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BACKGROUND: Calcium phosphate (CaP) coatings are widely used to improve the integration of titanium implants into bone but these coatings are associated with risks of infection. It is thus desirable to confer antibacterial properties to CaP coatings. OBJECTIVE: To prepare CaP-MgO composite coatings by impregnating magnesium oxide (MgO) sol into CaP coatings and assess the in vitro antibacterial activities and cytocompatibility. METHODS: An electrolyte was determined by titration and used for CaP coating electrodeposition on titanium (referred to as Ti-CaP). MgO was impregnated into the coating by immersing in an MgO sol with different mass fractions (15%, 30%, 50%) and subsequently calcined to form MgO-CaP composite coatings, which were recorded as Ti-CaP-15Mg, Ti-CaP-30Mg and Ti-CaP-50Mg, respectively. Microstructure, tensile properties, critical load, and Mg2+ release of coatings in vitro were characterized. Antibacterial activity was assayed using spread plate method by culturing S. aureus on the pure titanium sheet surface and Ti-CaP, Ti-Cap-15mg, Ti-Cap-30mg and Ti-Cap-50mg surfaces for 24 and 48 hours. Mouse osteoblast suspension was inoculated on pure titanium sheets and Ti-CaP, Ti-CaP-15Mg, Ti-CaP-30Mg and Ti-CaP-50Mg coated titanium sheets, respectively. Cell proliferation was detected by CCK-8 assay, and cell survival rate was calculated. The morphology of composite coating soaked in DMEM was also observed. RESULTS AND CONCLUSION: (1) Homogeneous, microporous CaP coatings consisting of octacaclium phosphate crystal flakes were prepared on titanium by electrodeposition. After sol impregnation-calcination, MgO aggregates were filled into the inter-flake voids. The extent of MgO filling and Mg concentration in the coating increased with the number of sol impregnation procedures. When immersed in phosphate buffered saline, all composite coatings actively released Mg2+ within 1 day; subsequently, the Mg2+ release slowed down on day 3. A small amount of Mg2+ release was still detected on day 7. The yield strength, tensile strength and fracture growth rate of Ti-CaP-30Mg coated titanium were not significantly different from those of pure titanium (P > 0.05). There was no significant difference in the critical load of Ti-CaP, Ti-CaP-15Mg, Ti-CaP-30Mg and Ti-CaP-50Mg groups (P > 0.05). (2) Except that pure titanium sheet and Ti-CaP had no antibacterial properties, the other samples had good antibacterial properties, and the antibacterial rate increased with the increase of MgO content in the coating. (3) After 1 and 3 days of co-culture, the cell survival rate of Ti-CaP-15Mg, Ti-CaP-30Mg and Ti-CaP-50Mg groups was lower than that of pure titanium group and Ti-CaP group (P < 0.05). After 5 and 7 days of culture, there was no significant difference in cell survival rate among five groups (P > 0.05). The content of MgO in the coating decreased gradually with the time of immersion in the medium. (4) The MgO sol impregnation added antibacterial properties to the CaP coatings while retained their biocompatibility. [ABSTRACT FROM AUTHOR]

It is imperative to enhance the mechanical properties and corrosion resistance of magnesium (Mg)-based metallic glasses for orthopedic implants to further their development. The addition of yttrium (Y) significantly improves both of these characteristics. The Mg52.5Zn40.5Ca5Y2 alloy was chosen for its optimal glass-forming capabilities, as evidenced by thermodynamic parameter, PHHS. This alloy demonstrates remarkable enhancements in both mechanical and corrosion properties, despite the presence of a stable Mg12YZn phase in the liquid, which precludes the complete formation of glass. The Mg52.5Zn40.5Ca5Y2 alloy exhibits a substantial increase in hardness, surpassing the Mg66Zn30Ca4 metallic glass by up to 30 HV. The compressive strength of this alloy is 690 MPa, which is approximately 138 MPa greater than that of the Mg66Zn30Ca4 alloy. The Mg52.5Zn40.5Ca5Y2 alloy exhibits a higher noble corrosion potential and a lower corrosion current density demonstrating a corrosion current density of 6.970 µA/cm2 and a corrosion potential of − 1.240 V. These values suggest a significant increase in corrosion resistance when contrasted with the baseline alloy, Mg66Zn30Ca4. The primary cause of this improvement in mechanical behavior and corrosion resistance is the formation of Mg12YZn long-period stacking ordered (LPSO) phases and Mg3YZn6 icosahedral phases. The material's overall strength and durability are enhanced by these phases, rendering it a promising candidate for applications that necessitate high performance in both mechanical and corrosive environments. As per the results, Mg52.5Zn40.5Ca5Y2 alloy is an exceptional choice for advanced material applications due to its distinctive phase composition, which results in superior properties. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abrasive water suspension jet (AWSJ) machining on carbon fiber-reinforced polymer (CFRP) composite-based orthopedic implants yielded insightful results based on experimental data and subsequent statistical validations. Underwater AWSJ cutting consistently outperformed free air cutting, with numerical findings demonstrating its superiority. For instance, at #100 abrasive size and 5 mm standoff distance (SOD), the material removal rate (MRR) peaked at 2.44 g/min with a kerf width of 0.89 mm and a surface roughness (SR) of 9.25 µm. Notably, the increase in abrasive size correlated with higher MRR values, such as achieving 2.15 g/min at #120 grit and 3 mm SOD. Furthermore, optimization techniques like the Taguchi method and response surface methodology (RSM) were applied to refine machining parameters. These methodologies enhanced MRR, exemplified by achieving 2.10 g/min with #120 abrasive size and 5 mm SOD in underwater cutting conditions. The research explored the impact of key process parameters, namely, the speed, feed, and SOD on the MRR, kerf width, and SR in both free air cutting and underwater cutting conditions, which is one of the novel research endeavors in the domain of abrasive jet machining of composites.

