Search Results (14)

Neck and lower back pain, often caused by spinal disorders such as scoliosis and degenerative disc disease, affects over 80% of the global population, with an estimated from 250,000 to 500,000 spinal cord injuries occurring annually according to the WHO. As the demand for spinal procedures continues to rise, advancements in implant materials have become essential. Orthopedic implants play a vital role in restoring mobility and improving the quality of life of patients with musculoskeletal disorders. Metallic implants, such as stainless steel, titanium, and its alloys, are commonly used to make fixation devices for spinal fusion surgery due to their excellent mechanical properties. However, complications such as stress shielding have been recorded. Polymeric materials offer new prospects as an alternative to metal-based materials such as those based on Polyaryletherketone (PEAK). Among the advanced materials used in these implants, PAEK has emerged as the preferred choice due to its exceptional mechanical strength, thermal stability, and chemical resistance. Polyetheretherketone (PEEK) and Polyetherketoneketone (PEKK) offer notable advantages, such as radiolucency and mechanical properties resembling those of natural bone, reducing stress shielding and facilitating postoperative imaging. Although PEEK and PEKK are considered as bioinert, it has been demonstrated that adding bioactive agents such as hydroxyapatite (HA) into the matrix to make composites solves this problem and can help with aiding direct bone apposition. Furthermore, PAEK’s compatibility with 3DP enables the creation of patient-specific implants with intricate geometries, enhancing the surgical outcomes. In addition, the lattice structures of orthopedic implants can alleviate stress shielding, provide an enhanced surface area for the release of bioactive agents (or antimicrobial materials), and eliminate more imaging artifacts compared to that of simple, solid metal implants. PAEK/HA composite implants represent a transformative solution, addressing the psychological, social, and economic burdens of spinal disorders, while enhancing the surgical outcomes. With continuous technological evolution, PAEK/HA composites are poised to play a pivotal role in modern spinal care. Full article

The biocompatible polymer polyetheretherketone (PEEK) is a suitable candidate to be part of potential all-polymer total joint replacements, provided its use is associated with better osseointegration, mechanical performance, and wear resistance. Seeking to meet the aforementioned requirements, respectively, we have manufactured a PEEK composite with different fillers: carbon fibers (CF), hydroxyapatite particles (HA) and graphene platelets (GNP). The mechanical outcomes of the composites with combinations of 0, 1.5, 3.0 wt% GNP, 5 and 15 wt% HA and 30% of wt% CF concentrations pointed out that one of the best filler combinations to achieve the previous objectives was 30 wt% CF, 8 wt% HA and 2 wt% of GNP. The study compares the bioactivity of human osteoblasts on this composite prepared by injection molding with that on the material manufactured by the Fused Filament Fabrication 3D additive technique. The results indicate that the surface adhesion and proliferation of human osteoblasts over time are better with the composite obtained by injection molding than that obtained by 3D printing. This result is more closely correlated with morphological parameters of the composite surface than its wettability behavior. Full article

Three-dimensional printing or additive manufacturing (AM) has enabled innovative advancements in tissue engineering through scaffold development. The use of scaffolds, developed by using AM technology for tissue repair (like cartilage and bone), could enable the growth of several cell types on the same implant. Scaffolds are 3D-printed using polymer-based composites. polyether ether ketone (PEEK)-based composites are ideal for scaffold 3D printing due to their excellent biocompatibility and mechanical properties resembling human bone. It is therefore considered to be the next-generation bioactive material for tissue engineering. Despite several reviews on the application of PEEK in biomedical fields, a detailed review of the recent progress made in the development of PEEK composites and the 3D printing of scaffolds has not been published. Therefore, this review focuses on the current status of technological developments in the 3D printing of bone scaffolds using PEEK-based composites. Furthermore, this review summarizes the challenges associated with the 3D printing of high-performance scaffolds based on PEEK composites. Full article

Polymers, in general, and Poly (Ether-Ether-Ketone) (PEEK) have emerged as potential alternatives to conventional osseous implant biomaterials. Due to its distinct advantages over metallic implants, PEEK has been gaining increasing attention as a prime candidate for orthopaedic and dental implants. However, PEEK has a highly hydrophobic and bioinert surface that attenuates the differentiation and proliferation of osteoblasts and leads to implant failure. Several improvements have been made to the osseointegration potential of PEEK, which can be classified into three main categories: (1) surface functionalization with bioactive agents by physical or chemical means; (2) incorporation of bioactive materials either as surface coatings or as composites; and (3) construction of three-dimensionally porous structures on its surfaces. The physical treatments, such as plasma treatments of various elements, accelerated neutron beams, or conventional techniques like sandblasting and laser or ultraviolet radiation, change the micro-geometry of the implant surface. The chemical treatments change the surface composition of PEEK and should be titrated at the time of exposure. The implant surface can be incorporated with a bioactive material that should be selected following the desired use, loading condition, and antimicrobial load around the implant. For optimal results, a combination of the methods above is utilized to compensate for the limitations of individual methods. This review summarizes these methods and their combinations for optimizing the surface of PEEK for utilization as an implanted biomaterial. Full article

