Orthopedic Devices Research Articles

A 13-Year Retrospective Review of Metal Series Patch Testing for Orthopaedic Devices

A 13-Year Retrospective Review of Metal Series Patch Testing for Orthopaedic Devices

Feasibility of automated surveillance of implantable devices in orthopaedics via clinical data warehouse: the Studio study

BackgroundTotal hip, knee and shoulder arthroplasties (THKSA) are increasing due to expanding demands in ageing population. Material surveillance is important to prevent severe complications involving implantable medical devices (IMD) by taking appropriate preventive measures. Automating the analysis of patient and IMD features could benefit physicians and public health policies, allowing early issue detection and decision support. The study aimed to demonstrate the feasibility of automated cohorting of patients with a first arthroplasty in two hospital data warehouses (HDW) in France.MethodsThe study included adult patients with an arthroplasty between 2010 and 2019 identified by 2 data sources: hospital discharge and pharmacy. Selection was based on the health insurance thesaurus of IMDs in the pharmacy database: 1,523 distinct IMD references for primary THSKA. In the hospital discharge database, 22 distinct procedures for native joint replacement allowing a matching between IMD and surgical procedure of each patient selected. A program to automate information extraction was implemented in the 1st hospital data warehouse using natural language processing (NLP) on pharmacy labels, then it was then applied to the 2nd hospital.ResultsThe e-cohort was built with a first arthroplasty for THKSA performed in 7,587 patients with a mean age of 67.4 years, and a sex ratio of 0.75. The cohort involved 4,113 hip, 2,630 knee and 844 shoulder surgical patients. Obesity, cardio-vascular diseases and hypertension were the most frequent medical conditions.DiscussionThe implementation of an e-cohort for material surveillance will be easily workable over HDWs France wild. Using NLP as no international IMD mapping exists to study IMD, our approach aims to close the gap between conventional epidemiological cohorting tools and bigdata approach.ConclusionThis pilot study demonstrated the feasibility of an e-cohort of orthopaedic devices using clinical data warehouses. The IMD and patient features could be studied with intra-hospital follow-up and will help analysing the infectious and unsealing complications.

Investigation of Elaeocarpus ganitrus seed (EGs) powder as a sustainable composite biomaterial: Effects of particle size on the mechanical, frictional, and thermal properties for potential biomedical applications

This study explores the potential of Elaeocarpus ganitrus seed (EGs) powder as a sustainable composite biomaterial, focusing on its particle size effects on the mechanical, frictional, and thermal properties of composite materials for potential biomedical applications such as prosthetics and implants. Composite specimens were produced using the compression hot molding method, utilizing EG powder particles of varying sizes (120, 140, and 200-mesh sieving). The influence of EG powder particle size on key properties was systematically investigated. The findings reveal that reducing the particle size of EGs leads to a decrease in density and hardness of the composite, with the largest particle size (BP1) resulting in the highest density and hardness. Friction coefficient measurements indicated suitability for biomedical applications where surface interaction and wear resistance are critical, such as joint prosthetics. Thermal analysis showed that BP1 exhibited superior thermal stability, with a maximum decomposition temperature (Tmax) exceeding 375 °C. Differential scanning calorimetry identified significant differences in glass transition temperature (Tg) and crystallization temperature (Tc) across specimens. The composites demonstrated exceptional thermal performance, surpassing previous benchmarks for biomaterials in high-temperature environments. The mechanical and thermal characteristics of Specimen BP1—2.725 g/cm3 density, 74 Shore D hardness, 0.159 coefficient of friction, 93.3% total residual, 378.14 °C Tmax, 426.25 °C Tc, and 376.87 °C Tg—suggest its potential for biomedical applications requiring durability and thermal resilience, such as in orthopedic devices and tissue engineering scaffolds.

