Search Results (24)

Background: Curettage represents a reliable therapeutic option for large-sized benign and locally aggressive bone tumors. In cases of impending fractures, internal fixation with plates and screws can be necessary to stabilize the treated bone after curettage. Metal plates have been the only fixation devices available on the market for decades, but Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) now represents an alternative in orthopedic oncology. Methods: We reviewed our patients with benign or locally aggressive bone tumors treated with curettage and fixation with CFR-PEEK plates. Plate length and curettage technique were chosen considering the characteristics of each lesion. We recorded the size and location of the lesions, adjuvant treatments and fillers used after curettage, complications, and local recurrences. Postoperative functionality was assessed using the MSTS score. Results: Forty cases were included in our study. The tumors were located in the distal femur (19 cases), femur shaft (1), humerus (17), or proximal tibia (3). Local adjuvants were used in 20 cases. Cavities were filled with bone allografts in 30 cases and cement in 10 cases. Only four cases suffered postoperative complications, and two developed local recurrences. The mean postoperative follow-up was 29.2 months. The mean postoperative upper and lower limb MSTS was 28.0 and 26.7, respectively. Conclusions: After an accurate curettage and an adequate filling of the resulting bone gap, CFR-PEEK plates can provide good mechanical resistance, and their radio-transparency can ease the early diagnosis of local recurrences. CFR-PEEK plates should be considered in selected cases, in a personalized surgical approach. Full article

Current standard of care treatment for patients with spine tumors includes multidisciplinary approaches, including the following: (1) surgical tumor debulking, epidural spinal cord decompression, and spine stabilization techniques; (2) systemic chemo/targeted therapies; (3) radiation therapy; and (4) surveillance imaging for local disease control and recurrence. Titanium pedicle screw and rod fixation have become commonplace in the spine surgeon’s armamentarium for the stabilization of the spine following tumor resection and separation surgery. However, the high degree of imaging artifacts seen with titanium implants on postoperative CT and MRI scans can significantly hinder the accurate delineation of vertebral anatomy and adjacent neurovascular structures to allow for the safe and effective planning of downstream radiation therapies and detection of disease recurrence. Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) spine implants have emerged as a promising alternative to titanium due to the lack of artifact signals on CT and MRI, allowing for more accurate and safe postoperative radiation planning. In this article, we review the tenants of the surgical and radiation management of spine tumors and discuss the safety, efficacy, and current limitations of CFR-PEEK spine implants in the multidisciplinary management of spine oncology patients. Full article

Spinal metastases occur in up to 40% of patients with cancer. Of these cases, 10% become symptomatic. The reported incidence of spinal metastases has increased in recent years due to innovations in imaging modalities and oncological treatments. As the incidence of spinal metastases rises, so does the demand for improved treatments and treatment algorithms, which now emphasize greater multidisciplinary collaboration and are increasingly customized per patient. Uniquely, we discuss the potential clinical applications of AI and NGS in the treatment of spinal metastases. Material and Methods: A PubMed search for articles published from 2000 to 2023 regarding spinal metastases and artificial intelligence in healthcare was completed. After screening for relevance, the key findings from each study were summarized in this update. Results: This review summarizes the evidence from studies reporting on treatment modalities for spinal metastases, including minimally invasive surgery (MIS), external beam radiation therapy (EBRT), stereotactic radiosurgery (SRS), CFR-PEEK instrumentation, radiofrequency ablation (RFA), next-generation sequencing (NGS), artificial intelligence, and predictive models. Full article

To explore the friction and wear performance of the valve pair with different wetting combinations under various working conditions in hydraulic oil lubrication, a low surface energy modification method was adopted in this paper to improve the surface wettability of the upper sample composed of SAF2507 and the lower sample composed of CFRPEEK, and to prepare valve plate pairs with different wetting combinations. The MMU-5G friction and wear testing machine was used to investigate its friction and wear characteristics under hydraulic oil lubrication. The results show that the surface free energy of SAF2507 and CFRPEEK decreased significantly after the treatment with a low surface energy solution, and the surface free energy of the upper and lower samples decreased by 41.9% and 42.2%, respectively. The oil contact angle of samples remained lipophilic, but the oil contact angle increased significantly. Under the working condition of low speed (800 r/min), the surface wettability of the valve plate pair has a great influence on its friction and wear characteristics. When operating at high speed (1200 r/min), the surface wettability of the valve plate pair has little influence on its friction and wear characteristics. Full article

