Orthopedic Biomaterials - Progress in Biology, Manufacturing, and Industry Perspectives

Preface

Contents

Part I: Design, Manufacturing, Assessment, and Applications

Nanotechnology for Orthopedic Applications: From Manufacturing Processes to Clinical Applications

1 Introduction

2 The Extracellular Matrix (ECM)

2.1 ECM Composition

2.2 The ECM as a Molecular Reservoir

2.3 Cell-ECM Interactions

2.4 Bone

2.4.1 Cortical Bone

2.4.2 Cancellous Bone

3 Tissue Engineering

3.1 Nanotechnology for Tissue Engineering

3.2 Control of Cell Functions Using Nanotechnology

3.3 Cell Sensitivity to Nanofeatures

3.4 Important Features of Scaffolds for Tissue Engineering

3.5 Materials for Scaffold Construction

4 Unmet Clinical Need

4.1 Substrate Properties for Osseointegration

4.2 Substrate Properties to Resist Bacterial Infection

4.2.1 Shot Peened 316 L Stainless Steel

4.2.2 Electrophoretic Deposition

5 Conclusions

References

Additive Manufacturing of Orthopedic Implants

1 Introduction

2 Additive Manufacturing Techniques

2.1 Binder Jetting

2.2 Directed Energy Deposition (DED)

2.3 Powder Bed Fusion (PBF)

2.4 Material Extrusion

3 Additively Manufactured Biomaterials

3.1 Metallic Biomaterials

3.1.1 Stainless Steel

3.1.2 Co-Cr Alloys

3.1.3 Titanium Alloys

3.1.4 Tantalum

3.2 Other Biomaterials

3.2.1 PEEK

3.2.2 Ceramics

4 AM Design Considerations

4.1 Patient-Specific Design Procedures

4.2 Porosity

4.3 Clinical Applications

4.4 Patient Variability

4.5 Shoulder and Other Joint Replacements

4.6 Fracture Fixation

4.7 Large Bone Defects

4.8 Surgical Guides

4.9 Additional Clinical Examples

5 Summary

References

3D Printed Porous Bone Constructs

1 Introduction

2 3D Printing Techniques

3 Porous Materials for Cell Growth

4 3D Printing of Porous Ceramic Materials

5 3D Printing of Porous Metal Materials

6 3D Printing of Porous Polymer Materials

7 Conclusions

References

Biopolymer Based Interfacial Tissue Engineering for Arthritis

1 Introduction

2 Anatomy of Osteochondral Tissue Interface

3 Conventional Vs. Interfacial Tissue Engineering

4 Polymeric Biomaterials for Interfacial Tissue Engineering

5 Design Considerations for Interfacial Tissue Engineering

5.1 Stratified Scaffold Design

5.2 Gradient Scaffold Design

6 Present Clinical Status of Interfacial Tissue Engineering

7 Future Perspectives of Interfacial Tissue Engineering in Orthopedic Applications

8 Conclusion

References

Performance of Bore-Cone Taper Junctions on Explanted Total Knee Replacements with Modular Stem Extensions: Mechanical Disassembly and Corrosion Analysis of Two Designs