Bioresorbable composites based on magnesium and hydroxyapatite for use in bone tissue engineering: focus on controlling and minimizing corrosion activity

A biodegradable matrix with a significant content of bioactive components can be applied for bone tissue replacement, including load-bearing applications in orthopedic surgery. The study outlines the optimized procedure for the production of bioresorbable magnesium-hydroxyapatite (Mg-HA) composites and their corrosion resistance properties. Composites were meticulously crafted by combining pure magnesium with microwave-synthesized hydroxyapatite nanopowder. Sintering occurred via spark plasma sintering technology (SPS). To align the degradation time of the resulting composites with bone remodeling, the corrosion resistance of SPS materials was enhanced through the application of plasma electrolytic oxidation (PEO) and polycaprolactone (PCL) spin-coating methods. The protective properties, morphology dynamics, and composition due to surface treatment and corrosion propagation were investigated using Electrochemical Impedance Spectroscopy (EIS), Potentiodynamic Polarization (PDP), hydrogen evolution tests, Scanning Electron Microscopy (SEM), Energy-dispersive X-ray (EDX) as well as X-ray diffraction (XRD) analysis. Analytics of the physicochemical properties data of the formed coatings indicate a significant improvement in protective characteristics and deceleration of the corrosive degradation of the samples. The application of polycaprolactone to the PEO coating leads to a decrease in the corrosion current compared to uncoated magnesium composites by more than three orders of magnitude: from 1 10-5 to 2 10-9 A cm-2. During long-term exposure of samples to 0.9 % NaCl solution, it was found that coating reduced the rate of corrosion degradation of samples from 1.5 to 80 times compared to an unprotected Mg-HA composite and sintered magnesium. Mg-HA composites treated with PEO exhibit potential application as bioactive and biodegradable materials for orthopedic implants and fixation devices.

Dhvar5- and MSI78-coated titanium are bactericidal against methicillin-resistant Staphylococcus aureus, immunomodulatory and osteogenic

Infection is one of the major issues associated with the failure of orthopedic devices, mainly due to implant bacterial colonization, biofilm formation, and associated antibiotic resistance. Antimicrobial peptides (AMP) are a promising alternative to conventional antibiotics given their broad-spectrum of activity, low propensity to induce bacterial resistance, and ability to modulate host immune responses. Dhvar5 (LLLFLLKKRKKRKY) and MSI78 (GIGKFLKKAKKFGKAFVKILKK) are two AMP with broad-spectrum activity against bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), one of the most problematic etiologic agents in Orthopedic Devices-Related Infections (ODRI). This work aims to evaluate the bactericidal, immunomodulatory and osteogenic potential of Dhvar5- and MSI78-coated titanium surfaces (AMP-Ti). Two AMP-Ti surfaces were successfully obtained by grafting Dhvar5 (0.8 ± 0.1 µM/mm2) or MSI78 (0.5 ± 0.3 µM/mm2) onto titanium substrates through a polydopamine layer. Both AMP-Ti were bactericidal against MRSA, eradicating bacteria upon contact for 6 h in a culture medium supplemented with human plasma proteins. The AMP-Ti immunomodulatory potential was evaluated using human primary macrophages, by assessing surfaces capacity to induce pro-/anti-inflammatory (M1/M2) markers and cytokines. While in naïve conditions both AMP-Ti surfaces slightly promoted the M2 marker CD163, in response to LPS and IFN-γ (simulating a bacterial infection), both AMP increased the M1 marker CCR7 and enhanced macrophage secretion of pro-inflammatory IL-6 and TNF-α cytokines, particularly for Ti-MSI78 surfaces. Additionally, both AMP-Ti surfaces were cytocompatible and promoted osteoblastic cell differentiation. This proof-of-concept study demonstrated the high potential of Dhvar5- and MSI78-Ti as antimicrobial coatings for ODRI prevention. STATEMENT OF SIGNIFICANCE: This study investigates the bactericidal effects of the antimicrobial peptides Dhvar5 and MSI78, immobilized on titanium (Ti) surfaces through a polydopamine coating, aiming at the prevention of Orthopedic-Device Related Infections (ODRIs). The developed coatings displayed MRSA-sterilizing activity, while revealing an immunomodulatory potential towards macrophages and promoting osteoblastic cell differentiation. This strategy allows a quick and easy immobilization of high quantities of AMP, unlike most other approaches, thus favoring its clinical translation.

