Surface Modification and Biological Approaches for Tackling Titanium Wear-Induced Aseptic Loosening

Abstract

Aseptic loosening induced by wear-induced osteolysis is considered to be one of the primary factors leading to the revision surgeries which represent a major hurdle for successful total joint arthroplasty. Even though Ti and its alloys possess high specific strength, reduced modulus, and excellent corrosion resistance beneficial for orthopedic implant applications, its success rates are impeded by inadequate wear resistance. Ti wear debris particles are capable of eliciting undesirable osteolytic events by activating pro-inflammatory cytokines such as (TNF)-α, IL1β, and IL6. An effective strategy to circumvent this limitation would require a synergistic (a) improvement of the wear resistance of Ti implant materials via surface modification and (b) inhibition of specific pathways leading to Ti particle-induced aseptic loosening. These two aspects are reviewed in the present article which covers pertinent surface modification strategies (shot peening, laser peening, burnishing, ion implantation and oxygen diffusion hardening) and biological approaches (protein-based biologics and polyphenolic flavanoids) to prevent osteolysis. Combining the respective beneficial aspects from the existing individual surface modification techniques, development of novel biocompatible material coating technologies with high wear resistance and a basic understanding of the biological approaches to prevent the unavoidable inflammatory reactions represent the need of the hour. The ideas outlined in the present review will assist in reducing the research gap between material science as well as biological approaches to reduce the complications associated with Ti wear-induced aseptic loosening leading to revision surgeries.