Inadequate osseointegration at the interface is a key factor in orthopedic implant failure. Mechanistically, traditional orthopedic implant interfaces fail to precisely match natural bone regeneration processes in vivo. In this study, a novel biomimetic coating on titanium substrates (DPA‐Co/GFO) through a mussel adhesion‐mediated ion coordination and molecular clicking strategy is engineered. In vivo and in vitro results confirm that the coating exhibits excellent biocompatibility and effectively promotes angiogenesis and osteogenesis. Crucially, the biomimetic coating targets the integrin α2β1 receptor to promote M2 macrophage polarization and achieves a synergistic effect between immunomodulation and vascularized bone regeneration, thereby maximizing osseointegration at the interface. Mechanical push‐out tests reveal that the pull‐out strength in the DPA‐Co/GFO group is markedly greater than that in the control group (79.04 ± 3.20 N vs 31.47 ± 1.87 N, P < 0.01) and even surpasses that in the sham group (79.04 ± 3.20 N vs 63.09 ± 8.52 N, P < 0.01). In summary, the novel biomimetic coating developed in this study precisely matches the natural process of bone regeneration in vivo, enhancing interface‐related osseointegration and showing considerable potential for clinical translation and applications. [ABSTRACT FROM AUTHOR]

Using orthopedic devices or prosthetic joints to treat various conditions is expected in a Traumatology and Orthopedics Unit. Recently, the materials used to build these different devices have evolved; however, pathogens can still infect these materials. Additionally, the immune system has limitations when defending against these pathogens, which results in bacterial infections like Staphylococcus aureus, Methicillin-susceptible Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA). A total of 276 patients who attended the Traumatology and Orthopedics Unit of our hospital from 1 June 2018 to 1 June 2019, were included in the present study. Our study analyzed the incidence of S. aureus and other bacterial pathogens in the surgical sites of patients with orthopedic implants, as well as the most used types of implants and implant materials. The specimens obtained from the surgical sites of the patients were cultured in anaerobic and aerobic media for subsequent identification using their phenotypic characteristics. Subsequently, antibiotic susceptibility tests were performed to establish the appropriate treatment. The primary pathogens identified were Staphylococcus aureus (26.4%), followed by Escherichia coli (21.0%) and Staphylococcus epidermidis (15.8%). The most commonly used implants were plates (41.7%), followed by endomedullary nails (20%), Kirschner wires (14.1%), and fixators (10.1%). As for the anatomical regions of the implants, the most frequent sites were the legs, followed by the thighs, wrists, and ankles. The pathogens were more susceptible to ciprofloxacin (95%), clindamycin (89%), and cefotaxime (86%). S. aureus is the primary infectious agent in our hospital, with an incidence of 26.4% after the placement of orthopedic implants. Although its incidence was lower compared to other tertiary hospitals, it is necessary to improve aseptic techniques in such a way as to reduce the incidence of this pathogen further. [ABSTRACT FROM AUTHOR]

Diamond-like carbon (DLC) films on titanium alloy Ti6Al4V substrates were tested with nanoindentation and surface roughness to look at the hardness and roughness of the coating and substrate systems as well as their mechanical properties. The powdered titanium alloy Ti6Al4V used in the substrate specimen was produced using laser powder bed fusion, an additive manufacturing process. In this study, we investigated the influence of substrates on the nanoindentation and surface roughness of the DLC film layer with an estimated 2.21μm thickness on Ti6Al4V substrates. The findings of the nanoindentation show that the reaction to the impact was more flexible than expected. Maximum load, residual nanoindentation depth, hardness, and modulus may influence mechanical properties. The DLC-film Ti6Al4V substrate materials’ top surface roughness is measured. As a result of the increased load-carrying ability of DLC/Ti6Al4V, Ti6Al4V is a superior choice for substrate materials for DLC films, A DLC coating, measuring 2.21μ m in thickness, was applied to a Ti6Al4V substrate utilizing a 5-min chromium deposition process. The biocompatibility of the substrates plays a crucial role in determining the DLC films capacity to prolong the lifespan of bone implants. [ABSTRACT FROM AUTHOR]

For orthopedic implants, biocompatibility is essential to ensure that they integrate with biological systems without causing negative reactions or impairing tissue function. Orthopedic implants must be cellularly acceptable to interact with neighboring tissues, including muscle, cartilage, and bone. Implant materials should not cause cytotoxic reactions or inflammatory responses that might hinder healing or result in long-term inflammation. Progress in surface engineering and biomaterials science is discovering implants that work well with the body, benefiting patients in the long run. The biocompatibility of orthopedic implants, their interaction with surrounding tissues, and the potential for biological problems are all important aspects of their design and operation. Orthopedic implants must be successful and long-lasting to ensure biocompatibility, promote osseointegration (osteointegration), avoid biofilm development, and consider the patient's biological environment. This paper discusses biocompatibility in orthopedic implants, its advancements, and challenges. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pulsed electromagnetic field is a non-invasive and non-radiative treatment method. Clinical use of pulsed electromagnetic fields in the treatment of orthopedic diseases has achieved certain results. OBJECTIVE: To review the current clinical application of the pulsed electromagnetic field in the treatment of orthopedic diseases, providing a scientific theoretical basis for the clinical treatment of orthopedic diseases. METHODS: The first author used a computer to search PubMed, CBM, Cochrane Library, CNKI, and WanFang Data for related studies on the pulsed electromagnetic field in the treatment of orthopedic diseases, using the keywords of “pulsed electromagnetic field, orthopedics, osteoarthritis, osteoporosis, bone healing, electromagnetic navigation” in English and Chinese. For the literature related to the same content, recent publications were selected. A total of 69 articles were selected from the search results for review. RESULTS AND CONCLUSION: Pulsed electromagnetic field has a definite curative effect on fracture healing. It can be used in the treatment of osteomyelitis by antibacterial, bactericidal, anti-inflammatory and promoting bone healing, and can inhibit osteoporosis and its progress. In addition, the treatment of early osteoarthritis, femoral head necrosis and postoperative rehabilitation of late joint replacement through various ways can become a treatment for orthopedic diseases. However, the therapeutic mechanism of the pulsed electromagnetic field for a variety of orthopedic diseases is still unclear, and most of the research is still in the primary stage. In the future, it is still necessary to obtain more reliable evidence from high-quality research and clinical trials to provide a more perfect basis for the clinical treatment of orthopedic diseases. [ABSTRACT FROM AUTHOR]

In this paper, the in vivo behavior of orthopedic implants covered with thin films obtained by matrix-assisted pulsed laser evaporation and containing bioactive glass, a polymer, and natural plant extract was evaluated. In vivo testing was performed by carrying out a study on guinea pigs who had coated metallic screws inserted in them and also controls, following the regulations of European laws regarding the use of animals in scientific studies. After 26 weeks from implantation, the guinea pigs were subjected to X-ray analyses to observe the evolution of osteointegration over time; the guinea pigs' blood was collected for the detection of enzymatic activity and to measure values for urea, creatinine, blood glucose, alkaline phosphatase, pancreatic amylase, total protein, and glutamate pyruvate transaminase to see the extent to which the body was affected by the introduction of the implant. Moreover, a histopathological assessment of the following vital organs was carried out: heart, brain, liver, and spleen. We also assessed implanted bone with adjacent tissue. Our studies did not find significant variations in biochemical and histological results compared to the control group or significant adverse effects caused by the implant coating in terms of tissue compatibility, inflammatory reactions, and systemic effects. [ABSTRACT FROM AUTHOR]

