Surface Finish has a Critical Influence on Biofilm Formation and Mammalian Cell Attachment to Additively Manufactured Prosthetics

Cox, Sophie C.; Jamshidi, Parastoo; Eisenstein, Neil; Webber, Mark A.; Burton, Hanna E.; Moakes, Richard J. A.; Addison, Owen; Attallah, Moataz M.; Shepherd, Duncan E.T.; Grover, Liam M.

doi:10.1021/acsbiomaterials.7b00336

Cited by 44 publications

(40 citation statements)

References 47 publications

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“…Without surface finishing, semi-melted particles on AM Ti-6Al-4V surfaces have the potential to detach following implantation, and cause localized osteolysis [191] . Semi-melted particles have been shown to affect cell migration and reduce the effective surface area for integration [191,192] . However there is little data in the literature at present to quantify this with regards to specific processes and parameters used.…”

Section: Surface Finishing and Sterilizationmentioning

confidence: 99%

“…Relatively few studies have compared processes but initial evidence suggests that sand blasting and electropolishing are inappropriate as the finishing media can be difficult to remove. Specifically, sand blasted parts display surfaces with impregnated blast media in the form of AlO x elements -Al ions in the outer oxide layer of Ti-6Al-4V have been shown to reduce the oxide stability and increase the likelihood of Al ion dissolution [191,192] . Electropolishing and chemical etching can lead to the formation of micropits, increasing oxygen infiltration, as well as destabilize the native oxide layer, reducing corrosion resistance [191,195] .…”

Section: Surface Finishing and Sterilizationmentioning

confidence: 99%

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Additive Manufacturing of Titanium Alloys for Orthopedic Applications: A Materials Science Viewpoint

et al. 2018

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Titanium‐based orthopedic implants are increasingly being fabricated using additive manufacturing (AM) processes such as selective laser melting (SLM), direct laser deposition (DLD), and electron beam melting (EBM). These techniques have the potential to not only produce implants with properties comparable to conventionally manufactured implants, but also improve on standard implant models. These models can be customized for individual patients using medical data, and design features, such as latticing, hierarchical scaffolds, or features to complement patient anatomy, can be added using AM to produce highly functional patient‐anatomy‐specific implants. Alloying prospects made possible through AM allow for the production of Ti‐based parts with compositions designed to reduce modulus and stress shielding while improving bone fixation and formation. The design‐to‐process lead time can be drastically shortened using AM and associated post‐processing, making possible the production of tailored implants for individual patients. This review examines the process and product characteristics of the three major metallic AM techniques and assesses the potential for these in the increased global uptake of AM in orthopedic implant fabrication.

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Section: Surface Finishing and Sterilizationmentioning

confidence: 99%

Section: Surface Finishing and Sterilizationmentioning

confidence: 99%

Additive Manufacturing of Titanium Alloys for Orthopedic Applications: A Materials Science Viewpoint

et al. 2018

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“…For example, sand-blasting followed by acid etching (SLA -Sand-blasted, Large grit, Acid etched) is a common surface finishing technique used to induce multi-scale roughness, both on commercial implants and in a laboratory setting [241,242]. However, its high directionality makes it inappropriate for the finishing of complex geometries or lattices [243], and the existing roughness of as-built AM surfaces may encourage entrapment of remnant grit, with a detrimental effect on biocompatibility and increased risk of bacterial colonisation [244]. Several commercially available implants utilise designed porosity, such as acetabular cups, and whilst bearing surfaces are machined smooth, removal of remnant powder from the porous surface is a key consideration.…”

Section: Surface Processingmentioning

confidence: 99%

“…As well as modifying roughness, these processes may alter the chemical composition of the surface, through deposition of remnant abrasive [244], or modification of oxide layers [251]. It is important to consider the effect of any post processing on oxide behaviour, as the extent and morphology of oxide film growth can be controlled [254].…”

Section: Surface Processingmentioning

confidence: 99%

Clinical, industrial, and research perspectives on powder bed fusion additively manufactured metal implants

Lowther

Louth

Davey

et al. 2019

Additive Manufacturing

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A B S T R A C TFor over ten years, metallic skeletal endoprostheses have been produced in select cases by additive manufacturing (AM) and increasing awareness is driving demand for wider access to the technology. This review brings together key stakeholder perspectives on the translation of AM research; clinical application, ongoing research in the field of powder bed fusion, and the current regulatory framework. The current clinical use of AM is assessed, both on a mass-manufactured scale and bespoke application for patient specific implants. To illuminate the benefits to clinicians, a case study on the provision of custom cranioplasty is provided based on prosthetist testimony. Current progress in research is discussed, with immediate gains to be made through increased design freedom described at both meso-and macro-scale, as well as long-term goals in alloy development including bioactive materials. In all cases, focus is given to specific clinical challenges such as stress shielding and osseointegration. Outstanding challenges in industrialisation of AM are openly raised, with possible solutions assessed. Finally, overarching context is given with a review of the regulatory framework involved in translating AM implants, with particular emphasis placed on customisation within an orthopaedic remit. A viable future for AM of metal implants is presented, and it is suggested that continuing collaboration between all stakeholders will enable acceleration of the translation process. fection or surgical complications [11][12][13].Currently, the majority of skeletal endoprostheses are produced from titanium (Ti) or cobalt chromium (CoCr) based alloys, which meet the criteria of durability, strength, corrosion resistance and a low immune response [14,15]. These characteristics however come at the cost of the high stiffness of these alloys in comparison to bone. Mismatch between the mechanical properties of bone and orthopaedic materials

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“…The level of detail provided of surface finishing process varied greatly through the literature. Surface finish affects biofilm formation and cell attachment [95], and can also promote osseointegration of implants [96].…”

Section: Surface Finishmentioning

confidence: 99%

Reporting fidelity in the literature for computer aided design and additive manufacture of implants and guides

Burton

Peel

Eggbeer

2018

Additive Manufacturing

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The aim of this study was to critically evaluate the nature and reporting fidelity of literature about applications of computer aided design (CAD) and metal additive manufacture (AM) to surgical guides and implants. Increasingly, non-specialist designers such as surgeons or prosthetists are partaking in some or all of the design process. To comply with local regulations, it is imperative that quality is ensured during the design process, yet it is rare for literature to report on the design process of medical devices with sufficient detail to allow proper evaluation or reproduction. This study reviewed the CAD/AM literature for implant and guide design, focussing on detailed justifications for design decisions, economic impacts, and production methods. This review showed that the fidelity of reporting in the literature was low; with opportunities to report crucial design decisions, engineering parameters, and how these relate to clinical results being frequently missed. This research proposes the low fidelity in reporting is likely due to a combination of: reporting for different specialisms, resulting in a lack of expert knowledge in certain areas and assumed knowledge in others; commercial sensitivity of design and manufacturing methods; low volume of clinical cases; and a large gap in translating research to clinical applications. This study concluded that higher fidelity in reporting methods are required when discussing the design of AM medical implants, which would allow comparisons between studies, provide evidence to support design quality, and enable evidence-based decision-making.

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Surface Finish has a Critical Influence on Biofilm Formation and Mammalian Cell Attachment to Additively Manufactured Prosthetics

Cited by 44 publications

References 47 publications

Additive Manufacturing of Titanium Alloys for Orthopedic Applications: A Materials Science Viewpoint

Additive Manufacturing of Titanium Alloys for Orthopedic Applications: A Materials Science Viewpoint

Clinical, industrial, and research perspectives on powder bed fusion additively manufactured metal implants

Reporting fidelity in the literature for computer aided design and additive manufacture of implants and guides

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