Osteolysis in the periprosthetic tissue can be caused by metallic wear particles and ions that can originate from implant surface corrosion. These products influence cellular behavior and stimulate the expression of proinflammatory cytokines. The purpose of this study was to evaluate the impact of CoCr29Mo6 ions on cell survival, differentiation, and cytokine expression in human osteoblasts and peripheral blood mononuclear cells (PBMCs). Thus, we exposed cells with a mixture of 200 µg/L ion solution and determined cell viability and apoptosis/necrosis. Gene expression analyses of osteoblastic and osteoclastic differentiation markers as well as pro-osteolytic mediators (IL-6, IL-8, TNF-α, MCP-1, MMP1, TIMP1) were performed. These markers were also investigated in mixed cultures of adherent and non-adherent PBMCs as well as in co-cultures of human osteoblasts and PBMCs. The ion solution induced necrosis in osteoblasts and PBMCs in single cultures. All examined mediators were highly expressed in the co-culture of osteoblasts and PBMCs whereas in the single cell cultures only IL-6, IL-8, and MMP1 were found to be stimulated. While the applied concentration of the CoCr29Mo6 ion solutions had only marginal effects on human osteoblasts and PBMCs alone, the co-culture may provide a comprehensive model to study osteolytic processes in response to Co and Cr ions. Full article

The use of additive manufacturing technologies to produce lightweight or functional structures is widespread. Especially Ti₆Al₄V plays an important role in this development field and parts are manufactured and analyzed with the aim to characterize the mechanical properties of open-porous structures and to generate scaffolds with properties specific to their intended application. An SLM and an EBM process were used respectively to fabricate the Ti₆Al₄V single struts. For mechanical characterization, uniaxial compression tests and hardness measurements were conducted. Furthermore, the struts were manufactured in different orientations for the determination of the mechanical properties. Roughness measurements and a microscopic characterization of the struts were also carried out. Some parts were characterized following heat treatment (hot isostatic pressing). A functional correlation was found between the compressive strength and the slenderness ratio (λ) as well as the equivalent diameter (d) and the height (L) of EBM and SLM parts. Hardness investigations revealed considerable differences related to the microstructure. An influence of heat treatment as well as of orientation could be determined. In this work, we demonstrate the influence of the fabrication quality of single struts, the roughness and the microstructure on mechanical properties as a function of orientation. Full article

The biomaterials used to maintain or replace functions in the human body consist mainly of metals, ceramics or polymers. In orthopedic surgery, metallic materials, especially titanium and its alloys, are the most common, due to their excellent mechanical properties, corrosion resistance, and biocompatibility. Aside from the established Ti6Al4V alloy, shape memory materials such as nickel-titanium (NiTi) have risen in importance, but are also discussed because of the adverse effects of nickel ions. These might be reduced by specific surface modifications. In the present in vitro study, the osteoblastic cell line MG-63 as well as primary human osteoblasts, fibroblasts, and macrophages were cultured on titanium alloys (forged Ti6Al4V, additive manufactured Ti6Al4V, NiTi, and Diamond-Like-Carbon (DLC)-coated NiTi) to verify their specific biocompatibility and inflammatory potential. Additive manufactured Ti6Al4V and NiTi revealed the highest levels of metabolic cell activity. DLC-coated NiTi appeared as a suitable surface for cell growth, showing the highest collagen production. None of the implant materials caused a strong inflammatory response. In general, no distinct cell-specific response could be observed for the materials and surface coating used. In summary, all tested titanium alloys seem to be biologically appropriate for application in orthopedic surgery. Full article