The material addition rate (MAR) of fused filament fabrication (FFF) is an indicator of process efficiency varied by process parameter settings, which affects energy consumption and part quality in FFF. This study aims to identify the optimal MAR of FFF using carbon-fiber-reinforced polyether-ether-ketone (CFR-PEEK) by considering a trade-off between energy consumption and the dimensional accuracy of FFF outputs. A design of experiments considering two main process parameters is planned to print three sample types through FFF for CFR-PEEK. Then, the MAR (i.e., deposited material volume per build time) of FFF is obtained to derive individual regression models of energy consumption and the dimensional accuracy measured for each sample type. Furthermore, a trade-off between energy consumption and dimensional accuracy on the MAR is formulated to derive an optimal MAR for each sample type. The results show that FFF for CFR-PEEK has a trade-off between energy consumption and dimensional accuracy; there exists a specific MAR that maximizes the overall performance of energy consumption and dimensional accuracy for each sample type. The optimal MAR is the highest for the small volume sample, whereas it becomes the lowest for the vertical build orientation sample. This study suggests that the optimal MAR should be flexibly adjusted based on a fabricated part. The findings from this study also address the fact that decision-making for optimal FFF operations needs a transition from the identification of specific process parameter settings to the management of a proper process efficiency level in FFF. Full article

Using gas-phase deposition (Physical Vapor Deposition (PVD) and Metal Organic Chemical Vapor Deposition (MOCVD)) methods, modern implant samples (Ti alloy and CFR-PEEK polymer, 30% carbon fiber) were functionalized with film heterostructures consisting of an iridium or gold sublayer, on the surface of which an antibacterial component (silver) was deposited: Ag/Ir(Au)/Ti(CFR-PEEK). The biocidal effect of the heterostructures was investigated, the effect of the surface relief of the carrier and the metal sublayer on antibacterial activity was established, and the dynamics of silver dissolution was evaluated. It has been shown that the activity of Ag/Ir heterostructures was due to high Ag⁺ release rates, which led to rapid (2–4 h) inhibition of P. aeruginosa growth. In the case of Ag/Au type heterostructures, the inhibition of the growth of P. aeruginosa and S. aureus occurred more slowly (from 6 h), and the antibacterial activity appeared to be due to the contribution of two agents (Ag⁺ and Au⁺ ions). It was found, according to the in vitro cytotoxicity study, that heterostructures did not exhibit toxic effects (cell viability > 95–98%). An in vivo biocompatibility assessment based on the results of a morphohistological study showed that after implantation for a period of 30 days, the samples were characterized by the presence of a thin fibrous capsule without volume thickening and signs of inflammation. Full article

Background: Proximal humerus fractures are seen frequently, particularly in older patients. The development of new osteosynthesis materials is being driven by the high complication rates following surgical treatment of proximal humerus fractures. Plate osteosyntheses made of steel, titanium and, for several years now, carbon fiber-reinforced polyetheretherketone (CFR-PEEK) are used most frequently. Methods: A prospective, randomized study was conducted in order to evaluate whether there are differences in the functional postoperative outcome when comparing CFR-PEEK and titanium implants for surgical treatment of proximal humerus fractures. The primary outcome of shoulder functionality 1 year after surgery was measured with the DASH score, the Oxford Shoulder Score, and the Simple Shoulder Test. Results: Bony consolidation of the respective fracture was confirmed in all the patients included in the study within the scope of postoperative follow-up care. No significant differences in the DASH score, Oxford Shoulder Score, or Simple Shoulder Test were observed 1 year post-operatively when comparing the implant materials CFR-PEEK and titanium. Conclusions: There are no differences in terms of the functional outcome between CFR-PEEK plates and titanium implants 1 year after surgery. Studies on the long-term outcomes using CFR-PEEK plates in osteoporotic bone should be the subject of further research. Full article

CFR-PEEK is gaining popularity in spinal oncological applications due to its reduction of imaging artifacts and radiation scattering compared with titanium, which allows for better oncological follow-up and efficacy of radiotherapy. We evaluated the use of these materials for the treatment of lumbar degenerative diseases (DDs) and considered the biomechanical potential of the carbon fiber in relation to its modulus of elasticity being similar to that of bone. Twenty-eight patients with DDs were treated using CRF-PEEK instrumentation. The clinical and radiographic outcomes were collected at a 12-month FU. Spinal fusion was evaluated in the CT scans using Brantigan scores, while the clinical outcomes were evaluated using VAS, SF-12, and EQ-5D scores. Out of the patients evaluated at the 12-month FU, 89% showed complete or almost certain fusion (Brantigan score D and E) and presented a significant improvement in all clinical parameters; the patients also presented VAS scores ranging from 6.81 ± 2.01 to 0.85 ± 1.32, EQ-5D scores ranging from 53.4 ± 19.3 to 85.0 ± 13.7, SF-12 physical component scores (PCSs) ranging from 29.35 ± 7.04 to 51.36 ± 9.75, and SF-12 mental component scores (MCSs) ranging from 39.89 ± 11.70 to 53.24 ± 9.24. No mechanical complications related to the implant were detected, and the patients reported a better tolerance of the instrumentation compared with titanium. No other series of patients affected by DD that was stabilized using carbon fiber implants have been reported in the literature. The results of this pilot study indicate the efficacy and safety of these implants and support their use also for spinal degenerative diseases. Full article

