Research

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13 pages, 3466 KiB

Open AccessArticle

Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution—An Ex Vivo Study in Goat Vertebrae

by Hsin-Tzu Lu, Jia-Yi Lin, Yu-Chuan Tsuei, Yung-Fu Hsu, Chung-Yi Chen, Shih-Hao Cheng, William Chu, Chuan Li and Woei-Chyn Chu

Bioengineering 2023, 10(7), 795; https://doi.org/10.3390/bioengineering10070795 - 03 Jul 2023

Cited by 1 | Viewed by 1031

Abstract

Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage [...] Read more.

Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage of bone cement (CL) during vertebroplasty (PV) is a major risk that can cause (serious) complications such as compression of the spinal cord, pulmonary embolism, or even paraplegia. In this study, we introduced a new aspiration technique with standard PV procedures (APV) to ameliorate the risk of leakage with quantitative verifications of its effectiveness. APV intends to create a differential pressure to guide the direction of cement flow within the vertebrae. To test this technique, Nubian goats’ ex vivo vertebral bodies (VBs) were used to simulate the PV surgical process in humans. Results show that the proposed APV has a lower leakage rate of 13% compared to the 53% of conventional PV. Additionally, the APV approach achieves more uniform cement distribution via the 9-score method with a value of 7 ± 1.30 in contrast to 4 ± 1.78 by conventional PV. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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11 pages, 1795 KiB

Open AccessArticle

Improving Mechanical Properties of Tendon Allograft through Rehydration Strategies: An In Vitro Study

by Chun Bi, Andrew R. Thoreson and Chunfeng Zhao

Bioengineering 2023, 10(6), 641; https://doi.org/10.3390/bioengineering10060641 - 25 May 2023

Viewed by 947

Abstract

Allogenic tendons grafts sourced from intrasynovial tendons are often used for tendon reconstruction. Processing is achieved through repetitive freeze–thaw cycles followed by lyophilization. Soaking the lyophilized tendon in saline (0.9%) for 24 h is the standard practice for rehydration. However, data supporting saline [...] Read more.

Allogenic tendons grafts sourced from intrasynovial tendons are often used for tendon reconstruction. Processing is achieved through repetitive freeze–thaw cycles followed by lyophilization. Soaking the lyophilized tendon in saline (0.9%) for 24 h is the standard practice for rehydration. However, data supporting saline rehydration over the use of other hydrating solutions are scant. The purpose of the current study was to compare the effects of different rehydration solutions on biomechanical properties of lyophilized tendon allograft. A total of 36 canine flexor digitorum profundus tendons were collected, five freeze–thaw cycles followed by lyophilization were performed for processing, and then divided into three groups rehydrated with either saline solution (0.9%), phosphate-buffered saline (PBS), or minimum essential medium (MEM). Flexural stiffness, tensile stiffness, and gliding friction were evaluated before and after allograft processing. The flexural moduli in both fibrous and fibrocartilaginous regions of the tendons were measured. After lyophilization and reconstitution, the flexural moduli of both the fibrocartilaginous and non-fibrocartilaginous regions of the tendons increase significantly in the saline and MEM groups (p < 0.05). Compared to the saline and MEM groups, the flexural moduli of the fibrocartilaginous and non-fibrocartilaginous regions of tendons rehydrated with PBS are significantly lower (p < 0.05). Tensile moduli of rehydrated tendons are significantly lower than those of fresh tendons for all groups (p < 0.05). The gliding friction of rehydrated tendons is significantly higher than that of fresh tendons in all groups (p < 0.05). There is no significant difference in either tensile moduli or gliding friction between tendons treated with different rehydration solutions. These results demonstrate that allograft reconstitution can be optimized through careful selection of hydrating solution and that PBS could be a better choice as the impact on flexural properties is lower. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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13 pages, 10367 KiB

Open AccessArticle

Global Compressive Loading from an Ultra-Thin PEEK Button Augment Enhances Fibrocartilage Regeneration of Rotator Cuff Enthesis

by Chia-Wei Lin, En-Rung Chiang, Shih-Hao Chen, Poyu Chen, Heng-Jui Liu and Joe Chih-Hao Chiu

