Nickel–titanium (NiTi) shape memory alloys are promising materials for orthopedic implants due to their unique mechanical properties, including superelasticity and shape memory effect. However, the high nickel content in NiTi alloys raises concerns about biocompatibility and potential cytotoxic effects. This review focuses on the recent advancements in surface modification techniques aimed at enhancing the properties of NiTi alloys for biomedical applications, with particular emphasis on low-temperature glow discharge plasma oxidation methods. The review explores various surface engineering strategies, including oxidation, nitriding, ion implantation, laser treatments, and the deposition of protective coatings. Among these, low-temperature plasma oxidation stands out for its ability to produce uniform, nanocrystalline layers of titanium dioxide (TiO2), titanium nitride (TiN), and nitrogen-doped TiO2 layers, significantly enhancing corrosion resistance, reducing nickel ion release, and promoting osseointegration. Plasma-assisted oxynitriding processes enable the creation of multifunctional coatings with improved mechanical and biological properties. The applications of modified NiTi alloys in orthopedic implants, including spinal fixation devices, joint prostheses, and fracture fixation systems, are also discussed. Despite these promising advancements, challenges remain in achieving large-scale reproducibility, controlling process parameters, and reducing production costs. Future research directions include integrating bioactive and antibacterial coatings, enhancing surface structuring for controlled biological responses, and expanding clinical validation. Addressing these challenges can unlock the full potential of surface-modified NiTi alloys in advanced orthopedic applications for safer, longer-lasting, and more effective medical implants.
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