Bone loss in the near-vicinity of implants can be a consequence of stress shielding due to stiffness mismatch. This can be avoided by reducing implant stiffness, i.e., by implementing an open-porous structure. Three open-porous designs were therefore investigated (cubic, pyramidal and a twisted design). Scaffolds were fabricated by a selective laser-melting (SLM) process and material properties were determined by conducting uniaxial compression testing. The calculated elastic modulus values for the scaffolds varied between 3.4 and 26.3 GP and the scaffold porosities between 43% and 80%. A proportional linear correlation was found between the elastic modulus and the geometrical parameters, between the elastic modulus and the compressive strengths, as well as between the strut width-to-diameter ratio (a/d) and elastic modulus. Furthermore, we found a power-law relationship between porosity and the modulus of elasticity that characterizes specific yielding. With respect to scaffold porosity, the description of specific yielding behaviour offers a simple way to characterize the mechanical properties of open-porous structures and helps generate scaffolds with properties specific to their intended application. A direct comparison with human bone parameters is also possible. We generated scaffolds with mechanical properties sufficiently close to that of human cortical bone. Full article

In the treatment of osseous defects micro-structured three-dimensional materials for bone replacement serve as leading structure for cell migration, proliferation and bone formation. The scaffold design and culture conditions are crucial for the limited diffusion distance of nutrients and oxygen. In static culture, decreased cell activity and irregular distribution occur within the scaffold. Dynamic conditions entail physical stimulation and constant medium perfusion imitating physiological nutrient supply and metabolite disposal. Therefore, we investigated the influence of different scaffold configurations and cultivation methods on human osteoblasts. Cells were seeded on three-dimensional porous Ti-6Al-4V scaffolds manufactured with selective laser melting (SLM) or electron beam melting (EBM) varying in porosity, pore size and basic structure (cubic, diagonal, pyramidal) and cultured under static and dynamic conditions. Cell viability, migration and matrix production were examined via mitochondrial activity assay, fluorescence staining and ELISA. All scaffolds showed an increasing cell activity and matrix production under static conditions over time. Expectations about the dynamic culture were only partially fulfilled, since it enabled proliferation alike the static one and enhanced cell migration. Overall, the SLM manufactured scaffold with the highest porosity, small pore size and pyramidal basic structure proved to be the most suitable structure for cell proliferation and migration. Full article

Both titanium and ceramic materials provide specific advantages in dental implant technology. However, some problems, like hypersensitivity reactions, corrosion and mechanical failure, have been reported. Therefore, the combining of both materials to take advantage of their pros, while eliminating their respective cons, would be desirable. Hence, we introduced a new technique to bond titanium and ceramic materials by means of a silica-based glass ceramic solder. Cylindrical compound samples (Ø10 mm × 56 mm) made of alumina toughened zirconia (ATZ), as well as titanium grade 5, were bonded by glass solder on their end faces. As a control, a two-component adhesive glue was utilized. The samples were investigated without further treatment, after 30 and 90 days of storage in distilled water at room temperature, and after aging. All samples were subjected to quasi-static four-point-bending tests. We found that the glass solder bonding provided significantly higher bending strength than adhesive glue bonding. In contrast to the glued samples, the bending strength of the soldered samples remained unaltered by the storage and aging treatments. Scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) analyses confirmed the presence of a stable solder-ceramic interface. Therefore, the glass solder technique represents a promising method for optimizing dental and orthopedic implant bondings. Full article

Long-term assessment of ambulatory behavior and joint motion are valuable tools for the evaluation of therapy effectiveness in patients with neuromuscular disorders and gait abnormalities. Even though there are several tools available to quantify ambulatory behavior in a home environment, reliable measurement of joint motion is still limited to laboratory tests. The aim of this study was to develop and evaluate a novel inertial sensor system for ambulatory behavior and joint motion measurement in the everyday environment. An algorithm for behavior classification, step detection, and knee angle calculation was developed. The validation protocol consisted of simulated daily activities in a laboratory environment. The tests were performed with ten healthy subjects and eleven patients with multiple sclerosis. Activity classification showed comparable performance to commercially available activPAL sensors. Step detection with our sensor system was more accurate. The calculated flexion-extension angle of the knee joint showed a root mean square error of less than 5° compared with results obtained using an electro-mechanical goniometer. This new system combines ambulatory behavior assessment and knee angle measurement for long-term measurement periods in a home environment. The wearable sensor system demonstrated high validity for behavior classification and knee joint angle measurement in a laboratory setting. Full article