Bioengineering 2023, 10(5), 565; https://doi.org/10.3390/bioengineering10050565 - 09 May 2023

Viewed by 1326

Abstract

A PEEK button is developed to improve the tendon-to-bone compression area. In total, 18 goats were divided into 12-week, 4-week, and 0-week groups. All underwent bilateral detachment of the infraspinatus tendon. In the 12-week group, 6 were fixed with a 0.8–1 mm-thick PEEK [...] Read more.

A PEEK button is developed to improve the tendon-to-bone compression area. In total, 18 goats were divided into 12-week, 4-week, and 0-week groups. All underwent bilateral detachment of the infraspinatus tendon. In the 12-week group, 6 were fixed with a 0.8–1 mm-thick PEEK augment (A-12, Augmented), and 6 were fixed with the double-row technique (DR-12). Overall, 6 infraspinatus were fixed with PEEK augment (A-4) and without PEEK augment (DR-4) in the 4-week group. The same condition was performed in the 0-week groups (A-0 and DR-0). Mechanical testing, immunohistochemistry assessment, cell responses, tissue alternation, surgical impact, remodeling, and the expression of type I, II, and III collagen of the native tendon-to-bone insertion and new footprint areas were evaluated. The average maximum load in the A-12 group (393.75 (84.40) N) was significantly larger than in the TOE-12 group (229.17 (43.94) N) (p < 0.001). Cell responses and tissue alternations in the 4-week group were slight. The new footprint area of the A-4 group had better fibrocartilage maturation and more type III collagen expression than in DR-4 group. This result proved the novel device is safe and provides superior load-displacement to the double-row technique. There is a trend toward better fibrocartilage maturation and more collagen III secretions in the PEEK augmentation group. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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12 pages, 6219 KiB

Open AccessArticle

Tissue Integration of Calcium Phosphate Compound after Subchondroplasty: 4-Year Follow-Up in a 76-Year-Old Female Patient

by Samo K. Fokter, Matevž Kuhta, Marko Hojnik, Živa Ledinek and Rok Kostanjšek

Bioengineering 2023, 10(2), 208; https://doi.org/10.3390/bioengineering10020208 - 04 Feb 2023

Cited by 7 | Viewed by 2481

Abstract

Subchondroplasty is a new minimally invasive surgical technique developed to treat bone marrow lesions (BML) and early osteoarthritis (OA). During the procedure, engineered calcium phosphate compound (CPC) is injected. It is claimed by the manufacturer that during the healing process, the CPC is [...] Read more.

Subchondroplasty is a new minimally invasive surgical technique developed to treat bone marrow lesions (BML) and early osteoarthritis (OA). During the procedure, engineered calcium phosphate compound (CPC) is injected. It is claimed by the manufacturer that during the healing process, the CPC is replaced with new bone. The purpose of this study was to verify the replacement of CPC with new bone after subchondroplasty for the first time in humans. A 76-year old woman was referred for resistant medial knee pain. Standing radiographs showed varus knee OA and magnetic resonance imaging (MRI) revealed BML. She was treated with subchondroplasty of medial femoral condyle. Excellent relief of pain was achieved after procedure. Afterwards, the pain worsened, the radiographs confirmed the OA progression and the patient was treated with a total knee arthroplasty (TKA) 4 years after primary procedure. The resected bone was examined histologically and with micro-computed tomography (CT). Histologically, bone trabeculae of subcortical bone were embedded in the amorphous mass. However, no signs of CPC resorption and/or bone replacement have been found with micro-CT. In short term, excellent pain relief could be expected after the subchondroplasty procedure. However, there was no replacement of CPC with bone and the technique probably did not influence the natural process of knee OA. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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14 pages, 2433 KiB

