Orthopedic Biomaterials Research Articles

Surface functionalization of Titania Nanotubes arrays and vancomycin controlled release using Silk Fibroin Nanofibers coating

Bacterial infections are the leading cause of failure in surgeries based on orthopedic implants. One of the promising methods to suppress bacterial infection, given the high efficiency of antibiotic administration, is to use Titania Nanotubes (Titania-NTs) loaded with antibiotics. Titania-NTs obtained by the electrochemical anodizing process have presented a modern approach in drug delivery applications. However, it is complicated to control the drug release process from drug delivery systems. This study investigates the controlled release of Vancomycin (V) from Titania-NTs surfaces enriched by drugs via physical absorption. Titania-NTs loaded with Vancomycin were coated by Silk Fibroin Nanofibers (SF-NFs). The results showed that the drug delivery was controlled through a coated layer of nanofibers. Moreover, Vancomycin inhibits bacterial development due to its antibacterial property. This is a feasible method, which enhances the viability of cells. Therefore, loading Titania-NTs with Vancomycin and using SF-NFs, as a high potential coating, can be an effective method to decrease infections after implanting orthopedic biomaterials. Drug release kinetics were calculated using different kinetic models and coefficient of determination (R2) for each model.

Development of n-HA/CS-GM biomimetic nanocomposite for biomedical applications

Nowadays, effective treatment and management of malignant osteomyelitis remain an alarming clinical challenge causing the creation of antimicrobial biomaterials for orthopedic surgeons. The has revived attention in creating antimicrobial biomaterials for orthopedics. The collaboration of nanotechnology and engineered biomaterials will probably provide perception for developing novel and hybrid composites. Because of improved control of the interaction between nanoparticles and polymers, nanohydroxyapatite (n-HA) incorporated nanocomposite would provide versatility in designing specific properties. As a result, the study describes the ethanolic extraction of Guar gum from native Cassia fistula seeds, as well as the development of (n-HA), Chitosan (CS), and Guar gum (GM) nanocomposite via the Co-precipitation method. The nanocomposites were characterized based on their physicochemical and morphological properties, such as XRD, FT-IR, and SEM. The nanocomposites were tested for antibacterial activity against Staphylococcus aureus(S.aureus) ATCC25923 and anticancer activity against MG 63 (osteosarcoma) cancer cell line MTT assay. The antibacterial result confirms that the n-HA/CS-GM hybrid nanocomposites exhibit excellent antibacterial properties against Staphylococcus aureus and average inhibition zones of the different content samples against S. aureus were 15.75 mm for n-HA/CS and 19.75 mm for n-HA/CS-GM hybrid microspheres, respectively. The cytotoxicity result showed that the average OD of cells treated with 7.8 to 1000 µg/mL concentration of n-HA/CS composite varied from 0.479 to 0.297 parallel to 88.70% to 55% cell viability, and the OD of n-HA/CS-GM composite varied from 0.447 to 0.273 corresponding 82.77% to 50.55% cell viability for 7.8µg/mL concentration up to 1000µg/mL.

A Multi-Attribute Decision-Making Model for the Selection of Polymer-Based Biomaterial for Orthopedic Industrial Applications.

The potential of quantifying the variations in IR active bands was explored while using the chemometric analysis of FTIR spectra for selecting orthopedic biomaterial of industrial scale i.e., ultra-high molecular weight PE (UHMWPE). The nano composites UHMWPE with multi-walled carbon nano-tubes (MWCNTs) and Mg-silicate were prepared and irradiated with 25 kGy and 50 kGy of gamma dose. Principal component analysis (PCA) revealed that first three principal components (PCs) are responsible for explaining the >99% of variance in FTIR data of UHMWPE on addition of fillers and/or irradiation. The factor loadings plots revealed that PC-1 was responsible for explaining the variance in polyethylene characteristics bands and the IR active region induced by fillers i.e., 440 cm−1, 456 cm−1, from 900–1200 cm−1, 1210 cm−1, 1596 cm−1, PC-2 was responsible for explaining the variance in spectra due to radiation-induced oxidation and cross linking, while the PC-3 is responsible for explaining the variance induced because of IR active bands of MWCNTs. Hierarchy cluster analysis (HCA) was employed to classify the samples into four clusters with respect to similarity in their IR active bands which is further confirmed by PCA. According to multi attribute analysis with PCA and HCA, 65 kGy irradiated sample is optimum choice from the existing alternatives in the group of irradiated pristine UHMWPE, UHMWPE/Mg-silicate irradiated with 25 kGy of gamma dose was the optimum choice for UHWMPE/Mg-silicate nano composites, and UHMWPE/γMWCNTs composites containing 1.0% dof γ MWCNTs for UHMWPE/MWCNTs nanocomposites, respectively. The results show the effectiveness of quantifying the variance for decision as far as optimization of biomaterials in orthopedic industrial applications is concerned.

