Reduce Stress Shielding Research Articles

A Customized Distribution of the Coefficient of Friction of the Porous Coating in the Short Femoral Stem Reduces Stress Shielding

Stress shielding and aseptic loosening have been identified as adverse effects of short-stem total hip arthroplasty resulting in hardware failure. However, there is a gap in research regarding the impact of stress shielding in customized porous coatings. The purpose of this study was to optimize the distribution of the coefficients of friction in the porous coating of a metaphyseal femoral stem to minimize stress shielding. Static structural analysis of an implanted short, tapered-wedge stem with a titanium porous coating was performed with the use of Analysis System Mechanical Software under axial loading. To limit computational time, we randomly sampled only 500 of the possible combinations of coefficients of friction. Results indicate that the coefficient of friction in the distal lateral porous coating significantly affected the mid-distal medial femoral surface and lateral femoral surface. The resultant increased proximal strains resulted from an increased coefficient of friction in lateral porous coating and a reduction in the coefficient of friction in medial mid-distal coating. These findings suggest that a customized porous coating distribution may produce strain patterns that are biomechanically closer to intact bone, thereby reducing stress shielding in short femoral stems.

Development and characterization of PLA nanocomposites reinforced with bio-ceramic particles for orthognathic implants: Enhanced mechanical and biological properties

The clinical application of osteofixation materials is crucial for maxillofacial reconstruction and orthognathic surgeries. To overcome the limitations of traditional metallic implants, bioabsorbable materials are gaining popularity due to their ability to avoid secondary removal surgeries and reduce stress shielding. This study investigates third-generation biomaterials, focusing on polylactic acid (PLA) for its biocompatibility and biodegradability, and hydroxyapatite (HAP) for its bioactive osteoconductive and bioresorbable properties. Eggshell nanoparticles (ES-NP), HAP, and bioinert alumina particles coated with titanium dioxide (TiO2@Al2O3) were prepared using ball milling, co-precipitation, and sol-gel methods, respectively. PLA-based nanocomposites PLA/ESNP/Al2O3 (PEA), PLA/HAP/Al2O3 (PHA), PLA/ESNP/TiO2@Al2O3 (PEAT), and PLA/HAP/TiO2@Al2O3 (PHAT) were fabricated via solvent casting. Characterization techniques including X-ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FT-IR), and Field-Emission Scanning Electron Microscopy (FE-SEM) were used to analyze the developed nanoparticles and composites. Results indicated PEAT and PHAT composites exhibited tensile strengths of 33.59 ± 0.38 MPa and 32.46 ± 0.46 MPa, tensile moduli of 1756.17 ± 95.43 MPa and 2367.21 ± 158.84 MPa, and shore d hardness values of 84.10 ± 1.45 SHN and 78.00 ± 2.25 SHN, respectively. Both composites achieved a wettability angle of ∼65° and surface roughness below 2.19 μm, enhancing osteoblast adhesion. Additionally, MG63 cell viability was approximately 80 %, and hemolysis rates were below 2.17 %, demonstrating their potential for maxillofacial implant applications.

Ultrasonic vibration-assisted femtosecond laser submerged ablation process for the preparation of titanium-based crack-free hydroxyapatite

