BIOMATERIALS AND CERAMICS

BIOMATERIALS IN ORTHOPAEDICSMODERATORDR.Jishnu Prakash BaruahPRESENTERDr.S.V.Harikrishnan(PGT 1st yr)

LEARNING OBJECTIVES

Basic concepts and definitionsCommon orthopaedic biomaterials and clinical applicationsGeneral tissue implant responsesComplication associated with biomaterialsRecent advances

INTRODUCTIONA biomaterial is substance / combination of substances (other than a drug) Origin: synthetic / naturallife span : not specifiedAugments / replaces any tissue, organ or function of the body

Bone plate in 1900,earliest successful biomedical implantsArtificial knee joint to alleviate pain and restore functions

BIOMATERIALS CLASSIFICATION

FIRST GENERATIONInvented in 1980AIM : Same physical properties to match replaced tissueMinimal toxic response to hostBio inert minimum immune response and foreign body reaction

SECOND GENERATIONInvented between 1980 and 2000AIMInteract with biological environmentEnhance biological response and tissue surface bonding (BIO ACTIVE)Undergo progressive degradation with healing and regeneration of tissues (BIODEGRADABLE)

THIRD GENERATIONInvented in 2002(Hench and polak)AIMTo stimulate specific cellular response at molecular levelSignal and stimulate specific cellular activity

BIOMATERIALS USED IN ORTHOPAEDICSMetal and metal alloysCeramics and ceramometallic materialsTissue adhesivesBone replacement materials Carbon materials and composites, polymers

BASIC CONCEPTS & DEFINITIONSForce applied will lead to deformation and if continued beyond a certain point will lead to ultimate failureThe force per unit area----- STRESS and Deformation is known as STRAIN

STRESS-STRAIN CURVE

YOUNGS MODULUS OF ELASTICITY Youngs modulus of elasticity

DEFINITIONSTENSILE STRENGTH/ ULTIMATE TENSILE STRENGTH The maximum stress on the curve before breakage

YIELD STRESS- Point at which elastic behaviour changes to plastic Behaviour

BREAKING STRESS Point at which the substance fails/brakes

FATIGUE FAILURE: The failure of a material with repetitive loading at stress levels below the ultimate tensile strength

YIELD STRESSULTIMATE STRESSBREAKING STRESSSTRESSSTRAINPLASTICELASTIC

DEFINITIONS STRENGTH: The degree of resistance to deformation of a material- Strong if it has a high tensile strength

TOUGHNESS: Amount of energy per unit volume that a material can absorb before failure

DUCTILITY/ BRITTLENESS- The amount by which a material deforms (i.e. the strain that occurs) before it breaks.

HOOKES LAW Stress Strain produced- The material behaves like a spring

BONE BIOMECHANICSAnisotropic:elastic modulus depends on direction of loading weakest in shear> tension> compression viscoelastic: stress-strain characteristics depend on the rate of loadingWOLFS LAW: Bone remodelling occurs along the line of stressBone density changes with age, disease, use and disuse

CLINICAL APPLICATIONS OF ORTHOPAEDIC IMPLANTSOsteosynthesis

Joint replacements

Nonconventional modular tumor implants

Spine implants

IDEAL IMPLANT MATERIALChemically inertNon-toxic to the bodyGreat strengthHigh fatigue resistanceLow Elastic ModulusAbsolutely corrosion-proofGood wear resistanceInexpensive

COMMON IMPLANT MATERIALS IN ORTHOPAEDICSMetal Alloys: stainless steelTitanium alloysCobalt chrome alloys

Nonmetals: Ceramics & Bioactive glasses Polymers (Bone cement, polyethylene)

STAINLESS STEEL COMPOSITION:Iron (62.97%)Chromium (18%) Nickel (16%)Molybdenum (3%)Carbon (0.03%)

The form used commonly is 316L (3% molybdenum, 16% nickel & L = Low carbon content)

STAINLESS STEELADVANTAGESRelatively ductile BiocompatibleRelatively cheap Reasonable corrosion resistance STRONG