Microstructural, mechanical, electrochemical, and biological studies of an electron beam melted Ti-6Al-4V alloy

This work studied the feasibility of an electron beam melting (EBM) Ti-6Al-4V alloy as a biomaterial for implants. Comparisons were made with a wrought forged Ti-6Al-4V alloy. The objective of this work was a detailed description of the microstructural and surface roughness effects on mechanical, electrochemical, and in-vivo biological performances. The EBMed condition showed higher mechanical properties, as well as higher electrochemical and ion release rates. These results were mainly influenced by the lamellar grain morphology and complex crystallographic texture of the EBMed alloy compared to the forged one. The higher area average roughness of the EBMed condition boosted the adhesion, proliferation, and biofilm formation of osteosarcoma (MG63), Staphylococcus epidermidis (S. epidermidis), and Staphylococcus aureus (S. aureus). The mechanical, ion release, corrosion, and in-vivo biological results in both studied conditions met the requirements for orthopedic and dental biomaterials. However, the forged condition is more recommended for patients with clinic stories related to S. epidermidis and S. aureus illnesses.

Endogenous repair theory enriches construction strategies for orthopaedic biomaterials: a narrative review.

ABSTRACTThe development of tissue engineering has led to new strategies for mitigating clinical problems; however, the design of the tissue engineering materials remains a challenge. The limited sources and inadequate function, potential risk of microbial or pathogen contamination, and high cost of cell expansion impair the efficacy and limit the application of exogenous cells in tissue engineering. However, endogenous cells in native tissues have been reported to be capable of spontaneous repair of the damaged tissue. These cells exhibit remarkable plasticity, and thus can differentiate or be reprogrammed to alter their phenotype and function after stimulation. After a comprehensive review, we found that the plasticity of these cells plays a major role in establishing the cell source in the mechanism involved in tissue regeneration. Tissue engineering materials that focus on assisting and promoting the natural self-repair function of endogenous cells may break through the limitations of exogenous seed cells and further expand the applications of tissue engineering materials in tissue repair. This review discusses the effects of endogenous cells, especially stem cells, on injured tissue repairing, and highlights the potential utilisation of endogenous repair in orthopaedic biomaterial constructions for bone, cartilage, and intervertebral disc regeneration.

APATITIC NANOPOWDERS AND COATINGS: A COMPREHENSIVE REVIEW

The use of artificial biomaterials has been acclaiming potential therapeutic scope in diverse clinical applications. This review started with the description of the basics of biomaterials, and desirable properties, which are the prerequisites to understand biomaterials. The orthopedic biomaterials, their classification and the importance of calcium phosphate (CaP) materials for hard-tissue applications were utterly discussed. Furthermore, among the various CaP biominerals, the importance of hydroxyapatite (HAP) and its synthesis techniques was comprehensively reviewed. The sol–gel route for the synthesis of HAP nanoparticles and deposition of coatings were systematically studied. Among the metallic substrates, Ti6Al4V alloy remained the focus of this study. Moreover, several film pre-preparation methods were also given due importance. The importance of other surface modification techniques, especially in the context of Ti6Al4V substrates, was also discussed. Among several coating techniques to deposit CaP coatings, special attention was paid to the spin and dip coating techniques. In addition to monolithic HAP coatings, reinforced and antimicrobial HAP coatings were also reviewed from broad perspectives. Therefore, this review provides an in-depth insight into the preparation and properties of apatitic nanoparticles and their coatings for orthopedic and dental applications.