Open AccessArticle

Biomechanical Effect of Hybrid Dynamic Stabilization Implant on the Segmental Motion and Intradiscal Pressure in Human Lumbar Spine

by Chih-Kun Hsiao, Yi-Jung Tsai, Cheng-Yo Yen, Yi-Chen Li, Hao-Yuan Hsiao and Yuan-Kun Tu

Bioengineering 2023, 10(1), 31; https://doi.org/10.3390/bioengineering10010031 - 26 Dec 2022

Cited by 4 | Viewed by 2034

Abstract

The hybrid dynamic stabilization system, Dynesys-Transition-Optima, represents a novel pedicle-based construct for the treatment of lumbar degenerative disease. The theoretical advantage of this system is to stabilize the treated segment and preserve the range of motion within the adjacent segment while potentially decreasing [...] Read more.

The hybrid dynamic stabilization system, Dynesys-Transition-Optima, represents a novel pedicle-based construct for the treatment of lumbar degenerative disease. The theoretical advantage of this system is to stabilize the treated segment and preserve the range of motion within the adjacent segment while potentially decreasing the risk of adjacent segment disease following lumbar arthrodesis. Satisfactory short-term outcomes were previously demonstrated in the Dynesys-Transition-Optima system. However, long-term follow-up reported accelerated degeneration of adjacent segments and segmental instability above the fusion level. This study investigated the biomechanical effects of the Dynesys-Transition-Optima system on segment motion and intradiscal pressure at adjacent and implanted levels. Segmental range of motion and intradiscal pressure were evaluated under the conditions of the intact spine, with a static fixator at L4–5, and implanted with DTO at L3–4 (Dynesys fixator) and L4–5 (static fixator) by applying the loading conditions of flexion/extension (±7.5 Nm) and lateral bending (±7.5 Nm), with/without a follower preload of 500 N. Our results showed that the hybrid Dynesys-Transition-Optima system can significantly reduce the ROM at the fusion level (L4–L5), whereas the range of motion at the adjacent level (L3–4) significantly increased. The increase in physiological loading could be an important factor in the increment of IDP at the intervertebral discs at the lumbar spine. The Dynesys-Transition-Optima system can preserve the mobility of the stabilized segments with a lesser range of motion on the transition segment; it may help to prevent the occurrence of adjacent segment degeneration. However, the current study cannot cover all the issues of adjacent segmental diseases. Future investigations of large-scale and long-term follow-ups are needed. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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16 pages, 4376 KiB

Open AccessArticle

The Role of the Assembly Force in the Tribocorrosion Behaviour of Hip Implant Head-Neck Junctions: An Adaptive Finite Element Approach

by Khosro Fallahnezhad, Mohsen Feyzi, Reza Hashemi and Mark Taylor

Bioengineering 2022, 9(11), 629; https://doi.org/10.3390/bioengineering9110629 - 01 Nov 2022

Cited by 8 | Viewed by 1299

Abstract

The cyclic loading, in the corrosive medium of the human body, results in tribocorrosion at the interface of the head-neck taper junction of hip implants. The resulting metal ions and wear debris adversely affect the local tissues. The force applied by surgeons to [...] Read more.

The cyclic loading, in the corrosive medium of the human body, results in tribocorrosion at the interface of the head-neck taper junction of hip implants. The resulting metal ions and wear debris adversely affect the local tissues. The force applied by surgeons to assemble the junction has proven to play a major role in the mechanics of the taper junction which, in turn, can influence the tribocorrosion damage. Recently, finite element method has been used to predict the material loss at the head-neck interface. However, in most finite element studies, the contribution of electrochemical corrosion has been ignored. Therefore, a detailed study to investigate the influence of the assembly force on the tribocorrosive behaviour of the head-neck junction, which considers both the mechanical and chemical material removal, is of paramount interest. In this study, a finite-element-based algorithm was used to investigate the effect of assembly force on the tribocorrosion damage at the junction interface, for over four million cycles of simulated level gait. The patterns of the material removal in the modelling results were compared with the damage patterns observed in a group of retrieved modular hip implants. The results of this study showed that for different cases, chemical wear was in the range of 25–50% of the total material loss, after four million cycles. A minimum assembly force (4 kN for the studied cases) was needed to maintain the interlock in the junction. The computational model was able to predict the damage pattern at the retrieved head-neck interface. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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20 pages, 78182 KiB

