. Two investigators independently reviewed studies for eligibility and an assessment of bias was performed for each study. A Bayesian network meta-analysis of the included RCTs was performed. Results: Five RCTs (326 patients) were included in our meta-analysis. Treatment methods included radial head arthroplasty (RHA), open reduction internal fixation (ORIF) with metal implants (ORIF-M), ORIF with biodegradable implants (ORIF-B) and non-operative management. In our network meta-analysis of 'good' or 'excellent' patient-reported outcome measures (PROMs), RHA was significantly favourable to ORIF-M (OR: 0.04, CrI: 0.0011, 0.87), ORIF-B (OR: 0.1 CrI: 0.00076, 6.37). Nonoperative treatment was not shown to be significantly worse than RHA (OR: 0.01 CrI: 2.5e–0.5, 3.61). Conclusions: This network meta-analysis shows that in displaced radial head fractures, RHA is associated with significantly superior functional PROMs than ORIF-M based on the evidence available. Nonoperative management has not been shown to be significantly worse. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Although rare, allergic reactions to metal implants represent a diagnostic challenge in view of missing guidelines. Objectives: To develop an European expert consensus on characteristics of metal allergy reactions and the utility of various diagnostic tools in suspected metal implant allergy. Methods: A nominal group technique (NGT) was applied to develop consensus statements. Initially an online literature database was created on a secure server to enable a comprehensive information. Twenty‐three statements were formulated on potential aspects of metal implant allergy with a focus on diagnostics and grouped into five domains. For the consensus development, the panel of 12 experts initially did refine and reformulate those statements that were ambiguous or had unclear wording. By face‐to‐face (9/12) or virtual participation (3/12), an anonymous online voting was performed. Results: Consensus (≥80% of agreement) was reached in 20/23 statements. The panel agreed that implant allergy despite being rare should be considered in case of persistent unexplained symptoms. It was, however, recommended to allow adequate time for resolution of symptoms associated with healing and integration of an implant. Obtaining questionnaire‐aided standardized medical history and standardized scoring of patient outcomes was also considered an important step by all experts There was broad consensus regarding the utility/performance of patch testing with additional late reading. It was recognized that the lymphocyte transformation test (LTT) has to many limitations to be generally recommended. Prior to orthopaedic implant, allergy screening of patients without a history of potential allergy to implant components was not recommended. Conclusions: Using an expert consensus process, statements concerning allergy diagnostics in suspected metal implant allergy were created. Areas of nonconsensus were identified, stressing uncertainty among the experts around topics such as preoperative testing in assumed allergy, histological correlate of periimplant allergy and in vitro testing, which underscores the need for further research. [ABSTRACT FROM AUTHOR]

Background: Pediatric forearm fractures represent a substantial proportion of childhood injuries, requiring effective and minimally invasive treatments. Our study investigated the mid-term outcomes of biodegradable poly-L-lactide-co-glycolide (PLGA) intramedullary implants in managing diaphyseal forearm fractures in children. Methods: A follow-up cohort study was conducted with 38 patients treated with PLGA implants. Control examinations were performed one year post-operation, assessing bone healing through radiographic evaluations and functional outcomes using injured and uninjured limb range of motion (ROM) comparisons. Scarring was evaluated employing the Vancouver Scar Scale (VSS), and satisfaction via a questionnaire. Results: Children were predominantly female (76.4%), with a mean age of 9.71 (SD: 2.69) years. Effective fracture stabilization and bone healing were found in all patients, with a minor reduction (mean difference of −1.5°, p = 0.282) in elbow flexion on the operated side (139.3°) compared to the intact (140.8°). Elbow extension presented negligible average changes (0.2°, p = 0.098). Forearm movements were slightly reduced on the operated side (mean pronation: 80.8° vs. 83.7°, p = 0.166; average supination: 83.5° vs. 85.7°, p = 0.141). Wrist palmar flexion and dorsiflexion showed no significant differences. VSS ratings indicated minimal scarring (mean guardian and doctor scores were 1.13 and 0.55, respectively, p = 0.020), and all patients reported satisfaction with the treatment outcomes. Conclusions: Biodegradable implants are effective for pediatric forearm fractures, providing stable bone healing while preserving functional ROM with minimal scarring and high patient satisfaction. PLGA proved to be a viable alternative to traditional metal implants, eliminating secondary removal surgeries. [ABSTRACT FROM AUTHOR]