Used in plates, screws, IM nails, external fixatorsDISADVANTAGES: Poor wear resistanceHigh Youngs modulus 200 G Pascals (10 that of bone) stress shielding of surrounding bone and bone resorption

21

COBALT CHROME ALLOYSContains primarily cobalt (30-60%)

Chromium (20-30%) added to improve corrosion resistance

Minor amounts of carbon, nickel and molybdenum added(ASTM F75 Vitallium)

COBALT CHROME ALLOYSAdvantages:Excellent resistance to corrosionExcellent long-term biocompatibilityStrength (very strong)

Disadvantages:Very high Youngs modulus Risk of stress shieldingExpensive

USESUsually for bearing surfacesTHRMetal-on-metal devices.

THR IMPLANT BEARING SURFACESMetal-on-polyethylene

Metal-on-metal

TITANIUM ALLOYS Contains:- Titanium (89%)- Aluminium (6%)- Vanadium (4%)- Others (1%) Most commonly orthopaedic titanium alloy is TITANIUM 64 (Ti-6Al-4v)

TITANIUM ALLOYSADVANTAGES:Corrosion resistantExcellent biocompatibilityDuctile Fatigue resistantLow Youngs modulusMR scan compatiblyosseointegration Useful in Int fixators , plates, vertebral spacers,IM nails etc.DISADANTAGES:poor wear characteristicsSystemic toxicity vanadium Relatively expensive

YOUNGS MODULUS AND DENSITY OF COMMON BIOMATERIALSMATERIALYOUNGS MODULUS (GPa)DENSITY (g/cm)Cancellous bone0.5-1.5-UHMWPE1.2-PMMA bone cement2.2-Cortical bone7-302.0Titanium alloy1104.4Stainless steel1908.0Cobalt chrome2108.5

COMPARISON OF METAL ALLOYSALLOYYoungs modulus (GPa)Yield strength (MPa)Ultimate tensile strength (MPa)Stainless Steel 316L190500750Titanium 64110800900Cobalt chrome F562230 10001200

BIOACTIVE IMPLANTS Coating of implant with a bioactive ceramic (HA and BGs). electrophoretic deposition plasma spraying, radio frequency or ionic ray sputtering, laser ablation or hot isostatic pressureAll are not cost effective

HA COATED IMPLANTS

CERAMICSCompounds of metallic elements e.g Aluminium bound ionically or covalently with nonmetallic elementsCommon ceramics include:- Alumina (aluminium oxide)- Silica (silicon oxide)- Zirconia (Zirconium oxide)- Hydroxyapatite (HA)

CERAMICSCeramics are refractory polycrystalline compoundsUsually inorganicHighly inertHard and brittleHigh compressive strengthGenerally good electric and thermal insulatorsGood aesthetic appearance

ALUMINA(INERT CERAMICS)APPLICATIONS:femoral headbone screws and platesporous coatings for femoral stemsporous spacers (specifically in revision surgery)knee prosthesis

ZIRCONIA(ZrO2 )Obtained from the mineral zircon(Zr)

APPLICATION: femoral head artificial knee bone screws and plates favored over UHMWPE due to superior wear resistance

CERAMICSADVANTAGESChemically inert & insoluble Best biocompatibility Very strong Osteoconductive Low wear resistance

DISADVANTAGESBrittlenessVery difficult to process high melting point Very expensive High youngs modulusLow tensile strengthPoor crack resistance

39

HA COATED SCREWS

BEARING SURFACESCeramic-on-polyethylene

Ceramic-on-ceramic

BIOACTIVE CERAMICSBio glassceramics calcium phosphates (CaPs) Silicon incorporated cements and ceramicsNot used in high load bearing devices due to low tensile strength and toughness

BIODEGRADABLE CERAMICS(CALCIUM PHOSPHATE)

Usesrepair material for bone damaged trauma or diseasevoid filling after resection of bone tumoursrepair and fusion of vertebraerepair of herniated disksrepair of maxillofacial and dental defectsdrug-delivery