Open AccessArticle

A Study on the Structure and Biomedical Application Characteristics of Phosphate Coatings on ZKX500 Magnesium Alloys

by Ying-Ting Huang, Wen-Yu Wu, Fei-Yi Hung, Fa-Chuan Kuan, Kai-Lan Hsu, Wei-Ren Su and Chen-Wei Yen

Bioengineering 2022, 9(10), 542; https://doi.org/10.3390/bioengineering9100542 - 11 Oct 2022

Cited by 2 | Viewed by 1135

Abstract

Magnesium-matrix implants can be detected by X-ray, making post-operative monitoring easier. Since the density and mechanical properties of Mg alloys are similar to those of human bones, the stress-shielding effect can be avoided, accelerating the recovery and regeneration of bone tissues. Additionally, Mg [...] Read more.

Magnesium-matrix implants can be detected by X-ray, making post-operative monitoring easier. Since the density and mechanical properties of Mg alloys are similar to those of human bones, the stress-shielding effect can be avoided, accelerating the recovery and regeneration of bone tissues. Additionally, Mg biodegradability shields patients from the infection risk and medical financial burden of needing another surgery. However, the major challenge for magnesium-matrix implants is the rapid degradation rate, which necessitates surface treatment. In this study, the ZKX500 Mg alloy was used, and a non-toxic and eco-friendly anodic oxidation method was adopted to improve corrosion resistance. The results indicate that the anodic coating mainly consisted of magnesium phosphate. After anodic oxidation, the specimen surface developed a coating and an ion-exchanged layer that could slow down the degradation and help maintain the mechanical properties. The results of the tensile and impact tests reveal that after being immersed in SBF for 28 days, the anodic oxidation-treated specimens maintained good strength, ductility, and toughness. Anodic coating provides an excellent surface for cell attachment and growth. In the animal experiment, the anodic oxidation-treated magnesium bone screw used had no adverse effect and could support the injured part for at least 3 months. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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13 pages, 3301 KiB

Open AccessArticle

Feasibility of Implanting a Foot–Ankle Endoprosthesis within Skin in a Rabbit Model of Transtibial Amputation

by Dustin L. Crouch, Patrick T. Hall, Caleb Stubbs, Caroline Billings, Alisha P. Pedersen, Bryce Burton, Cheryl B. Greenacre, Stacy M. Stephenson and David E. Anderson

Bioengineering 2022, 9(8), 348; https://doi.org/10.3390/bioengineering9080348 - 27 Jul 2022

Viewed by 2099

Abstract

Prosthetic limbs that are completely implanted within skin (i.e., endoprostheses) could permit direct, physical muscle–prosthesis attachment to restore more natural sensorimotor function to people with amputation. The objective of our study was to test, in a rabbit model, the feasibility of replacing the [...] Read more.