The alternative Ti-6Al-7Nb alloy has gained extensive progression due to its ability to eliminate the cytotoxicity of vanadium (V) in Ti-6Al-4V alloy for orthopedic implants. The production of titanium alloys by centrifugal casting shows significant potential to reduce costs. Heat treatment and aging can tailor the microstructure and improve the corrosion resistance of titanium alloys. This study examines the effects of various ageing times on the microstructure and corrosion resistance of a centrifugal cast Ti-6Al-7Nb alloy that has previously been heated and treated at a temperature of 1050 °C, and subsequently cooled to room temperature in argon atmosphere gas. Ageing was carried out at a temperature of 550 °C with variable times of 0, 4, 6, and 8 hours. The surface morphology, metal phase changes, and electrochemical characterization were tested using an optical microscope (OM), X-ray diffraction (XRD), potentiodynamic polarization (PDP), and electrochemical impedance spectroscopy (EIS). The basket-weave microstructure is formed where globularization occurs in some phases as ageing time increases. Increasing the FWHM α value is correlated with increasing the amount of α′ martensite phase. As an ageing time enhances, the temperature might offer a greater driving constrain for the nucleation and expansion of the lamellar phase (α). Ageing of 8 hours has the lowest corrosion rate, 0.0023 mpy and highest corrosion resistance, 90457 Ω∙cm², due to the partially bimodal structure and grain refinement with a smallest grain size of 327.87 µm. Tafel polarization results show that all passivated samples are stable in the Solution Body Fluid (SBF). This work can be used as a starting point for developing microstructural evolution in titanium alloys [ABSTRACT FROM AUTHOR]

AbstractPorous implants reduce stress-shielding within implanted bones. Body-centered-cubic (BCC) and cubic cellular structures were investigated in this study to mimic bone properties. For this purpose, CAD models (7 BCC and 7 cubic) with 50% to 80% porosity were designed and 3D-printed. Morphological analysis revealed minor dimensional deviations between the CAD and the 3D-printed models. Using finite element analysis, experimental approach, and regression analysis, an ideal porosity range to mimic the mechanical properties of bone has been established. Lattices with a porosity of 60%–65% and 50%–55% for cubic and BCC, respectively, can emulate the mechanical properties of cortical bones. [ABSTRACT FROM AUTHOR]

Magnesium composites stay relevant for the applications of biodegradable implant as they are harmless and possess characteristics such as density and elastic modulus analogous to the cortical bone in humans. But corrosion is one major issue associated with magnesium when the biomedical applications are contemplated. Moreover, load bearing abilities are also required in case of an orthopedic implant. In this study, to achieve the desired implant characteristics, hybrid nanocomposites (HNCs) of Mg–2.5Zn binary alloys such as metal matrix, hydroxyapatite (HAp), and reduced graphene oxide (rGO) as reinforcements were fabricated via the vacuum-assisted stir casting method. The overall weight percentage of the reinforcements was fixed at 3% and both the reinforcements varied in compositions by weight to prepare the samples S0 (Pure Magnesium), S1 (Mg–2.5Zn–0.5HAp–2.5rGO), S2 (Mg–2.5Zn–1.0HAp–2.0rGO), S3 (Mg–2.5Zn–1.5HAp–1.5rGO), S4 (Mg–2.5Zn–2.0HAp–1.0rGO), and S5 (Mg–2.5Zn–2.5HAp–0.5rGO), respectively. The influence of mechanical characteristics such as tensile strength, compressive strength, and microhardness as well as the corrosion over the surface of the nanocomposite in simulated body fluid (SBF) have been assessed for their suitability as biodegradable orthopedic implants. Results suggest that the fabricated nanocomposites exhibit superior characteristics in comparison to pure magnesium. Increasing the HAp from 0.5 wt.% to 2.5 wt.% enhanced the compressive strength and reduced the corrosion rate. On the other hand, increasing the rGO from 0.5 wt.% to 1.5 wt.% increased the tensile strength. The formation of apatite layer over the composites is observed in the SBF solution. Among all the fabricated hybrid nanocomposite samples, the sample S3 (Mg–2.5Zn–1.5HAp–1.5rGO) with equal wt.% of HAp and rGO exhibited 209.60 MPa of ultimate tensile strength, 300.1 MPa of ultimate compressive strength, and a corrosion rate of 0.91 mm/year thus making it the best suited and a prospective material for biodegradable implant application. [ABSTRACT FROM AUTHOR]

Abstract Inadequate osseointegration at the interface is a key factor in orthopedic implant failure. Mechanistically, traditional orthopedic implant interfaces fail to precisely match natural bone regeneration processes in vivo. In this study, a novel biomimetic coating on titanium substrates (DPA‐Co/GFO) through a mussel adhesion‐mediated ion coordination and molecular clicking strategy is engineered. In vivo and in vitro results confirm that the coating exhibits excellent biocompatibility and effectively promotes angiogenesis and osteogenesis. Crucially, the biomimetic coating targets the integrin α2β1 receptor to promote M2 macrophage polarization and achieves a synergistic effect between immunomodulation and vascularized bone regeneration, thereby maximizing osseointegration at the interface. Mechanical push‐out tests reveal that the pull‐out strength in the DPA‐Co/GFO group is markedly greater than that in the control group (79.04 ± 3.20 N vs 31.47 ± 1.87 N, P < 0.01) and even surpasses that in the sham group (79.04 ± 3.20 N vs 63.09 ± 8.52 N, P < 0.01). In summary, the novel biomimetic coating developed in this study precisely matches the natural process of bone regeneration in vivo, enhancing interface‐related osseointegration and showing considerable potential for clinical translation and applications.