The attention on orthopedic biomaterials has shifted from their direct osteogenic properties to their osteoimmunomodulation, especially the modulation of macrophage polarization. Presently, advanced technologies endow polyetheretherketone (PEEK) with good osteoimmunomodulation by modifying PEEK surface characteristics or incorporating bioactive substances with regulating macrophage polarization. Recent studies have demonstrated that the fabrication of a hydrophilic surface and the incorporation of bioactive substances into PEEK (e.g., zinc, calcium, and phosphate) are good strategies to promote osteogenesis by enhancing the polarization of M2 macrophages. Furthermore, the modification by other osteoimmunomodulatory composites (e.g., lncRNA-MM2P, IL-4, IL-10, and chitosan) and their controlled and desired release may make PEEK an optimal bio-activated implant for regulating and balancing the osteogenic system and immune system. The purpose of this review is to comprehensively evaluate the potential of bio-activated PEEK in polarizing macrophages into M2 phenotype to improve osteogenesis. For this objective, we retrieved and discussed different kinds of bio-activated PEEK regarding improving osteogenesis through modulating macrophage polarization. Meanwhile, the relevant challenges and outlook were presented. We hope that this review can shed light on the development of bio-activated PEEK with more favorable osteoimmunomodulation. Full article

The incorporation of bioactive ceramic into polyether ether ketone (PEEK) was expected to improve the bioinertia and hydrophobicity of pure PEEK, further facilitating osseointegration and bone ingrowth. However, the addition of bioceramic also changes the anisotropy of mechanical properties and failure mechanism of composite. Therefore, three-dimensional printed (3D-printed) PEEK/hydroxyapatite (HA) composite filaments with differing proportions (HA content: 10–30 wt%) were prepared using physical mixture and melting extrusion processes. The tensile elastic modulus and tensile strength of composite filaments were tested experimentally. These microscopic models, with multiple diameter variations and differing dispersity of HA particles, were built to estimate mechanical properties using finite element analysis. Based on a generalized version of Hooke’s Law, the influence of diameter variation and particle clustering on the elastic modulus was evaluated. The mathematical relationship between the elastic modulus and volume fraction of the bioceramic was established using the Halpin–Tsai model. The results showed that with an increase in HA content from 10 wt% to 30 wt%, the elastic modulus of the composite increased from 2.36 GPa to 2.79 GPa, tensile strength decreased from 95 MPa to 74 MPa, and fracture elongation decreased from 63% to 23%, presenting brittle fracture failure. When the dispersion of particles was uniform, the elastic modulus was less affected by diameter variation, but the modulus anisotropic coefficient was greatly affected by the composition ratio, particle diameter, and dispersity. Hence, 3D-printed PEEK/HA composite filaments can meet the strength requirements of human bone, and understanding the influence of mechanical anisotropy plays a very important role in the design, manufacture, and clinical application of medical implants. Full article

In this study, Strontium (Sr) and Zinc (Zn) doped-HA nanoparticles were synthesized and incorporated into polyetheretherketone (PEEK) up to 30 wt.% and processed by a novel approach i.e., fused deposition modelling (FDM) 3D printing for the production of patient specific cranial implants with improved bioactivity and the required mechanical performance. Filaments were produced via extrusion and subsequently 3D-printed using FDM. To further improve the bioactivity of the 3D-printed parts, the samples were dip-coated in polyethylene glycol-DOPA (PEG-DOPA) solution. The printing quality was influenced by filler loading, but was not significantly influenced by the nature of doped-HA. Hence, the printing conditions were optimized for each sample. Micro-CT and Scanning Electron Microscopy (SEM) showed a uniform distribution of bioceramic particles in PEEK. Although agglomeration of particles increased with increase in filler loadings. Differential Scanning Calorimetry (DSC) showed that the melting point and crystallinity of PEEK increased with an increase in doped-HA loading from 343 °C to 355 °C and 27.7% to 34.6%, respectively. Apatite formation was confirmed on the 3D-printed samples after immersion in simulated body fluid (SBF) for 7, 14 and 28 days via SEM, X-ray diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR). The tensile strength and impact strength decreased from 75 MPa to 51 MPa and 14 kJ/m² to 4 kJ/m², respectively, while Young’s modulus increased with increasing doped-HA content from 2.8 GPa to 4.2 GPa. However, the tensile strengths of composites remained in the range of human cortical bone i.e., ≥50 MPa. In addition, there was a slight increase in mechanical strength after 28 days immersion which was attributed to apatite formation. Water contact angle showed that the hydrophilicity of the samples improved after coating the 3D-printed samples with PEG-DOPA. Hence, based on the results, the 3D-printed PEEK nanocomposites with 20 wt.% doped-HA is selected as the best candidate for the 3D-printing of craniomaxillofacial implants. Full article