Prosthetic limbs that are completely implanted within skin (i.e., endoprostheses) could permit direct, physical muscle–prosthesis attachment to restore more natural sensorimotor function to people with amputation. The objective of our study was to test, in a rabbit model, the feasibility of replacing the lost foot after hindlimb transtibial amputation by implanting a novel rigid foot–ankle endoprosthesis that is fully covered with skin. We first conducted a pilot, non-survival surgery in two rabbits to determine the maximum size of the skin flap that could be made from the biological foot–ankle. The skin flap size was used to determine the dimensions of the endoprosthesis foot segment. Rigid foot–ankle endoprosthesis prototypes were successfully implanted in three rabbits. The skin incisions healed over a period of approximately 1 month after surgery, with extensive fur regrowth by the pre-defined study endpoint of approximately 2 months post surgery. Upon gross inspection, the skin surrounding the endoprosthesis appeared normal, but a substantial subdermal fibrous capsule had formed around the endoprosthesis. Histology indicated that the structure and thickness of the skin layers (epidermis and dermis) were similar between the operated and non-operated limbs. A layer of subdermal connective tissue representing the fibrous capsule surrounded the endoprosthesis. In the operated limb of one rabbit, the subdermal connective tissue layer was approximately twice as thick as the skin on the medial (skin = 0.43 mm, subdermal = 0.84 mm), ventral (skin = 0.80 mm, subdermal = 1.47 mm), and lateral (skin = 0.76 mm, subdermal = 1.42 mm) aspects of the endoprosthesis. Our results successfully demonstrated the feasibility of implanting a fully skin-covered rigid foot–ankle endoprosthesis to replace the lost tibia–foot segment of the lower limb. Concerns include the fibrotic capsule which could limit the range of motion of jointed endoprostheses. Future studies include testing of endoprosthetics, as well as materials and pharmacologic agents that may suppress fibrous encapsulation. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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16 pages, 3040 KiB

Open AccessArticle

Effects on Tissue Integration of Collagen Scaffolds Used for Local Delivery of Gentamicin in a Rat Mandible Defect Model

by Caroline Billings, Austin J. Bow, Steven D. Newby, Robert L. Donnell, Madhu Dhar and David E. Anderson

Bioengineering 2022, 9(7), 275; https://doi.org/10.3390/bioengineering9070275 - 24 Jun 2022

Viewed by 1589

Abstract

Surgical site infections (SSIs) are a common complication following orthopedic surgery. SSIs may occur secondary to traumatic or contaminated wounds or may result from invasive procedures. The development of biofilms is often associated with implanted materials used to stabilize injuries and to facilitate [...] Read more.

Surgical site infections (SSIs) are a common complication following orthopedic surgery. SSIs may occur secondary to traumatic or contaminated wounds or may result from invasive procedures. The development of biofilms is often associated with implanted materials used to stabilize injuries and to facilitate healing. Regardless of the source, SSIs can be challenging to treat. This has led to the development of devices that act simultaneously as local antibiotic delivery vehicles and as scaffolds for tissue regeneration. The goal for the aforementioned devices is to increase local drug concentration in order to enhance bactericidal activity while reducing the risk of systemic side effects and toxicity from the administered drug. The aims of this study were to assess the effect of antibiotic loading of a collagen matrix on the tissue integration of the matrix using a rat mandibular defect model. We hypothesized that the collagen matrix could load and elute gentamicin, that the collagen matrix would be cytocompatible in vitro, and that the local delivery of a high dose of gentamicin via loaded collagen matrix would negatively impact the tissue–scaffold interface. The results indicate that the collagen matrix could load and elute the antimicrobial gentamicin and that it was cytocompatible in vitro with or without the presence of gentamicin and found no significant impact on the tissue–scaffold interface when the device was loaded with a high dose of gentamicin. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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7 pages, 449 KiB

Open AccessArticle

The Resistance Force of the Anterior Cruciate Ligament during Pull Probing Is Related to the Mechanical Property

by Takehito Hananouchi, Tomoyuki Suzuki, Erik W. Dorthe, Jiang Du and Darryl D. D’Lima

Bioengineering 2022, 9(1), 4; https://doi.org/10.3390/bioengineering9010004 - 23 Dec 2021

Cited by 1 | Viewed by 2408

Abstract

There are various methods for reconstructing the anterior cruciate ligament (ACL) from other muscles or tendons. Initial tension of the reconstructed ACL is one of the key elements affecting postoperative outcomes. However, tension cannot be measured after graft fixation. The only intraoperative assessment [...] Read more.