Nickel(Ni)-containing materials have been widely used in a wide range of medical applications, including orthopaedics. Despite their excellent properties, there is still a problem with the release of nickel ions into the patient's body, which can cause changes in the behaviour of surrounding cells and tissues. This study aims to evaluate the effects of Ni on bone cells with an emphasis on the determination of Ni localization in cellular compartments in time. For these purposes, one of the most suitable models for studying the effects induced by metal implants was used—the patient's osteoarthritic cells. Thanks to this it was possible to simulate the pathophysiological conditions in the patient's body, as well as to evaluate the response of the cells which come into direct contact with the material after the implantation of the joint replacement. The largest differences in cell viability, proliferation and cell cycle changes occurred between Ni 0.5 mM and 1 mM concentrations. Time-dependent localization of Ni in cells showed that there is a continuous transport of Ni ions between the nucleus and the cytoplasm, as well as between the cell and the environment. Moreover, osteoarthritic osteoblasts showed faster changes in concentration and ability to accumulate more Ni, especially in the nucleus, than physiological osteoblasts. The differences in Ni accumulation process explains the higher sensitivity of patient osteoblasts to Ni and may be crucial in further studies of implant-derived cytotoxic effects. [ABSTRACT FROM AUTHOR]

Ti6Al4V superalloy is recognized as a good candidate for bone implants owing to its biocompatibility, corrosion resistance, and high strength-to-weight ratio. While dense metal implants are associated with stress shielding issues due to the difference in densities, stiffness, and modulus of elasticity compared to bone tissues, the surface of the implant/scaffold should mimic the properties of the bone of interest to assure a good integration with a strong interface. In this study, we investigated the additive manufacturing of porous Ti6Al4V scaffolds and coating modification for enhanced osteoconduction using osteoblast cells. The results showed the successful fabrication of porous Ti6Al4V scaffolds with adequate strength. Additionally, the surface treatment with NaOH and Dopamine Hydrochloride (DOPA) promoted the formation of Dopamine Hydrochloride (DOPA) coating with an optimized coating process, providing an environment that supports higher cell viability and growth compared to the uncoated Ti6Al4V scaffolds, as demonstrated by the higher proliferation ratios observed from day 1 to day 29. These findings bring valuable insights into the surface modification of 3D-printed scaffolds for improved osteoconduction through the coating process in solutions. [ABSTRACT FROM AUTHOR]

The evolution of three dimensional (3D) printed porous metallic biomaterials and their clinical applications are currently receiving much consideration. Many research works have been focused on the shaping by 3D printing of lightweight metal implants with improved mechanical properties. In the same way, the effect of surface finishes on roughness and porosity distribution on biological properties is still debated. Therefore, several factors need to be addressed and revisited in this context. This review focuses on the importance of porous metallic implant design and its relationship with biological and mechanical properties. First, the additive manufacturing (AM) techniques for bio-inert metals and alloys will be discussed. The review will then introduce the most efficient surface treatments and coating approaches for biomedical porous metals to enhance bone tissue regeneration, prevent corrosion, reduce revision surgery and improve implant lifetime. A critical study of the various parameters impacting the biological properties will also be carried out in this review. [ABSTRACT FROM AUTHOR]

TiZrNbMo coatings have been deposited using the direct current pulsed magnetron sputtering method in an argon atmosphere. The synthesis processes have been conducted under various process parameters. The structure (chemical and phase composition) and mechanical properties of the obtained multicomponent coatings are investigated as a function of plasma modulation frequency (10 Hz and 1000 Hz) and substrate bias (0 to −150 V). It is the case that an increase in the substrate bias decreases the deposition rate and alters the coating's chemical composition. The latter leads to a Ti concentration decrease and a simultaneous increase in Mo and Nb concentrations in the final coating material. X-ray diffraction measurements indicate a single-phase BCC structure, with grain size decreasing as substrate bias increases. This ultimately forms an amorphous–nanocrystalline structure at −150 V. The mechanical properties of the multicomponent TiZrNbMo coatings have been determined using the nanoindentation method. The maximum values of hardness (13.45 GPa) and elastic modulus (188.6 GPa) are achieved at a substrate bias of −150 V. We also show that the minimum elastic modulus (41.8 GPa) is achieved at an intermediate substrate bias of −100 V. [ABSTRACT FROM AUTHOR]