In Ukrainian

Microwave irradiation (MWI) in the synthesis of materials has been an actively developing branch of science for the last three decades. Structures based on calcium phosphates (CaP) are one of the most well-known and widely used synthetic biomaterials in orthopedics and dentistry. The main topic of this review is the use of MWI in the formation of biomaterials based on calcium phosphate phases and their complexes with biopolymers (chitosan, alginate, silk fibroin). The physical bases of MW interaction with different materials are considered, including the influence of this irradiation on the structure, physicochemical and mechanical properties of biomaterials (crystallite size, porosity, strength, capability to absorb and release drugs). The main heating mechanisms during MWI are described, namely: the dipolar losses, and losses of conductivity. Important advantages of MWI treatment are reducing processing time, reducing electricity use, reducing waste and improving quality of the synthesized biomaterials. A list and comparison is made of articles describing the production of HA crystals with different morphology (nanowires, spherical, needle- and rod-shaped) with all the initial conditions and their effect on the synthesized material. The latest developments in the field of biomaterials conducted based on the laboratory “Bionanocomposite” of Sumy State University are considered. The original synthesis method of CaP-biopolymer materials is described, as well as the advantages of the synthesized scaffolds over foreign developments. It is expected that this review of the interdisciplinary topic will contribute to the further study of other new applications of microwave technologies in the synthesis of the latest modern biomaterials created by scientists, biomedical engineers in other laboratories and institutions in Ukraine and around the world.

Biocompatibility assessment of biomaterials used in orthopedic devices: An overview (Review).

Biocompatibility is one of the mandatory requirements for the clinical use of biomaterials in orthopedics. It refers to the ability of a biomaterial to perform its function without eliciting toxic or injurious effects on biological systems but producing an appropriate host response in a specific case. Today, the biocompatibility concept includes not only bio-inertia, but also biofunctionality and biostability. High biocompatibility and functional properties are highly desirable for new biomaterials. The chemical, mechanical, structural properties of biomaterials, their interaction with biological environment or even the methodology of assessment can influence the biocompatibility. The biological evaluation of biomaterials includes a broad spectrum of in vitro and in vivo tests related to the cytocompatibility, genotoxicity, sensitization, irritation, acute and chronic toxicity, hemocompatibility, reproductive and developmental toxicitity, carcinogenicity, implantation and degradation as specified in different international standards. A brief review of the main assays used in the biocompatibility testing of orthopedic biomaterials is presented. In addition, their main biocompatibility issues are overviewed.

Bimetallic ions regulated PEEK of bone implantation for antibacterial and osteogenic activities

After the surgical implantation of polyetheretherketone (PEEK) orthopedic biomaterials, there are two major clinical challenges, implantation-related pathogen infection and poor osseointegration-caused aseptic loosening, threaten the lifespan and the success of the implants. In this study, we developed PEEK implants with antibacterial and osteogenesis capabilities by the bimetallic ions immersion method. Specifically, we pre-treated the PEEK implants with polydopamine (PDA) and then immobilized it (PEEK-PDA) with Mn2+ and Cu 2+ to obtain the bimetallic ions-modified PEEK denoted as PEEK-PDA-Mn/Cu. The PEEK-PDA-Mn/Cu exhibited enhanced antibacterial capabilities in both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) compared with PEEK without the modification of Cu 2+. In addition, MC3T3-E1 cells showed better morphology and enhanced osteogenic differentiation with the treatment of PEEK-PDA-Mn/Cu than other PEEK implants. Furthermore, S. aureus-infected femur-defect Sprague-Dawley rat models were developed to evaluate the function of PEEK-PDA-Mn/Cu in vivo. After 2 and 4 weeks of implantations, rats treated with PEEK-PDA-Mn/Cu exhibited limited bacterial infections and enhanced new bone formation compared with the rats treated with other PEEK implants. Overall, the PEEK-PDA-Mn/Cu can inhibit bacterial infections and promote osteogenic differentiation both in vitro and in vivo, which could provide a promising PEEK candidate for clinical applications.