Bone infection evolution

The present minireview aims to provide a context for imagination of the timespan for bone infection evolution from the origin of cellular bone tissue to modern orthopedic surgery. From a phylogenetic osteomyelitis-bracketing perspective, and due to the time of osteocyte origin, bacteria might have been able to infect the skeleton for approximately 400 million years. Thereby, bone infections happened simultaneously with central expansions of the immune system and development of terrestrial bone structure. This co-evolution might aid in explaining the many immune evasion strategies seen in the field of bone infections. Bone infection patients with long disease-free periods followed by sudden recurrence and anamnesis of long-term and low-grade infections indicate that bacteria can perform silent parasitism within bone tissue (parasitism; one organism lives on another organism, the host, causing it harm and is structurally adapted to it). The silence seems to be disturbed by immunosuppression and the present minireview shows that a compromised immune system has been associated with bone infection development across all species in the phylogenetic tree. Orthopedic surgery, including arthroplasty and osteosynthesis, favor introduction of bacteria and prosthesis/implant related infections are thus anthropogenic infections (anthropogenic; resulting from the influence of human beings on nature). In that light it is important to remember that the skeleton and immune system have not evolved for millions of years to protect titanium alloys and other metals, commonly used for orthopedic devices from bacterial invasion. Therefore, these relatively new orthopedic infection types must be seen as distinct with unique implant/prosthesis related pathophysiology and immunology.

Organic-Inorganic Biocompatible Coatings for Temporary and Permanent Metal Implants.

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

Exploring Drug Resistance: Microbial Profiles, Antibiotic Sensitivity, and Biofilm Development in Orthopedic Implant Infections.

Background With the advent of and rise in antibiotic resistance globally, especially in postoperative patients, studying the antibiogram and associated factors is the need of the hour. The present study was undertaken to document the microbiological profile in postoperative orthopedic patients with the infected implant in situ and to observe the antibiotic susceptibility patterns of isolated organisms in such infections. Methods This study was conducted in the Department of Microbiology of a tertiary care hospital for six months after obtaining institutional ethical approval. A total of 236 samples from patients with orthopedic implant infections were received during the study period, out of which 53 samples with positive culture isolate were further analyzed for microbiological profile including biofilm production. All observations and demographics were recorded and analyzed using SPSS software version 21.0(IBM Corp., Armonk, NY, USA) and represented in the form of graphs, data, and tables. Results and conclusion The study showed a culture positivity rate of 53 (23%) out of 236 samples, in which gram-negative isolates 36 (68%)were more than gram-positive isolates 17 (32%). The most common isolate was staphylococcus aureus 17 (32%) of which the majority were MRSA 13 (76%), followed by Escherichia coli 9 (17%) and Klebsiella pneumoniae 9 (17%). Out of the 53 isolates, 20 were biofilm producers. Biofilm-producing isolates were more resistant to tested routine antibiotics compared to non-biofilm. This study could represent the initial interdisciplinary effort in an ongoing process to better understand and manage orthopedic implant infections at the hospital, specifically focusing on infections related to orthopedic devices.

The Influence of Social Media in Orthopaedics

Social media's presence has extended to almost every industry in the world. In orthopaedics, this lends benefits to practitioners, allowing them to interact with patients, build their practice, recruit research subjects, advertise residency programs, and disperse research findings. It also allows advantages to patients, allowing them to learn about their conditions and potential treatments as many patients use social media to get health information. However, patients can also be heavily influenced by what they read online. Much of this information is not vetted by governing bodies such as the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC), organizational bodies such as the American Academy of Orthopaedic Surgeons (AAOS), or the social media companies themselves. Manufacturers have started to exploit this lack of oversight by marketing products to patients with false claims that do not have rigorous clinical data behind them, creating the potential for harm. Patients are not well equipped to understand what is appropriate for the specifics of their conditions but are convinced by these powerful marketing techniques. They then come to appointments requesting treatments that are not indicated for their conditions. This strains the patient-physician relationship and can cause worse patient outcomes. Products are marketed in many fields of medicine, and orthopaedic device companies are increasingly targeting patients. This review, therefore, explores the potential benefits and drawbacks of social media in medicine in general and orthopaedics specifically and possible solutions to these issues. Namely, the introduction of some form of filtering from the FDA, CDC, other orthopaedic governing bodies, or social media platforms.

