The introduction of a foreign material will determine host response with

local, systemic, remote effect

]

Stress Shielding =
 Stainless Steel

Cobalt-Based alloy

Titanium and its alloy

Oxidized Zirconium-Niobium Alloy (Oxinium)

Porous Tantalum =

Other method, 3D printing of porous Ti

Ti Microstructure

Ti has low wear resistance. Improved by surface modification.

Nitinol
Two way =
Cooled below Mf  Bent  Heated above Af  freely take Austenitic shape
Need training for 20-30 cycles

Load change it into martensite. SIM = stress induced martensite

Stress straini curve

Factor =

Concern =
Polymeric =
PMMA (Polymethyl Methacrylate) = bone filler

UHMWPE (Ultra High Molecular Weight Polyethylene) = bearing

Oxidative chain scission (gamma radiation in air)  Cross-linking

Osteolysis

Ceramic. Inert = Al2O3, ZrO2

Bioactive = Ca-based, bioglass
Usage =

Alumina

Zirconia

Ca-Based

Bioglass – mineral-rich structure to bond the bone

Surface modification = sintered fibers, sintered beads, plasma spray coating

Failure = - Long-term stability

- Wear (osteolysis) - Fracture
- Infection - Dislocation
- Stress shielding - Post-surgical care

Location = articulating surface Implant – bone interface

Implant junction Bone – cement interface

Damage = abrasive wear (fine wear), delamination wear (large particle),

fatigue fracture, wear
Knee 

Shoulder 
THA Revision

Revision prosthesis = Calcar, Arcos, and Custom

Remove cement = using ultra drive, cement remover

Atherosclerosis =

Treatment  stent

How to make stent safer?

1. Inhibition of neointima formation
2. Promotion of endothelial coverage
Treatment =
1. Balloon angioplasty

2. Stenting

Inflate by balloon
Stainless Steel 316L

CoCr alloy

Nitinol alloy
 Drug eluting

Fe as biodegradable

Magnesium
Failure

Biodegradable material for stent

 Scaffold = structure

Bioactives =
1. Chemical
2. Extracellular matrix
a. Growth factor
3. Gene theraphy
b. Supplement
4. Mechanical loading
c. Hormones
d. Vitamins
e. Amino acid
Ethics

Consideration
Cellular response

(Bio)chemical modification of titanium surface

Interfacial processes following implantation of Ti
(Bio)chemical modification of titanium surface

Self-assembled monolayers

Regenerative medicine
Gait shows multidirectional movement
Reduce polyethylene wear

Zirconic on conventional polyethylene

Ceramic on ceramic

Highly X linked Polyethylene = good result

Can be added with vitamin E to reduce wear.

Metal particle = nano size, more dangerous

Polyethylene particle = macro

Large head = stable

Small head = less wear
Player for body response

Monocyte  macrophage  foreign body giant cell

Nautrophilic granulocyte, or polymorphonuclear phagocyte (PMN) : aggresive

Monocyte / macrophage / dendritic cell

Non adhesive surface

Tissue integrating surface

Contact killing surface

Antimicrobial releasing coating

Ideal multifunctional coating

Surface antibacterial activity testing

Antimicrobial coating
Honey!