Titanium alloy-based hydroxyapatite (HAp) coating materials are beneficial for reducing stress shielding and improving the biocompatibility of implants. However, the significant disparity in thermal conductivity between titanium alloy and hydroxyapatite results in the material being highly susceptible to cracking during preparation, which diminishes the mechanical properties of the material and predisposes the implant to aseptic loosening. To obtain coatings of HAp that are free of cracks, this study proposes a process method of ultrasonic-assisted femtosecond laser under-liquid ablation of a Ca/P solution to synthesize HAp by a one-step process and apply coatings on the surface of TC4 titanium alloy. The relationship between the laser process parameters and the resulting surface morphology, coating spatial distribution, elemental composition, chemical state of the elements, phase, coating thickness, coating bonding, friction coefficient, corrosion resistance and the number of cells was investigated through a series of analytical techniques, including high-speed photographic observation, scanning electron microscopy (SEM), X-ray Photoelectron Spectroscopy (XPS), energy-dispersive spectroscopy (EDS), X-ray diffraction (XRD), scratch testing, Tafel plot and cell adhesion assays. The findings demonstrate that titanium-based HAp coatings with a thickness of 42.5 μm, a bonding force of 55 N, a polarization resistance of 10 Ω.cm2, the absence of cracks defects, and notable bioactivity can be produced with ultrasonic-assisted submerged laser ablation in a highly concentrated Ca/P solution. The proposed method represents a novel approach to the preparation of multifunctionalized implants.

Recent Advances and Prospects in β-type Titanium Alloys for Dental Implants Applications.

Titanium and its alloys, especially Ti-6Al-4V, are widely studied in implantology for their favorable characteristics. However, challenges remain, such as the high modulus of elasticity and concerns about cytotoxicity. To resolve these issues, research focuses on β-type titanium alloys that incorporate elements such as Mo, Nb, Sn, and Ta to improve corrosion resistance and obtain a lower modulus of elasticity compatible with bone. This review comprehensively examines current β titanium alloys, evaluating their mechanical properties, in particular the modulus of elasticity, and corrosion resistance. To this end, a systematic literature search was carried out, where 81 articles were found to evaluate these outcomes. In addition, this review also covers the formation of the alloy, processing methods such as arc melting, and its physical, mechanical, electrochemical, tribological, and biological characteristics. Because β-Ti alloys have a modulus of elasticity closer to that of human bone compared to other metal alloys, they help reduce stress shielding. This is important because the alloy allows for a more even distribution of forces by having a modulus of elasticity more similar to that of bone. In addition, these alloys show good corrosion resistance due to the formation of a noble titanium oxide layer, facilitated by the incorporation of β stabilizers. These alloys also show significant improvements in mechanical strength and hardness. Finally, they also have lower cytotoxicity and bacterial adhesion, depending on the β stabilizer used. However, there are persistent challenges that require detailed research in critical areas, such as optimizing the composition of the alloy to achieve optimal properties in different clinical applications. In addition, it is crucial to study the long-term effects of implants on the human body and to advance the development of cutting-edge manufacturing techniques to guarantee the quality and biocompatibility of implants.