Silver, silicon co-substituted hydroxyapatite modulates bacteria-cell competition for enhanced osteogenic function

Combating bacteria while promoting tissue regeneration is an aim of highest priority for employing biomaterials in orthopedics that often embroiled with pre-operative contamination. Through simulating a surgical site infection environment and an infected implant site, we showcase the ability of a functionally modified hydroxyapatite, Ag,Si-HA that permits preferential adhesion of human bone marrow derived mesenchymal stem cells (BMSCs) over co-cultured bacterial pathogen, Pseudomonas aeruginosa, by displaying immediate suppression and killing of the bacteria present with minimum cytotoxicity for 28 d. And, at the same time, Ag,Si-HA stimulates BMSCs towards osteogenic differentiation despite being within the contaminated milieu. These findings provide well-defined requirements for incorporating antibacterial properties to biomaterials in managing pre-operative contamination. In addition, it highlights the dual positive attributes of Ag,Si-HA as an effective antibacterial biomaterial and at the same time, promotes bone tissue regeneration.

Properties improvement of titanium alloys scaffolds in bone tissue engineering: a literature review

Owing to their excellent biocompatibility and corrosion-resistant properties, titanium (Ti) (and its alloy) are essential artificial substitute biomaterials for orthopedics. However, flaws, such as weak osteogenic induction ability and higher Young’s modulus, have been observed during clinical application. As a result, short- and long-term postoperative follow-up has found that several complications have occurred. For decades, scientists have exerted efforts to compensate for these deficiencies. Different modification methods have been investigated, including changing alloy contents, surface structure transformation, three-dimensional (3D) structure transformation, coating, and surface functionalization technologies. The cell-surface interaction effect and imitation of the natural 3D bone structure are the two main mechanisms of these improved methods. In recent years, significant progress has been made in materials science research methods, including thorough research of titanium alloys of different compositions, precise surface pattern control technology, controllable 3D structure construction technology, improvement of coating technologies, and novel concepts of surface functionalization. These improvements facilitate the possibility for further research in the field of bone tissue engineering. Although the underlying mechanism is still not fully understood, these studies still have some implications for clinical practice. Therefore, for the direction of further research, it is beneficial to summarize these studies according to the basal method used. This literature review aimed to classify these technologies, thereby providing beginners with a preliminary understanding of the field.

Nanoclay Reinforced Biomaterials for Mending Musculoskeletal Tissue Disorders.

Nanoclay-reinforced biomaterials have sparked a new avenue in advanced healthcare materials that can potentially revolutionize treatment of musculoskeletal defects. Native tissues display many important chemical, mechanical, biological, and physical properties that engineered biomaterials need to mimic for optimal tissue integration and regeneration. However, it is time-consuming and difficult to endow such combinatorial properties on materials via feasible and nontoxic procedures. Fortunately, a number of nanomaterials such as graphene, carbon nanotubes, MXenes, and nanoclays already display a plethora of material properties that can be transferred to biomaterials through a simple incorporation procedure. In this direction, the members of the nanoclay family are easy to functionalize chemically, they can significantly reinforce the mechanical performance of biomaterials, and can provide bioactive properties by ionic dissolution products to upregulate cartilage and bone tissue formation. For this reason, nanoclays can become a key component for future orthopedic biomaterials. In this review, we specifically focus on the rapidly decreasing gap between clinic and laboratory by highlighting their application in a number of promising in vivo studies.

Inorganic Agents for Enhanced Angiogenesis of Orthopedic Biomaterials.

