Biomedical & Functional

Materials
•Marking Scheme will be based on:
– Portfolio
– Quizzes, tests
– Assignment Sessions
– Projects & Practical work
•Books
– Biomaterials Principles and Applications,
Joon B. Park, Joseph D. Bronzino
– Biomaterials Science: An Introduction to
Materials in Medicine, Buddy D. Ratner
– Biomaterials, Sujata V. Bhat
 An Introduction to the course
• Functional Materials
– Material which is not primarily used for its mechanical
properties but for other properties such as physical or
chemical.
• Biomedical Materials
– is a nonviable material used in a medical device, intended
to interact with biological systems (Williams, 1987)
– Biomaterials are rarely used on their own but are more
commonly integrated into devices or implants. Thus, the
subject cannot be explored without also considering
biomedical devices and the biological response to them.
 Some Important Definitions
• Biomaterials:
– Any substance, other than a drug, or a combination of
substances, synthetic or natural in origin which can be
used for any period of time, as a whole or part of a system
which treats, augments or replaces any tissue, organ or
function of the body.
– A biomaterial is a nonviable material used in a medical
device, intended to interact with biological systems
(Williams, 1987)
If the word “nonviable” is removed, the definition
becomes even more general and can address new tissue
engineering and hybrid artificial organ applications where
living cells are used.
Consensus:
A nonviable material used in a medical device, intended to
interact with biological systems.
 Some Important Definitions
• Medical Device:
– An instrument, apparatus, implement, machine,
contrivance, in vitro reagent, or other similar or related
article which intended for use in the diagnosis , cure,
mitigation or treatment of disease or other conditions
– It does not depend on being metabolized or being part of a
chemical action within or on the body
• Implant
– Any medical device made from one or more biomaterials
that is intentionally placed within the body, either totally
or partially buried beneath an surface
– it is usually intended to remain there for a significant
period of time
 CHARACTERISTICS OF BIOMATERIALS
AS A FIELD
• It’s Multidisciplinary
– Some disciplines that intersect in the development, study and
application of biomaterials include: bioengineer, chemist,
chemical engineer, electrical engineer, mechanical engineer,
materials scientist, biologist, microbiologist, physician,
veterinarian, ethicist, nurse, lawyer, regulatory specialist and
venture capitalist.
• It Uses Many Diverse Materials
– Many different synthetic and modified natural materials are
used in biomaterials and some understanding of the differing
properties of these materials is important.
• A hip joint might be fabricated from metals and polymers (and
sometimes ceramics) and will be interfaced to the body via a
polymeric bone cement – 3 different types of materials
• The End product is the Development of Devices
 Functional Materials
• Definition:
– Material which is not primarily used for its mechanical
properties but for other properties such as physical or
chemical.

• Examples:
– Superconductors
• An element, intermetallic, compound that will conduct electricity
without any resistance below a certain temperature
• Magnetic levitation, maglev, or magnetic suspension is a method
by which an object is suspended with no support other than
magnetic fields
• http://www.superconductors.org/INdex.htm

– Dielectric Material
• electrically insulating material
• contains polar molecules that reorient in external electric field
• Used as insulating material between the plates of a capacitator
Functional Materials - Examples
– Ferromagnetic Materials
• The ability to become highly magnetic and
have the ability to retain a permanent
magnetic moment

– Future Applications:
• The Mercedes-Benz SilverFlow makes use of
metallic particles and a special liquid that can be
arranged via magnetic fields in different forms,
thus creating a different vehicle depending on
the user's requirements
• Any damage can be self repaired and a variety of
color/configuration/size are possible
 Assignment #1
Q1) Explain & Compare the following:
– Piezoelectric Materials
– Feroelectric Materials
– Pyroelectric Materials

Q2) Explain the working principles of the ‘Invisibility Cloak’

and the research so far made in this field
– Due Date: 25th Jan 2010
 Biomedical Materials
• Biomedical Materials
– is a nonviable material used in a medical device, intended to interact
with biological systems (Williams, 1987)

– By contrast, a biological material is a material such as skin

or artery, produced by a biological system.