Metallic screws are one of the most common implants in orthopedics. However, the solid design of the screw has often resulted in stress shielding and postoperative loosening, substantially impacting its long-term fixation effect after surgery. Four additive manufacturing porous structures (Fischer-Koch S, Octet, Diamond, and Double Gyroid) are now introduced into the screw to fix those issues. Upon applying the four porous structures, elastic modulus in the screw decreased about 2∼15 times to reduce the occurrence of stress shielding, and bone regeneration effect on the screw surface increased about 1∼50 times to improve bone tissue regrowing. With more bone tissue regrowing on the inner surface of porous screw, a stiffer integration between screw and bone tissue will be achieved, which improves the long-term fixation of the screw tremendously. The biofunctions of the four topologies on osteogenesis have been fully explored, which provides an advanced topology optimization scheme for the screw utilized in orthopedic fixation.

ABSTRACT Intramedullary nails are the focus of scientific studies in small animal orthopedic surgery because the use of these materials in fractures of immature, small-sized patients, and in proximal bone regions is challenging. In this context, elastic osteosynthesis has been strongly advocated for the treatment of patients under four months of age. Therefore, the objective of this study was to report two cases of non-exposed complete fractures of proximal femurs in felines, resulting from trauma, both patientes under six months of age, treated with the elastic technique using a locked intramedullary nail. Both cases were treated through a surgical approach to the fracture site using the "open, but don't touch" method. In both cases, the bone consolidation process occurred in less than 60 days, along with satisfactory and early patient ambulation. Given the advocated osteosynthesis technique in the two patients and the promising results obtained, it is admitted that the use of locked intramedullary nails is a viable alternative for the treatment of proximal bone fractures in young felines.

This review summarizes recent progress on nanocellulose and its composite materials as emerging biomaterials for orthopedic implant applications. The three main types of nanocellulose - cellulose nanocrystals (CNCs), cellulose nanofibrils (CNFs) and bacterial nanocellulose (BNC) possess exceptional mechanical properties exceeding traditional implant materials like metals, ceramics and polymers. Their high strength, stiffness, porosity, surface area, hydrophilicity and biocompatibility make nanocellulose well-suited as a scaffold material for bone regeneration. This review covers the fabrication of nanocellulose-based composites with ceramics and polymers to further enhance their mechanical performance and bioactivity. Various methods are utilized to develop nanocellulose implants and scaffolds with controlled architecture optimized for bone ingrowth. In vitro studies demonstrate nanocellulose supports stem cell osteogenic differentiation and growth. In vivo results in animal models show bone regeneration in critical sized defects, though challenges remain in vascularization. While further research is required to control degradation and scale up manufacturing, nanocellulose has strong potential to address limitations of current orthopedic implants as the next generation of high performance biomaterials. This review provides a comprehensive perspective on the state-of-the-art in nanocellulose materials for advanced orthopedic implants.

This review summarizes recent progress on nanocellulose and its composite materials as emerging biomaterials for orthopedic implant applications. The three main types of nanocellulose - cellulose nanocrystals (CNCs), cellulose nanofibrils (CNFs) and bacterial nanocellulose (BNC) possess exceptional mechanical properties exceeding traditional implant materials like metals, ceramics and polymers. Their high strength, stiffness, porosity, surface area, hydrophilicity and biocompatibility make nanocellulose well-suited as a scaffold material for bone regeneration. This review covers the fabrication of nanocellulose-based composites with ceramics and polymers to further enhance their mechanical performance and bioactivity. Various methods are utilized to develop nanocellulose implants and scaffolds with controlled architecture optimized for bone ingrowth. In vitro studies demonstrate nanocellulose supports stem cell osteogenic differentiation and growth. In vivo results in animal models show bone regeneration in critical sized defects, though challenges remain in vascularization. While further research is required to control degradation and scale up manufacturing, nanocellulose has strong potential to address limitations of current orthopedic implants as the next generation of high performance biomaterials. This review provides a comprehensive perspective on the state-of-the-art in nanocellulose materials for advanced orthopedic implants. [ABSTRACT FROM AUTHOR]

With continued declines in reimbursement for total joint arthroplasty, health systems have explored implant cost containment measures to generate sustainable margins. This review evaluated how implementation of (1) implant price control programs, (2) vendor purchasing agreements, and (3) bundled payment models affected implant costs and physician autonomy in implant selection. PubMed, EBSCOhost, and Google Scholar were searched to identify studies that evaluated the efficacy of total hip or total knee arthroplasty implant selection strategies. The review included publications between January 1, 2002, and October 17, 2022. The mean Methodological Index for Nonrandomized Studies score was 18.3 ± 1.8. A total of 13 studies (32,197 patients) were included. All studies implementing implant price capitation programs found decreased implant costs, ranging 2.2 to 26.1% and increased utilization of premium implants. Most studies found bundled payments models reduced total joint arthroplasty implant costs with greatest reduction being 28.9%. Additionally, while absolute single vendor agreements had higher implant costs, preferred single vendor agreements had reduced implant costs. When given price constraints, surgeons tended to select more premium implants. Alternative payment models that incorporated implant selection strategies saw reduced costs and surgeon utilization of premium implants. The study findings encourage further research on implant selection strategies, which must balance the goals of cost containment with physician autonomy and optimized patient care. Level III. [ABSTRACT FROM AUTHOR]

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.

Implant infection is one of the most common and serious complications in orthopedics, and it is also an important reason for the failure of implant surgery. When bacteria form a biofilm on the implant surface, it is extremely difficult to be eliminated and attracts more bacteria and fungi. A large number of studies have shown that the use of surface modification technology can effectively reduce the adhesion and accumulation of pathogenic bacteria, thereby preventing peri-implant infection. The formation process of bacterial biofilm on the surface of orthopedic implants and the antibacterial mechanism of metal antibacterial agents were first analyzed. Then, some of the most widely used metal-based inorganic antibacterial coatings at home and abroad and their related preparation processes were reviewed, the problems and improvement methods in the application of these coatings were also discussed, and the development direction of inorganic antibacterial coatings in the future was prospected, such as synergistic antibacterial coatings and bone-promoting antibacterial coatings.

