TYPE AND BIOMATERIAL

OF IMPLANT IN
ORTHOPAEDICS
Dr.Yoyos Dias Ismiarto, dr., Sp.OT (K),
M.Kes, CCD
Definition of Biomaterial
• material that interacts with human tissue and body fluids to treat, improve, or
replace anatomical element(s) of the human body.

• In orthopaedics are commonly called implants; these are manufactured for a great
number of orthopaedics applications
Interaction with human body
• Clinical results in orthopaedics have demonstrated that a great need exists to find
new and better biomaterials that will help satisfy the minimum requirements for
orthopaedics devices

• There are main fundamental requirements that orthopaedics devices must fulfil in
order to function adequately
 Fundamental Requirements
Biocompatibility

Appropriate Design and manufacturability of implants

Mechanical and Biological Stabilities

Properties of Biomaterials

Resistance to Implant wear and aseptic Loosening

 Biocompatibility

The primary Characteristic that a medical device

should have in any orthopaedic application; that
is, it must not adversely affect the local and
systemic host environment of interaction ( bone ,
soft tissues, ionic composition of plasma)
 Properties of Biomaterials

Some of the most important properties of biomaterials

that should be carefully studied and analysed in their
application are tensile strength, yield strength , elastic
modulus, corrosion and fatigue resistance, surface
finish, creep , and hardness
 Resistance to Implant

Implant wear and aseptic loosening are very Important

Failure Problems that should be taken into
consideration when dealing with long term prosthetic
devices. Corrosion of metallic implants that occur
within human body constitutes an ion sources that may
potentially affect the local and systemic host
environment
 Biomaterial Types in Orthopaedics

• The main biomaterials used in orthopaedics surgery are

divided into two groups : metals and non-metals

Its important for orthopaedics surgeons to understand nature

of biomaterials, their structural configurations, and their
properties, as well ass the effects of their interaction with soft
and hard tissues, blood, and intra and extracellular fluids of
the human body
 Metals

Metallic Implants were used in 17th century .

And in the 18th century a metal screw
implant was used for the first time

The majority of elements in the periodics

table are metals. They have their main
applications in load-bearing systems such as
hip and knee prostheses and for fixation of
internal and external bone fractures
The metallic implants most
widely used in orthopaedics are :

• Low carbon grade

austenitic stainless steels
:316L
• Titanium and titanium base
alloys : CP Ti, Ti 6Al-4V
• Cobalt Alloys : Co-Cr-Mo
 STAINLESS STEEL (316 L)
• Iron-carbon, chromium, nickel , molybdenum,
manganese
• Nickel:
increases corrosion resistance and stabilizes
molecular structure
• Chromium : Form a passive surface oxide,
improving corrosion resistance
• Molybdenum : Prevents pitting and crevice
corrosion
• Manganese : Improve crystalline stability
• “L” = low carbon : greater corrosion resistance
 Cobalt Based
• Cobalt-chromium-molybdenum (Co-Cr-Mo)
• 65% cobalt, 35% chromium, 5% molybdenum
• Special forging process
• Nickel may be added to improve ease of forging
• Co-Cr: macrophage proliferation and synovial
degeneration
• Ions excreted through the kidneys
 Titanium Based
• Titanium is extremely biocompatible
• Rapidly forms an adherent oxide coating (self
passivation) ; decreases corrosion
• A nonreactive ceramic coating
• Most closely emulates axial and torsional stiffness of
bone
• High yield strength
 Stainless steel vs Titanium
 Titanium has high resistance to repeated loading so its
ideal for use as an implant
Titanium is stronger and lighter in weight compared to
stainless steel
A lower modulus of elasticity that stainless steel,
titanium is less rigid limiting the tension on bone
structure
 Titanium is less prone to the generation of an immune
reaction
 Non Metals
• The tree main subgroups
make up this category :
polymers, ceramics, and
composites
 Polymers

• Organic materials that form large chains made up of many

repeating units. Polymers are extensively used in joint
replacement components , currently polymers mostly used in
joint replacements are :
 Ultrahigh molecular weight polyethylene (UHMWPE)
 Acrylic bone cements
 Thermoplastic polyether ether ketone (PEEK)
 Bioabsorbables
 Polymethylmethacrylate (PMMA, bone cement)
 Ceramics

• Polycrystalline materials. The great majority are compouns made up of metallic as

well as nonmetalics elements ; the have ionic bond or ionic with some covalent
bonds
• The main characteristic of ceramic material are hardness and brittleness. They
work mainly on compression force ,
 Alumina , Al2O3 ; for acetabular and femoral components
 Zicronia , ZrO2 ; for acetabular and femoral components
 Hydroxiapatite : for coating stem femoral components to integrate the
surface material to the bone
 Composites
• Are made with a filler(reinforcement) addition to a matrix
material in order to obtain properties that improve every one
of the components . This means that the composite materials
may have several phases.