Biofilm Formation, Antibiotic Resistance, and Infection (BARI): The Triangle of Death.

Fracture-related infection (FRI) is a devastating event, directly affecting fracture healing, impairing patient function, prolonging treatment, and increasing healthcare costs. Time plays a decisive role in prognosis, as biofilm maturation leads to the development of antibiotic resistance, potentially contributing to infection chronicity and increasing morbidity and mortality. Research exploring the association between biofilm maturation and antibiotic resistance in orthopaedics primarily addresses aspects related to quality of life and physical function; however, little exists on life-threatening conditions and mortality. Understanding the intrinsic relationship between biofilm maturation, bacterial resistance, and mortality is critical in all fields of medicine. In the herein narrative review, we summarize recent evidence regarding biofilm formation, antibiotic resistance, and infection chronicity (BARI), the three basic components of the "triangle of death" of FRI, and its implications. Preoperative, perioperative, and postoperative prevention strategies to avoid the "triangle of death" of FRI are presented and discussed. Additionally, the importance of the orthopaedic trauma surgeon in understanding new tools to combat infections related to orthopaedic devices is highlighted.

Clinical evolution of patients with infection associated with orthopedic devices in treatment with continuous negative pressure

To describe the use of negative pressure therapy with (TPNi) and without instillation (TPNs) as adjuvant treatment in the management of orthopedic device-associated infections (IADO). Analytic observational study of records of patients with IADO managed with TPNi and TPNs with 0.9% saline solution, in patients > 18 years, operated on in 2018-2021. Clinical characteristics of infection, infectious agent as well as sociodemographic variables were evaluated. TPN was performed with the V.A.C. VERAFLO™ system. Analysis with χ2, Fisher and t-Student. Statistically accepted value p < 0.05. Sample 40 patients. 75% male. Fractures 42.5% exposed and 57.5% closed. 92.5% applied prophylactic antibiotic (30-120 min). 35% plate implants, 12.5% centromedullary nail, 10% knee prosthesis and 12.5% hip. 47.5% bleeding < 500 ml. 72.5% surgical time of 2-4 hours. Previous hospitalization time, TPNs 3 weeks 55.9% and 4 weeks 26.5%; TPNi, 3 weeks 50% and 4 weeks 33.3%. Conservation of the implant 73.5% TPNs and 50% TPNi (p = 0.341). Wound closure 91.2% with TPNs and 100% with TPNi (p = 1.000). The use of TPNs and TPNi were useful as adjuvant treatments in the management of IADO, in addition they allowed to preserve the implant and wound closure in a large part of the patients.

Platelet interaction and performance of antibacterial bioinspired nanostructures passivated with human plasma

The ever-increasing ageing of the world population is demanding superior orthopedic devices. Issues such as implant infection, poor osseointegration, or chronic inflammation remain problematic to the lifespan and long-term efficacy of implants. Fabrication of materials with bioinspired nanostructures is one emerging antibacterial strategy to prevent implant infection, however their interactions with blood components, and whether they retain their bactericidal properties in an environment displaying a complex protein corona, remains largely unexplored. In the present study, titanium alloy, commercially pure and plasma-sprayed titania were hydrothermally etched, passivated with human native plasma to develop a protein corona, and then incubated with either Staphylococcus aureus, Pseudomonas aeruginosa or human platelets. Surface analysis was first used to characterize the topography, chemical composition or crystallinity of each material. Fluorescence staining and SEM were performed to evaluate the nanostructure bactericidal properties, as well as to study platelet attachment and morphology. Composition of platelet supernatant was studied using ELISA and flow cytometry. Overall, our study showed that the bioinspired nanostructured surfaces displayed both impressive antibacterial properties in a complex environment, and a superior blood biocompatibility profile in terms of platelet activation (particularly for titanium alloy). Additionally, the amount of pro-inflammatory cytokines released by platelets was found to be no different to that found in native plasma (background levels) and, in some cases, presented a more pro-healing profile with an increased secretion of factors such as TGF-β, PDGF-BB or BMP-2. The nanostructured surfaces performed equally, or better, than hydroxyapatite-coated titanium which is one of the current gold standards in orthopedics. Although further in vivo studies are required to validate these results, such bioinspired nanostructured surfaces certainly show promise to be safely applied to medical device surfaces used in orthopedics and other areas.