Using orthopedic devices or prosthetic joints to treat various conditions is expected in a Traumatology and Orthopedics Unit. Recently, the materials used to build these different devices have evolved; however, pathogens can still infect these materials. Additionally, the immune system has limitations when defending against these pathogens, which results in bacterial infections like Staphylococcus aureus, Methicillin-susceptible Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA). A total of 276 patients who attended the Traumatology and Orthopedics Unit of our hospital from 1 June 2018 to 1 June 2019, were included in the present study. Our study analyzed the incidence of S. aureus and other bacterial pathogens in the surgical sites of patients with orthopedic implants, as well as the most used types of implants and implant materials. The specimens obtained from the surgical sites of the patients were cultured in anaerobic and aerobic media for subsequent identification using their phenotypic characteristics. Subsequently, antibiotic susceptibility tests were performed to establish the appropriate treatment. The primary pathogens identified were Staphylococcus aureus (26.4%), followed by Escherichia coli (21.0%) and Staphylococcus epidermidis (15.8%). The most commonly used implants were plates (41.7%), followed by endomedullary nails (20%), Kirschner wires (14.1%), and fixators (10.1%). As for the anatomical regions of the implants, the most frequent sites were the legs, followed by the thighs, wrists, and ankles. The pathogens were more susceptible to ciprofloxacin (95%), clindamycin (89%), and cefotaxime (86%). S. aureus is the primary infectious agent in our hospital, with an incidence of 26.4% after the placement of orthopedic implants. Although its incidence was lower compared to other tertiary hospitals, it is necessary to improve aseptic techniques in such a way as to reduce the incidence of this pathogen further.

Graft fixation during cruciate ligament reconstruction using interference screws is a common and frequently used surgical technique. These interference screws are usually made of metal or bioabsorbable materials. This paper describes the development of an allograft interference screw from cortical human bone. During the design of the screw, particular attention was paid to the choice of the screw drive and the screw shape, as well as the thread shape. Based on these parameters, a prototype was designed and manufactured. Subsequently, the first biomechanical tests using a bovine model were performed. The test procedure comprised a torsion test to determine the ultimate failure torque of the screw and the insertion torque during graft fixation, as well as a pull-out test to asses the ultimate failure load of the graft fixation. The results of the biomechanical analysis showed that the mean value of the ultimate failure torque was 2633 N m m , whereas the mean occurring insertion torque during graft fixation was only 1125 N m m. The mean ultimate failure load of the graft fixation was approximately 235 N. The results of this work show a good overall performance of the allograft screw compared to conventional screws, and should serve as a starting point for further detailed investigations and studies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Materials Engineering / Cailiao Gongcheng is the property of Journal of Materials Engineering Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this paper, the in vivo behavior of orthopedic implants covered with thin films obtained by matrix-assisted pulsed laser evaporation and containing bioactive glass, a polymer, and natural plant extract was evaluated. In vivo testing was performed by carrying out a study on guinea pigs who had coated metallic screws inserted in them and also controls, following the regulations of European laws regarding the use of animals in scientific studies. After 26 weeks from implantation, the guinea pigs were subjected to X-ray analyses to observe the evolution of osteointegration over time; the guinea pigs’ blood was collected for the detection of enzymatic activity and to measure values for urea, creatinine, blood glucose, alkaline phosphatase, pancreatic amylase, total protein, and glutamate pyruvate transaminase to see the extent to which the body was affected by the introduction of the implant. Moreover, a histopathological assessment of the following vital organs was carried out: heart, brain, liver, and spleen. We also assessed implanted bone with adjacent tissue. Our studies did not find significant variations in biochemical and histological results compared to the control group or significant adverse effects caused by the implant coating in terms of tissue compatibility, inflammatory reactions, and systemic effects.

Polyether-ether-ketone (PEEK) is increasingly becoming popular in medicine because of its excellent mechanical strength, dimensional stability, and chemical resistance properties. However, PEEK being bioinert, has weak bone osseointegration properties, limiting its clinical applications. In this study, a porous PEEK structure was developed using a chemical etching method with 98 wt% sulfuric acids and three post-treatments were performed to improve bone cell adhesion and proliferation. Four groups of PEEK samples were prepared for the study: Control (untreated; Group 1); Etched with sulfuric acid and washed with distilled water (Group 2); Etched with sulfuric acid and washed with acetone and distilled water (Group 3); and Etched with sulfuric acid and washed with 4 wt% sodium hydroxide and distilled water (Group 4). Surface characterization of the different groups was evaluated for surface topology, porosity, roughness, and wettability using various techniques, including scanning electron microscopy, profilometer, and goniometer. Further chemical characterization was done using Energy-dispersive X-ray spectroscopy to analyze the elements on the surface of each group. Bone cell studies were conducted using cell toxicity and alkaline phosphatase activity (ALP) assays. The SEM analysis of the different groups revealed porous structures in the treatment groups, while the control group showed a flat topology. There was no statistically significant difference between the pore size within the treated groups. This was further confirmed by the roughness values measured with the profilometer. We found a statistically significant increase in the roughness from 7.22 × 10−3 μm for the control group to the roughness range of 0.1 µm for the treated groups (Groups 2–4). EDX analysis revealed the presence of a 0.1% weight concentration of sodium on the surface of Group 4, while sulfur weight percentage concentration was 1.1%, 0.1%, and 1.4% in groups 2, 3, and 4, respectively, indicating different surface chemistry on the surface due to different post-treatments. Cell toxicity decreased, and ALP activity increased in groups 3 and 4 over 7 days compared with the control group. It is demonstrated that the surface modification of PEEK using a chemical etching method with post-processing with either acetone or sodium hydroxide provides a nano-porous structure with improved properties, leading to enhanced osteoblastic cell differentiation and osteogenic potential.

3D printed porous titanium cage is believed with physiology mechanical properties and biocompatibility for orthopedic usage. Typical split cage design with a grafting window and infilled bone graft has raised a lot of questions. In this research, a modified hydrothermal approach, employing chelated calcium to enhance the medium stability and increase the generated amount, is proposed to construct bioactive hydroxyapatite coating inside the porous structure of 3D printed porous titanium cage. The in vitro and transcriptomic results indicated the hydroxyapatite enhanced the cells physical sensing system, therefore enhanced the osteogenesis inside titanium/hydroxyapatite cage. The in vivo goat spinal fusion experiment indicated the integrative titanium/hydroxyapatite cage, compared with typical split cage/graft cage, showed better bone tissue ingrowth and spinal fusion ability. This research provides a promising hydroxyapatite coating strategy for complex porous structure and revealed the potential advantage of integrative titanium/hydroxyapatite intervertebral cage design.