Metal-implant associated bacterial infections are a major clinical problem due to antibiotic treatment failure. As an alternative, we determined the effects of bacteriophage ISP on clinical isolates of Staphylococcus aureus in various stages of its life cycle in relation to biofilm formation and maturation. ISP effectively eliminated all planktonic phase bacteria, whereas its efficacy was reduced against bacteria attached to the metal implant and bacteria embedded within biofilms. The biofilm architecture hampered the bactericidal effects of ISP, as mechanical disruption of biofilms improved the efficacy of ISP against the bacteria. Phages penetrated the biofilm and interacted with the bacteria throughout the biofilm. However, most of the biofilm-embedded bacteria were phage-tolerant. In agreement, bacteria dispersed from mature biofilms of all clinical isolates, except for LUH15394, tolerated the lytic activity of ISP. Lastly, persisters within mature biofilms tolerated ISP and proliferated in its presence. Based on these findings, we conclude that ISP eliminates planktonic phase Staphylococcus aureus while its efficacy is limited against bacteria attached to the metal implant, embedded within (persister-enriched) biofilms, and dispersed from biofilms. [ABSTRACT FROM AUTHOR]

Patellar fractures represent approximately 1% of all fractures and the pattern is influenced by the quality of the bone and the energy of the trauma. Transverse fractures are associated with extensor mechanism failure and interruption of joint congruence. Patellar fractures are generally fixed using tension band principles, through K-wires and metal cerclage. The tension band was conceived to transform the considerable tensile force applied to the patella into a compressive one to obtain a stable fixation. The use of metal implants might be associated with a significant discomfort, mostly related to the irritating action of K-wires and cerclage on the surrounding soft tissues, often leading to the need for implant removal. Therefore, we introduced an original technique for fix patellar fractures by using only a non-adsorbable braided polyblend suture. Postoperative care included progressive range of motion recovery using an articulated knee brace and a specific protocol. The suture-only tension band technique seems to be a useful technique in terms of complications and reoperation rate while allowing secure and early mobilization. [ABSTRACT FROM AUTHOR]

Titanium (Ti), as a hard tissue implant, is facing a big challenge for rapid and stable osseointegration owing to its intrinsic bio-inertness. Meanwile, surface-related infection is also a serious threat. In this study, large-scale quasi-vertically aligned sodium titanate nanowire (SNW) arrayed coatings incorporated with bioactive Cu2+ ions were fabricated through a compound process involving acid etching, hydrothermal treatment (HT), and ion exchange (IE). A novel coating based on sustained ion release and a shape-preserving design is successfully obtained. Cu2+ substituted Na+ in sodium titanate lattice to generate Cu-doped SNW (CNW), which maintains the micro-structure and phase components of the original SNW, and can be efficiently released from the structure by immersing them in physiological saline (PS) solutions, ensuring superior long-term structural stability. The synergistic effects of the acid etching, bidirectional cogrowth, and solution-strengthening mechanisms endow the coating with higher bonding strengths. In vitro antibacterial tests demonstrated that the CNW coatings exhibited effective good antibacterial properties against both Gram-positive and Gram-negative bacteria based on the continuous slow release of copper ions. This is an exciting attempt to achieve topographic, hydrophilic, and antibacterial activation of metal implants, demonstrating a paradigm for the activation of coatings without dissolution and providing new insights into insoluble ceramic-coated implants with high bonding strengths. [ABSTRACT FROM AUTHOR]

