Enhance Bone Ingrowth Research Articles

In Vivo Assessment of a Triple Periodic Minimal Surface Based Biomimmetic Gyroid as an Implant Material in a Rabbit Tibia Model.

Biomimetic approaches to implant construction are a rising frontier in implantology. Triple Periodic Minimal Surface (TPMS)-based additively manufactured gyroid structures offer a mean curvature of zero, rendering this structure an ideal porous architecture. Previous studies have demonstrated the ability of these structures to effectively mimic the mechanical cues required for optimal implant construction. The porous nature of gyroid materials enhances bone ingrowth, thereby improving implant stability within the body. This enhancement is attributed to the increased surface area of the gyroid structure, which is approximately 185% higher than that of a dense material of the same form factor. This larger surface area allows for enhanced cellular attachment and nutrient circulation facilitated by the porous channels. This study aims to evaluate the biological performance of a gyroid-based Ti6Al-4V implant material compared to a dense alloy counterpart. Cellular viability was assessed using the lactate dehydrogenase (LDH) assay, which demonstrated that the gyroid surface allowed marginally higher viability than dense material. The in vivo integration was studied over 6 weeks using a rabbit tibia model and characterized using X-ray, micro-CT, and histopathological examination. With a metal volume of 8.1%, the gyroid exhibited a bone volume/total volume (BV/TV) ratio of 9.6%, which is 11-fold higher than that of dense metal (0.8%). Histological assessments revealed neovascularization, in-bone growth, and the presence of a Haversian system in the gyroid structure, hinting at superior osteointegration.

3D-printed porous titanium suture anchor: a rabbit lateral femoral condyle model

BackgroundThe inclusion of a connecting path in a porous implant can promote nutrient diffusion to cells and enhance bone ingrowth. Consequently, this study aimed to evaluate the biomechanical, radiographic, and histopathological performance of a novel 3D-printed porous suture anchor in a rabbit femur model.MethodsThree test groups were formed based on the type of suture anchor (SA): Commercial SA (CSA, Group A, n = 20), custom solid SA (CSSA, Group B, n = 20), and custom porous SA (CPSA, Group C, n = 20). The SAs were implanted in the lateral femoral condyle of the right leg in each rabbit. The rabbits (New Zealand white rabbits, male, mean body weight of 2.8 ± 0.5 kg, age 8 months) underwent identical treatment and were randomized into experimental and control groups via computer-generated randomization. Five rabbits (10 femoral condyles) were euthanized at 0, 4, 8, and 12 weeks post-implantation for micro-CT, histological analysis, and biomechanical testing.ResultsAt 12 weeks, the CPSA showed a higher BV/TV (median 0.7301, IQR 0.7276–0.7315) than the CSSA and CSA. The histological analysis showed mineralized osteocytes near the SA. At 4 weeks, new bone was observed around the CPSA and had penetrated its porous structure. By 12 weeks, there was no significant difference in ultimate failure load between the CSA and CPSA.ConclusionsWe demonstrated that the innovative 3D-printed porous suture anchor exhibited comparable pullout strength to conventional threaded suture anchors at the 12-week postoperative time-point period. Furthermore, our porous anchor design enhanced new bone formation and facilitated bone growth into the implant structure, resulting in improved biomechanical stability.

A 3D printed ultra-short dental implant based on lattice structures and ZIRCONIA/Ca2SiO4 combination

Additive Manufacturing (AM) enables the generation of complex geometries and controlled internal cavities that are so interesting for the biomedical industry due to the benefits they provide in terms of osseointegration and bone growth. These technologies enable the manufacturing of the so-called lattice structures that are cells with different geometries and internal pores joint together for the formation of scaffold-type structures. In this context, the present paper analyses the feasibility of using diamond-type lattice structures and topology optimisation for the re-design of a dental implant. Concretely, a new ultra-short implant design is proposed in this work. For the manufacturing of the implant, digital light processing additive manufacturing technique technology is considered. The implant was made out of Nano-zirconia and Nano-Calcium Silicate as an alternative material to the more common Ti6Al4V. This material combination was selected due to the properties of the calcium-silicate that enhance bone ingrowth. The influence of different material combination ratios and lattice pore sizes were analysed by means of FEM simulation. For those simulations, a bio-material bone-nanozirconia model was considered that represents the final status after the bone is integrated in the implant. Results shows that the mechanical properties of the biocompatible composite employed were suitable for dental implant applications in dentistry. Based on the obtained results it was seen that those designs with 400 μm and 500 μm pore sizes showed best performance and led to the required factor of safety.