Featured Application: Prediction of orthopedic implant stability, particularly pedicle screws, as an index comparable to insertion torque. To prevent pedicle screw implant failure, a diagnostic technique that allows surgeons to evaluate implant stability easily, quickly, and quantitatively in clinical orthopedic situations is required. This study aimed to predict the insertion torque equivalent to laboratory-level evaluation accuracy. This serves as an index of the implant stability of pedicle screws placed in cadaveric bone, which relies on laser resonance frequency analyses (L-RFA) when irradiating with two types of lasers. The machine learning analysis was optimized using a dataset with artificial bone as teaching data. In this analysis, many explanatory variables extracted from the laser-induced vibration spectra obtained during an analysis/RFA evaluation were predicted by selecting important variables using the least absolute shrinkage and selection operator and performing a non-linear approximation using support vector regression. It was found that combining both artificial and cadaveric bone data with the bone densities as teaching data dramatically improved the determination coefficient from R2 = −0.144 to R2 = 0.858 as the prediction accuracy and reduced the influence of differences between artificial and cadaveric bones. This technology will contribute to the development of preventive diagnostic technologies that can be used during surgery, which is necessary in order to further advance treatment technologies. [ABSTRACT FROM AUTHOR]

Calcium phosphate/Bioglass composite coatings on AISI 316L were investigated with regard to their potential role as a beneficial coating for orthopedic implants. These coatings were realized by the galvanic co-deposition of calcium phosphate compounds and Bioglass particles. A different amount of Bioglass 45S5 was used to study its effect on the performance of the composite coatings. The morphology and chemical composition of the coatings were investigated before and after their aging in simulated body fluid. The coatings uniformly covered the AISI 316L substrate and consisted of a brushite and hydroxyapatite mixture. Both phases were detected using X-ray diffraction and Raman spectroscopy. Additionally, both analyses revealed that brushite is the primary phase. The presence of Bioglass was verified through energy-dispersive X-ray spectroscopy, which showed the presence of a silicon peak. During aging in simulated body fluid, the coating was subject to a dynamic equilibrium of dissolution/reprecipitation with total conversion in only the hydroxyapatite phase. Corrosion tests performed in simulated body fluid at different aging times revealed that the coatings made with 1 g/L of Bioglass performed best. These samples have a corrosion potential of −0.068V vs. Ag/AgCl and a corrosion current density of 8.87 × 10−7 A/cm2. These values are better than those measured for bare AISI 316L (−0.187 V vs. Ag/AgCl and 2.52 × 10−6 A/cm2, respectively) and remained superior to pure steel for all 21 days of aging. This behavior indicated the good protection of the coating against corrosion phenomena, which was further confirmed by the very low concentration of Ni ions (0.076 ppm) released in the aging solution after 21 days of immersion. Furthermore, the absence of cytotoxicity, verified through cell viability assays with MC3T3-E1 osteoblastic cells, proves the biocompatibility of the coatings. [ABSTRACT FROM AUTHOR]

Objectives: Orthopedic implants have improved the quality of life in aging society but also induces several kinds of tissue reactions, referred to as orthopedic implant hypersensitivity (OIH). The aim of our study is to report the clinical characteristics of OIH and the effects of photobiomodulation therapy (PBMT) on these groups of patients. Materials and Methods: We collected cases that complained of skin rashes with pruritus after orthopedic implants from January 2017 to June 2022 at the Dermatology clinic in Hualien Tzu Chi Hospital. We recorded the sites and material of orthopedic implants, skin lesions onset time, symptoms, location after implantation, and the disease duration. Laboratory tests were measured, including complete blood count, differential count, serum immunoglobulin E (IgE) level, as well as inflammatory and autoimmune markers. PBMT, including UVB311 nm or low-level laser therapy 808 nm, was performed. Dose, duration, and response were documented. Results: Fourteen patients were diagnosed with OIH; twelve presented with localized eczema at the implant sites, and two with generalized eczema. Eleven patients (78.6%) had either elevated eosinophils percentage (>6%) or IgE level (>200 U/mL) or both. Seven patients (50%) had favorable outcome after PBMT and successfully withdrew from systemic steroid. Conclusion: In our case series, localized eczema at implant sites was a common cutaneous presentation in OIH. Hence, a surgical scar at the eczema site or long-term waxing and waning generalized eczema should prompt physicians on the possibility of OIH. Blood eosinophils percentage and serum IgE level can be reference biomarkers for OIH. PBMT provides a noninvasive and effective treatment strategy for immune regulation and tissue regeneration.

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.

In recent years, zinc alloys have shown great potential as orthopedic plant materials because of their excellent biocompatibility, osteoinductive and biodegradation activities in vivo. The physiological function, degradation rate and mechanical properties of pure zinc were introduced in this review. Taking the gap between the above indicators and the clinical needs of orthopedics as the clue and the alloy elements as the classification basis, the existing achievements of researchers to improve the properties of zinc-based materials by changing the microstructure of materials and triggering the corresponding strengthening mechanism, and using the physiological synergistic function of added elements were expounded in this paper. The standard formulation, alloy design improvement and the introduction of new technologies such as additive manufacturing in the field of medical zinc based materials were discussed in order to meet the diversified needs of clinical diagnosis and treatment.

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.

This study aims to develop novel low-modulus, corrosion-resistant Ti-based alloys with enhanced antimicrobial properties for bone-related implant applications. Novel β-type (Ti–45Nb)-based alloys with minor additions of the antibacterial elements Ga and/or Cu (up to 4 wt.%) were produced by a two-step casting process followed by homogenization treatment. Three nominal compositions (Ti–45Nb)96-4 Ga, (Ti–45Nb)96–4Cu and (Ti–45Nb)96-2 Ga–2Cu (wt.%) were prepared based on alloy design approach using [Mo]eq and electron per atom (e/a) ratio. The influence of Ga and/or Cu addition on the phase constitution, mechanical response and corrosion characteristics in simulated body fluids (PBS, 37.5 °C) has been investigated. X-ray diffraction studies displayed a single β phase structure for all alloys, with an observed lattice contraction evidenced by the reduction of lattice parameters during Rietveld analysis. Homogenous equiaxed microstructures with grain sizes ranging from 55 μm up to 323 μm were observed for (Ti–45Nb)96-4 Ga, (Ti–45Nb)96-2 Ga–2Cu and (Ti–45Nb)96–4Cu alloys. The alloys displayed excellent plasticity with no cracking, or fracturing during compression tests. Their tensile strength, Young's modulus, maximum tensile strain and elastic energy were measured in the ranges of 544–681 MPa, 73–78 GPa, 17–28% and 2.5–3.7 MJ/m3, in the order (Ti–45Nb)96-4 Ga > (Ti–45Nb)96-2 Ga–2Cu > (Ti–45Nb)96–4Cu. In addition, it has been observed that micro-alloying Ti–Nb alloy with Ga and/or Cu posed no deleterious effect on the corrosion resistance in simulated body fluid conditions. The improvement in strength of the developed alloys has been discussed based on grain boundary and solid-solution strengthening, whereas the improved plasticity is attributed to work hardening.