The prevalence of total knee arthroplasty (TKA) is increasing with the aging population. Although long-term results are satisfactory, suspected postoperative complications often require imaging with the implant in place. Advancements in computed tomography (CT), such as tin prefiltration, metal artifact reduction algorithms, dual-energy CT with virtual monoenergetic imaging postprocessing, and the application of cone-beam CT and photon-counting detector CT, allow a better depiction of the tissues adjacent to the metal. For magnetic resonance imaging (MRI), high bandwidth (BW) optimization, the combination of view angle tilting and high BW, as well as multispectral imaging techniques with multiacquisition variable-resonance image combination or slice encoding metal artifact correction, have significantly improved imaging around metal implants, turning MRI into a useful clinical tool for patients with suspected TKA complications. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM) enables patient-specific lattice-based implants with porosity engineered to encourage bone ingrowth and to mimic bone's mechanical stiffness. The strength of the bone-implant interface can be measured through a destructive 'push-out' testing. The aim of this study is to explore the effect of implant-bone stiffness ratio (γ) on the push-out force using numerical simulation and a small experimental study. Numerical simulations of an implant-bone interface during a push-out test showed a fundamental change of failure mode for γ ranging from 0.1 to 10. For the geometry considered, the largest push-out forces were predicted for γ ≈ 0.7, essentially doubling the push-out force compared to a solid titanium implant. The experimental and simulation results also demonstrated that using an intermediate stiffness metal implant lattice geometry, γ ≈ 1.35, does not significantly improve the peak force of the push-out test compared to the solid implant. For the experimental study, critical-sized defects were simulated via robotic bone resection in the right lateral distal femur of a group of ~ 2.5-year-old healthy sheep, and then solid or lattice-based Ti6Al4V implants inserted. The femurs were harvested 6 months after implantation. Nine of the implanted femurs (six solid and three lattice-based) were used for fixation testing. The experimental study showed no significant difference in push-out force between a solid and moderately stiff lattice metal implant as indicated by the numerical simulation. [ABSTRACT FROM AUTHOR]

One of the main therapeutic problems worldwide is the restoration of cartilaginous lesions in order to prevent osteoarthritis which can lead to heavy and high‐cost joint replacement operations with metal implants. In situations where large cartilage lesions occur, the only solution is the transplantation of autologous cells such as chondrocytes or mesenchymal cells. These transplants require the use of scaffolds that are derived from various animals or even synthetic materials, acting as carriers of the above‐mentioned cells. In the context of this study, an integrated system is introduced aiming to rapidly design and fabricate customized 3D‐printed scaffolds, which are constructed from biomaterials, providing that way a valuable solution to their production as well as eliminating the need for multiple operations. The main idea is the employment of a stereoscopic endoscope during the arthroscopy operation extracting stereoscopic images of the investigated area in order to perform a 3D reconstruction of the cartilage lesion area prior and after the surgeon's operation. The fusion of the preoperative images (magnetic resonance imaging [MRI] for organic tissue and computed tomography [CT] for synthetic phantoms) with the captured stereoscopic images allows the formulation of an appropriate 3D model of the scaffold. In addition, the physical model of the scaffold is manufactured with the aid of a sterilized 3D printer utilizing biomaterials, such as polycaprolactone (PCL), chitosan, etc. Finally, the 3D printed scaffold is impregnated with autologous cells and inserted into the cartilage lesion during the arthroscopy operation saving precious time and reducing the overall rehabilitation cost. [ABSTRACT FROM AUTHOR]