Thirty-five Years of Reporting of Sex and Race in Clinical Studies of U.S. FDA-Authorized Orthopaedic Devices.

At the U.S. Food and Drug Administration (FDA), the mission of the Center for Devices and Radiological Health (CDRH) is to ensure that all patients and providers have timely and continued access to safe, effective, and high-quality medical devices and safe radiation-emitting products. Although the CDRH has observed enrollment differences in some clinical trials, no systematic analysis has been conducted regarding enrollment differences in baseline demographics, to our knowledge. The CDRH has summarized information on study participants and their baseline demographics in public-facing documentation for all authorized medical devices that involved orthopaedic clinical studies from 1985 to 2020. Descriptive analyses and exploratory statistical testing have been conducted to investigate the reported percentages by sex and race compared with those reported in the U.S. National Census and the American Joint Replacement Registry (AJRR), respectively. We identified 94 submissions and corresponding combined clinical trials from 261 original clinical study arms with 34,193 participants. Most of the submissions reported age and sex, while only 36 submissions (38.3%) reported racial demographics. Among the 88 trials providing enrollment by sex, the female enrollment percentage ranged from 22.2% to 88.7%, with a mean of 55.0%. In the submissions that reported racial data (38.3%), White and Black patients had a mean enrollment of 89.2% (range, 64.8% to 98.7%) and 6.2% (range, 0.4% to 20.7%), respectively. The enrollment for other minority groups ranged from 0% to 3.0%. These clinical trials have shown numerically lower female representation (55.0%) but higher White representation (89.2%) than what has been reported in the AJRR. The other racial groups have participated much less than their corresponding percentages in the U.S. population, but they are similarly represented in the AJRR. The clinical trials supporting the FDA's authorization of orthopaedic devices had a wide range of sex and racial enrollments. It appears that female enrollment mirrors the percentage of women in the U.S. population. However, despite prior efforts, some racial groups are still underrepresented. The FDA has made a commitment to advancing health equity as part of the 2022-2025 Strategic Priorities of the CDRH. We hope that the results of this study will help health-care professionals make informed clinical decisions when using medical devices.

Covalent Grafting of Tanfloc on Titania Nanotube Arrays: An Approach to Mitigate Bacterial Adhesion and Improve the Antibacterial Efficacy of Titanium Implants

AbstractImplanted medical devices often face the challenge of infections, which can compromise their successful integration and use. To address this issue, this study demonstrates the covalent grafting of a tannin‐based antimicrobial biopolymer tanfloc (TAN) onto the titania nanotube arrays (TiNTs) surface to enhance antibacterial properties. Due to its polyphenolic and ionic structural configuration, tanfloc possesses unique properties that enable it to interact with and disrupt bacterial cell walls and membranes. Combining the topographical effect of TiNTs with the inherent antibacterial properties of tanfloc, this approach aims to mitigate bacterial threats on medical implants effectively. The successful attachment of tanfloc on TiNTs is confirmed through X‐ray photoelectron spectroscopy (XPS) and Fourier‐transform infrared spectroscopy (FT‐IR). The antibacterial and antibiofilm efficacy of the tanfloc‐functionalized TiNTs is evaluated against Staphylococcus aureus (Gram‐positive) and Pseudomonas aeruginosa (Gram‐negative) bacteria. The findings suggest that the covalent conjugation of tanfloc onto TiNTs is a promising approach to improve the infection resistance of titanium‐based medical implants, with potential applications in orthopedic, dental, and other biomedical device areas.

