Bone cement implantation syndrome during hip replacement in a patient with pemphigus and Parkinson’s disease: A case report

BACKGROUND Bone cement implantation syndrome(BCIS)is characterized by hypotension,arrhythmia,diffuse pulmonary microvascular embolism,shock,cardiac arrest,any combination of these factors,or even death following bone cement implantation.CASE SUMMARY An 80-year-old patient with pemphigus and Parkinson’s disease underwent total hip replacement under spinal subarachnoid block and developed acute pulmonary embolism after bone cement implantation.The patient received mask mechanical ventilation with a continuous intravenous infusion of adrenaline(2μg/mL)at a rate of 30 mL/h.Subsequently,the symptoms of BCIS were markedly alleviated,and the infusion rate of adrenaline was gradually reduced until the infusion was completely stopped 45 min later.The patient was then transferred to the Department of Orthopedics,and anticoagulation therapy began at 12 h postoperatively.No other complications were observed.CONCLUSION This is a rare case of BCIS in a high-risk patient with pemphigus and Parkinson’s disease.

Successful Resuscitation of Bone Cement Implantation Syndrome in a Patient with Pre-Existing Pulmonary Hypertension: A Case Report

Background: In patients with pre-existing pulmonary hypertension undergoing surgery, there is an inherent risk of decompensation and right ventricular failure. Cemented hemi-arthroplasty in patients with pre-existing pulmonary hypertension predisposes them even more to morbidity and mortality from bone cement implantation syndrome (BCIS) with worsening of pulmonary hypertension. This risk should be recognized and steps taken for increased awareness, risk counselling and minimization of adverse effects. Case: We report a case of successful resuscitation of a patient with pre-existing pulmonary hypertension who developed 2 episodes of cardiac arrests—Grade 3 BCIS, shortly after cement implantation. Learning Points: Patients with pre-existing pulmonary hypertension for cemented hemi-arthroplasty are at additional risks and should be identified. Adequate risk counselling needs to be undertaken prior to surgery. A multi-disciplinary team effort is required. Discussion should be undertaken with the orthopaedic surgeon about the risks and benefits of using cemented implants. The anaesthetist needs to be vigilant for signs of BCIS, especially at the time of cement implantation and institute immediate resuscitation. Supportive treatment is the mainstay of management.

Design multifunctional Mg–Zr coatings regulating Mg alloy bioabsorption

Magnesium(Mg)alloys are widely used for temporary bone implants due to their favorable biodegradability,cytocompatibility,hemocompatibility,and close mechanical properties to bone.However,rapid degradation and inadequate strength limit their applicability.To overcome this,the direct current magnetron sputtering technique is employed for surface coating in Mg-based alloys using various zirconium(Zr)content.This approach presents a promising strategy for simultaneously improving corrosion resistance,maintaining biocompatibility,and enhancing strength without compromising osseointegration.By leveraging Mg’s inherent biodegradability,it has the potential to minimize the need for secondary surgeries,thereby reducing costs and resources.This paper is a systematic study aimed at understanding the corrosion mechanisms of Mg–Zr coatings,denoted Mg-xZr(x=0–5 at.%).Zr-doped coatings exhibited columnar growth leading to denser and refined structures with increasing Zr content.XRD analysis confirmed the presence of the Mg(00.2)basal plane,shifting towards higher angles(1.15°)with 5 at.%Zr doping due to lattice parameter changes(i.e.,decrease and increase of“c”and“a”lattice parameters,respectively).Mg–Zr coatings exhibited“liquidphilic”behavior,while Young’s modulus retained a steady value around 80 GPa across all samples.However,the hardness has significantly improved across all samples’coating,reaching the highest value of(2.2±0.3)GPa for 5 at.%Zr.Electrochemical testing in simulated body fluid(SBF)at 37℃ revealed a significant enhancement in corrosion resistance for Mg–Zr coatings containing 1.0–3.4 at.%Zr.Compared with the 5 at.%Zr coating which exhibited a corrosion rate of 32 mm/year,these coatings displayed lower corrosion rates,ranging from 1 to 12 mm/year.This synergistic enhancement in mechanical properties and corrosion resistance,achieved with 2.0–3.4 at.%Zr,suggests potential ability for reducing stress shielding and controlled degradation performance,and consequently,promising functional biodegradable materials for temporary bone implants.