Computer-aided design (CAD) models can now be directly converted into products and structures. One technique to realize such approach is through Additive Manufacturing (AM). AM is relatively new manufacturing technology in which products are manufactured by layering various materials like rubber, metal, ceramic, composites, and polymers. However, the use of this technology requires consideration of its associated cost to ensure its competitiveness. In this paper, a simplified mathematical cost model is suggested. The model considers the main components of costs. The model formula utilizes expenses related to the pre-processing, main processing, and the post-processing operations. To validate the model, it is tested to estimate the cost of medical implants manufacturing using AM technique. In many cases, medical implants require unique or dedicated design for each patient. Hence cost estimation will help to assess and estimate the required financial resources for such operations. A case study is provided in this paper to estimate the manufacturing cost of a finger's phalanges bone, with metal implant using AM technique. The developed model may be described as Activity Based Costing (ABC). The model is introduced to estimate the cost of parts produced using AM technique. Although the model is developed to suit custom implant manufacturing using AM technique, its use may also be adapted to suit the manufacturing of many other parts and products. The developed model is aiming to achieve several tasks namely assigning cost drivers to each activity, estimating the cost of individual actions, allocating overhead expenses, calculating the overall production cost, and establishing an acceptable selling price. It assists companies in computing the cost of custom implants for customers, enhancing the accuracy of production cost estimates, and ultimately boosting profitability. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro–Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: Angular and longitudinal deformities of leg alignment create excessive stresses across joints, leading to pain and impaired function. Multiple measurements are used to assess these deformities on anteroposterior (AP) full-length radiographs. An artificial intelligence (AI) software automatically locates anatomical landmarks on AP full-length radiographs and performs 13 measurements to assess knee angular alignment and leg length. The primary aim of this study was to evaluate the agreements in LLD and knee alignment measurements between an AI software and two board-certified radiologists in patients without metal implants. The secondary aim was to assess time savings achieved by AI. Methods: The measurements assessed in the study were hip-knee-angle (HKA), anatomical-tibiofemoral angle (aTFA), anatomical-mechanical-axis angle (AMA), joint-line-convergence angle (JLCA), mechanical-lateral-proximal-femur-angle (mLPFA), mechanical-lateral-distal-femur-angle (mLDFA), mechanical-medial-proximal-tibia-angle (mMPTA), mechanical-lateral-distal-tibia- angle (mLDTA), femur length, tibia length, full leg length, leg length discrepancy (LLD), and mechanical axis deviation (MAD). These measurements were performed by two radiologists and the AI software on 164 legs. Intraclass-correlation-coefficients (ICC) and Bland–Altman analyses were used to assess the AI's performance. Results: The AI software set incorrect landmarks for 11/164 legs. Excluding these cases, ICCs between the software and radiologists were excellent for 12/13 variables (11/13 with outliers included), and the AI software met performance targets for 11/13 variables (9/13 with outliers included). The mean reading time for the AI algorithm and two readers, respectively, was 38.3, 435.0, and 625.0 s. Conclusion: This study demonstrated that, with few exceptions, this AI-based software reliably generated measurements for most variables in the study and provided substantial time savings. [ABSTRACT FROM AUTHOR]

Background: Concern of metal sensitization in pre- and postsurgical evaluation is growing, with the recent guidelines remaining the criterion standard for consideration of patch testing. Information remains scarce on surgical screening in the groups of patients who reported a history of metal sensitivity versus those with no reported history. Objective: The objective of this study was to assess the utility of patch testing in surgical candidates based on reported metal allergy history. The secondary objective was to evaluate the utility and outcomes in postsurgical patch testing. Methods: Nine hundred and thirty-one patient charts of patients with the diagnosis of “contact dermatitis” who underwent an evaluation at a single allergy clinic site between January 2013 and December 2022 were identified and reviewed as part of a retrospective chart review study. Patients were included in subgroups based on the time of patch testing and history of reported metal allergy. Results: In all, 67 patients underwent patch testing, 10 (14.9%) of whom were surgical candidates without a history of metal sensitivity, 31 (46.2%) of whom were surgical candidates with a history of metal sensitivity, and 26 (38.8%) of whom were postsurgical patients. Twenty-nine (43.3%) of patients had positive patch testing results, with only one (10%) in the presurgical group, 17 (54.8%) in the presurgical with a history of metal sensitivity, and 11 (42.3%) in the postsurgical group. Zero patients in our cohort without metal sensitivity who were undergoing the Nuss procedure had positive reactions on patch testing, whereas two of four (50%) with reported metal sensitivity who were undergoing the Nuss procedure had positive relevant metal reactions. Conclusion: Ambiguity in the utility of patch testing for surgical decision making remains, despite common utilization. Recent guidelines along with coordination of care among the surgeon, allergist, and patient remains the criterion standard of care. [ABSTRACT FROM AUTHOR]