Machine learning-based design for additive manufacturing in biomedical engineering

While ceramic additive manufacturing (AM) technologies have shown great promise to create functional scaffolds with tailored biomechanical properties, the true potential of these advanced techniques has not been fully exploited yet due to lack of practical design optimisation approaches. To address this challenge, a machine learning (ML)-based design approach is proposed herein where ceramic 3D printing techniques are combined to fabricate functionally graded tissue scaffolds composed of Triply Periodic Minimal Surfaces (TPMS), aiming to fulfil the anticipated biomechanical requirements for the target bone regeneration outcomes. The proposed ML based design strategy couples a Bayesian optimisation (BO) algorithm to enable time-dependent mechano-biological optimisation of the 3D printed ceramic scaffolds at a reasonably low computational cost. For a representative example relating to bone scaffolding in a segmental defect of sheep tibia, the simulated results demonstrate that the optimised functionally graded scaffolds significantly enhance bone ingrowth outcomes. Furthermore, a Lithography-based Ceramic Manufacturing (LCM) technique is employed to fabricate the optimised scaffolds based on the proposed ML-based design framework, followed by micro-CT analyses of the additively manufactured ceramic scaffolds to assess their geometric qualities. This study is expected to gain new insights into mechanical sciences on design for varying material conditions and provide an effective design tool for ceramic additive manufacturing.

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective.

The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient's age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon's preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.

Designing an anatomical contour titanium 3D-printed oblique lumbar interbody fusion cage with porous structure and embedded fixation screws for patients with osteoporosis.

This study aimed to design an anatomical contour metal three-dimensional (3D)-printed oblique lateral lumbar interbody fusion (OLIF) cage with porous (lattices) structure and embedded screw fixation to enhance bone ingrowth to reduce the risk of cage subsidence and avoid the stress-shielding effect. Finite element (FE) analysis and weight topology optimization (WTO) were used to optimize the structural design of the OLIF cage based on the anatomical contour morphology of patients with osteoporosis. Two oblique embedded fixation screws and lattice design with 65% porosity and average pore size of 750 μm were equipped with the cage structure. The cage was fabricated via metal 3D printing, and static/dynamic compression and compressive-shear tests were performed in accordance with the ASTM F2077-14 standard to evaluate its mechanical resistance. On FE analysis, the OLIF cage with embedded screw model had the most stability, lowest stress values on the endplate, and uniform stress distribution versus standalone cage and fixed with lateral plate under extension, lateral flexion, and rotation. The fatigue test showed that the stiffnesses/endurance limits (pass 5 million dynamic test) were 16,658 N/mm/6000 N for axial load and 19,643 N/mm/2700 N for compression shear. In conclusion, an OLIF cage with embedded fixation screws can be designed by integrating FE and WTO analysis based on the statistical results of endplate morphology. This improves the stability of the OLIF cage to decrease endplate destruction. The complex contour and lattice design of the OLIF cage need to be manufactured via metal 3D printing; the dynamic axial compression and compressive-shear strengths are greater than that of the U.S. Food and Drug Administration (FDA) standard.

Conceptual design of compliant bone scaffolds by full-scale topology optimization

A promising new treatment for large and complex bone defects is to implant specifically designed and additively manufactured synthetic bone scaffolds. Optimizing the scaffold design can potentially improve bone in-growth and prevent under- and over-loading of the adjacent tissue. This study aims to optimize synthetic bone scaffolds over multiple-length scales using the full-scale topology optimization approach, and to assess the effectiveness of this approach as an alternative to the currently used mono- and multi-scale optimization approaches for orthopaedic applications. We present a topology optimization formulation, which is matching the scaffold's mechanical properties to the surrounding tissue in compression. The scaffold's porous structure is tuneable to achieve the desired morphological properties to enhance bone in-growth. The proposed approach is demonstrated in-silico, using PEEK, cortical bone and titanium material properties in a 2D parameter study and on 3D designs. Full-scale topology optimization indicates a design improvement of 81% compared to the multi-scale approach. Furthermore, 3D designs for PEEK and titanium are additively manufactured to test the applicability of the method. With further development, the full-scale topology optimization approach is anticipated to offer a more effective alternative for optimizing orthopaedic structures compared to the currently used multi-scale methods.