– Artificial materials that simply are in contact with the

skin, such as hearing aids and wearable artificial limbs,
are not included in our definition of biomaterials since
the skin acts as abarrier with the external world.
A Little History on Biomaterials
• Romans, Chinese, and Aztecs used gold in
dentistry over 2000 years ago, Cu not good.
– Copper ion poisoning
• Aseptic surgery 1860 (Lister)
• Bone plates 1900, joints 1930
• Turn of the century, synthetic plastics came into
use
– WWII, shards of PMMA [poly(methyl methacrylate), aka
Lucite or Plexiglass] unintentionally got lodged into eyes
of aviators, led to its use in lenses
– Parachute cloth used for vascular prosthesis
• 1960- Polyethylene and stainless steel being used
for hip implants
 First Generation Implants
• “ad hoc” implants
• specified by physicians using common and
borrowed materials
• most successes were accidental rather than by
design
• Examples
– gold fillings, wooden teeth, PMMA dental prosthesis
– steel, gold, ivory, etc., bone plates
– eyes and other body parts
– dacron and parachute cloth vascular implants
 Dental Applications - Gold
• Because of its bio-compatibility, malleability and
resistance to corrosion, gold has been used in dental
work for nearly three thousand years. The Etruscans
in the seventh century BC used gold wire to hold in
place substitute teeth, usually from a cow or calf,
when their own were knocked out. The first printed
book on dentistry published in 1530 recommends
gold leaf for filling cavities.
 Intraocular Lens
3 basic materials - PMMA, acrylic, silicone
•An intraocular lens (IOL) is an implanted lens in the eye, usually replacing the
existing crystalline lens because it has been clouded over by a cataract, or as a
form of refractive surgery to change the eye's optical power.
•Advances in technology have brought about the use of silicone and acrylic, both
of which are soft foldable inert materials. This allows the lens to be folded and
inserted into the eye through a smaller incision
•Acrylic is not always an ideal choice due to its added expense
•For a gruesome yet painless eye procedure:
http://www.youtube.com/watch?v=kN-KqYcjEqk
 Material for Intraocular Lens
• Silicones are polymers that include silicon together with carbon,
hydrogen, oxygen and sometimes other chemical elements
• silicones are mixed inorganic-organic polymers with the chemical formula
[R2SiO]n, where R is an organic group such as methyl, ethyl, or phenyl
• consist of an inorganic silicon-oxygen backbone (…-Si-O-Si-O-Si-O-…) with
organic side groups attached to the silicon atoms
• They are largely inert, man-made compounds with a wide variety of forms
and uses:
– Typically heat-resistant, nonstick, and rubber-like, they are commonly
used in cookware, medical applications, sealants, adhesives,
lubricants, insulation
• Poly(methyl methacrylate) (PMMA) is a transparent thermoplastic. It is
sold under many trade names, including Policril, Plexiglass, Gavrieli.
• Acrylic, or acrylic fiber refers to polymers or copolymers containing
polyacrylonitrile.
 Vascular Implants

Parachute cloth and Dacron

 Second generation implants
• engineered implants using common and borrowed materials
developed through collaborations of physicians and engineers
• built on first generation experiences
• used advances in materials science

Examples — Second generation

implants
• titanium alloy dental and orthopaedic implants
• cobalt-chromium-molybdinum orthopaedic implants
• UHMW polyethylene bearing surfaces for total joint
replacements
• heart valves and pacemakers
 Artificial Hip Joints

http://www.totaljoints.info/Hip.jpg
 Third generation implants
• bioengineered implants using bioengineered materials
• few examples on the market
• some modified and new polymeric devices
• many under development
Example - Third generation implants
•tissue engineered implants designed to re grow rather than replace
•artificial skin
•cartilage cell procedure
•uses your own cartilage cells (chondrocytes) to repair the
articular cartilage damage in your knee. When implanted into a
cartilage injury, your own cells can form new cartilage
•some resorbable bone repair cements
•calcium-phosphate bone cements
•genetically engineered “biological” components
Substitute Heart Valves
SEM displaying the cross section of a composite disk, which
had been seeded with cultured bone marrow stromal cells.
 Synthetic polymer scaffolds

... in the shape of a nose (left) is "seeded" with cells called

chondrocytes that replace the polymer with cartilage over time
(right) to make a suitable implant.
 Evolution of Biomaterials