This article provides an overview of several allergic disorders and their challenges for allergist-immunologists. It covers topics such as hereditary angioedema, asthma patients' allergen reactivity patterns, upper-airway diseases, bronchiectasis, and metal implant allergy. The authors emphasize the importance of understanding the complexities of allergy and immunology for patient care, and discuss the diagnosis and management of these conditions. The article also includes information on patch testing in surgical decision-making, an accelerated induction protocol for Hymenoptera venom immunotherapy, and the lack of information on amphotericin B desensitization protocols in pediatric patients. Additionally, it mentions a case presentation involving the evaluation and treatment of a 16-year-old boy with a drug allergy. The text aims to provide clinicians with timely information to improve patient management and outcomes. [Extracted from the article]

Fixation plates are crucial to ensure the fracture site remains stable and prevent any movement that could widen the gap between broken bones, ultimately promoting the healing process of the bone. Topological optimization is a solution to increase the strength-to-mass ratio and produce lightweight metal implants with less stiffness to reduce stress shielding. Laser-Directed Energy Deposition (L-DED) is a 3d printing method to fabricate objects with near-net shapes. However, the manufactured implants' surface quality is still a major issue and further leads to an increase in the release of metal ions, which can cause inflammation and infection and lead to screw loosening. The current study aims to design and develop the topologically optimized fixation plate to reduce stress shielding further fabricated and polished by the L-DED and H-ECMR super polishing method, respectively. Herein, the H-ECMR super finishing method reduced the Ra value of the manufactured parts to 29.26 nm. [ABSTRACT FROM AUTHOR]

BACKGROUND: Micro-arc oxidation can effectively add bioactive elements to the metal surface and improve the anti-bacterial and anti-inflammatory properties of biomedical metal materials, so this technology has become one of the hotspots of biomedical materials. OBJECTIVE: To summarize the anti-bacterial and anti-inflammatory properties of surface coatings prepared by the combination of micro-arc oxidation and other surface modification technologies. METHODS: Articles from January 1996 to December 2022 were searched on CNKI, WanFang and PubMed databases using Chinese and English search terms “micro-arc oxidation, antibacterial properties, anti-inflammatory properties, metal implants”. After preliminary screening according to inclusion and exclusion criteria, 89 articles were retained and summarized. RESULTS AND CONCLUSION: The ceramic layer prepared by micro-arc oxidation can improve the anti-bacterial and anti-inflammatory properties of titanium, magnesium and other alloys. Combination with other surface modification technologies can effectively solve the effect of pores on the surface properties of the alloy, and further improve the biological properties of the oxide film. It has a wide application prospect in orthopedics and dentistry. At present, most studies are limited to metal coatings, and most of them focus on metal elements with good antibacterial properties such as silver and copper, while only a few studies mention non-metallic coatings such as graphene oxide, hydroxyapatite and chitosan. In the future, extensive studies can be conducted on inorganic coatings and polymer coatings, and more combinations of different bioactive elements can also be adopted to improve antibacterial properties. Currently, studies on the inflammation of implant coatings prepared by micro-arc oxidation are mostly limited to the immune system and focused on macrophages, while studies on neutrophils and platelets are scarce. In the future, a variety of advanced technologies should be combined to explore the specific effects of micro-arc oxidation coating on other immune cells and inflammatory cells. [ABSTRACT FROM AUTHOR]

Objective. To demonstrate that complete cone beam CT (CBCT) scans from both MV-energy and kV-energy LINAC sources can reduce metal artifacts in radiotherapy guidance, while maintaining standard-of-care x-ray doses levels. Approach. MV-CBCT and kV-CBCT scans are acquired at half normal dose. The impact of lowered dose on MV-CBCT data quality is mitigated by the use of a 4-layer MV-imager prototype and reduced LINAC energy settings (2.5 MV) to improve photon capture. Additionally, the MV-CBCT is used to determine the 3D position and pose of metal implants, which in turn is used to guide model-based poly-energetic correction and interleaving of the kV-CBCT and MV-CBCT data. Certain edge-preserving regularization steps incorporated into the model-based correction algorithm further reduce MV data noise. Main results. The method was tested in digital phantoms and a real pelvis phantom with large 2.5″ spherical inserts, emulating hip replacements of different materials. The proposed method demonstrated an appealing compromise between the high contrast of kV-CBCT and low artifact content of MV-CBCT. Contrast-to-noise improved 3-fold compared to MV-CBCT with a clinical 1-layer architecture at matched dose (37 mGy) and edge blur levels. Visual delineation of the bladder and prostate improved noteably over kV- or MV-CBCT alone. Significance. The proposed method demonstrates that a full MV-CBCT scan can be combined with kV-CBCT to reduce metal artifacts without resorting to complicated beam collimation strategies to limit the MV-CBCT dose contribution. Additionally, significant improvements in CNR can be achieved as compared to metal artifact reduction through current clinical MV-CBCT practices. [ABSTRACT FROM AUTHOR]