Three-Stage Non-Surgical Treatment of Skeletal Class III Malocclusion in Adolescents—A Report of Four Cases with Long-Term Follow-Up

(1) Background: Postponing orthodontic treatment in Class III malocclusion until deterioration and growth cessation to perform orthognathic surgery does not seem to be an optimal solution for every patient. This report describes short- and long-term outcomes for nonsurgical treatment of four adolescents with severe Class III malocclusion. (2) Methods: Four patients (aged 13–15 y) with skeletal Class III (Wits appraisal below 7.5 mm) started a three-stage treatment, consisting of a six-month-long phase I and involving orthopedic treatment with an individual chin-cup. Phase II involved orthopedic treatment with a bonded Haas-type expander on acrylic splints, a face-mask, a lower fixed appliance and Class III elastics; phase III involved full fixed appliance, elastics and reuse of the individual chin-cup. Pre and posttreatment cephalograms were analyzed and superimposed. (3) Results: Improved skeletal and dental relationships and facial appearance was achieved in all patients. Wits appraisal, angles ANB, ANPg and lower face height increased; an improvement of overbite was noted. (4) Conclusions: Severe skeletal Class III in adolescents may be successfully treated with combined orthopedic/camouflage treatment with a Haas-type expander on acrylic splints, Class III elastics, fixed appliance and orthopedic devices (individual chin-cup and facemask) with a very good compliance.

Ten-year occlusion comparison of patients with cleft palate who received treatment with active or passive pre-surgical orthopedic devices

Ten-year occlusion comparison of patients with cleft palate who received treatment with active or passive pre-surgical orthopedic devices

Performance of a NLP Tool for Text Classification from Orthopaedic Operative Reports, Using Data from the Large Network of Clinical Data Warehouses of the West of France: The HACRO-HUGORTHO Project.

Electronic health data concerning implantable medical devices (IMD) opens opportunities for dynamic real-world monitoring to assess associated risks related to implanted materials. Due to population ageing and expanding demands, total hip, knee, and shoulder arthroplasties are increasing. Automating the collection and analysis of orthopedic device features could benefit physicians and public health policies enabling early issue detection, IMD monitoring and patient safety assessment. A machine learning tool using natural language processing (NLP) was developed for the automated extraction of operation information from medical reports in orthopedics. A corpus of 959 orthopaedic operative reports from 5 centres was manually annotated using the Prodigy software® with a strong inter-annotator agreement of 0.80. Data to extract concerned key clinical and procedure information (n= 9) selected by a multidisciplinary group based on the French health authority checklist. Performances parameters of the NLP model estimated an overall strong precision and recall of respectively 97.0 and 96.0 with a F1-score 96.3. Systematic monitoring of orthopedic devices could be ensured by an automated tool, leveraging clinical data warehouses. Traceability of medical devices with implantation modalities will allow detection of implant factors leading to complications. The evidence from real-world data could provide concrete and dynamic insights to surgeons and infectious disease specialists concerning implant follow-up, guiding therapeutic decision-making, and informing public health policymakers. The tool will be applied on clinical data warehouses to automate information extraction and presentation, providing feedback on mandatory information completion and contents of operative reports to support improvements, and thereafter implant research projects.

Amorphous TiO2 nano-coating on stainless steel to improve its biological response