The aim of the present study was to evaluate the biotribology of current surface modifications on femoral heads in terms of wettability, polyethylene wear and ion-release behavior. Three 36 mm diameter ion-treated CoCr heads and three 36 mm diameter TiNbN-coated CoCr heads were articulated against sequentially cross-linked polyethylene inserts (X3) in a hip joint simulator, according to ISO 14242. Within the scope of the study, the cobalt ion release in the lubricant, as well as contact angles at the bearing surfaces, were investigated and compared to 36 mm alumina ceramic femoral heads over a period of 5 million cycles. The mean volumetric wear rates were 2.15 ± 0.18 mm³·million cycles⁻¹ in articulation against the ion-treated CoCr head, 2.66 ± 0.40 mm³·million cycles⁻¹ for the coupling with the TiNbN-coated heads and 2.17 ± 0.40 mm³·million cycles⁻¹ for the ceramic heads. The TiNbN-coated femoral heads showed a better wettability and a lower ion level in comparison to the ion-treated CoCr heads. Consequently, the low volumes of wear debris, which is comparable to ceramics, and the low concentration of metal ions in the lubrication justifies the use of coated femoral heads. Full article

By means of plasma polymerization, positively charged, nanometre-thin coatings can be applied to implant surfaces. The aim of the present study was to quantify the adhesion of human bone cells in vitro and to evaluate the bone ongrowth in vivo, on titanium surfaces modified by plasma polymer coatings. Different implant surface configurations were examined: titanium alloy (Ti6Al4V) coated with plasma-polymerized allylamine (PPAAm) and plasma-polymerized ethylenediamine (PPEDA) versus uncoated. Shear stress on human osteoblast-like MG-63 cells was investigated in vitro using a spinning disc device. Furthermore, bone-to-implant contact (BIC) was evaluated in vivo. Custom-made conical titanium implants were inserted at the medial tibia of female Sprague-Dawley rats. After a follow-up of six weeks, the BIC was determined by means of histomorphometry. The quantification of cell adhesion showed a significantly higher shear stress for MG-63 cells on PPAAm and PPEDA compared to uncoated Ti6Al4V. Uncoated titanium alloyed implants showed the lowest BIC (40.4%). Implants with PPAAm coating revealed a clear but not significant increase of the BIC (58.5%) and implants with PPEDA a significantly increased BIC (63.7%). In conclusion, plasma polymer coatings demonstrate enhanced cell adhesion and bone ongrowth compared to uncoated titanium surfaces. Full article

Synthetic materials for bone replacement must ensure a sufficient mechanical stability and an adequate cell proliferation within the structures. Hereby, titanium materials are suitable for producing patient-individual porous bone scaffolds by using generative techniques. In this in vitro study, the viability of human osteoblasts was investigated in porous 3D Ti6Al4V scaffolds, which were produced by electron-beam (EBM) or laser-beam melting (LBM). For each examination, two cylindrical scaffolds (30 mm × 10 mm in size, 700 µm × 700 µm macropores) were placed on each other and seeded with cells. The oxygen consumption and the acidification in the center of the structures were investigated by means of microsensors. Additionally, the synthesis of pro-collagen type 1 was analyzed. On the LBM titanium scaffolds, vital bone cells were detected in the center and in the periphery after 8 days of cultivation. In the EBM titanium constructs, however, vital cells were only visible in the center. During the cultivation period, the cells increasingly produced procollagen type 1 in both scaffolds. In comparison to the periphery, the oxygen content in the center of the scaffolds slightly decreased. Furthermore, a slight acidification of the medium was detectable. Compared to LBM, the EBM titanium scaffolds showed a less favorable behavior with regard to cell seeding. Full article