Design of functionally graded porous lattice structure tibial implant for TAR

Use of porous lattice structures and functionally graded (FG) implants in orthopaedic applications has emerged as a promising solution to reduce stress shielding. However, there is a notable research gap in examining the effects of post-operative scenarios within the lattice pores and different porosity distribution laws in functionally graded porous lattice structure (FGPLS) implants on the biomechanical performance of tibial implant for total ankle replacement (TAR). The objective of the study is to investigates the effects of both post-operative tissues and various porosity distribution laws on the biomechanical performance of tibial implant for TAR and proposes a new design strategy. CAD models for lattice structures at various porosities were developed to incorporate the effects of post-operative tissues such as fibrous tissue, cartilage, immature bone, and mature bone. The pore spaces of these lattice structures were assumed to be filled with the post-operative ingrowth tissues. The lattice structure and these tissues together form the Representative volume element (RVE), whose effective properties were calculated using Asymptotic homogenization (AH) technique. Equations linking mechanical properties and porosity were established and used to assign mechanical properties to macro-FE models of FGPLS tibial implants based on three different power laws i.e. n = 0.1,1 and 5. Macro-FE models for intact and implanted tibia bones were developed using homogeneous properties of cortical bone and heterogeneous cancellous bone properties. The proximal part of the tibia was fixed, and a compressive load was applied through the anterior nodes of the meniscal bearing to represent dorsiflexion loading during normal walking. The Finite Element Analysis (FEA) was utilized to investigate the biomechanical performance of these implanted models in terms of stress distribution in the tibia bone and implant-bone micromotion. A comparison was made between models with solid metallic implants and those with FGPLS implants. Additionally, models with varying post-operative tissues in the pore space were compared, as well as models with different porosity variation laws were also compared. Results demonstrated that models implanted with FGPLS implants having porosity variation based on power law n = 0.1 showed increased bone stress and micromotion compared to those with solid metallic implants. Specifically, in models with FGPLS implants with porosity variation based on a power law of n = 0.1, the bone area with stress ranging from 2–5 MPa increased significantly in the periprosthetic region compared to models with solid metallic implants. The bone stress value for the majority of the region above the medial and lateral peg increased from 1–2 MPa to 2–5 MPa. Although there was a slight increase in micromotion values, they remained below the acceptable threshold of 50 µm. Models with porosity variations based on power laws n = 1 and n = 5 exhibited similar bone stress and micromotion results as solid metallic implants. Additionally, no significant difference in bone stresses was observed for different stages of bone ingrowth at pore space. These findings indicate that both the porous structure and porosity distribution within the implant significantly influence the biomechanical performance of tibial implants for TAR. So, it can be concluded that FGPLS implants with power law n = 0.1 are effective in reducing stress shielding and supporting the long-term survival of TAR by increasing bone stress and reducing the chances of aseptic loosening due to implant induced adaptive bone remodelling.

3D Topology Optimization and Mesh Dependency for Redesigning Locking Compression Plates Aiming to Reduce Stress Shielding.

Current fixation plates for bone fracture treatments are built with biocompatible metallic materials such as stainless steel, titanium, and its alloys (e.g., Ti6Al4V). The stiffness mismatch between the metallic material of the plate and the host bone leads to stress shielding phenomena, bone loss, and healing deficiency. This paper explores the use of three dimensional topology-optimization, based on compliance (i.e., strain energy) minimization, reshaping the design domain of three locking compression plates (four-screw holes, six-screw holes, and eight-screw holes), considering different volume reductions (25, 45, and 75%) and loading conditions (bending, compression, torsion, and combined loads). A finite-element study was also conducted to measure the stiffness of each optimized plate. Thirty-six designs were obtained. Results showed that for a critical value of volume reductions, which depend on the load condition and number of screws, it is possible to obtain designs with lower stiffness, thereby reducing the risk of stress shielding.

Effect of cortical bone thickness on shear stress and force in orthodontic miniscrew-bone interface – A finite element analysis

Miniscrews are widely used in orthodontics as an anchorage device while aligning teeth. Shear stress in the miniscrew-bone interface is an important factor when the miniscrew makes contact with the bone. The objective of this study was to analyze the shear stress and force in the screw-bone interface for varying Cortical Bone Thickness (CBT) using Finite Element Analysis (FEA). Varying CBT of 1.09 mm (1.09CBT) and 2.66 mm (2.66CBT) with miniscrews of Ø1.2 mm, 10 mm length (T1), Ø1.2 mm, 6 mm length (T2) and Ø1.6 mm, 8 mm length (T3) were analyzed. Six Finite Element (FE) models were developed with cortical, cancellous bone, miniscrews and gingiva as a prism. A deflection of 0.1 mm was applied on the neck of the miniscrews at 0°, +30° and −30° angles. The shear stress and force in the screw-bone interface were assessed. The results showed that the CBT affects the shear stress and force in the screw-bone interface region in addition to the screw dimensions and deflection angulations. T1 screw generated lesser shear stress in 1.09CBT and 2.66CBT compared to T2 and T3 screws. Higher CBT is preferred for better primary stability in shear aspect. Clinically applied forces of 200 gms to 300 gms to an anchorage device induces shear stress in the miniscrew-bone interface region might cause stress shielding. Thus, clinicians need to consider the effect of varying CBT and the size of the miniscrews for the stability, reduced stress shielding and better anchorage during orthodontic treatment.