Design and Development of Tantalum and Strontium Ion Doped Hydroxyapatite Composite Coating on Titanium Substrate: Structural and Human Osteoblast-like Cell Viability Studies.

In order to reduce the loosening of dental implants, surface modification with hydroxyapatite (HA) coating has shown promising results. Therefore, in this present study, the sol-gel technique has been employed to form a tantalum and strontium ion-doped hybrid HA layer coating onto the titanium (Ti)-alloy substrate. In this study, the surface modification was completed by using 3% tantalum pent oxide (Ta2O5), 3% strontium (Sr), and a combination of 1.5% Ta2O5 and 1.5% Sr as additives, along with HA gel by spin coating technique. These additives played a prominent role in producing a porous structure layer coating and further cell growth. The MG63 cell culture assay results indicated that due to the incorporation of strontium ions along with tantalum embedded in HA, cell proliferation increased significantly after a 48 h study. Therefore, the present results, including microstructure, crystal structure, binding energy, and cell proliferation, showed that the additives 1.5% Ta2O5 and 1.5% Sr embedded in HA on the Ti-substrate had an optimized porous coating structure, which will enhance bone in-growth in surface-modified Ti-implants. This material had a proper porous morphology with a roughness profile, which may be suitable for tissue in-growth between a surface-modified textured implant and bone interface and could be applicable for dental implants.

Influences of surface topography of porous titanium scaffolds manufactured by powder bed fusion on osteogenesis

Powder bed fusion (PBF) has emerged as a useful metal-three-dimensional (3D) printing technology for manufacturing porous structures; it has been widely employed for the production of medical implants. Multiple previous reports have suggested that the bone ingrowth characteristics of porous structures, among the most important factors for medical implants, are affected by 3D printing parameters (e.g., pore shape). The topography of 3D-printed metal surfaces can also influence cellular responses, including osteoblast differentiation. The surface topography may change according to the shape of the printed pores. Nevertheless, it remains unclear how the surface topography changes. In addition, it is still unknown how the pore shape and the resulting surface topography can further impact the bone ingrowth efficiency of the porous structure. Therefore, to better understand the relationship, we prepared Ti–6Al–4V specimens with different pore shapes (i.e., circular, triangular, and rectangular) using the PBF method, then analyzed the surface topographies of these 3D scaffolds based on curvature and roughness profiles. Through subsequent in vitro studies, we investigated how changes in pore shape and surface topography affect the activity of Saos-2 human osteosarcoma cells. The results of this study confirmed that the curvature radii and local surface roughness change according to pore shape because of the characteristics of PBF. Furthermore, differences in local surface topography and pore shape led to differences in cell proliferation and differentiation. Through our findings, we anticipate that the meticulous design of pore shape and sophisticated control of the processing parameters, such as laser speed and paths, in the fabrication of orthopedic and dental implants will result in significantly enhanced bone ingrowth efficiency.

Fabrication of a lattice structure with periodic open pores through three-dimensional printing for bone ingrowth

Lattice structures for implants can be printed using metal three-dimensional (3D)-printing and used as a porous microstructures to enhance bone ingrowth as orthopedic implants. However, designs and 3D-printed products can vary. Thus, we aimed to investigate whether targeted pores can be consistently obtained despite printing errors. The cube-shaped specimen was printed with one side 15 mm long and a full lattice with a dode-thin structure of 1.15, 1.5, and 2.0 mm made using selective laser melting. Beam compensation was applied, increasing it until the vector was lost. For each specimen, the actual unit size and strut thickness were measured 50 times. Pore size was calculated from unit size and strut thickness, and porosity was determined from the specimen’s weight. The actual average pore sizes for 1.15, 1.5, and 2.0 mm outputs were 257.9, 406.2, and 633.6 μm, and volume porosity was 62, 70, and 80%, respectively. No strut breakage or gross deformation was observed in any 3D-printed specimens, and the pores were uniformly fabricated with < 10% standard deviation. The actual micrometer-scaled printed structures were significantly different to the design, but this error was not random. Although the accuracy was low, precision was high for pore cells, so reproducibility was confirmed.