CALCIUM PHOSPHATE

POLYMERSConsists of many repeating units of a basic sequence (monomer)Used extensively in orthopaedicsMost commonly used are: - Polymethylmethacrylate (PMMA, Bone cement)- Ultrahigh Molecular Weight Polyethylene (UHMWPE)

PMMAThe powder contains:PMMA copolymerBarium or Zirconium oxide (radio-opacifier)Benzoyl peroxide (catalyst) Clinically relevant stages of cement reaction:DOUGH TIME 2to 3 minsWORKING TIME 5 to 8 minsSETTING TIME 8 to 10 mins

PMMA (BONE CEMENT)Mainly used to fix prosthesis in placecan also be used as void fillersAvailable as liquid and powderThe liquid contains:The monomer N,N-dimethyltoluidine (the accelerator) Hydroquinone (the inhibitor)

ToughDuctileResilientResistant to wear

DISADVANTAGESSusceptible to abrasionWear usually caused by third body inclusionsThermoplastic (may be altered by extreme temperatures)weaker than bone in tension

ADVANTAGESUSES:-It provides an excellent primary fixation of the prosthesis

UHMWPEA polymer of ethylene with MW of 2-6millionUsed for acetabular cups in THR prostheses and tibial components in TKRMetal on polyethylene has high success rate in bearing surface in THR Osteolysis produced due to polyethylene wear debris causes aseptic looseningIncreases polymer chain cross-linking whichimproves wear characteristics

BIODEGRADABLE POLYMERSPolyglycolic acid, Polylactic acid, copolymersAs stiffness of polymer decreases, stiffness of callus increasesHardware removal not necessary (reduces morbidity and cost)

CARBON FIBRESAPPLICATIONS:Total hip replacementInternal fixation for various fracturesSpine surgeries DISADVANTAGES:Release of carbon debris in to surrounding medium

TISSUE ADHESIVESPROPERTIES OF TISSUE ADHESIVES:Moderately viscous (spread easily)Ability to degrade at a appropriate rateBiocompabilityCommonly used tissue adhesives are - fibrin gel,albumim,cyanoacrylates and mucopolysaccharides

55

GENERAL TISSUE-IMPLANT RESPONSESAll implant materials elicit some response from the hostThe response occurs at tissue-implant interfaceResponse depend on many factors;- Type of tissue/organ; - Mechanical load- Amount of motion- Composition of the implant- Age of patient

TISSUE-IMPLANT RESPONSES BIOMATERIAL TOXIC NON TOXIC

DEATH OF SURROUNDING TISSUESBIO ACTIVEBIO INERT

FIBROUS ENCAPSULATION INTERFACIAL BOND FORMATION

BIODEGRADABLE

DISSOLUTION OF MATERIAL

COMPLICATIONS Aseptic Loosening:- Caused by osteolysis from bodys reaction to wear debrisStress Shielding:- Implant prevents bone from being properly loadedCorrosion:- Reaction of the implant with its environment resulting in its degradation to oxides/hydroxides

COMPLICATIONSInfectionMetal hypersensitivityManufacturing errorsVARIOUS FACTORS CONTRIBUTE TO IMPLANT FAILURE

RECENT ADVANCESAim is to use materials with mechanical properties that match those of the boneModifications to existing materials to minimize harmful effects- Ex; nickel-free metal alloysPossibility of use of anti-cytokine in the prevention of osteolysis around implantsAntibacterial implant

RECENT ADVANCESPorous tantalum is also being successfully used clinically in several orthopaedic applications. high volumetric porosity, low elastic modulus good frictional characteristicsIdeal candidate for weight-bearing applications such as total joint arthroplasty

CONCLUSIONAdequate knowledge of implant materials is an essential platform to making best choices for the patientPromising and satisfying results from use of existing implant materials Advances in biomedical engineering will go a long way in helping the orthopedic surgeonThe search is on

BIBLIOGRAPHYCAMPBELLS OPERATIVE ORTHOPAEDICS 12th edition KULKARNI textbook of othopaedics and trauma 2nd edition http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706047/#bib197

THANKING YOU

65