• The following composites are considered in orthopaedic

devices
 Fiber- reinforced polymers
 Aggregates to polymethyl methacrylate(PMMA)
 ORTHOPAEDIC IMPLANTS
Orthopaedic Implants can be divided into four main groups :
 Osteosynthesis (stabilization and fixation of bone)
 Joint replacements
 Nonconvetional modular tumor implants
 Spine Implants
 Osteosynthesis
• The main implants used in
osteosynthesis are screw,
plates, nails, and pins, in a
number of different shapes
and forms to fulfil the
required characteristics to
successfully consolidate
internal and external bone
fracture fixation
 Joint Replacement
Prosthetic devices are implanted in
the human body to replace the
affected joint in order to eliminate
pain and restore its normal function
 Spine Implants
Its used to :
1. Maintain disc height between vertebrae
to help prevent nerve compression
2. Restore and preserve the lumbar spine's
natural alignment
3. Promote spinal fusion
4. Stand alone to provide structural
stability
5. Carrier (holder) for fusion material (such
as bone graft)
PLATES
• Bone Plates are like internal splints holding together the
fractured ends of a bone
• A bone plate has two mechanical functions
It transmits forces from one end of bone to the other,
bypassing and thus protecting the area of fractures

It also holds the fracture ends together while maintaining

the proper alignment of fragments throughout the healing
process
 Name of Plates

1. Shape (semitubular, 1/3 tubular)

2. Width of plate (small, Narrow,Broad)
3. Shape of screw hole ( round, oval)
4. Surface contact characteristics (LC,PC)
5. Intended site of application ( Condylar plate)
6. According to the function
 Standard plates

Narrow DCP 4,5mm Broad DCP 4,5 mm 3,5 mm DCP

LC DCP 4,5mm Reconstruction plate 1/3 tubular plate 2,7

4,5mm mm. 3,5 mm
 Special Plates

T Plates T&L Buttress plates

Lateral proximal tibial
Buttress plates

Narrowlengthening Clover leaf plates

Condylar Buttress
plates
plates
Problem with dynamic compression plate
(DCP)
• Unstable fixation leads to fatigue and failure
• Strict adherence to principles of compression
• Compromised blood supply due to intimate contact with
underlying cortex
• “ Refractures” after plate removal
 Less contact – Dynamic compression
plate (LC-DCP)
• Have a design change
• Overcome DCP problems
• Plate footprint reduced
• Minimized kinking at screw holes, more countourable,
reduce plate fatigue at hole
• Allow more inclination of the screw in longitudinal plane and
transverse plane
• Improve blood circulation by minimizing plate bone contact
• Allow small bone bridge beneath plate
 A: DCP
B: LC-DCP
Tubular Plates
• 3.5 system – 1/3 tubular
• 4,5 system – semitubular
• Limited stability
Oval holes – axial compression can be
achieved
Low rigidity ( 1mm thick)
lateral malleolus
Distal Ulna
Distal humerus
 Reconstruction plate

• Deep notches between

holes
• Accurate contouring in any
plane
• Can be used in pelvis ,
acetabulum, distal
humerus, clavicle,
olecranon
 Locking Compression Plate (LCP)
• Internal fixator
• Combination of locking screw with
conventional screw
• Extraperiosteal location of plate
• Achieving angular stability within the
plate holes with the screw lock
• LCP used as internal fixator to bridge
multifragmentary diaphyseal fracture
zone
 Type of plate - functional
Regardless of their length , thickness, geometry,
configuration, and types of hole, all plate may be classified in
to 4 groups according to their function
1. Neutralization plate : act as a bridge protection
2. Compression plate : produce locking force across fracture
3. Buttress plate : strengthen a weakened area of cortex
4. Tension band plates
THANK YOU