A Finite Element Analysis Study of Influence of Femoral Stem Material in Stress Shielding in a Model of Uncemented Total Hip Arthroplasty: Ti-6Al-4V versus Carbon Fibre-Reinforced PEEK Composite

Total hip arthroplasty is one of the most common and successful orthopaedic operations. Occasionally, periprosthetic osteolysis associated with stress shielding occurs, resulting in a reduction of bone density where the femur is not properly loaded and the formation of denser bone where stresses are confined. To enhance proximal load transfer and reduce stress shielding, approaches, including decreasing the stiffness of femoral stems, such as carbon fibre-reinforced polymer composites (CFRPCs), have been explored through novel modular prostheses. The purpose of the present study was to analyse, by the finite element analysis (FEA) method, the effect that the variation of material for the distal part of the femoral stem has on stress transmission between a modulable prosthesis and the adjacent bone. Methods: Through three-dimensional modelling and the use of commercially available FEA software Ansys R2023, the mechanical behaviour of the distal part of the femoral stem made of CFRPC or Ti-6Al-4V was obtained. A load was applied to the head of the femoral stem that simulates a complete walking cycle. Results: The results showed that the use of a material with mechanical characteristics close to the bone, like CFRPC, allowed for optimisation of the transmitted loads, promoting a better distribution of stress from the proximal to the distal part of the femur. This observation was also found in some clinical studies in literature, which reported not only an improved load transfer with the use of CFRPC but also a higher cell attachment than Ti-6Al-4V. Conclusions: The use of a material that has mechanical properties that are close to bone promotes load transfer from the proximal to the distal area. In particular, the use of CFRPC allows the material to be designed based on the patient’s actual bone characteristics. This provides a customised design with a lower risk of prosthesis loss due to stress shielding.

Evaluation of Lattice Structures for Medical Implants: A Study on the Mechanical Properties of Various Unit Cell Types

Lattice structures are a prime candidate for applications in the medical implant industry due to their versatile mechanical behaviour, which can be tailored to meet specific patient needs and reduce stress shielding, while enabling the natural flow of body fluids. In this work, the mechanical properties of metallic lattices made of five different unit cell types, Cubic (C), Truncated Octahedron (TO), Truncated Cubic (TC), Rhombicuboctahedron (RCO), and Rhombitruncated Cuboctahedron (RTCO), were evaluated under uniaxial compression at three different relative densities, 5%, 15%, and 45%. The evaluation was experimental, and it was compared with previous and new finite element simulations. Specimens for the experimental tests were fabricated in stainless steel 316L by laser powder bed fusion, and stress–strain curves were obtained for the different lattices. The combination of the test results with a critical interpretation of the deformation mechanisms allowed us to confirm that two unit cell types, TO and RTCO, are stable for the whole range of relative densities evaluated. The other three unit cells exhibit more unpredictable behaviour, either due to manufacturing defects or limitations, or because their unstable compression behaviour leads to bucking. For these reasons, TO and RTCO unit cell types are mechanically more adequate for applications in the medical implant industry.

Biomechanical study of using patient-specific diaphyseal femoral cone in revision total knee arthroplasty (rTKA)

BackgroundThe primary objective of revision total knee surgery is to achieve solid bone fixation. Generally, this could be accomplished using sleeves and long stems, which require substantial remaining bone stock and may increase the risk of stem tip pain. An alternative approach involves the use of customized diaphyseal cones, which can preserve the integrity of the bone canal. This study evaluates the impact of employing femoral diaphyseal cones with various stem lengths on stress distribution and relative motion. MethodsCT scan data from five patients were used to generate the 3D model of the femur, cement, customized stems, and cones, along with assigning patient-specific material for each candidate's femur. Three different stem lengths, both with and without the customized cone, were assessed under three gait loading conditions to compare the resulting Von Mises stress distribution and relative motion. ResultsAnalysis indicated that the use of customized femoral cones moderately increases stress distribution values up to 30 % while significantly reducing relative motion at the femoral canal-cone interface by nearly 60 %. The presence of the cone did not significantly alter relative motion with varying stem lengths, although stem length variation without a cone substantially affected these values. ConclusionIncorporating cones alongside stems enhances metaphyseal fixation, reduces stress shielding, potentially allowing for the use of shorter stems. Furthermore, cones promote osseointegration by minimizing relative motion, ultimately improving prosthetic stability.