Study on Z-H/BMP Toughened Compound Artificial Bone and Its Osteogenesis

The purpose of this study was to find a kind of new artificial bone for anterior spinal fusion.ZrO 2 stabilized by Y 2O 3(Y-PSZ),porous hydroxyapatite(HA) and bone morphogenetic protein (BMP) were used to make artificial compound bone (Y 2O 3) ZrO 2-HA/BMP(Z-H/BMP),whose function was tested,microstructure and mineralogic composition constitution were analysised by SEM and XRD,and the corresponding animal tests were porformed.Osteogenesis of the material was observed by eyes,histology and SEM.Experimental results show that the component and ossific activity of Z-H/BMP were satisfactory.

3D printing of PEEK–cHAp scaffold formedical bone implant

The major drawback associated with PEEK implants is their biologically inert surface,which caused unsatisfactory cellular response and poor adhesion between the implants and surrounding soft tissues against proper bone growth.In this study,polyetheretherketone(PEEK)was incorporated with calcium hydroxyapatite(cHAp)to fabricate a PEEK-cHAp biocomposite,using the fused deposition modeling(FDM)method and a surface treatment strategy to create microporous architectures onto the filaments of PEEK lattice scaffold.Also,nanostructure and morphological tests of the PEEK-cHAp biocomposite were modeled and analyzed on the FDM-printed PEEK-cHAp biocomposite sample to evaluate its mechanical and thermal strengths as well as in vitro cytotoxicity via a scanning electron microscope(SEM).A technique was used innovatively to create and investigate the porous nanostructure of the PEEK with controlled pore size and distribution to promote cell penetration and biological integration of the PEEK-cHAp into the tissue.In vivo tests demonstrated that the surface-treated micropores facilitated the adhesion of newly regenerated soft tissues to form tight implant-tissue interfacial bonding between the cHAp and PEEK.The results of the cell culture depicted that PEEK-cHAp exhibited better cell proliferation attachment spreading and higher alkaline phosphatase activity than PEEK alone.Apatite islands formed on the PEEK-cHAp composite after immersion in simulated body fluid of Dulbecco’s modified Eagle medium(DMEM)for 14 days and grew continuously with more or extended periods.The microstructure treatment of the crystallinity of PEEK was comparatively and significantly different from the PEEK-cHAp sample,indicating a better treatment of PEEK-cHAp.The in vitro results obtained from the PEEK-cHAp biocomposite material showed its biodegradability and performance suitability for bone implants.This study has potential applications in the field of biomedical engineering to strengthen the conceptual knowledge of FDM and medical implants fabricated from PEEK-cHAp biocomposite materials.

Advances in biocermets for bone implant applications

As two promising biomaterials for bone implants,biomedical metals have favorable mechanical properties and good machinability but lack of bioactivity;while bioceramics are known for good biocompatibility or even bioactivity but limited by their high brittleness.Biocermets,a kind of composites composing of bioceramics and biomedical metals,have been developed as an effective solution by combining their complementary advantages.This paper focused on the recently studied biocermets for bone implant applications.Concretely,biocermets were divided into ceramic-based biocermets and metal-based biocermets according to the phase percentages.Their characteristics were systematically summarized,and the fabrication methods for biocermets were reviewed and compared.Emphases were put on the interactions between bioceramics and biomedical metals,as well as the performance improvement mechanisms.More importantly,the main methods for the interfacial reinforcing were summarized,and the corresponding interfacial reinforcing mechanisms were discussed.In addition,the in vitro and in vivo biological performances of biocermets were also reviewed.Finally,future research directions were proposed on the advancement in component design,interfacial reinforcing and forming mechanisms for the fabrication of high-performance biocermets.