Ceramics are a very popular material in dental implant technology due to their tribological properties, their biocompatibility and their esthetic appearance. However, their natural surface structure lacks the ability of proper osseointegration, which constitutes a crucial process for the stability and, thus, the functionality of a bone implant. We investigated the application of a glass solder matrix in three configurations—consisting mainly of SiO₂, Al₂O₃, K₂O and Na₂O to TZP-A ceramic specimens. The corresponding adhesive strength and surface roughness of the coatings on ceramic specimens have been analyzed. Thereby, high adhesive strength (70.3 ± 7.9 MPa) was found for the three different coatings. The obtained roughness (R_z) amounted to 18.24 ± 2.48 µm in average, with significant differences between the glass solder configurations. Furthermore, one configuration was also tested after additional etching which did not lead to significant increase of surface roughness (19.37 ± 1.04 µm) or adhesive strength (57.2 ± 5.8 MPa). In conclusion, coating with glass solder matrix seems to be a promising surface modification technique that may enable direct insertion of ceramic implants in dental and orthopaedic surgery. Full article

Currently, imaging methods are used to diagnose loosening of endoprosthetic implants, but fail to achieve 100% accuracy. In this study, a passive sensor array which is based on the interaction between magnetic oscillators inside the implant and an excitation coil outside the patient was investigated. The excited oscillators produce sound in the audible range, which varies according to the extent of loosening. By performing several experimental tests, the sensor array was optimized to guarantee reproducible and selective excitation of the sound emission. Variation in the distance between the oscillators demonstrated a definite influence on the quality of the generated sound signal. Furthermore, a numerical design analysis using the boundary element method was generated for consideration of the magnetic field and the selectivity of the oscillators during excitation. The numerical simulation of the coil showed the higher selectivity of a coil with a C-shape compared to a cylindrical coil. Based on these investigations, the passive sensor system reveals the potential for detection of implant loosening. Future aims include the further miniaturization of the oscillators and measurements to determine the sensitivity of the proposed sensor system. Full article

Restoration of segmental defects in long bones remains a challenging task in orthopedic surgery. Although autologous bone is still the ‘Gold Standard’ because of its high biocompatibility, it has nevertheless been associated with several disadvantages. Consequently, artificial materials, such as calcium phosphate and titanium, have been considered for the treatment of bone defects. In the present study, the mechanical properties of three different scaffold designs were investigated. The scaffolds were made of titanium alloy (Ti6Al4V), fabricated by means of an additive manufacturing process with defined pore geometry and porosities of approximately 70%. Two scaffolds exhibited rectangular struts, orientated in the direction of loading. The struts for the third scaffold were orientated diagonal to the load direction, and featured a circular cross-section. Material properties were calculated from stress-strain relationships under axial compression testing. In vitro cell testing was undertaken with human osteoblasts on scaffolds fabricated using the same manufacturing process. Although the scaffolds exhibited different strut geometry, the mechanical properties of ultimate compressive strength were similar (145–164 MPa) and in the range of human cortical bone. Test results for elastic modulus revealed values between 3.7 and 6.7 GPa. In vitro testing demonstrated proliferation and spreading of bone cells on the scaffold surface. Full article

In current therapeutic strategies, bone defects are filled up by bone auto- or allografts. Since they are limited by insufficient availability and donor site morbidity, it is necessary to find an appropriate alternative of synthetic porous bone materials. Because of their osteoconductive characteristics, ceramic materials like tricalciumphosphate (TCP) are suitable to fill up bone defects. Another advantage of TCP implants is the ability of patient-specific engineering. Objective of the present in-vitro study was to analyze the migration capacity and viability of human primary osteoblasts in porous three-dimensional TCP scaffolds in a static cell culture. To obtain data of the cellular supply with nutrients and oxygen, we determined the oxygen concentration and the pH value within the 3D scaffold compared to the surrounding medium using microsensors. After eight days of cultivation we found cells on all four planes. During incubation, the oxygen concentration within the scaffold decreased by approximately 8%. Furthermore, we could not demonstrate an increasing acidification in the core of the TCP scaffold. Our results suggest that osteoblasts could migrate and survive within the macroporous TCP scaffolds. The selected size of the macropores prevents overgrowth of cells, whereby the oxygen and nutrients supply is sufficiently guaranteed. Full article