Increased stability of short femoral stem through customized distribution of coefficient of friction in porous coating

Stress shielding and aseptic loosening are complications of short stem total hip arthroplasty, which may lead to hardware failure. Stems with increased porosity toward the distal end were discovered to be effective in reducing stress shielding, however, there is a lack of research on optimized porous distribution in stem’s coating. This study aimed to optimize the distribution of the coefficient of friction of a metaphyseal femoral stem, aiming for reducing stress shielding in the proximal area. A finite element analysis model of an implanted, titanium alloy short-tapered wedge stem featuring a porous coating made of titanium was designed to simulate a static structural analysis of the femoral stem's behavior under axial loading in Analysis System Mechanical Software. For computational feasibility, 500 combinations of coefficients of friction were randomly sampled. Increased strains in proximal femur were found in 8.4% of the models, which had decreased coefficients of friction in middle medial areas of porous coating and increased in lateral proximal and lateral and medial distal areas. This study reported the importance of the interface between bone and middle medial and distal lateral areas of the porous coating in influencing the biomechanical behavior of the proximal femur, and potentially reducing stress shielding.

Printable functionally graded tibial implant for TAR: FE study comparing implant materials, FGM properties, and implant designs

Tibial implants with functionally graded material (FGM) for total ankle replacement (TAR) can provide stiffness similar to the host tibia bone. The FGM implants with low stiffness reduce stress shielding but may increase implant-bone micromotion. A trade-off between stress shielding and implant-bone micromotion is required if FGMs are to substitute traditionally used Ti and CoCr metal implants. The FGM properties such as material gradation law and volume fraction index may influence the performance of FGM implants. Along with the FGM properties, the design of FGM implants may also have a role to play. The objective of this study was to examine FGM tibial implants for TAR, by comparing implant materials, FGM properties, and implant designs. For this purpose, finite element analysis (FEA) was conducted on 3D FE models of the intact and the implanted tibia bone. The tibial implants were composed of CoCr and Ti, besides them, the FGM of Ti and HA was developed. The FGM implants were modelled using exponential, power, and sigmoid laws. Additionally, for power and sigmoid laws, different volume fraction indices were taken. The effect of implant design was observed by using keel type and stem type TAR fixation designs. The results indicated that FGM implants are better than traditional metal implants. The power law is most suitable for developing FGM implants because it reduces stress shielding. For both power law and sigmoid law, low values of the volume fraction index are preferrable. Therefore, FGM implant developed using power law with 0.1 vol fraction index is ideal with the lowest stress shielding and marginally increased implant-bone micromotion. FGM implants are more useful for keel type fixation design than stem type design. To conclude, with FGMs the major complication of stress shielding can be solved and the longevity and durability of TAR implants can be enhanced.