Low elastic modulus and highly porous triply periodic minimal surfaces architectured implant for orthopedic applications

A mismatch between the implant and interacting bone Young's modulus causes stress shielding phenomena, which leads to instability of the implant and early failure. This paper focuses on the development of medical-grade titanium alloy (Ti6Al4V)-based metallic highly porous structure to mitigate the stress shielding effect. In this study, we propose an effective method to generate a highly porous implant based on triply periodic minimal surfaces (TPMS) architecture. Three-dimensional models of different TPMS architectures such as Diamond, Gyroid, I-graph-Wrapped Package graph (IWP), and Primitive were constructed with a 2 × 2 × 2 mm lattice size and unit cell size of 1 mm. Mechanical testing of the finite-element models was performed under static loading conditions to evaluate the effective elastic modulus ( Eeff) of each porous architecture. It was found that the primitive structure exhibits the lowest Eeff, whereas the Gyroid exhibits the highest Eeff, results indicate that porous architecture reduces Eeff by more than 95%, thereby reducing the stress shielding effect. Moreover, pore size and surface-area-to-volume ratio (SA/V ratio) were also investigated. Findings suggested that the primitive structure has the highest pore size, which will be suitable for enhanced bone ingrowth. A high SA/V ratio in IWP offers the possibility of enhanced cell adhesion, migration, and proliferation.

A novel CKIP-1 SiRNA slow-release coating on porous titanium implants for enhanced osseointegration.

Osseointegration between implants and bone tissue lays the foundation for the long-term stability of implants. The incorporation of a porous structure and local slow release of siRNA to silence casein kinase-2 interacting protein-1 (CKIP-1), a downregulator of bone formation, is expected to promote osseointegration. Here, porous implants with a porous outer layer and dense inner core were prepared by metal coinjection molding (MIM). Mg-doped calcium phosphate nanoparticles (CaPNPs)-grafted arginine-glycine-aspartate cell adhesion sequence (RGD) and transcribed activator (TAT) (MCPRT)/CKIP-1 siRNA complex and polylysine (PLL) were coated onto the surface of the porous implants by layer-by-layer (LBL) self-deposition. The in vitro results showed that the MCPRT-siRNA coating promoted MG63 cell adhesion and proliferation, enhanced the protein expressions (ALP and OC) and bone formation-related gene expression (OPN, OC and COL-1α) in vitro. The in vivo results demonstrated that the porous structure enhanced bone ingrowth and that the local slow release of MCPRT-siRNA accelerated new bone formation at the early stage. The porous structure coupled with local CKIP-1 siRNA delivery constitutes a promising approach to achieve faster and stronger osseointegration for dental implants.

Irregular porous titanium enhances implant stability and bone ingrowth in an intra-articular ovine model.

Two commercially available porous coatings, Gription and Porocoat, were compared for the first time in a challenging intra-articular, weight-bearing, ovine model. Gription has evolved from Porocoat and has higher porosity, coefficient of friction, and microtextured topography, which are expected to enhance bone ingrowth. Cylindrical implants were press-fit into the weight-bearing regions of ovine femoral condyles and bone ingrowth and fixation strength evaluated 4, 8, and 16 weeks postoperatively. Biomechanical push-out tests were performed on lateral femoral condyles (LFCs) to evaluate the strength of the bone-implant interface. Bone ingrowth was assessed in medial femoral condyles (MFCs) as well as implants retrieved from LFCs following biomechanical testing using backscattered electron microscopy and histology. By 16 weeks, Gription-coated implants exhibited higher force (2455 ± 1362vs. 1002 ± 1466 N; p = 0.046) and stress (12.60 ± 6.99vs. 5.14 ± 7.53 MPa; p = 0.046) at failure, and trended towards higher stiffness (11,510 ± 7645vs. 5010 ± 8374 N/mm; p = 0.061) and modulus of elasticity (591 ± 392vs. 256 ± 431 MPa; p = 0.061). A strong, positive correlation was detected between bone ingrowth in LFC implants and failure force (r = 0.93, p < 10-13 ). By 16 weeks, bone ingrowth in Gription-coated implants in MFCs was 10.50 ± 6.31% compared to 5.88 ± 2.77% in Porocoat (p = 0.095). Observations of the bone-implant interface, made following push-out testing, showed more bony material consistently adhered to Gription compared to Porocoat at all three time points. Gription provided superior fixation strength and bone ingrowth by 16 weeks.