In this work, approaches to the formation of multifunctional film heterostructures based on noble metals for the modification of the surface of implant materials (titanium alloy TiAl₆V₄ and carbon-fiber-reinforced polyetheretherketone CFR-PEEK) are developed. Such heterostructures consist of continuous layers of platinum (Pt) or iridium (Ir) and antibacterial components on their surface, namely silver (nanoparticles or discontinuous films) and gold (nanoparticles). Chemical or physical gas-phase deposition methods were used for their preparation. The influence of the concentration and form of the antibacterial component on the antibacterial activity and in vivo biocompatibility of the film structures was evaluated for the first time. Differences in the dynamics of silver dissolution depending on Ag concentration in the sample and the type of bottom surface (the noble metal layer = Ir, Pt or TiAl₆V₄) surfaces allowed us to better understand the nature of the antibacterial action against Staphylococcus aureus and Pseudomonas aeruginosa (S. aureus and P. aeruginosa) of Ag/M heterostructures. From in vivo histological studies using rats, the best biocompatibility was shown by the Ag/M heterostructure with a prolonged release of the low fraction of antibacterial component (Ag). Full article

A water lubricating axial piston pump (WLPP) is the core power component of a green and environmentally friendly water hydraulic system. The friction and wear of the friction pairs of a WLPP are the key factors that restrict its development. In order to explore the friction and wear mechanism of materials, the tribological properties of CFRPEEK against 316L and 1Cr17Ni2 under water lubrication were investigated in a friction testing machine and an axial piston pump, respectively. An environmental scanning electron microscope (ESEM), confocal laser scanning microscopy and a surface profiler were used to analyze the morphology of the samples. In a friction testing machine, two different metals are paired with CFRPEEK, and the friction coefficient and wear rate barely show any differences. The wear rate of CFRPEEK is two orders of magnitude higher than that of metal. In the WLPP, 316L can hardly be paired with CFRPEEK, while 1Cr17Ni2 works well. The wear of 1Cr17Ni2 in the WLPP is greater than that of CFRPEEK. The high-pressure water film lubrication friction pairs cause the wear of the metal and show the difference in these two test methods. The wear mechanism is mainly abrasive wear. Improving the wear resistance of metals is very important for the development of WLPP. Full article

(1) Background: Surgery for spinal metastases has gained a decisive role in modern oncological treatment. Recently, carbon-fiber-reinforced (CFR) polyethyl-ether-ether-ketone (PEEK) pedicle screw systems were introduced, reducing artifacts on imaging and showing less perturbation effects on photon radiation. Preliminary clinical experience with CFR-PEEK implants for spinal metastases exists. The aim of this monocentric study is to report on the safety and efficacy of CFR-PEEK pedicle screw systems for spinal neoplasms in a large cohort of consecutive patients. (2) Methods: We retrospectively analyzed prospectively the collected data of consecutive patients being operated on from 1 August 2015 to 31 October 2021 using a CFR-PEEK pedicle screw system for posterior stabilization because of spinal metastases or primary bone tumors of the spine. (3) Results: We included 321 patients of a mean age of 65 ± 13 years. On average, 5 ± 2 levels were instrumented. Anterior reconstruction was performed in 121 (37.7%) patients. Intraoperative complications were documented in 30 (9.3%) patients. Revision surgery for postoperative complications was necessary in 55 (17.1%) patients. Implant-related complications, such as intraoperative screw breakage (3.4%) and screw loosening (2.2%), were rare. (4) Conclusions: CFR-PEEK is a safe and efficient alternative to titanium for oncological spinal instrumentation, with low complication and revision rates in routine use and with the advantage of its radiolucency. Full article