There are various methods for reconstructing the anterior cruciate ligament (ACL) from other muscles or tendons. Initial tension of the reconstructed ACL is one of the key elements affecting postoperative outcomes. However, tension cannot be measured after graft fixation. The only intraoperative assessment is pull probing, which is performed by pulling joint soft tissues with the arthroscopic probe and can be measured quantitatively. Therefore, its value might be used as an alternative value for the mechanical property of the ACL. Using a probing device one author developed to measure the resistance force of soft tissues quantitatively while probing, we measured the resistance force of dissected ACLs and used tensile testing to investigate the correlation between the resistance force and the mechanical property of the ligaments. According to the results, when a certain amount of tension (strain; 16.6%) was applied, its mechanical properties were moderately correlated (r = 0.56 [p = 0.045]) with the probing force. Therefore, the tension of the reconstructed ACL after fixation under real ACL reconstruction surgery can be derived from the value of the probing device. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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Review

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14 pages, 1543 KiB

Open AccessReview

Implant Imaging: Perspectives of Nuclear Imaging in Implant, Biomaterial, and Stem Cell Research

by Andras Polyak, Zita Képes and György Trencsényi

Bioengineering 2023, 10(5), 521; https://doi.org/10.3390/bioengineering10050521 - 25 Apr 2023

Cited by 1 | Viewed by 1554

Abstract

Until now, very few efforts have been made to specifically trace, monitor, and visualize implantations, artificial organs, and bioengineered scaffolds for tissue engineering in vivo. While mainly X-Ray, CT, and MRI methods have been used for this purpose, the applications of more sensitive, [...] Read more.

Until now, very few efforts have been made to specifically trace, monitor, and visualize implantations, artificial organs, and bioengineered scaffolds for tissue engineering in vivo. While mainly X-Ray, CT, and MRI methods have been used for this purpose, the applications of more sensitive, quantitative, specific, radiotracer-based nuclear imaging techniques remain a challenge. As the need for biomaterials increases, so does the need for research tools to evaluate host responses. PET (positron emission tomography) and SPECT (single photon emission computer tomography) techniques are promising tools for the clinical translation of such regenerative medicine and tissue engineering efforts. These tracer-based methods offer unique and inevitable support, providing specific, quantitative, visual, non-invasive feedback on implanted biomaterials, devices, or transplanted cells. PET and SPECT can improve and accelerate these studies through biocompatibility, inertivity, and immune-response evaluations over long investigational periods at high sensitivities with low limits of detection. The wide range of radiopharmaceuticals, the newly developed specific bacteria, and the inflammation of specific or fibrosis-specific tracers as well as labeled individual nanomaterials can represent new, valuable tools for implant research. This review aims to summarize the opportunities of nuclear-imaging-supported implant research, including bone, fibrosis, bacteria, nanoparticle, and cell imaging, as well as the latest cutting-edge pretargeting methods. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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12 pages, 1251 KiB

Open AccessReview

Cervical and Lumbar Disc Arthroplasty: A Review of Current Implant Design and Outcomes

by Ian J. Wellington, Cameron Kia, Ergin Coskun, Barrett B. Torre, Christopher L. Antonacci, Michael R. Mancini, John P. Connors, Sean M. Esmende and Heeren S. Makanji

Bioengineering 2022, 9(5), 227; https://doi.org/10.3390/bioengineering9050227 - 23 May 2022

Cited by 4 | Viewed by 3250

Abstract

While spinal disc pathology has traditionally been treated using fusion-based procedures, recent interest in motion-preserving disc arthroplasties has grown. Traditional spinal fusion is associated with loss of motion, alteration of native spine kinematics, and increased risks of adjacent segment disease. The motion conferred [...] Read more.

While spinal disc pathology has traditionally been treated using fusion-based procedures, recent interest in motion-preserving disc arthroplasties has grown. Traditional spinal fusion is associated with loss of motion, alteration of native spine kinematics, and increased risks of adjacent segment disease. The motion conferred by disc arthroplasty is believed to combat these complications. While the first implant designs resulted in poor patient outcomes, recent advances in implant design and technology have shown promising radiographic and clinical outcomes when compared with traditional fusion. These results have led to a rapid increase in the utilization of disc arthroplasty, with rates of cervical arthroplasty nearly tripling over the course of 7 years. The purpose of this review was to discuss the evolution of implant design, the current implant designs utilized, and their associated outcomes. Although disc arthroplasty shows significant promise in addressing some of the drawbacks associated with fusion, it is not without its own risks. Osteolysis, implant migration, and the development of heterotopic ossification have all been associated with disc arthroplasty. As interest in these procedures grows, so does the interest in developing improved implant designs aimed at decreasing these adverse outcomes. Though they are still relatively new, cervical and lumbar disc arthroplasty are likely to become foundational methodologies for the treatment of disc pathology. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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11 pages, 2879 KiB

