Orthopaedic implant technology: biomaterials from past to future.

Department of Orthopaedic Surgery, National University Health System, Singapore.
Annals of the Academy of Medicine, Singapore (Impact Factor: 1.22). 05/2011; 40(5):237-44.
Source: PubMed

ABSTRACT Orthopaedic implant technology is heavily based on the development and use of biomaterials. These are non-living materials (e.g. metals, polymers and ceramics) that are introduced into the human body as constituents of implants that fulfill or replace some important function. Examples would be prosthetic joint replacements and fracture fixation implants. For orthopaedic biomaterials to succeed in their desired functions and outcomes in the body, a number of factors need to be considered. The most obvious mechanical properties of the implants are that they need to suit their intended function, and various classes and types of biomaterials have been developed and characterised for use in different implant components depending on their demands. Less well understood but no less important are the interactions that occur between the constituent biomaterials and the living cells and tissues, both of the human host as well as pathogens such as bacteria. Biomaterials used for orthopaedic applications are generally considered to be biocompatible. However, adverse effects arising from interactions at the implant interface can result in various modes of implant failure, such as aseptic loosening and implant infection. This review paper uses the illustrative example of total hip replacement (which has been called the operation of the century) to highlight key points in the evolution of orthopaedic biomaterials. It will also examine research strategies that seek to address some of the major problems that orthopaedic implant surgery are facing today.

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    Chemical Reviews 04/2014; · 45.66 Impact Factor
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    ABSTRACT: The main objective of the present study was to investigate chemical composition and possible cyto/genotoxic potential of several medical implant materials commonly used in total hip joint replacement. For that purpose medical implant metal alloy (Ti6Al4V and CoCrMo) and high density polyethylene particles were analyzed by energy dispersive X-ray spectrometry which showed that none of the elements identified deviate from the chemical composition defined by appropriate ISO standard. Toxicological characterization was done on human lymphocytes, as sensitive biomarkers of exposure, using multi-biomarker approach, showing that the tested materials were non-cyto/genotoxic as determined by the comet and cytokinesis-block micronucleus (CBMN) assay. Although orthopedic implants proved to be non-cyto/genotoxic, in tested concentration (10μg/ml) there is a constant need for monitoring of patients that have implanted artificial hips or other joints, to minimizing the risks of any unwanted health effects. Particle morphology was found (by using scanning electron and optical microscope) as flat, sharp-edged, irregularly shaped fiber-like grains with the mean particle size less than 10μm; this corresponds to the so-called "submicron wear". The very large surface area per wear volume enables high reactivity with surrounding media and cellular elements. The fractal and multifractal analyses, performed in order to evaluate the degree of particle shape effect, showed that the fractal and multifractal terms are related to the "remnant" level of the particle toxicity especially with the cell viability (trypan blue method) and total number of nucleoplasmic bridges and nuclear buds as CBMN assay parameters.
    Biochimica et Biophysica Acta 10/2013; · 4.66 Impact Factor
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    ABSTRACT: In an attempt to regain function and aesthetics in the craniofacial region, different biomaterials, including titanium, hydroxyapatite, biodegradable polymers and composites, have been widely used as a result of the loss of craniofacial bone. Although these materials presented favorable success rates, osseointegration and antibacterial properties are often hard to achieve. Although bone-implant interactions are highly dependent on the implant's surface characteristics, infections following traumatic craniofacial injuries are common. As such, poor osseointegration and infections are two of the many causes of implant failure. Further, as increasingly complex dental repairs are attempted, the likelihood of infection in these implants has also been on the rise. For these reasons, the treatment of craniofacial bone defects and dental repairs for long-term success remains a challenge. Various approaches to reduce the rate of infection and improve osseointegration have been investigated. Furthermore, recent and planned tissue engineering developments are aimed at improving the implants' physical and biological properties by improving their surfaces in order to develop craniofacial bone substitutes that will restore, maintain and improve tissue function. In this review, the commonly used biomaterials for craniofacial bone restoration and dental repair, as well as surface modification techniques, antibacterial surfaces and coatings are discussed.
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