Screw Osteointegration—Increasing Biomechanical Resistance to Pull-Out Effect
Abstract
:1. Introduction
2. Spinal Fixation Devices
2.1. Plates
2.2. Cages
2.3. Rods
2.4. Screws
2.5. Overview
3. Pull-Out Effect
4. Osteointegration
5. Material Optimization
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Devices | Applications | Standard Materials | Advantages/Benefits | Disadvantages/Problems | Refs. |
---|---|---|---|---|---|
Plates | Spinal stabilization | Titanium | Increased spinal stability Direct decompression of the spinal cord High rate of neurologic improvement Low complication rate | Not preferred for multilevel fusion Not a stand-alone fixation method | [6,33,34] |
Cages | Anterior/posterior interbody fusion (restore the height of collapsed disc from injury, degenerative disc disease, or scoliosis) | Titanium PEEK Ceramic Acrylic | Increased spinal stability Preserved facet joints Minimal destruction of the posterior and facet joint ligaments and of the endplates | Fibrosis occurrence Increased minimal principal stresses Maintenance of disc heights and lordotic alignment not achieved in the long term | [6,35] |
Rods | Spinal fusion (add stability to a spinal implant; used for scoliosis correctional surgery) | Titanium CoCr PEEK Stainless steel Nitinol | Increased spinal stability High fusion rates Increased load sharing Preferred over plates for multilevel fusion | Not a stand-alone fixation method | [6,34,36] |
Screws | Pedicle screw fixation (holds vertebrae together to attach plates and rods) | Titanium (Ti6Al4V) doped with: | Increased spinal stability Firm fixation Complete decompression and strain relief on the spinal nerves Early patient discharge | Loss of fixation Improper placement Fatigue and bending failure Dural tears Cerebral spinal fluid leaks Nerve root injury Infection | [6,30,31] |
|
Proposed Strategy | Device Specifications | Observations | Ref. |
---|---|---|---|
Screws with metallic core (i.e., Ti6Al4V) and polymeric shell (i.e., poly L-lactic acid) | Pull-out force: 150–182 N Bending force: 574–614 N | Improved structural rigidity Quick healing property for the bones attributed to the outer bioabsorbable material Minimization of the loading on the bone during dynamic activities | [67] |
Biomicroconcretes containing porous hydroxyapatite–chitosan granules and α-tricalcium phosphate-based bone cement | Total open porosity: 45 ± 5 vol.% (Series A) and 50 ± 5 vol.% (Series B) Pore size distribution: ranging from 0.005 µm to 40 µm Mechanical strength of Series A composites: ranging from 5.4 ± 0.8 MPa to 6.2 ± 1.0 MPa [similar to compressive strength of trabecular bone (4–12 MPa)] | Mechanical strength is influenced by the amount of chitosan in hybrid HAp–CTS granules Higher compressive strength was noticed for biomicroconcretes containing granules with a lower amount of chitosan (17 wt.%) | [75] |
Bioactive glass/hydroxyapatite composites for Ti6Al4V implant improvement | Morphology: highly porous coral-like coating Bioactive glass thickness: ranging from 6 μm to 30 μm Nanocrystalline hydroxyapatite layer thickness: 150 nm | The presence of the bioactive glass-topcoat layer significantly improves the reactivity in terms of mineralization response compared to single-layered hydroxyapatite coating | [76] |
Antimicrobial protamine-loaded hydroxyapatite coating | Disc diameter: 15 mm Disc thickness: 1–2 mm Antimicrobial powder amount: 0.30 g | Bactericidal properties against Escherichia coli and Staphylococcus aureus Osteoconductivity and biocompatibility proven through in vitro and in vivo tests | [77] |
Copper–titanium alloy screws | Tensile strength: 597 ± 3.1 MPa Elongation: 26% ± 3.5% Yield strength: 457 ± 7.0 MPa Vickers hardness: 215 ± 8.5 HV Total length: 7 mm Upper width: 4 mm Thread width: 2 mm Thread length: 3 mm | Excellent mechanical properties and bio-functionalization Corrosion resistance and antibacterial performance Improved fixation stability stimulates the vascular network reconstruction around the implant Promotes the proliferation and differentiation of osteoblasts, mineralization, and deposition of collagens | [78] |
Radiolucent carbon fiber-reinforced PEEK pedicle screw coated with titanium | Carbon-fiber amount: 55% volume Length: 100 mm Diameter: 5.5 mm | Increased turnout resistance Less material fatigue than standard titanium alloy devices Postoperative artifact–reduced imaging | [68] |
Porous PEKK implants | Morphology: interconnected macropores and micro/nano topography Pore size: >200 μm Maximum push-out force: 97.6 ± 9.4 N | More than double the amount of newly formed bone than in PEEK implants Better osteointegration and mechanical stability than PEEK devices | [79] |
Biodegradable poly(lactic acid) implants surface-functionalized with TiO2 + ZrO2 nanocomposites | Crystal size of Ti–Zr nanocomposites: 19.2 nm Nanocomposite layer weight: ~62 mg Weight of apatite layer deposited on the 18th day: 65 mg | Improved osteointegration Enhanced mechanical properties | [8] |
Metallic titanium implants with nanoleafy surface pattern | Surface morphology: a network of vertically aligned, non-periodic, leaf-like structures with thickness in the nanoscale Critical load to adhesive failure: 0.44 ± 0.023 N | Good biocompatibility A higher increase in osteoblast cell proliferation, alkaline phosphatase activity, and collagen synthesis than other nanomorphologies A higher percentage of bone contact with no inflammatory cytokine production | [65] |
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Costăchescu, B.; Niculescu, A.-G.; Grumezescu, A.M.; Teleanu, D.M. Screw Osteointegration—Increasing Biomechanical Resistance to Pull-Out Effect. Materials 2023, 16, 5582. https://doi.org/10.3390/ma16165582
Costăchescu B, Niculescu A-G, Grumezescu AM, Teleanu DM. Screw Osteointegration—Increasing Biomechanical Resistance to Pull-Out Effect. Materials. 2023; 16(16):5582. https://doi.org/10.3390/ma16165582
Chicago/Turabian StyleCostăchescu, Bogdan, Adelina-Gabriela Niculescu, Alexandru Mihai Grumezescu, and Daniel Mihai Teleanu. 2023. "Screw Osteointegration—Increasing Biomechanical Resistance to Pull-Out Effect" Materials 16, no. 16: 5582. https://doi.org/10.3390/ma16165582