Open AccessReview

Spinal Implant Osseointegration and the Role of 3D Printing: An Analysis and Review of the Literature

by Cameron Kia, Christopher L. Antonacci, Ian Wellington, Heeren S. Makanji and Sean M. Esmende

Bioengineering 2022, 9(3), 108; https://doi.org/10.3390/bioengineering9030108 - 06 Mar 2022

Cited by 10 | Viewed by 5205

Abstract

The use of interbody implants for spinal fusion has been steadily increasing to avoid the risks of complications and donor site morbidity when using autologous bone. Understanding the pros and cons of various implant designs can assist the surgeon in choosing the ideal [...] Read more.

The use of interbody implants for spinal fusion has been steadily increasing to avoid the risks of complications and donor site morbidity when using autologous bone. Understanding the pros and cons of various implant designs can assist the surgeon in choosing the ideal interbody for each individual patient. The goal of these interbody cages is to promote a surface area for bony ingrowth while having the biomechanical properties to support the axial skeleton. Currently, the majority of interbody implants consists of metal or polyether ether ketone (PEEK) cages with bone graft incorporated inside. Titanium alloy implants have been commonly used, however, the large difference in modulus of elasticity from bone has inherent issues. PEEK implants have a desirable surface area with the benefit of a modulus of elasticity closer to that of bone. Unfortunately, clinically, these devices have had increased risk of subsidence. More recently, 3D printed implants have come into the market, providing mechanical stability with increased surface design for bony ingrowth. While clinical outcomes studies are limited, early results have demonstrated more reliable and quicker fusion rates using 3D custom interbody devices. In this review, we discuss the biology of osseointegration, the use of surface coated implants, as well as the potential benefits of using 3D printed interbodies. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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24 pages, 1914 KiB

Open AccessEditor’s ChoiceReview

Role of Implantable Drug Delivery Devices with Dual Platform Capabilities in the Prevention and Treatment of Bacterial Osteomyelitis

by Caroline Billings and David E. Anderson

Bioengineering 2022, 9(2), 65; https://doi.org/10.3390/bioengineering9020065 - 06 Feb 2022

Cited by 6 | Viewed by 6318

Abstract

As medicine advances and physicians are able to provide patients with innovative solutions, including placement of temporary or permanent medical devices that drastically improve quality of life of the patient, there is the persistent, recurring problem of chronic bacterial infection, including osteomyelitis. Osteomyelitis [...] Read more.

As medicine advances and physicians are able to provide patients with innovative solutions, including placement of temporary or permanent medical devices that drastically improve quality of life of the patient, there is the persistent, recurring problem of chronic bacterial infection, including osteomyelitis. Osteomyelitis can manifest as a result of traumatic or contaminated wounds or implant-associated infections. This bacterial infection can persist as a result of inadequate treatment regimens or the presence of biofilm on implanted medical devices. One strategy to mitigate these concerns is the use of implantable medical devices that simultaneously act as local drug delivery devices (DDDs). This classification of device has the potential to prevent or aid in clearing chronic bacterial infection by delivering effective doses of antibiotics to the area of interest and can be engineered to simultaneously aid in tissue regeneration. This review will provide a background on bacterial infection and current therapies as well as current and prospective implantable DDDs, with a particular emphasis on local DDDs to combat bacterial osteomyelitis. Full article

(This article belongs to the Special Issue Bioengineered Systems: Implants and Devices for Orthopaedic Applications)

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