Anterior Lumbar Intervertebral Fusion with Artificial Bone in Place of Autologous Bone

The feasibility of anterior lumbar intervertebral fusion with artificial bone in place of autogenous bone was investigated Porous hydroxyapatite(HA)/ZrO 2 ceramics loading bone morphogenetic protein (BMP) were implanted after removal of lumbar vertebral disc in rabbits The adjacent intervertebral discs were also removed by the same way and autogenous illic bone was implanted SEM observation and biomechanical test were carried out Compound bone had a bit lower osteoinductive activity than autogenous bone by SEM(Osteoindutive activity of artificial bone in 12 weeks was the same as that of autogenous bone in 9 weeks) Biomechanical test revealed that compound bone had lower anti-pull strength than autogenous bone ( P< 0 001), but there was no significant difference in anti-pull strength between compound bone at 12th week and autogenous bone at 9th week (P>0 05) It was concluded that compound bone could be applied for anterior spinal fusion, especially for those patients who can't use autogenous bone

Mechanical Experiment for 3D Printing of Titanium Bone Bionic Dental Implants

[Objectives] To explore the flexural strength of 3D printed titanium bone bionic dental implants and provide a scientific basis for the clinical application of 3D printed porous bionic bone dental implants. [Methods] The cone-beam CT( CBCT) image information of 20 premolars extracted by orthodontic requirement was collected,and a new porous bone bionic dental implant was produced using modeling software and 3D printer. The premolars were divided into two groups( A and B). The universal testing machine was used to test the flexural strength of the two groups and the difference in flexural strength between the two groups was compared through statistics. [Results]Twenty 3D printed porous titanium bone bionic implants were accurately produced; the morphology of group A and group B were extremely similar to each other; the average flexural strength of group A was 2 767. 92 N,while the average flexural strength of group B was 778. 77 N,showing that the average flexural strength of group A was significantly higher than that of group B,and the difference was statistically significant( P < 0. 05).[Conclusions]The personalized porous structure root implants produced by 3D printing technology are very similar to the target tooth morphology,and show high accuracy and small error of production. Besides,the flexural strength of 3D printed personalized porous structure root implants can fully meet the requirements of the maximum occlusal force for dental implant restoration. It is expected to provide a scientific basis for clinical application of 3 D printed porous bionic bone tooth implants.

The Tissue Reactions and Changes of a Surface of Various Metal Implants after Their Introduction in a Bone Tissue in Experiment

Screw metal implants (3S, Israel) with rough or smooth polished surface were introduced in a tibial proximal condyle of not purebred rabbits. The condition of surrounding tissues in 2 and 6 months after implantation was compared by light microscopy and X-ray methods. Within 6 months after operation the considerable distinctions of radiological and morphological data were revealed not. 2 months later after introduction of implants with a rough surface the effort enclosed for its twisting is, much more, than for removal of the polished product. However, stability of fixing of implants was practically made even at 6 months. On remote rough implants there is a set of tissue scraps whereas on products with a smooth surface the tissue remains were much less. Surrounding tissues strongly join a rough surface, grow into cavities, and during removal of such products there is a considerable trauma of tissues round an implantation place. Smooth implants have the smaller area of contact with organism tissues, they are fixed due to bicortical implantation, during removal easily get out and don’t break off surrounding tissues. The signs of inflammation and formation of merged multinuclear macrophages were not found at all cases, which give evidence to the inertness of material of the mentioned articles for living organism. In some observations however and by implantation of the rough article and by introduction of polished implants, metal particles were found, but after use of the foreign body with grit-blasted treatment of surface metal was found more frequently, and its fragments had larger volume.

Effect of the implant composite of poly lactide-co-glycolide and bone mesenchymal stem cells modified by basic fibroblast growth factor on injured spinal cord in rats

Objective To investigate the effect of the implant composite of poly lactide-co-glycolide(PLGA)and bone mesenchymal stem cells (BMSCs) modified by basic fibroblast growth factor (bFGF) on injured spinal cord in rats.Methods Two hundred and

多孔髓芯减压支撑植骨并关节囊开窗治疗早期股骨头缺血性坏死的疗效观察

目的:探讨多孔髓芯减压支撑植骨并关节囊开窗治疗早期股骨头缺血性坏死的疗效。方法:收治股骨头坏死患者148例(160髋),分为两组,对照组(80髋)为单纯髓芯减压组;试验组(80髋)为多孔髓芯减压支撑植骨并关节囊开窗组,临床采用Harris评分系统评估,并分期X线MRI检查。结果:经平均18个月随访,两组末次随访时髋关节Harris评分均高于术前,多孔髓芯减压支撑植骨并关节囊开窗组Harris评分高于单纯减压组(P<0.01)。结论:多孔髓芯减压支撑植骨并关节囊开窗可有效进行骨内及关节内减压,改善内环境,减轻疼痛,阻止病情发展或延缓病情发展,该方法简单有效,花费低,适合早期股骨头缺血性坏死的患者,优于单纯髓芯减压治疗。