Titanium (Ti) is a popular biomaterial for orthopedic implant applications due to its superior mechanical properties such as corrosion resistance and low modulus of elasticity. However, around 10% of these implants fail annually due to bacterial infection and poor osseointegration, resulting in severe pain and suffering for the patients. To improve their performance, nanoscale surface modification approaches and doping of trace elements on the surfaces can be utilized which may help in improving cell adhesion for better osseointegration while reducing bacterial infection. In this work, at first, titania (TiO2) nanotube arrays (NT) were fabricated on commercially available pure Ti surfaces via anodization. Then zinc (Zn) doping was conducted following two distinct methods: hydrothermal and alkaline heat treatment. Scanning electron microscopic (SEM) images of the prepared surfaces revealed unique surface morphologies, while energy dispersive X-ray spectroscopy (EDS) revealed Zn distribution on the surfaces. Contact angle measurements indicated that NT surfaces were superhydrophilic. X-ray photoelectron spectroscopy (XPS) provided the relative amount of Zn on the surfaces and indicated that hydrothermally treated surfaces had more Zn compared to the alkaline heat-treated surfaces. X-ray crystallography (XRD) and nanoindentation techniques provided the crystal structure and mechanical properties of the surfaces. While testing with adipose-derived stem cells (ADSC), the surfaces showed no apparent cytotoxicity to the cells. Finally, bacteria adhesion and morphology were evaluated on the surfaces after 6 h and 24 h of incubation. From the results, it was confirmed that NT surfaces doped with Zn drastically reduced bacteria adhesion compared to the Ti control. Zn-doped NT surfaces thus offer a potential platform for orthopedic implant application. [ABSTRACT FROM AUTHOR]

The High Speed High Pressure Torsion (HSHPT) is the severe plastic deformation method (SPD) designed for the grain refinement of hard-to-deform alloys, and it is able to produce large, rotationally complex shells. In this paper, the new bulk nanostructured Ti-Nb-Zr-Ta-Fe-O Gum metal was investigated using HSHPT. The biomaterial in the as-cast state was simultaneously compressed up to 1 GPa and torsion was applied with friction at a temperature that rose as a pulse in less than 15 s. The interaction between the compression, the torsion, and the intense friction that generates heat requires accurate 3D finite element simulation. Simufact Forming was employed to simulate severe plastic deformation of a shell blank for orthopedic implants using the advancing Patran Tetra elements and adaptable global meshing. The simulation was conducted by applying to the lower anvil a displacement of 4.2 mm in the z-direction and applying a rotational speed of 900 rpm to the upper anvil. The calculations show that the HSHPT accumulated a large plastic deformation strain in a very short time, leading to the desired shape and grain refinement. [ABSTRACT FROM AUTHOR]

Polymers, in general, and Poly (Ether-Ether-Ketone) (PEEK) have emerged as potential alternatives to conventional osseous implant biomaterials. Due to its distinct advantages over metallic implants, PEEK has been gaining increasing attention as a prime candidate for orthopaedic and dental implants. However, PEEK has a highly hydrophobic and bioinert surface that attenuates the differentiation and proliferation of osteoblasts and leads to implant failure. Several improvements have been made to the osseointegration potential of PEEK, which can be classified into three main categories: (1) surface functionalization with bioactive agents by physical or chemical means; (2) incorporation of bioactive materials either as surface coatings or as composites; and (3) construction of three-dimensionally porous structures on its surfaces. The physical treatments, such as plasma treatments of various elements, accelerated neutron beams, or conventional techniques like sandblasting and laser or ultraviolet radiation, change the micro-geometry of the implant surface. The chemical treatments change the surface composition of PEEK and should be titrated at the time of exposure. The implant surface can be incorporated with a bioactive material that should be selected following the desired use, loading condition, and antimicrobial load around the implant. For optimal results, a combination of the methods above is utilized to compensate for the limitations of individual methods. This review summarizes these methods and their combinations for optimizing the surface of PEEK for utilization as an implanted biomaterial. [ABSTRACT FROM AUTHOR]

The objective of bioimplant engineering is to develop biologically compatible materials for restoring, preserving, or altering damaged tissues and/or organ functions. The variety of substances used for orthopedic implant applications has been substantially influenced by modern material technology. Therefore, nanomaterials can mimic the surface properties of normal tissues, including surface chemistry, topography, energy, and wettability. Moreover, the new characteristics of nanomaterials promote their application in sustaining the progression of many tissues. The current review establishes a basis for nanotechnology-driven biomaterials by demonstrating the fundamental design problems that influence the success or failure of an orthopedic graft, cell adhesion, proliferation, antimicrobial/antibacterial activity, and differentiation. In this context, extensive research has been conducted on the nano-functionalization of biomaterial surfaces to enhance cell adhesion, differentiation, propagation, and implant population with potent antimicrobial activity. The possible nanomaterials applications (in terms of a functional nanocoating or a nanostructured surface) may resolve a variety of issues (such as bacterial adhesion and corrosion) associated with conventional metallic or non-metallic grafts, primarily for optimizing implant procedures. Future developments in orthopedic biomaterials, such as smart biomaterials, porous structures, and 3D implants, show promise for achieving the necessary characteristics and shape of a stimuli-responsive implant. Ultimately, the major barriers to the commercialization of nanotechnology-derived biomaterials are addressed to help overcome the limitations of current orthopedic biomaterials in terms of critical fundamental factors including cost of therapy, quality, pain relief, and implant life. Despite the recent success of nanotechnology, there are significant hurdles that must be overcome before nanomedicine may be applied to orthopedics. The objective of this review was to provide a thorough examination of recent advancements, their commercialization prospects, as well as the challenges and potential perspectives associated with them. This review aims to assist healthcare providers and researchers in extracting relevant data to develop translational research within the field. In addition, it will assist the readers in comprehending the scope and gaps of nanomedicine’s applicability in the orthopedics field.

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.