This study delves into the potential of amorphous titanium oxide (aTiO2) nano-coating to enhance various critical aspects of non-Ti-based metallic orthopedic implants. These implants, such as medical-grade stainless steel (SS), are widely used for orthopedic devices that demand high strength and durability. The aTiO2 nano-coating, deposited via magnetron sputtering, is a unique attempt to improve the osteogenesis, the inflammatory response, and to reduce bacterial colonization on SS substrates. &#xD;The study characterized the nanocoated surfaces (SS-a TiO2) in topography, roughness, wettability, and chemical composition. Comparative samples included uncoated SS and sandblasted/acid-etched Ti substrates (Ti). The biological effects were assessed using human mesenchymal stem cells (MSCs) and primary murine macrophages. Bacterial tests were carried out with two aerobic pathogens (S. aureus and S. epidermidis) and an anaerobic bacterial consortium representing an oral dental biofilm.&#xD;Results from this study provide strong evidence of the positive effects of the aTiO2 nano-coating on SS surfaces. The coating enhanced MSC osteoblastic differentiation and exhibited a response similar to that observed on Ti surfaces. Macrophages cultured on aTiO2 nano-coating and Ti surfaces showed comparable anti-inflammatory phenotypes. Most significantly, a reduction in bacterial colonization across tested species was observed compared to uncoated SS substrates, further supporting the potential of aTiO2 nano-coating in biomedical applications.&#xD;The findings underscore the potential of magnetron-sputtering deposition of aTiO2 nano-coating on non-Ti metallic surfaces such as medical-grade SS as a viable strategy to enhance osteoinductive factors and decrease pathogenic bacterial adhesion. This could significantly improve the performance of metallic-based biomedical devices beyond titanium.

Toward Fully Automated Personalized Orthopedic Treatments: Innovations and Interdisciplinary Gaps.

Personalized orthopedic devices are increasingly favored for their potential to enhance long-term treatment success. Despite significant advancements across various disciplines, the seamless integration and full automation of personalized orthopedic treatments remain elusive. This paper identifies key interdisciplinary gaps in integrating and automating advanced technologies for personalized orthopedic treatment. It begins by outlining the standard clinical practices in orthopedic treatments and the extent of personalization achievable. The paper then explores recent innovations in artificial intelligence, biomaterials, genomic and proteomic analyses, lab-on-a-chip, medical imaging, image-based biomechanical finite element modeling, biomimicry, 3D printing and bioprinting, and implantable sensors, emphasizing their contributions to personalized treatments. Tentative strategies or solutions are proposed to address the interdisciplinary gaps by utilizing innovative technologies. The key findings highlight the need for the non-invasive quantitative assessment of bone quality, patient-specific biocompatibility, and device designs that address individual biological and mechanical conditions. This comprehensive review underscores the transformative potential of these technologies and the importance of multidisciplinary collaboration to integrate and automate them into a cohesive, intelligent system for personalized orthopedic treatments.

Improved assessment of radiofrequency electromagnetic field power deposition near orthopaedic device using a bone-inclusive ASTM phantom under 1.5T and 3T MRI

Objective. A bone-inclusive ASTM phantom is proposed to improve the assessment of radiofrequency electromagnetic field (RF-EMF) power deposition near orthopedic device under 1.5 T and 3 T magnetic resonance imaging (MRI). Approach. A phantom is created by introducing a cylindrical bone structure inside the American Society for Testing and Materials (ASTM) phantom. Four orthopaedic implant families—rod, nailing system, plate system, and hip replacement—are used in the study. RF-EMF power deposition (in terms of peak averaged specific absorption rate over 1 gram) near these implants are evaluated by placing these implants inside the standard ASTM phantom, the developed bone-inclusive ASTM phantom, and two anatomically representative human body phantoms, known as Duke and Ella. Numerical simulations are performed to calculate the RF-EMF power deposition near various orthopaedic devices within these phantoms. Main Results. For devices implanted inside or near bone tissue, the evaluation of RF-EMF power deposition using the developed bone-inclusive ASTM phantom shows better correlations to the human body phantoms than the ASTM phantom. This improvement is attributed to the portion of the devices implanted within the bone tissue. Significance. The bone-inclusive ASTM phantom has the different tissue of interests surrounding the implants compared to the ASTM phantom. This variation can lead to the different resonance frequency under RF-EMF exposure. This leads to better correlation of RF-EMF power deposition near orthopaedic implants inside human body, making the bone-inclusive ASTM phantom more suitable for evaluating RF-EMF power deposition than ASTM phantom in MRI scans.