Analysis of mechanical characteristics and permeability of TPMS and Voronoi porous structure for bone scaffold

Bionic porous structure has been widely used in the field of bone implantation, because it can imitate the topological structure of bone, reduce the elastic modulus of metal bone implantation, and meet the mechanical properties and material transmission characteristics after implantation. This paper mainly studies the effects of different bionic porous structures on the mechanical and material transport properties of bone scaffolds. Firstly, under the same porosity condition, 12 groups of bionic porous structures with different shapes were designed, including G, P, D, I-type three period minimal surface (TPMS) and Voronoi porous structures with different irregularities. Then uses ABAQUS to carry out mechanical finite element simulation on different bionic porous structures, and uses Ti-6Al-4V alloy as forming material, uses laser powder bed fusion technology (LPBF) to prepare the scaffold, then carries out compression experiments. At the same time, COMSOL software is used to simulate the flow characteristics, analyze the permeability characteristics, and verified through cell experiment in vivo. The results show that the mechanical and permeability are different with vary scaffolds. In terms of topology, the morphological characteristics of TPMS are similar to trabecular bone, its compressive strength is relatively strong. Voronoi scaffold has lower elastic modulus, which can provide sufficient mechanical support while reducing stress shielding. In addition, the permeability of TPMS scaffold is better than Voronoi scaffold, which is helpful to promote cell proliferation and bone ingrowth. These bionic porous structures have their own advantages. Therefore, when designing porous structures for bone implantation, it is necessary to select the appropriate porous structure according to different bone implantation requirements. The research will help promote the clinical application of porous structures in the field of bone implantation, and provide theoretical support for the exploration of bone implantation structure design.

Debulking of the Femoral Stem in a Primary Total Hip Joint Replacement: A Novel Method to Reduce Stress Shielding.

In current-generation designs of total primary hip joint replacement, the prostheses are fabricated from alloys. The modulus of elasticity of the alloy is substantially higher than that of the surrounding bone. This discrepancy plays a role in a phenomenon known as stress shielding, in which the bone bears a reduced proportion of the applied load. Stress shielding has been implicated in aseptic loosening of the implant which, in turn, results in reduction in the in vivo life of the implant. Rigid implants shield surrounding bone from mechanical loading, and the reduction in skeletal stress necessary to maintain bone mass and density results in accelerated bone loss, the forerunner to implant loosening. Femoral stems of various geometries and surface modifications, materials and material distributions, and porous structures have been investigated to achieve mechanical properties of stems closer to those of bone to mitigate stress shielding. For improved load transfer from implant to femur, the proposed study investigated a strategic debulking effort to impart controlled flexibility while retaining sufficient strength and endurance properties. Using an iterative design process, debulked configurations based on an internal skeletal truss framework were evaluated using finite element analysis. The implant models analyzed were solid; hollow, with a proximal hollowed stem; FB-2A, with thin, curved trusses extending from the central spine; and FB-3B and FB-3C, with thick, flat trusses extending from the central spine in a balanced-truss and a hemi-truss configuration, respectively. As outlined in the International Organization for Standardization (ISO) 7206 standards, implants were offset in natural femur for evaluation of load distribution or potted in testing cylinders for fatigue testing. The commonality across all debulked designs was the minimization of proximal stress shielding compared to conventional solid implants. Stem topography can influence performance, and the truss implants with or without the calcar collar were evaluated. Load sharing was equally effective irrespective of the collar; however, the collar was critical to reducing the stresses in the implant. Whether bonded directly to bone or cemented in the femur, the truss stem was effective at limiting stress shielding. However, a localized increase in maximum principal stress at the proximal lateral junction could adversely affect cement integrity. The controlled accommodation of deformation of the implant wall contributes to the load sharing capability of the truss implant, and for a superior biomechanical performance, the collared stem should be implanted in interference fit. Considering the results of all implant designs, the truss implant model FB-3C was the best model.