Revision for Aseptic Loosening of Highly Porous Acetabular Components in Primary Total Hip Arthroplasty: An Analysis of 20,993 Total Hip Replacements.

Highly porous-coated titanium acetabular components have a high coefficient of friction and ultraporous surfaces to enhance bone ingrowth and osseointegration in total hip arthroplasty (THA). There have been concerns with the development of early radiolucent lines and aseptic loosening of highly porous acetabular components. It is unclear whether these concerns relate to a specific implant or the entire class. The aim of this study is to compare the revision rates for aseptic loosening of highly porous acetabular combinations in primary THA using data from a large joint replacement registry. Data were retrieved from the Australian Orthopedic Association National Joint Replacement Registry for the study period September 1999 to December 2019. All primary THA procedures recorded and performed for osteoarthritis using the most common combinations for each highly porous acetabular component with highly cross-linked polyethylene and a 32-mm or 36-mm femoral head were included. The primary outcome measure was revision for aseptic loosening of the acetabular component. Results were adjusted for patient age and gender. There were 20,993 primary THA procedures performed for osteoarthritis using a highly porous acetabular component across 6 combinations. Relative to the POLARSTEM/R3 (StikTite), the Exeter V40/Tritanium had a significantly higher risk of revision for aseptic loosening of the acetabular component (hazard ratio 0.21, 95% confidence interval 0.06-0.74, P= .014). There was no difference between any other highly porous acetabular component combination and no late revisions for aseptic loosening. Highly porous-coated titanium acetabular components have low rates of aseptic loosening with long-term follow-up. A difference between components may exist. Level III.

Predicting friction at the bone – Implant interface in cementless total knee arthroplasty

Cementless total knee arthroplasty (TKA) components have rough and porous surface coatings which can enhance bone ingrowth and stability at the bone-implant. To achieve primary stability in the postoperative period where no apposition is formed, the resistance against motions between bone and implant is optimized by increasing the friction at the interface. This is necessary, as excessive relative motions can inhibit bone ingrowth, which might result in loosening and pain. In this research, it was found that the friction can be predicted by measuring the surface morphology of rough implants, and calculating the corresponding perpendicular and lateral contact area parameters. The ratio between these areas, is used to predict the resulting coefficient of friction (COF). This is validated experimentally, by analysing the tribological behaviour of 2 porous and rough titanium coatings against human cadaveric knee bones using reciprocal friction tests with varying normal loads. The results for 2 different coatings showed similar findings for the predicted COF (0.75 and 0.88) versus the calculated values based on the measurement (0.82 and 0.86) proving the feasibility of the approach.

In silico and in vivo studies of the effect of surface curvature on the osteoconduction of porous scaffolds.

Recent evidence shows that the curvature of porous scaffold plays a significant role in guiding tissue regeneration. However, the underlying mechanism remains controversial to date. In this study, we developed an in silico model to simulate the effect of surface curvature on the osteoconduction of scaffold implants, which comprises the primary aspects of bone regeneration. Selective laser melting was used to manufacture a titanium scaffold with channels representative of different strut curvatures for in vivo assessment. The titanium scaffold was implanted in the femur condyles of rabbits to validate the mathematical model. Simulation results suggest that the curvature affected the distribution of growth factors and subsequently induced the migration of osteoblast lineage cells and bone deposition to the locations with higher curvature. The predictions of the mathematical model are in good agreement with the in vivo assessment results, in which newly formed bone first appeared adjacent to the vertices of the major axes in elliptical channels. The mechanism of curvature-guided osteoconduction may provide a guide for the design optimization of scaffold implants to achieve enhanced bone ingrowth.

3D printed tricalcium phosphate-bioglass scaffold with gyroid structure enhance bone ingrowth in challenging bone defect treatment

Ceramic materials were applied to the area of bone defect treatment for a long time. The structure character and preparation method of ceramic scaffolds are of great importance to the satisfaction of defect repair. Among the myriads of forming methods, 3D printing technology allows to form porous and individualized ceramic scaffolds. Normally the extrusion-based 3D printing technique can only build scaffolds with grid structures, instead of complicated ones. In this study, the tricalcium phosphate/bioglass composite (TCP/BG) scaffold with gyroid structure was successfully and precisely manufactured using digital light processing (DLP) method. The surface characters, mechanical properties, and structural parameters of TCP/BG gyroid scaffold were analyzed. In vivo experiments demonstrated that compared to commercial artificial bone graft manufactured by conventional foaming method, TCP/BG scaffold with gyroid structure could effectively induce bone ingrowth and integration, meanwhile keep the surrounding trabeculae structure as natural. This kind of scaffolds presented great potential in the field of challenging bone defect treatment.