1 Introduction

2 Materials and Methods

2.1 Implant Retrieval and Archiving

2.2 Assessment of Surface Corrosion Area

2.3 Damage Mode Characterization

2.4 Data Analysis

3 Results

4 Discussion

4.1 Effects of Design and Modes of Corrosion

4.2 Effects of Patient Factors and Anatomical Location

4.3 Mechanical Disassembly and Surface Corrosion Area

4.4 Limitations

5 Conclusion

References

Wear Simulation Testing for Joint Implants

1 Introduction: Why Joint Simulator?

2 What Is a Joint Simulator?

3 Types of Joint Simulators

4 Current Wear Simulation Standards

5 The Achievement of Wear Simulation

6 The Limitation of Wear Simulation

7 Conclusions

References

Mechanical Stimulation Methods for Cartilage Tissue Engineering

1 Cartilage Anatomy

2 Cartilage as a Material

3 Cartilage Tissue Engineering

4 Dynamic Loading Scenarios for Mechanical Stimulation

4.1 Compression

4.1.1 Confined Compression

4.1.2 Unconfined Compression

4.1.3 Indentation

4.2 Tension

4.2.1 Uniaxial

4.2.2 Biaxial or Multiaxial

4.3 Shear

4.3.1 Hydrodynamic Shear

4.3.2 Mechanical Shear

4.4 Friction

4.5 Vibration

4.5.1 High-Frequency Ultrasonic Vibration

4.5.2 Lower-Frequency Mechanical Vibrations

5 General Drawbacks of Mechanical Stimulation

6 Mixed Mode Loading

6.1 Compression and Shear

6.2 Compression and Vibration

7 Future Directions

References

Mechanically Assisted Electrochemical Degradation of Alumina-TiC Composites

1 Introduction

2 Methods and Materials

2.1 Brushing Abrasion Setup

2.2 Sample Preparation

2.3 Electrochemical Measurements

2.4 Brushing Abrasion Testing

2.4.1 Effect of Brushing Acceleration and Speed

2.4.2 Effect of Temperature

2.4.3 Effect of Environment

2.5 Electrochemical Impedance Study

2.6 Surface Characterization

2.7 Chemical Analysis

3 Results and Discussion

3.1 Electrochemical Response to Brushing Abrasion

3.2 Surface Characterization

3.3 Chemical Analysis

3.4 Electrochemical Impedance Data Analysis

3.5 Understanding the Degradation Mechanism of Alumina-TiC Composite

4 Conclusions

References

Part II: Biology and Clinical and Industrial Perspectives

Biomaterials in Total Joint Arthroplasty

1 Introduction

2 Stability

3 Sterility

4 Survivability

5 Bearing Surfaces: Polyethylene

5.1 Polyethylene Then

5.2 Polyethylene Now

5.3 Polyethylene: Case Reports 1–4 (Figs. 3, 4, 5 and 6)

6 Bearing Surfaces: Metal

6.1 Metal Then

6.2 Metal Now

6.3 Metal on Metal: Case Report 5 and 6 (Figs. 7 and 8)

7 Bearing Surfaces: Ceramic

7.1 Ceramic Then

7.2 Ceramic Now

7.3 Ceramic: Case Report 7 (Fig. 9)

8 Conclusion

References

Modulating Innate Inflammatory Reactions in the Application of Orthopedic Biomaterials

1 Introduction

2 Inflammation and Immunomodulating Strategy

2.1 Innate Immune Response and Macrophages

2.2 Macrophage Polarization

2.3 Interaction Between Macrophages and Orthopedic Biomaterials

2.4 Modulation of Macrophage-Mediated Pro-Inflammatory Response

3 Sequential Modulation of Inflammatory Response for Optimal Bone Regeneration/Osseointegration

3.1 Essential Role of Acute Inflammation in Bone Regeneration

3.2 Transition of Macrophage Polarization Status for Optimal Bone Formation

4 Application of Immunomodulating Reagents on Orthopedic Biomaterials

4.1 Protein-Based Biomolecules

4.2 Nucleic Acid

4.3 Small Molecules

4.4 Cell-Based Therapy

5 Conclusion

References

Anti-Infection Technologies for Orthopedic Implants: Materials and Considerations for Commercial Development