Objective: To compare the image quality of low-dose CT (LD-CT) with tin filtration of the lumbar spine after metal implants to standard clinical CT, and to evaluate the potential for metal artifact and dose reduction. Materials and methods: CT protocols were optimized in a cadaver torso. Seventy-four prospectively included patients with metallic lumbar implants were scanned with both standard CT (120 kV) and tin-filtered LD-CT (Sn140kV). CT dose parameters and qualitative measures (1 = worst,4 = best) were compared. Quantitative measures included noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and the width and attenuation of the most prominent hypodense metal artifact. Standard CT and LD-CT were assessed for imaging findings. Results: Tin-filtered LD-CT was performed with 60% dose saving compared to standard CT (median effective dose 3.22 mSv (quartile 1–3: 2.73–3.49 mSv) versus 8.02 mSv (6.42–9.27 mSv; p <.001). Image quality of CT and tin-filtered low-dose CT was good with excellent depiction of anatomy, while image noise was lower for CT and artifacts were weaker for tin-filtered LD-CT. Quantitative measures also revealed increased noise for tin-filtered low-dose CT (41.5HU), lower SNR (2) and CNR (0.6) compared to CT (32HU,3.55,1.03, respectively) (all p <.001). However, tin-filtered LD-CT performed superior regarding the width and attenuation of hypodense metal artifacts (2.9 mm and -767.5HU for LD-CT vs. 4.1 mm and -937HU for CT; all p <.001). No difference between methods was observed in detection of imaging findings. Conclusion: Tin-filtered LD-CT with 60% dose saving performs comparable to standard CT in detection of pathology and surgery related complications after lumbar spinal instrumentation, and shows superior metal artifact reduction. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM) permits sustainable production of personalized load‐bearing metal implants with complex structures. Regulations prescribe that implants have to meet strict requirements to not harm patients, and production technique should allow the certification of their performance. Process, materials, operating parameters, and customization to patient's needs could limit AM. Layer‐by‐layer material deposition and repeated thermal cycles may make outer surface of AM implants chemically and physically uneven and rough, eliciting biological response of host tissue and hindering therapeutic success. In this paper, we discuss the clinical challenges that AM must overcome to replace traditional techniques in implant and prostheses design. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM) of load‐bearing metal implants allows sustainable production of personalized implants with complex shapes and inner architectures. Implants must meet strict requirements to not harm patients, and production technique must certify their performance. Available materials, many production parameters and implant personalization on patient's needs represent limits of AM. Layer‐by‐layer material deposition and repeated thermal cycles typical of AM may also cause discontinuities between layers affecting implant mechanical features, and its match to the host body. In this paper the mechanical challenges that AM must overcome to replace traditional manufacturing techniques are discussed, in order to better understand whether AM has to be limited to implant personalization for exceptional cases. [ABSTRACT FROM AUTHOR]

Despite a long period of application of metal implants, carbon–carbon medical composites are also widely used for bone defect prosthesis in surgery, dentistry, and oncology. Such implants might demonstrate excellent mechanical properties, but their biocompatibility and integration efficiency into the host should be improved. As a method of enhancing, the electrophoretic deposition of fine-dispersed hydroxyapatite (HAp) on porous carbon substrates might be recommended. With electron microscopy, energy dispersion X-ray and Raman spectroscopy, and X-ray diffraction, we found that the deposition and subsequent heat post-treatment (up to the temperature of 400 °C for 1 h) did not lead to any significant phase and chemical transformations of raw non-stoichometric HAp. The Ca/P ratio was ≈1.51 in the coatings. Their non-toxicity, cyto- and biocompatibility were confirmed by in vitro and in vivo studies and no adverse reactions and side effects had been detected in the test. The proposed coating and subsequent heat treatment procedures provided improved biological responses in terms of resorption and biocompatibility had been confirmed by histological, magnetic resonance and X-ray tomographic ex vivo studies on the resected implant-containing biopsy samples from the BDF1 mouse model. The obtained results are expected to be useful for modern medical material science and clinical applications. [ABSTRACT FROM AUTHOR]