Design multifunctional Mg–Zr coatings regulating Mg alloy bioabsorption

Magnesium (Mg) alloys are widely used for temporary bone implants due to their favorable biodegradability, cytocompatibility, hemocompatibility, and close mechanical properties to bone. However, rapid degradation and inadequate strength limit their applicability. To overcome this, the direct current magnetron sputtering technique is employed for surface coating in Mg-based alloys using various zirconium (Zr) content. This approach presents a promising strategy for simultaneously improving corrosion resistance, maintaining biocompatibility, and enhancing strength without compromising osseointegration. By leveraging Mg's inherent biodegradability, it has the potential to minimize the need for secondary surgeries, thereby reducing costs and resources.This paper is a systematic study aimed at understanding the corrosion mechanisms of Mg–Zr coatings, denoted Mg-xZr (x = 0–5 at.%). Zr-doped coatings exhibited columnar growth leading to denser and refined structures with increasing Zr content. XRD analysis confirmed the presence of the Mg (00.2) basal plane, shifting towards higher angles (1.15°) with 5 at.% Zr doping due to lattice parameter changes (i.e., decrease and increase of “c” and “a” lattice parameters, respectively). Mg–Zr coatings exhibited “liquidphilic” behavior, while Young's modulus retained a steady value around 80 GPa across all samples. However, the hardness has significantly improved across all samples’ coating, reaching the highest value of (2.2 ± 0.3) GPa for 5 at.% Zr. Electrochemical testing in simulated body fluid (SBF) at 37 °C revealed a significant enhancement in corrosion resistance for Mg–Zr coatings containing 1.0–3.4 at.% Zr. Compared with the 5 at.% Zr coating which exhibited a corrosion rate of 32 mm/year, these coatings displayed lower corrosion rates, ranging from 1 to 12 mm/year. This synergistic enhancement in mechanical properties and corrosion resistance, achieved with 2.0–3.4 at.% Zr, suggests potential ability for reducing stress shielding and controlled degradation performance, and consequently, promising functional biodegradable materials for temporary bone implants.

Porous versus solid shoulder implants in humeri of different bone densities: A finite element analysis.

Porous metallic prosthesis components can now be manufactured using additive manufacturing techniques, and may prove beneficial for promoting bony ingrowth, for accommodating drug delivery systems, and for reducing stress shielding. Using finite element modeling techniques, 36 scenarios (three porous stems, three bone densities, and four held arm positions) were analysed to assess the viability of porous humeral stems for use in total shoulder arthroplasty, and their resulting mechanobiological impact on the surrounding humerus bone. All three porous stems were predicted to experience stresses below the yield strength of Ti6Al4V (880 MPa) and to be capable of withstanding more than 10 million cycles of each loading scenario before failure. There was an indication that within an 80 mm region of the proximal humerus, there would be a reduction in bone resorption as stem porosity increased. Overall, this study shows promise that these porous structures are mechanically viable for incorporation into permanent shoulder prostheses to combat orthopedic infections.

Additively manufactured patient specific implants: A review

Medical applications of additive manufacturing have seen a significant growth in recent years due to availability of advanced medical imaging and design software and wide range of materials. The range of additively manufactured medical implants is growing rapidly and surgeons need to keep themselves updated with state-of-the-art of the technology. This article reviews several articles related to medical implants to help surgeons and researchers to stay up-to-date on recent developments in the domain. Additively manufactured medical implants are reviewed into five categories: orthopedic implants, dental implants, cranioplasty implants, scaffold implants for tissue engineering and other medical implants including chest wall reconstructive implants, anti-migration enhanced tracheal stents, and buccopharyngeal stents. Additive manufacturing process and material for fabrication of each type of implant are highlighted in the study. It has been observed that titanium alloy is a suitable material for cementless arthroplasty. Porosity in the implants supports bone ingrowth, which results in a significant reduction in stress shielding. Additive manufacturing has a very attractive future in medical implant fabrication due to its capability to produce complex and customized implants. The AM provides freedom to researcher to explore the complex design of medical implants for better bone regeneration and improved osseointegration.