Development of open-porosity magnesium foam produced by investment casting

High-porosity,open-cell AZ91 magnesium alloy foams of two pore sizes were fabricated by means of investment casting technology,using PUR foam patterns.Foam casting variables such as pressure,mould temperature and metal pouring temperature were thoroughly investigated to define the most optimal casting conditions.The mechanical properties of the fabricated foams were measured in compression tests.A potential application for the foams considered is temporary bioresorbable bone implants,therefore the mechanical properties of the foams were compared with those of cancellous bone tissue.Foams with smaller pore size and lower porosity(20 PPI and 80%±87%)exhibited mechanical properties in the lower regions of the cancellous bone property range(Young’s modulus 36.5±77.5 MPa),while foams with higher pore size and porosity(10 PPI and~90%)were found to have insufficient compression strength(Young’s modulus 11.65±23.8),but thickening their walls and lowering their porosity below 90%yielded foams with Young’s modulus between 36.5 and 77.5 MPa.Foam fractures were also investigated to determine their collapse mechanism.A series of corrosion tests in stimulated body fluid was carried out to determine their applicability as a biomaterial.The Plasma Electrolytic Oxidation(PEO)process was used in a feasibility study to examine the microstructure and chemical composition of foams with protective coating.

Degradation of 3D-printed magnesium phosphate ceramics in vitro and a prognosis on their bone regeneration potential

Regenerative bone implants promote new bone formation and ideally degrade simultaneously to osteogenesis.Although clinically established calcium phosphate bone grafts provide excellent osseointegration and osteoconductive efficacy,they are limited in terms of bioresorption.Magnesium phosphate(MP)based ceramics are a promising alternative,because they are biocompatible,mechanically extremely stable,and degrade much faster than calcium phosphates under physiological conditions.Bioresorption of an implant material can include both chemical dissolution as well as cellular resorption.We investigated the bioresorption of 3D powder printed struvite and newberyite based MP ceramics in vitro by a direct human osteoclast culture approach.The osteoclast response and cellular resorption was evaluated by means of fluorescence and TRAP staining,determination of osteoclast activities(CA II and TRAP),SEM imaging as well as by quantification of the ion release during cell culture.Furthermore,the bioactivity of the materials was investigated via SBF immersion,whereas hydroxyapatite precipitates were analyzed by SEM and EDX measurements.This bioactive coating was resorbed by osteoclasts.In contrast,only chemical dissolution contributed to bioresorption of MP,while no cellular resorption of the materials was observed.Based on our results,we expect an increased bone regeneration effect of MP compared to calcium phosphate based bone grafts and complete chemical degradation within a maximum of 1.5-3.1 years.

Additive manufacturing of multi-morphology graded titanium scaffolds for bone implant applications

Porous Titanium scaffolds have attracted widespread attention as bone implants for avoiding the stress shielding effect and promoting bone-in-growth.In this study,multi-morphology graded scaffolds hy-bridized by Primitive and Gyroid structures with porosity of 50,60,and 70%were designed(denoted as PG50,PG60,and PG70,respectively)and fabricated by selective laser melting.The simulation results showed that the maximum von-Mises stress of hybridized scaffolds increased from 504.22 to 884.24 MPa with porosity.The permeability and average pore size of multi-morphology PG50,PG60,and PG70 were in the range of 3.58×10^(-9)-5.50×10^(-9) m^(2) and 568.1-758.4μm,respectively.The microstructure of multi-morphology graded scaffolds consisted of a fully martensiticα′phase.Tested permeabilities of PG50 and PG60 were 3.27×10^(-9) and 4.35×10^(-9) m^(2),respectively,which were within the range of human bone(0.01-12.1×10^(-9) m^(2)).Elastic modulus and compressive yield strength of PG50 and PG60 ranged within 5.93^(-9).86 and 180.06-257.08 MPa,respectively.Therein,the PG50 not only exhibited a similar elastic modulus compared to human cortical bone(10.1 GPa)but also had higher strength(257.08 vs 131 MPa).The results of in vitro biocompatibility assay showed that PG50 and PG60 have better cyto-compatibility than mono-morphology scaffolds with the same porosity.Taken together,PG50 is promising to be used for the restoration of bone defects due to its excellent mechanical properties,appropriate per-meability,and good cytocompatibility.