Aseptic loosening of a permanent prosthesis remains one of the most common reasons for bone implant failure. To improve the fixation between implant and bone tissue as well as enhance blood vessel formation, bioactive agents are incorporated into the surface of the biomaterial. This study reviews and compares five bioactive elements (copper, magnesium, silicon, strontium, and zinc) with respect to their effect on the angiogenic behavior of endothelial cells (ECs) when incorporated on the surface of biomaterials. Moreover, it provides an overview of the state-of-the-art methodologies used for the in vitro assessment of the angiogenic properties of these elements. Two databases are searched using keywords containing ECs and copper, magnesium, silicon, strontium, and zinc. After applying the defined inclusion and exclusion criteria, 59 articles are retained for the final assessment. An overview of the angiogenic properties of five bioactive elements and the methods used for assessment of their in vitro angiogenic potential is presented. The findings show that silicon and strontium can effectively enhance osseointegration through the simultaneous promotion of both angiogenesis and osteogenesis. Therefore, their integration onto the surface of biomaterials can ultimately decrease the incidence of implant failure due to aseptic loosening.

Nanohydroxyapatite as a Biomaterial for Peripheral Nerve Regeneration after Mechanical Damage-In Vitro Study.

Hydroxyapatite has been used in medicine for many years as a biomaterial or a cover for other biomaterials in orthopedics and dentistry. This study characterized the physicochemical properties (structure, particle size and morphology, surface properties) of Li+- and Li+/Eu3+-doped nanohydroxyapatite obtained using the wet chemistry method. The potential regenerative properties against neurite damage in cultures of neuron-like cells (SH-SY5Y and PC12 after differentiation) were also studied. The effect of nanohydroxyapatite (nHAp) on the induction of repair processes in cell cultures was assessed in tests of metabolic activity, the level of free oxygen radicals and nitric oxide, and the average length of neurites. The study showed that nanohydroxyapatite influences the increase in mitochondrial activity, which is correlated with the increase in the length of neurites. It has been shown that the doping of nanohydroxyapatite with Eu3+ ions enhances the antioxidant properties of the tested nanohydroxyapatite. These basic studies indicate its potential application in the treatment of neurite damage. These studies should be continued in primary neuronal cultures and then with in vivo models.

A Bibliometric Analysis and Visualisation of Research Trends in Nickel-Based Orthopaedic Implants

Nickel is one of the widely used metal for orthopaedic implants. The bibliometric analysis had been conducted to understand the active authors, organizations, journals, and countries involved in the research domain of “Nickel-based orthopaedic implants”. All published articles related to “Nickel-based orthopaedic implants” from “Scopus”, were analyzed using the VOS viewer to develop analysis tables and visualization maps. This article had set the objective to consolidate the scientific literature regarding “Nickel-based orthopaedic implants” and also to find out the trends related to the same. The most active journals in this research domain were the Journal of Orthopaedic Research and Biomaterials. The most active country was the United States of America. The leading organization engaged in research regarding knee implants was the City University of Hong Kong. The most active authors who had made valuable contributions related to orthopaedic implants were Chu. P.K.

Three-Dimensional (3D) printing and bioprinting for orthopaedic biomaterials - A short review

Tissue engineering is a non-conventional approach in creating artificial organs and tissues to heal from bone fracture or organs malfunction by regenerating the damaged tissues. This review paper focuses on bone scaffold fabrication methods using three-dimensional (3D) printing and bioprinting for tissue engineering applications. Various types of biomaterials and fabrication techniques of bone scaffolds aimed for tissue engineering were thoroughly discussed. Suitability of biomaterial and polymer for bone scaffolds is deliberated as part of the review paper. Several biomaterials, mechanical properties and porosity of scaffolds were reviewed to give an in depth understanding on 3D printing and tissue engineering field.

The State of the Art and Prospects for Osteoimmunomodulatory Biomaterials.

The critical role of the immune system in host defense against foreign bodies and pathogens has been long recognized. With the introduction of a new field of research called osteoimmunology, the crosstalk between the immune and bone-forming cells has been studied more thoroughly, leading to the conclusion that the two systems are intimately connected through various cytokines, signaling molecules, transcription factors and receptors. The host immune reaction triggered by biomaterial implantation determines the in vivo fate of the implant, either in new bone formation or in fibrous tissue encapsulation. The traditional biomaterial design consisted in fabricating inert biomaterials capable of stimulating osteogenesis; however, inconsistencies between the in vitro and in vivo results were reported. This led to a shift in the development of biomaterials towards implants with osteoimmunomodulatory properties. By endowing the orthopedic biomaterials with favorable osteoimmunomodulatory properties, a desired immune response can be triggered in order to obtain a proper bone regeneration process. In this context, various approaches, such as the modification of chemical/structural characteristics or the incorporation of bioactive molecules, have been employed in order to modulate the crosstalk with the immune cells. The current review provides an overview of recent developments in such applied strategies.