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. [Display omitted] • Carboxymethyl chitosan nanofibers (CMCHn) as novel multifunctional implant coating • CMCn and CMCHn nanofibrous morphology resembles extracellular matrix nanostructures. • The best cell proliferation rate for CMCHn with a positively charged surface • CMCn and CMCHn reduce bacterial colony formation by 80 % and 73 %, respectively. • ECM proteins may be mimicked using ampholyte polysaccharide nanofibers. [ABSTRACT FROM AUTHOR]

Subchondroplasty is a new minimally invasive surgical technique developed to treat bone marrow lesions (BML) and early osteoarthritis (OA). During the procedure, engineered calcium phosphate compound (CPC) is injected. It is claimed by the manufacturer that during the healing process, the CPC is replaced with new bone. The purpose of this study was to verify the replacement of CPC with new bone after subchondroplasty for the first time in humans. A 76-year old woman was referred for resistant medial knee pain. Standing radiographs showed varus knee OA and magnetic resonance imaging (MRI) revealed BML. She was treated with subchondroplasty of medial femoral condyle. Excellent relief of pain was achieved after procedure. Afterwards, the pain worsened, the radiographs confirmed the OA progression and the patient was treated with a total knee arthroplasty (TKA) 4 years after primary procedure. The resected bone was examined histologically and with micro-computed tomography (CT). Histologically, bone trabeculae of subcortical bone were embedded in the amorphous mass. However, no signs of CPC resorption and/or bone replacement have been found with micro-CT. In short term, excellent pain relief could be expected after the subchondroplasty procedure. However, there was no replacement of CPC with bone and the technique probably did not influence the natural process of knee OA. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Statistical data of many national registers and medical societies show that aseptic instability of the hip joint prosthesis is one of the main obstacles in the path to application of orthopedic implants. One of the causes for aseptic instability is manifestation of stress shielding effect, which is due to mismatch of the moduli of elasticity of the implant and bone tissue. Methods are considered, which allow lowering the modulus of elasticity of the metal implant, bringing it closer to the respective modulus of elasticity of bone tissue. It is found that reaching the posed goal by replacement of the traditional metals, which are used for implant manufacture, by alloys with much lower modulus of elasticity, is a task, which has not been solved technologically in their mass production. The currently most common methods of lowering the modulus of elasticity of orthopedic implants were analyzed, and their advantages and short-comings are indicated. The most serious problem in mass application of advanced additive technologies in implant manufacture is their labour- and material consumption. It is found that application of surface modification technologies, in particular plasma methods of porous coating deposition is the most affordable and effective method of lowering the modulus of elasticity of the implant surface, contacting the bone, with a high probability of reduction of the stress shielding effect manifestation. 53 Ref., 8 Fig. [ABSTRACT FROM AUTHOR]

Statistical data of many national registers and medical societies show that aseptic instability of the hip joint prosthesis is one of the main obstacles in the path to application of orthopedic implants. One of the causes for aseptic instability is manifestation of stress shielding effect, which is due to mismatch of the moduli of elasticity of the implant and bone tissue. Methods are considered, which allow lowering the modulus of elasticity of the metal implant, bringing it closer to the respective modulus of elasticity of bone tissue. It is found that reaching the posed goal by replacement of the traditional metals, which are used for implant manufacture, by alloys with much lower modulus of elasticity, is a task, which has not been solved technologically in their mass production. the currently most common methods of lowering the modulus of elasticity of orthopedic implants were analyzed, and their advantages and short-comings are indicated. The most serious problem in mass application of advanced additive technologies in implant manufacture is their labour- and material consumption. It is found that application of surface modification technologies, in particular plasma methods of porous coating deposition is the most affordable and effective method of lowering the modulus of elasticity of the implant surface, contacting the bone, with a high probability of reduction of the stress shielding effect manifestation. [ABSTRACT FROM AUTHOR]

The biodegradation behavior of newly developed orthopedic implant materials provides essential insight into the potential degradation products and their ability to match the rate of bone healing prior to complete degradation. Ironically, biodegradation performance is not only influenced by alloy design or advanced surface treatment on the alloy, but also it is dominantly controlled by the specific inorganic species and their concentration in the corrosion media as well as their pH level. In this study, the biodegradation behavior of commercially pure magnesium (CP Mg) and a Mg-1.0Ca-0.5Sr alloy was evaluated in 27 mM HCO 3 − - Simulated Body Fluid (r-SBF) due to its identical ionic species and concentrations with human blood plasma via immersion test, including (i) hydrogen evolution test (H2), (ii) pH trend, and (iii) weight-loss measurement. To simulate the pH regulation by the physiological homeostatic response, the pseudo-physiological solution was treated with two treatments: through a (i) a 24 h corrosion media renewal routine and through the use of (ii) a TRIS-HCL buffer reagent. The Mg-1.0Ca-0.5Sr alloy is shown to have superior corrosion resistance due to grain refinement and unique secondary phases, whereas the daily renewal routine imparts a better emulation of in vivo corrosion control. [ABSTRACT FROM AUTHOR]

The majority of the properties required for orthopedic implant operation are demonstrated by magnesium and its alloys, however, the metal degrades rapidly in the body’s environment. Therefore, a magnesium-based metal matrix composite capable of safely and gradually degrading in the body within the required healing time is required, thereby eliminating the need for a second surgery. The degradability of this newly formed alloy was done via corrosion test of this alloy in various corrosive media namely, H20, NaCl, Urine, Blood, and Plasma. Three samples A (50% reinforcement), B (25% reinforcement), and C (No reinforcement) of grade AZ31B Magnesium alloy and Calcium Carbonate powder reinforcement were developed via stir-casting technique. The impact strength of this alloy was carried out by using Charpy Impact Tester, while the microstructural characterization was determined by Scanning Electron Microscope (SEM). [ABSTRACT FROM AUTHOR]

Traditional inert materials used in internal fixation have caused many complications and generally require removal with secondary surgeries. Biodegradable materials, such as magnesium (Mg)-, iron (Fe)- and zinc (Zn)-based alloys, open up a new pathway to address those issues. During the last decades, Mg-based alloys have attracted much attention by researchers. However, the issues with an over-fast degradation rate and release of hydrogen still need to be overcome. Zn alloys have comparable mechanical properties with traditional metal materials, e.g., titanium (Ti), and have a moderate degradation rate, potentially serving as a good candidate for internal fixation materials, especially at load-bearing sites of the skeleton. Emerging Zn-based alloys and composites have been developed in recent years and in vitro and in vivo studies have been performed to explore their biodegradability, mechanical property, and biocompatibility in order to move towards the ultimate goal of clinical application in fracture fixation. This article seeks to offer a review of related research progress on Zn-based biodegradable materials, which may provide a useful reference for future studies on Zn-based biodegradable materials targeting applications in orthopedic internal fixation. [ABSTRACT FROM AUTHOR]