Corrosion and biocompatibility improvement of magnesium-based alloys as bone implant materials:a review

Magnesium(Mg)or its alloys are widely tested as potential orthopedic implants,particularly as biodegradable alloys for fracture fixation due to their mechanical properties are close to those of bone.Currently,available Mg or its alloys are confronted with challenges in passing regulatory biosafety tests prior to clinical trials due to its fast degradation and associated degradation products.The degradation of Mg is accompanied by the release of Mg ions,the rise of pH and osmolality in surrounding environments.According to the standard of ISO 10993 Part 13,the pH value shall be appropriate to the site of intended use maintaining in an appropriate range.Approaches to overcome these challenges include the selection of adequate alloying elements,proper surface treatment techniques and control of the degradation rate of Mg or its alloys developed as orthopedic implants.To date,Mg or its alloy-based bone implants have not yet been widely used in clinical applications as medical implants.This review critically summarized published methods to improve the corrosion resistance of Mg and its alloys.The current progress on in vitro cytotoxicity and in vivo biocompatibility properties of these metals was also reviewed.This review aimed to provide a reference for further research and development(R&D)of biodegradable Mg and its alloys with regard to the evaluation of their corrosion process and biocompatibility and facilitation of their translation to clinical applications.

Bone remodeling effect of a chitosan and calcium phosphate-based composite

Chitosan is a biocompatible polymer that has been widely studied for tissue engineering purposes.The aim of this research was to assess bone regenerative properties of an injectable chitosan and calcium phosphate-based composite and identify optimal degree of deacetylation(%DDA)of the chitosan polymer.Drill holes were generated on the left side of a mandible in Sprague-Dawley rats,and the hole was either left empty or filled with the implant.The animals were sacrificed at several time points after surgery(7–22 days)and bone was investigated using micro-CT and histology.No significant new bone formation was observed in the implants themselves at any time points.However,substantial new bone formation was observed in the rat mandible further away from the drill hole.Morphological changes indicating bone formation were found in specimens explanted on Day 7 in animals that received implant.Similar bone formation pattern was seen in control animals with an empty drill hole at later time points but not to the same extent.A second experiment was performed to examine if the%DDA of the chitosan polymer influenced the bone remodeling response.The results suggest that chitosan polymers with%DDA between 50 and 70%enhance the natural bone remodeling mechanism.

Porous silicon carbide coated with tantalum as potential material for bone implants

Porous silicon carbide(SiC)has a specific biomorphous microstructure similar to the trabecular microstructure of human bone.Compared with that of bioactive ceramics,such as calcium phosphate,SiC does not induce spontaneous interface bonding to living bone.In this study,bioactive tantalum(Ta)metal deposited on porous SiC scaffolds by chemical vapour deposition was investigated to accelerate osseointegration and improve the bonding to bones.Scanning electron microscopy indicated that the Ta coating evenly covered the entire scaffold structure.Energy-dispersive spectroscopy and X-ray diffraction analysis showed that the coating consisted of Ta phases.The bonding strength between the Ta coating and the SiC substrate is 88.4MPa.The yield strength of porous SiC with a Ta coating(pTa)was 45.862.9MPa,the compressive strength was 61.463.2MPa and the elasticmodulus was4.8GPa.When MG-63 human osteoblasts were co-cultured with pTa,osteoblasts showed good adhesion and spreading on the surface of the pTa and its porous structure,which showed that it has excellent bioactivity and cyto-compatibility.To further study the osseointegration properties of pTa.PTa and porous titanium(pTi)were implanted into the femoral neck of goats for 12weeks,respectively.The Van-Gieson staining of histological sections results that the pTa group had better osseointegration than the pTi group.These results indicate that coating bioactive Ta metal on porous SiC scaffolds could be a potential material for bone substitutes.