Innovations in Orthopedic Biomaterials and Regenerative Medicine in China

RETURN TO ISSUEEditorialNEXTInnovations in Orthopedic Biomaterials and Regenerative Medicine in ChinaHongwei Ouyang*Hongwei Ouyang*Email: [email protected]More by Hongwei Ouyanghttp://orcid.org/0000-0003-0627-2536Cite this: ACS Biomater. Sci. Eng. 2021, 7, 3, 804–805Publication Date (Web):March 8, 2021Publication History Received9 February 2021Published online8 March 2021Published inissue 8 March 2021https://doi.org/10.1021/acsbiomaterials.1c00214Copyright © Published 2021 by American Chemical SocietyRIGHTS & PERMISSIONSArticle Views483Altmetric-Citations-LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InReddit PDF (562 KB) Get e-AlertsSUBJECTS:Anatomy,Biomaterials,Scaffolds,Regenerative medicine,Polymer scaffolds Get e-Alerts

The AAHKS Best Podium Presentation Research Award: Comparing the Efficacy of Irrigation Solutions on Staphylococcal Biofilm Formed on Arthroplasty Surfaces

BackgroundA diverse array of antibacterial solutions is utilized by orthopedic surgeons in an attempt to disperse bacterial biofilm. Few studies compare these agents against biofilm grown on clinically relevant orthopedic biomaterials, such as plastic, acrylic cement, and porous titanium. MethodsMSSA biofilm was grown on plastic 48-well plates, polymethylmethacrylate cement beads and porous Ti-6Al-4V acetabular screw caps. Antibacterial solutions were tested according to manufacturer guidance and included: isotonic saline, vancomycin (1 mg/mL), polymyxin-bacitracin (500,000 U/L-50,000 U/L), povidone-iodine 0.3%, povidone-iodine 10%, a 1:1 combination of povidone-iodine 10% & 4% hydrogen peroxide, polyhexamethylene biguanide (PHMB) and betaine 0.04%, a commercial solution containing chlorhexidine gluconate (CHG) 0.05%, and a commercial solution containing benzalkonium chloride and ethanol. Twenty four and 72-hour biofilms were exposed to solutions for 3 minutes to reproduce intraoperative conditions. Solution efficacy was measured through sonication of treated surfaces followed by counting colony forming units and validated with a resazurin assay to assess cell viability. Experiments were performed in triplicate and repeated at least once. A three-fold log reduction in CFU counts versus controls was considered as a measure of solution efficacy. ResultsSaline, vancomycin and polymyxin-bacitracin were ineffective compared to other solutions against planktonic MSSA. Povidone-iodine 10% and a 1:1 solution of povidone-iodine 10% and 4% hydrogen peroxide were the only effective solutions against biofilm across all three surfaces and time points. ConclusionCommercial antibacterial solutions vary significantly in their efficacy against MSSA biofilm. Efficacy globally decreased as biofilm maturity increased. Increased solution cost did not confer increased efficacy.

Micropatterning biomineralization with immobilized mother of pearl proteins

In response to the drawbacks of autograft donor-site morbidity and bone morphogenetic protein type 2 (BMP2) carcinogenesis and ectopic bone formation, there has been an increased research focus towards developing alternatives capable of achieving spatial control over bone formation. Here we show for the first time both osteogenic differentiation and mineralization (from solution or mediated by cells) occurring within predetermined microscopic patterns. Our results revealed that both PEGylated BMP2 and nacre proteins induced stem cell osteodifferentiation in microscopic patterns when these proteins were covalently bonded in patterns onto polyethylene glycol diacrylate (PEGDA) hydrogel substrates; however, only nacre proteins induced mineralization localized to the micropatterns. These findings have broad implications on the design and development of orthopedic biomaterials and drug delivery.