Due to their outstanding mechanical properties and biocompatibility, additively manufactured titanium porous structures are extensively utilized in the domain of medical metal implants. Implants frequently undergo cyclic loading, underscoring the significance of predicting their fatigue performance. Nevertheless, a fatigue life model tailored to additively manufactured titanium porous structures is currently absent. This study employs multiple linear regression, artificial neural networks, support vector machines, and random forests machine learning models to assess the impact of structural and mechanical factors on fatigue life. Four standard maximum likelihood models were trained, and their predictions were compared with fatigue experiments to validate the efficacy of the machine learning models. The findings suggest that the fatigue life is governed by both the fatigue stress and the overall yield stress of the porous structures. Furthermore, it is recommended that the optimal combination of hyperparameters involves setting the first hidden layer of the artificial neural network model to three or four neurons, establishing the gamma value of the support vector machine model at 0.0001 with C set to 30, and configuring the n_estimators of the random forest model to three with max_depth set to seven. [ABSTRACT FROM AUTHOR]

The study investigated the use of patch testing with sodium tetrachloropalladate (Na2PdCl4) and palladium chloride (PdCl2) to detect palladium sensitization in patients. Results showed a higher proportion of positive reactions to Na2PdCl4 compared to PdCl2, with a significant number of clinically relevant reactions. The study suggests that Na2PdCl4 at 3% pet. is more suitable for detecting palladium sensitization due to its increased concentration of palladium and diagnostic performance. The findings align with previous studies indicating the higher sensitivity of Na2PdCl4 compared to PdCl2 in detecting palladium sensitization. [Extracted from the article]

A 58-year-old male developed a generalised rash and keratoderma after receiving a hip replacement containing titanium. Despite initial treatments, his condition worsened, leading to a diagnosis of allergic contact dermatitis to titanium. After a hip revision surgery, his symptoms improved significantly, highlighting the importance of considering metal allergies in cases of unexplained skin reactions to implants. The case study underscores the need for clear guidelines on titanium patch testing to improve diagnostic accuracy in similar situations. [Extracted from the article]

Background: To compare the potential of various bone evaluations by considering photon-counting CT (PCCT) and multiple energy-integrating-detector CT (EIDCT), including three dual-energy CT (DECT) scanners with standardized various parameters in both standard resolution (STD) and ultra-high-resolution (UHR) modes. Methods: Four cadaveric forearms were scanned using PCCT and five EIDCTs, by applying STD and UHR modes. Visibility of bone architecture, image quality, and a non-displaced fracture were subjectively scored against a reference EIDCT image by using a five-point scale. Image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were also compared. To assess metal artifacts, a forearm with radial plate fixation was scanned by with and without Tin filter (Sn+ and Sn−), and virtual monoenergetic image (VMI) at 120 keV was created. Regarding Sn+ and VMI, images were only obtained from the technically available scanners. Subjective scores and the areas of streak artifacts were compared. Results: PCCT demonstrated significantly lower noise (p < 0.001) and higher bone SNR and CNR (p < 0.001) than all EIDCTs in both resolution modes. However, there was no significant difference between PCCT and EIDCTs in almost all subjective scores, regardless of scan modes, except for image quality where a significant difference was observed, compared to several EIDCTs. Metal artifact analysis revealed PCCT had larger artifact in Sn− and Sn+ (p < 0.001), but fewer in VMIs than three DECTs (p < 0.001 or 0.001). Conclusions: Under standardized conditions, while PCCT had almost no subjective superiority in visualizing bone structures and fracture line when compared to EIDCTs, it outperformed in quantitative analysis related to image quality, especially in lower noise and higher tissue contrast. When using PCCT to assess cases with metal implants, it may be recommended to use VMIs to minimize the possible tendency for artifact to be pronounced. [ABSTRACT FROM AUTHOR]