Improving the fretting biocorrosion of Ti6Al4V alloy bone screw by decorating structure optimised TiO2 nanotubes layer

TiO2 nanotubes(NT)has been demonstrated its potential in orthopaedic applications due to its enhanced surface wettability and bio-osteointegration.However,the fretting biocorrosion is the main concern that limited its successfully application in orthopaedic application.In this study,a structure optimised thin TiO2 nanotube(SONT)layer was successfully created on Ti6Al4V bone screw,and its fretting corrosion performance was investigated and compared to the pristine Ti6Al4V bone screws and NT decorated screw in a bone-screw fretting simulation rig.The results have shown that the debonding TiO2 nanotube from the bone screw reduced significantly,as a result of structure optimisation.The SONT layer also exhibited enhanced bio-corrosion resistance compared pristine bone screw and conventionally NT modified bone screw.It is postulated that interfacial layer between TiO2 nanotube and Ti6Al4V substrate,generated during structure optimisation process,enhanced bonding of TiO2 nanotube layer to the Ti6Al4V bone screws that leading to the improvement in fretting corrosion resistance.The results highlighted the potential SONT in orthopaedic application as bone fracture fixation devices.

Investigation of bioactivity and biodegradability of Mg-bioceramic implants:An in vitro study for biomedical applications

In this study,Mg-based composites,by the addition of ZnO,Ca_(2)ZnSi_(2)O_(7),Ca_(2)MgSi_(2)O_(7),and CaSiO_(3)as bioactive agents,were fabricated using friction stir processing.The microstructure and in vitro assessment of bioactivity,biodegradation rate,and corrosion behavior of the resultant composites were investigated in simulated body fluid(SBF).The results showed that during the immersion of composites in SBF for 28 d,due to the release of Ca^(2+)and PO_(4)^(3-)ions,hydroxyapatite(HA)crystals with cauliflower shaped morphology were deposited on the surface of composites,confirming good bioactivity of composites.In addition,due to the uniform distribution of bioceramic powders throughout Mg matrix,grain refinement of the Mg matrix,and uniform redistribution of secondary phase particles,the polarization resistance increased,and the biodegradation rate of composites significantly reduced compared to monolithic Mg matrix.The polarization corrosion resistance of Mg-ZnO increased from 0.216 to 2.499 kΩ/cm^(2)compared to monolithic Mg alloy.Additionally,Mg-ZnO composite with the weight loss of 0.0217 g after 28 d immersion showed lower weight loss compared to other samples with increasing immersion time.Moreover,Mg-ZnO composite with the biodegradation rate of 37.71 mm/a exhibited lower biodegradation rate compared to other samples with increasing immersion time.

Preparation of Chitin-PLA laminated composite for implantable application

The present study explores the possibilities of using locally available inexpensive waste prawn shell derived chitin reinforced and bioabsorbable polylactic acid(PLA)laminated composites to develop new materials with excellent mechanical and thermal properties for implantable application such as in bone or dental implant.Chitin at different concentration(1e20%of PLA)reinforced PLA films(CTP)were fabricated by solvent casting process and laminated chitin-PLA composites(LCTP)were prepared by laminating PLA film(obtained by hot press method)with CTP also by hot press method at 160
C.The effect of variation of chitin concentration on the resulting laminated composite's behavior was investigated.The detailed physico-mechanical,surface morphology and thermal were assessed with different characterization technique such as FT-IR,XRD,SEM and TGA.The FTIR spectra showed the characteristic peaks for chitin and PLA in the composites.SEM images showed an excellent dispersion of chitin in the films and composites.Thermogravimetric analysis(TGA)showed that the complete degradation of chitin,PLA film,5%chitin reinforced PLA film(CTP2)and LCTP are 98%,95%,87%and 98%respectively at temperature of 500
C.The tensile strength of the LCTP was found 25.09 MPa which is significantly higher than pure PLA film(18.55 MPa)and CTP2 film(8.83 MPa).After lamination of pure PLA and CTP2 film,the composite(LCTP)yielded 0.265e1.061%water absorption from 30 min to 24 h immerse in water that is much lower than PLA and CTP.The increased mechanical properties of the laminated films with the increase of chitin content indicated good dispersion of chitin into PLA and strong interfacial actions between the polymer and chitin.The improvement of mechanical properties and the results of antimicrobial and cytotoxicity of the composites also evaluated and revealed the composite would be a suitable candidate for implant application in biomedical sector.