The authors aimed to impart the apatite-forming ability to 50 wt% carbon fiber-polyetheretherketone composite (50C-PEEK), which has more suitable mechanical properties as artificial bone materials than pure PEEK. First, the 50C-PEEK was treated with sulfuric acid in a short time to form pores on the surface. Second, the surface of the 50C-PEEK was treated with oxygen plasma to improve the hydrophilicity. Finally, fine particles of calcium phosphate, which the authors refer to as “apatite nuclei”, were precipitated on the surface of the 50C-PEEK by soaking in an aqueous solution containing multiple inorganic ions such as phosphate and calcium (modified-SBF) at pH 8.20, 25 °C. The 50C-PEEK without the modified-SBF treatment did not show the formation of apatitic phase even after immersion in simulated body fluid (SBF) for 7 days. The 50C-PEEK treated with the modified-SBF showed the formation of apatitic phase on the entire surface within 1 day in the SBF. The apatite nuclei-precipitated 50C-PEEK will be expected as a new artificial bone material with high bioactivity that is obtained without complicated fabrication processes. Full article

Polyetheretherketone (PEEK) is a high-performance thermoplastic polymer which has found increasing application in orthopaedics and has shown a lot of promise for ‘made-to-measure’ implants via additive manufacturing approaches. However, PEEK is bioinert and needs to undergo surface modification to make it at least osteoconductive to ensure a more rapid, improved, and stable fixation that will last longer in vivo. One approach to solving this issue is to modify PEEK with bioactive agents such as hydroxyapatite (HA). The work reported in this study demonstrates the direct 3D printing of PEEK/HA composites of up to 30 weight percent (wt%) HA using a Fused Filament Fabrication (FFF) approach. The surface characteristics and in vitro properties of the composite materials were investigated. X-ray diffraction revealed the samples to be semi-crystalline in nature, with X-ray Photoelectron Spectroscopy and Time-of-Flight Secondary Ion Mass Spectrometry revealing HA materials were available in the uppermost surface of all the 3D printed samples. In vitro testing of the samples at 7 days demonstrated that the PEEK/HA composite surfaces supported the adherence and growth of viable U-2 OS osteoblast like cells. These results demonstrate that FFF can deliver bioactive HA on the surface of PEEK bio-composites in a one-step 3D printing process. Full article

Polyetheretherketone (PEEK) has the potential to overcome some of the disadvantages of titanium interbody implants in anterior cervical and discectomy and fusion (ACDF). However, PEEK shows an inferior biological behavior regarding osseointegration and bioactivity. Therefore, the aim of the study was to create a bioactive surface coating on PEEK implants with a unique nanopore structure enabling the generation of a long-lasting interfacial composite layer between coating material and implant. Seventy-two PEEK implants—each thirty-six pure PEEK implants (PI) and thirty-six PEEK implants with a sprayed coating consisting of nanocrystalline hydroxyapatite (ncHA) embedded in a silica matrix and interfacial composite layer (SPI)—were inserted in the femoral condyles of adult rats using a split-side model. After 2, 4 and 8 weeks, the femur bones were harvested. Half of the femur bones were used in histological and histomorphometrical analyses. Additionally, pull-out tests were performed in the second half. Postoperative healing was uneventful for all animals, and no postoperative complications were observed. Considerable crestal and medullary bone remodeling could be found around all implants, with faster bone formation around the SPI and fewer regions with fibrous tissue barriers between implant and bone. Histomorphometrical analyses showed a higher bone to implant contact (BIC) in SPI after 4 and 8 weeks (p < 0.05). Pull-out tests revealed higher pull-out forces in SPI at all time points (p < 0.01). The presented findings demonstrate that a combination of a bioactive coating and the permanent chemical and structural modified interfacial composite layer can improve bone formation at the implant surface by creating a sustainable bone-implant interface. This might be a promising way to overcome the bioinert surface property of PEEK-based implants. Full article