1 Introduction

2 Working Theories of Implant Related Infection

3 Current Clinical Options

4 Biomaterial Strategies for Infection Prevention

4.1 Passive Surface Modification

4.1.1 Nanotopography

4.1.2 Photocatalytic Titanium Oxide

4.1.3 Covalently Bound Antimicrobials

4.2 Active Surface Modification

4.2.1 Antibiotic Bone Cement

4.2.2 Antibiotic Coated Implants

4.2.3 Bone Graft Substitutes with Antibiotics

4.2.4 Antimicrobial Silver Coatings

Silver Antimicrobial Mechanism of Action

Current Commercial Products with Antimicrobial Silver

Silver Coating Technologies in Development

Potential for Toxicity of Silver in Orthopedics

4.2.5 Antimicrobial Iodine Coatings

4.3 Perioperative Local Antibiotics

4.3.1 Direct Local Application of Antibiotics

4.3.2 Local Antibiotic Carriers

5 Regulatory and Commercial Considerations

5.1 Preclinical Data

5.2 Regulatory and Market Hurdles

6 Summary

References

Platelet Rich Plasma: Biology and Clinical Usage in Orthopedics

1 Introduction

2 Biology of Platelet Rich Plasma

2.1 What is PRP (PRP Definition)?

2.2 Principles for PRP Isolation and Classification

2.2.1 Principle for PRP Isolation

2.2.2 PRP Classification

2.3 Biologics of PRP

2.3.1 Platelet and Platelet Released Factors

Platelet Alpha Granules

Dense Granules

The Lambda Granules

Regulation of Platelet Secretion

2.3.2 Leukocytes

2.3.3 Red Blood Cells

2.3.4 Extracellular Vehicles (EVs)

3 Clinical Applications of Platelet-Rich Plasma in Orthopedics Surgery

3.1 Tendons

3.2 ligament

3.3 Cartilage

3.4 Muscle

3.5 Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO)

3.6 In Summary

References

Bioresorbable Materials for Orthopedic Applications (Lactide and Glycolide Based)

1 Introduction

2 Bioresorbable Polymers

2.1 Poly(glycolic acid) (PGA)

2.2 Poly(lactic acid) (PLA)

2.3 Poly(lactic-co-glycolic acid) (PLGA)

2.4 Polycaprolactone (PCL)

2.5 Polydioxanone (PDO)

3 Bioresorbable Degradation

3.1 Factors Affecting Degradation

3.1.1 Inherent Polymer Factors

3.1.2 Secondary Ingredients

4 Mechanical Performance

4.1 Factors Affecting Mechanical Performance

4.2 Mechanical Enhancement via Additives.

4.3 Effect of Implant Design on Mechanical Performance

5 Bioactivity

5.1 Inorganic Additives

5.1.1 Calcium Phosphate Based

Hydroxyapatite (HA)

Tricalcium Phosphate (TCP)

Biphasic Calcium Phosphate (BCP)

Calcium Sulfate

5.2 Other Additives

6 Biocompatibility

7 Processing and Fabrication

7.1 Material Effect on Pre-Processing and Processing

7.2 Conventional Processing Methods

7.2.1 Extrusion

7.2.2 Injection Molding

7.2.3 Compression Molding

7.3 Novel Methods (Additive Manufacturing)

7.3.1 Fused Deposition Modelling (FDM)

7.3.2 Selective Laser Sintering (SLS)

7.4 Other Methods

7.4.1 Electrospinning

7.5 Effect of Post-Processing

7.5.1 Annealing

7.5.2 Sterilization

8 Current Applications

8.1 Craniomaxillofacial (CMF)

8.2 Sutures and Suture Anchors

8.3 Interference Screw

8.4 Distal Radius Plate

9 Regenerative Medicine

10 Conclusion

References

The Role of Polymer Additives in Enhancing the Response of Calcium Phosphate Cement