Three-dimensional-printed porous implant combined with autograft reconstruction for giant cell tumor in proximal tibia

BackgroundThis study is to describe the design and surgical techniques of three- dimensional-printed porous implants for proximal giant cell tumors of bone and evaluate the short-term clinical outcomes.MethodsFrom December 2016 to April 2020, 8 patients with giant cell tumor of bone in the proximal tibia underwent intralesional curettage of the tumor and reconstruction with bone grafting and three-dimensional-printed porous implant. Detailed anatomy data were measured, including the size of lesion and thickness of the subchondral bone. Prostheses were custom-made for each patient by our team. All patients were evaluated regularly and short-term clinical outcomes were recorded.ResultsThe mean follow-up period was 26 months. According to the different defect sizes, the mean size of the plate and mean length of strut were 35 × 35 mm and 20 mm, respectively. The mean affected subchondral bone percentage was 31.5%. The average preoperative and postoperative thickness of the subchondral bone was 2.1 mm and 11.1 mm, respectively. There was no wound infection, skin necrosis, peroneal nerve injury, or other surgical related complications. No degeneration of the knee joint was found. Osseointegration was observed in all patients. The MSTS improved from an average of 12 preoperatively to 28 postoperatively.ConclusionThe application of three-dimensional-printed printed porous prosthesis combined autograft could supply enough mechanical support and enhance bone ingrowth. The design and operation management lead to satisfactory subchondral bone reconstruction.

Evaluation of Patient-Specific Cranial Implant Design Using Finite Element Analysis

Various studies have investigated the load-bearing capacity of patient-specific cranial implants. However, little attention has been given to the evaluation of the design of ceramic-titanium (CeTi) implants. A biomechanical evaluation of 3 patient-specific cranial implants was performed using finite element analysis. The results of the analyses allowed the identification of the implant regions as well as the magnitudes of the maximum stresses on, and displacements along, these regions after traumatic impact. The analyses also showed that polyether ether ketone cranial implants offer inferior brain and neurocranial protection due to their high flexibility and local peak stresses at the bone-screw interface. In contrast, CeTi implants were able to evenly distribute the stresses along the interface and thus reduced the risk of neurocranial fracture. The scaffold structure at the border of these implants reduced stress shielding and enhanced bone ingrowth. Moreover, brain injuries were less likely to occur, as the CeTi implant exhibits limited deflection. From the finite element analyses, CeTi cranial implants appear less likely to induce calvarial fractures with a better potential to protect the brain under impact loads.

Peptide-Enriched Silk Fibroin Sponge and Trabecular Titanium Composites to Enhance Bone Ingrowth of Prosthetic Implants in an Ovine Model of Bone Gaps.

Osteoarthritis frequently requires arthroplasty. Cementless implants are widely used in clinics to replace damaged cartilage or missing bone tissue. In cementless arthroplasty, the risk of aseptic loosening strictly depends on implant stability and bone–implant interface, which are fundamental to guarantee the long-term success of the implant. Ameliorating the features of prosthetic materials, including their porosity and/or geometry, and identifying osteoconductive and/or osteoinductive coatings of implant surfaces are the main strategies to enhance the bone-implant contact surface area. Herein, the development of a novel composite consisting in the association of macro-porous trabecular titanium with silk fibroin (SF) sponges enriched with anionic fibroin-derived polypeptides is described. This composite is applied to improve early bone ingrowth into the implant mesh in a sheep model of bone defects. The composite enables to nucleate carbonated hydroxyapatite and accelerates the osteoblastic differentiation of resident cells, inducing an outward bone growth, a feature that can be particularly relevant when applying these implants in the case of poor osseointegration. Moreover, the osteoconductive properties of peptide-enriched SF sponges support an inward bone deposition from the native bone towards the implants. This technology can be exploited to improve the biological functionality of various prosthetic materials in terms of early bone fixation and prevention of aseptic loosening in prosthetic surgery.