The main obstacles in the melt-processing of hydroxyapatite (HA) and carbon fiber (CF) reinforced polyetheretherketone (PEEK) composite are the high melting temperature of PEEK, poor dispersion of HA nanofillers, and poor processability due to high filler content. In this study, we prepared PEEK/HA/CF ternary composite using two different non-melt blending methods; suspension blending (SUS) in ethanol and mechanofusion process (MF) in dry condition. We compared the mechanical properties and bioactivity of the composite in a spinal cage application in the orthopedic field. Results showed that the PEEK/HA/CF composite made by the MF method exhibited higher flexural and compressive strengths than the composite prepared by the SUS method due to the enhanced dispersibility of HA nanofiller. On the basis of in vitro cell compatibility and cell attachment tests, PEEK/HA/CF composite by mechanofusion process showed an improvement in in vitro bioactivity and osteo-compatibility. Full article

In this article, recent advances in the development, preparation, biocompatibility and mechanical properties of polyetheretherketone (PEEK) and its composites for hard and soft tissue engineering are reviewed. PEEK has been widely employed for fabricating spinal fusions due to its radiolucency, chemical stability and superior sterilization resistance at high temperatures. PEEK can also be tailored into patient-specific implants for treating orbital and craniofacial defects in combination with additive manufacturing process. However, PEEK is bioinert, lacking osseointegration after implantation. Accordingly, several approaches including surface roughening, thin film coating technology, and addition of bioactive hydroxyapatite (HA) micro-/nanofillers have been adopted to improve osseointegration performance. The elastic modulus of PEEK is 3.7–4.0 GPa, being considerably lower than that of human cortical bone ranging from 7–30 GPa. Thus, PEEK is not stiff enough to sustain applied stress in load-bearing orthopedic implants. Therefore, HA micro-/nanofillers, continuous and discontinuous carbon fibers are incorporated into PEEK for enhancing its stiffness for load-bearing applications. Among these, carbon fibers are more effective than HA micro-/nanofillers in providing additional stiffness and load-bearing capabilities. In particular, the tensile properties of PEEK composite with 30wt% short carbon fibers resemble those of cortical bone. Hydrophobic PEEK shows no degradation behavior, thus hampering its use for making porous bone scaffolds. PEEK can be blended with hydrophilic polymers such as polyglycolic acid and polyvinyl alcohol to produce biodegradable scaffolds for bone tissue engineering applications. Full article

Addition of bioactive materials such as calcium phosphates or Bioglass, and incorporation of porosity into polyetheretherketone (PEEK) has been identified as an effective approach to improve bone-implant interfaces and osseointegration of PEEK-based devices. In this paper, a novel production technique based on the extrusion freeforming method is proposed that yields a bioactive PEEK/hydroxyapatite (PEEK/HA) composite with a unique configuration in which the bioactive phase (i.e., HA) distribution is computer-controlled within a PEEK matrix. The 100% interconnectivity of the HA network in the biocomposite confers an advantage over alternative forms of other microstructural configurations. Moreover, the technique can be employed to produce porous PEEK structures with controlled pore size and distribution, facilitating greater cellular infiltration and biological integration of PEEK composites within patient tissue. The results of unconfined, uniaxial compressive tests on these new PEEK/HA biocomposites with 40% HA under both static and cyclic mode were promising, showing the composites possess yield and compressive strength within the range of human cortical bone suitable for load bearing applications. In addition, preliminary evidence supporting initial biological safety of the new technique developed is demonstrated in this paper. Sufficient cell attachment, sustained viability in contact with the sample over a seven-day period, evidence of cell bridging and matrix deposition all confirmed excellent biocompatibility. Full article

The synthetic thermoplastic polymer polyetheretherketone (PEEK) is becoming a popular component of clinical orthopedic and spinal applications, but its practical use suffers from several limitations. Although PEEK is biocompatible, chemically stable, radiolucent and has an elastic modulus similar to that of normal human bone, it is biologically inert, preventing good integration with adjacent bone tissues upon implantation. Recent efforts have focused on increasing the bioactivity of PEEK to improve the bone-implant interface. Two main strategies have been used to overcome the inert character of PEEK. One approach is surface modification to activate PEEK through surface treatment alone or in combination with a surface coating. Another strategy is to prepare bioactive PEEK composites by impregnating bioactive materials into PEEK substrate. Researchers believe that modified bioactive PEEK will have a wide range of orthopedic applications. Full article