1 Introduction

2 Advantages of Calcium Phosphate Cement

3 Disadvantages of Calcium Phosphate Cement

4 Calcium Phosphate Applications

5 Calcium Phosphate Additives and Setting Time

5.1 Chitosan

5.2 Fibrin Glue

5.3 Gelatin

5.4 Collagen

5.5 Polyethylene Glycol (PEG)

6 Calcium Phosphate Additives: Material and Mechanical Properties

6.1 Natural Polymers

6.1.1 Alginate

6.1.2 Chitosan

6.2 Synthetic Polymers

6.2.1 Polyacrylic Acid

6.2.2 Polycaprolactone

6.2.3 Polylactic Acid (PLA)

6.2.4 Poly(lactic-co-glycolic) Acid

6.3 Carbon Nanotubes, Clay Nanoparticles and Graphene

6.3.1 Carbon Nanotubes

6.3.2 Clay Nanoparticles

6.3.3 Halloysite Nanotubes

6.3.4 Laponite

6.3.5 Montmorillonite (MT)

6.3.6 Graphene

6.4 Natural Fibrous Material

6.4.1 Cellulose

6.4.2 Collagen

7 Calcium Phosphate: Injectability

8 Calcium Phosphate: Biological Response

8.1 CPC/Growth Factor/Polymer Composites for Cell Growth and Functionality

8.2 CPC/polymer Composites for Cell Encapsulation

8.3 Bioactive Glass and Silica Materials

8.3.1 Bioactive Glass

8.3.2 Silica Materials

8.4 Metal Nanoparticles

8.4.1 Copper and Zinc

8.4.2 Magnesium

8.4.3 Zirconia

9 Future Studies

References

Biological Fixation: The Role of Screw Surface Design

1 Introduction

2 History

3 A Brief Review of Common Orthopedic Materials

4 A Brief Overview of Peri-implant Bone Healing

5 How Topography Affects Anchorage of an Implant in Bone

5.1 Implant Surface Nanotopography

5.2 Implant Surface Microtopography

5.3 Implant Macrotopography and Geometry

6 Conclusion

References

Fracture Fixation Biomechanics and Biomaterials

1 Clinical Aspects

1.1 Introduction

1.2 Types of Implants

1.3 Anatomical Constraints

2 Fracture Healing Biology

2.1 Fracture Healing

2.2 Infection

3 Biomechanics

3.1 Implant Loading

3.2 Implant Stress and Failure

3.3 Fracture Gap Strain

3.4 Biomechanical Variables

4 Biomaterials

4.1 Stainless Steel Vs. Titanium alloys & Other Materials

4.2 Biocompatibility

4.3 Corrosion

5 Experimental and Computational Modeling of Fracture Fixation Mechanics

5.1 Experimental

5.2 Computational

6 Internal Plating

7 Intramedullary Nailing

8 Perspective

References

Biomaterials for Bone Tissue Engineering: Recent Advances and Challenges

1 Introduction

2 Tissue Engineering

3 Bone

3.1 Structure and Composition of Bone

3.2 Types of Bone

4 Stem Cells for Tissue Engineering

4.1 Embryonic Stem Cells

4.2 Adult Stem Cells

4.3 Mesenchymal Stem Cells (MSCs)

5 Scaffold

6 Scaffold Fabrication Techniques

6.1 Particulate-Leaching Technique

6.2 Gas Foaming

6.3 Lyophilization

6.3.1 Solid-Liquid Phase Separation

6.3.2 Liquid-Liquid Phase Separation

6.4 Electro-Spinning

6.5 Solid Freeform Fabrication Technique (SFFT)

7 Structural Design

7.1 Porosity

7.2 Pore Size

8 Mechanical Properties

9 Composite Scaffold Material

9.1 Synthetic Biopolymer/CaP Composite Scaffold

9.2 Natural Biopolymer/Bioactive Ceramic Based Composite

10 Challenges and Opportunities

10.1 Mechanical Integrity of Porous Scaffolds

10.2 In vitro Degradation

10.3 In vitro and In vivo Characterization

11 Discussion and Future Aspects

References

Progress of Bioceramic and Bioglass Bone Scaffolds for Load-Bearing Applications

1 Introduction

2 Design Concepts

2.1 Microstructure Design: Micropore Size, Microporosity, Grain Size/Morphology and Second Phase

2.1.1 Pore Size

2.1.2 Porosity

2.1.3 Grain Size and Morphology

2.1.4 Second Phase Teinforcement

2.2 Macrostructure Design: Macropore Shape, Pore size, Macroporosity and Pore Connecting Part Width

2.2.1 Pore Shape

2.2.2 Pore Size and Pore Connecting Part Width

2.2.3 Macroporosity

3 Manufacturing Methods

3.1 3D printing

3.2 Freeze Casting

3.3 Slip Casting (Polymer Template Burn-Out)

3.4 Thermally Bonding of Particles

4 In Vitro Characterization of Load-Bearing Capacity

5 In Vivo Assessment via Load Bearing Bone Defect Model

6 Bioinspiration Design and Future Perspectives

References

Index