This paper presents pioneering results on the evaluation of noble metal film hetero-structures to improve some functional characteristics of carbon-based implant materials: carbon-composite material (CCM) and carbon-fiber-reinforced polyetheretherketone (CFR-PEEK). Metal-organic chemical vapor deposition (MOCVD) was successfully applied to the deposition of Ir, Pt, and PtIr films on these carriers. A noble metal layer as thin as 1 µm provided clear X-ray imaging of 1–2.5 mm thick CFR-PEEK samples. The coated and pristine CCM and CFR-PEEK samples were further surface-modified with Au and Ag nanoparticles (NPs) through MOCVD and physical vapor deposition (PVD) processes, respectively. The composition and microstructural features, the NPs sizes, and surface concentrations were determined. In vitro biological studies included tests for cytotoxicity and antibacterial properties. A series of samples were selected for subcutaneous implantation in rats (up to 3 months) and histological studies. The bimetallic PtIr-based heterostructures showed no cytotoxicity in vitro, but were less biocompatible due to a dense two-layered fibrous capsule. AuNP heterostructures on CFR-PEEK promoted cell proliferation in vitro and exhibited a strong inhibition of bacterial growth (p < 0.05) and high in vitro biocompatibility, especially Au/Ir structures. AgNP heterostructures showed a more pronounced antibacterial effect, while their in vivo biocompatibility was better than that of the pristine CFR-PEEK, but worse than that of AuNP heterostructures. Full article

Background: This study aimed to investigate the biomechanical behaviors of polyether ether ketone (PEEK) and traditional materials (titanium and fiber) when used to restore tooth defects in the form of prefabricated post or customized post via computational modelling. Methods: First, the prototype of natural tooth, and the prototypes of prefabricated post and customized post were established, respectively, whilst the residual root was restored with dentin ferrule using reverse engineering methods. Then, the stress and strain of CFR-PEEK (PEEK reinforced by 30% carbon fiber) and pure PEEK (PEEK without any reprocessing) post were compared with those made in traditional materials using the three-dimensional finite element method. Results: From the stress point of view, compared with metal and fiber posts, CFR-PEEK and pure PEEK prefabricated post both demonstrated reduced post-core interface stress, post stress, post-root cement stress and root cement stress; moreover, CFR-PEEK and pure PEEK customized post demonstrated reduced post stress, post-root cement stress and root cement stress, while the strain of CFR-PEEK post was the closest to that of dentin. Conclusions: Compared with the traditional posts, both the CFR-PEEK and pure PEEK posts could reduce the risk of debonding and vertical root fracture, whether they were used as prefabricated posts or customized posts, but the biomechanical behavior of carbon fiber-reinforced CFR-PEEK restorations was the closest to dentin, no matter if they were used as prefabricated post or customized post. Therefore, the CFR-PEEK post could be more suitable to restore massive tooth defects. Pure PEEK needs filler reinforcement to be used for post-retained restoration. Full article

With the increasing market demand for artificial hip joints, total hip joint replacement has gradually become an effective means of treating a series of hip joint diseases. In order to improve the service life of artificial hip joints, some new artificial hip joint materials, including polyetheretherketone (PEEK) and carbon fiber reinforced polyetheretherketone (CFR-PEEK), have been developed. In this paper, pin-on-plate wear tests under different cross-shear ratios and contact pressures were carried out to study the wear mechanism and worn surface topography of PEEK and CFR-PEEK. The experimental results showed that the wear of PEEK was associated with cross-shear, while CFR-PEEK was not. When the cross-shear ratio was 0.039 and contact pressure was 3.18 MPa, PEEK had poor wear resistance and its wear factor was about eight times that of ultra-high molecular weight polyethylene (UHMWPE). The wear resistance of CFR-PEEK had a significant advantage, since its wear factor was about 30% of that of PEEK. The wear factors of PEEK and CFR-PEEK increased as the contact pressure increased. The arithmetic average of the height amplitude of the surface, Sa, also increased gradually according to the topography of the worn surface. The wear mechanisms of PEEK and CFR-PEEK were scratching, plough cutting, and abrasion Since CFR-PEEK had good wear resistance and insensitivity to cross-shear motion, it is suitable for making artificial hip joints under low contact pressure condition. Full article

This paper aimed to evaluate the biomechanical effects of tibial bearing materials, from ultra-high-molecular-weight polyethylene (UHMWPE) to poly-ether-ether-ketone (PEEK) and carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK). The studies were conducted based on a validated finite element model. The geometry of the intact knee model was developed from computed tomography and magnetic resonance imaging of the left knee joint of a 37-year-old healthy male volunteer. Three different loading conditions, related to the loads applied in the experimental research, were applied to this study for model predictions and validation. The contact stress in the other compartments was under normal walking conditions. Also, stresses on five regions of the tibia bone were analyzed under normal walking conditions. The lowest contact stress between the lateral meniscus and tibial cartilage was achieved in the order of the use of CFR-PEEK, PEEK, and UHMWPE tibial bearings. Moreover, CFR-PEEK and PEEK tibial bearings indicated lower and greater stresses on cortical and trabecular bones, respectively, compared to the UHMWPE tibial bearing. These results show that CFR-PEEK can be used as a tibial bearing material as an alternative to UHMWPE, and such a change in the material may be a good method for reducing potential anteromedial pain. Full article