Improving bioactivity in 3D-printed Ti-6Al-4V alloy scaffold via CaO-MgO-SiO2 glass-ceramic coating

This work proposes an effective design of bioactive 3D-printed Ti-6Al-4V scaffold with the CaO-MgO-SiO2 glass-ceramic coating to realize a comparable elastic modulus of bone tissue and boost osteogenic differentiation. The improved elastic modulus and stiffness of Ti alloy were achieved via effectively increasing surface area of Ti alloy to reduce stress shielding effect. A hydrophilic surface and bioactive glass-ceramic coating were conducted via chemical etching and heat-treatment under argon atmosphere to enhance cells attachment and boost cell proliferation and osteogenic differentiation. The expression of osteogenic genes in bioactive CaO-MgO-SiO2 glass-ceramic was evaluated through ALP, OPN, Runx2, and Col1A1 gene markers to explore the mechanism of superior osteogenic differentiation. Significant increase in OPN expression level confirmed the effect of CaO-MgO-SiO2 coating for the enhancement of osteogenic bioactivity. This work provides a feasible approach through surface etching and bioactive CaO-MgO-SiO2 glass-ceramic coating on the Ti alloy surface to enhance bioactivity and osteogenesis.

Assessing the compressive and tensile properties of TPMS-Gyroid and stochastic Ti64 lattice structures: A study on laser powder bed fusion manufacturing for biomedical implants

In the field of additive manufacturing, the design and fabrication of lattice structures have garnered substantial attention, particularly for their potential in advanced material applications. This study focuses on the mechanical properties of titanium alloy Ti64 lattice structures fabricated by Laser Powder Bed Fusion. It examines the mechanical features of two structure types, TPMS Gyroid and Stochastic Voronoi, analyzing their design and fabrication interplay. To evaluate mechanical properties, two methodologies to compute stress were employed: Method A, nominal diameter calculations of the cross-sectional area as a bulk material, and Method B, averaged cross-sectional area measurements along the open-cell porous structures. Method A generally showed lower Elastic Modulus and Yield Stress than Method B, highlighting the importance of geometric accuracy in lattice design mechanics. Both TPMS gyroid and stochastic lattices, within a 0.1–0.5 relative density range, displayed mechanical properties similar to human bone, suggesting their potential in orthopedic use. This could help reduce stress shielding and improve implant lifespan. The findings were further complemented by Scanning Electron Microscopy and Digital Image Correlation evaluations, highlighting the intricate relationship between fabrication parameters, lattice morphology, and the emergent microstructural characteristics.

Nanotextured and drug loaded Neovius Ti6Al4V ELI scaffolds with osteogenesis and anti-cancer potential

IntroductionThe use of Ti6Al4V for orthopedic implants though widely accepted, is 10X stiffer than bone, that leads to stress shielding and aseptic loosening. Further, oral delivery demands significantly large dosage of drugs. To address these twin challenges, we have fabricated open cell porous scaffolds capable of sustained dual drug delivery. Drug delivery from open cell porous Ti6Al4V implants is a promising approach for in situ delivery in orthopedic and dental implant applications. MethodologyIn this study, selective laser melting technology was used to fabricate open cell porous Ti6Al4V ELI scaffolds of 50 % volume fractions with Neovius architecture (NOCL). Electrochemical anodization was used to create micro and nano scale surface features for efficient drug loading. The two payloads: an osteogenic agent (Baicalein) and an anti-cancerous drug (Paclitaxel) were then loaded to different levels for differential release. An osteogenic agent was loaded in the nano reservoirs while paclitaxel was mixed with poloxamer and coated over the scaffold. ResultsThe mechanical stiffness of the designed NOCL lattices is approximately 1.29 ± 0.05 GPa, which is comparable to the human bone. This helps to reduce stress shielding effect. The scaffolds loaded with baicalein and paclitaxel yielded a sustained drug release profiles, releasing 57 % and 79 % of the pharmaceuticals over a 7-day period, respectively. Additionally, the baicalein-loaded nano reservoirs promote osteoblast differentiation in mesenchymal stem cells. As a result, bio-inspired 3D-printed open cell porous titanium scaffolds loaded with dual drugs offer a workable solution to the problems associated with orthopedic implants.