Structural

Soft Tissue
Replacements

Functional Tissue
Engineering Constructs
 Assignment #2
Q) Define and differentiate between the
following terminologies:
Biocompatibility
Host reaction
Bioinert
Bioactive
 Metallic Biomaterials
• Metals make attractive • Applications in the human
biomaterials because body:
of they possess the – as total hip and knee joints,
following properties: for fracture healing aids as
– excellent electrical bone plates and screws,
spinal fixation devices, and
– mechanical properties
dental implants
– closely packed atomic
arrangement resulting – in devices such as vascular
in high specific gravity stents, catheter guide wires,
and good strength orthodontic archwires, and
cochlear implants
– high melting points
 Metallic Implants
Two primary purposes
• As prosthesis – to replace a portion of the body such as:
– joints, long bones & skull plates
• Fixation Devices – to stabilize broken bones while the normal
healing proceeds
– Bone plates, intramedullary nails, screws and sutures
Problems:
1. Biocompatibility: The ability of a material to perform with an
appropriate host response in a specific situation
2. Corrosion
3. Design of metallic implants
4. Design limitations the of anatomy
5. Physics properties of the tissue and reactions of the tissue to the
implant and of the implant to the tissues (Host Response)
 Different Metallic Biomaterials
• Stainless Steel • TiNi Alloys
– SS 316 – Nitinol
– SS 316L – Shape Memory effect
• CoCr Alloys • Platinum group metals
– the castable CoCrMo
alloy (PGM)
– The CoNiCrMo alloy – Pt, Pd, Rh, Ir, Ru, and Os
which is usually wrought – extremely corrosion
by (hot) forging resistant
• Ti alloys – poor mechanical
– Pure Ti properties
– Ti6Al4V – pacemaker tips
• conductivity.
 Development of SS for use in human
body
• The first metal alloy developed specifically for human use was the
“vanadium steel” which was used to manufacture bone fracture
plates and screws.
• Vanadium steel is no longer used in implants since its corrosion
resistance is inadequate in vivo
• The first stainless steel utilized for implant fabrication was the 18-8
(type 302 in modern classification), which is stronger and more
resistant to corrosion than the vanadium steel.
• Later 18-8sMo stainless steel was introduced which contains a small
percentage of molybdenum to improve the corrosion resistance in
chloride solution (salt water). This alloy became known as type 316
stainless steel
• In the 1950s the carbon content of 316 stainless steel was reduced
from 0.08 to a maximum amount of 0.03% (weight percent), and
hence became known as type 316L stainless steel
Advantage of SS 316 & 316L over other
grades of Steel
• Biocompatible
• These austenitic stainless steels cannot be
hardened by HT but can be hardened by cold
working
• possesses better corrosion resistance than any
other steels
• The inclusion of molybdenum enhances
resistance to pitting corrosion in salt water
 The 316L Stainless Steel
• (ASTM) recommends type
316L rather than 316 for
implant fabrication.
• The only difference in
composition between the
316L and 316 SS is the
maximum content of
carbon, i.e., 0.03% and
0.08%, respectively.
• So what makes 316L
special?????
Mechanical Properties & Corrosion
Resistance of 316L
 Assignment #3
Q) Why is Stainless Steel chosen instead of other
grades of Steel for use as a biomaterial? And
among Stainless Steel why is 316 L considered to
be the most suitable biomaterial? Justify your
answers with all possible reasons.
Q) Read Chapter #3 of Biomaterials by Sujata Bhat
and read chapter 1 of Biomaterials principles and
Applications by Joon B. Park
Q) What is sensitization of Steel. How can it be
restricted?
 Mechanical Properties & Corrosion
Resistance of 316L
• Even the 316L stainless steels may corrode inside the
body under certain circumstances in a highly stressed and
oxygen depleted region, such as the contacts under the
screws of the bone fracture plate. Thus, these stainless
steels are suitable for use only in Temporary implant
devices such as fracture plates, screws, and hip nails.
• Surface modification methods are widely used in order to
improve corrosion resistance, wear resistance, and fatigue
strength of 316L stainless steel
– anodization, passivation
– glow-discharge nitrogen implantation
 Deficiency Factors Responsible for
failure of SS implants
• Deficiency of Mo
• Use of sensitized steel
• Inadvertent use of mixed metals and
incompatible components
• Topography and metallurgical finish
• Improper implant and implant material
selection
 Assignment #2
Q) Define and differentiate between the
following terminologies:
Biocompatibility
Host reaction
Bioinert
Bioactive
 Metallic Biomaterials
• Metals make attractive • Applications in the human
biomaterials because of body:
they possess the – as total hip and knee joints,
following properties: for fracture healing aids as
bone plates and screws,
– excellent electrical
spinal fixation devices, and
– mechanical properties dental implants
– closely packed atomic – in devices such as vascular
arrangement resulting in stents, catheter guide wires,
high specific gravity and orthodontic archwires, and
good strength cochlear implants
– high melting points
 Metallic Implants
Two primary purposes
• As prosthesis – to replace a portion of the body such as:
– joints, long bones & skull plates
• Fixation Devices – to stabilize broken bones while the normal
healing proceeds
– Bone plates, intramedullary nails, screws and sutures
Problems:
1. Biocompatibility: The ability of a material to perform with an
appropriate host response in a specific situation
2. Corrosion
3. Design of metallic implants
4. Design limitations the of anatomy
5. Physics properties of the tissue and reactions of the tissue to the
implant and of the implant to the tissues (Host Response)
 Different Metallic Biomaterials
• Stainless Steel • TiNi Alloys
– SS 316 – Nitinol
– SS 316L – Shape Memory effect
• CoCr Alloys • Platinum group metals
– the castable CoCrMo (PGM)
alloy – Pt, Pd, Rh, Ir, Ru, and Os
– The CoNiCrMo alloy – extremely corrosion
which is usually wrought resistant
by (hot) forging – poor mechanical
• Ti alloys properties
– Pure Ti – pacemaker tips
– Ti6Al4V • conductivity.
 Development of SS for use in human
body
• The first metal alloy developed specifically for human use was the
“vanadium steel” which was used to manufacture bone fracture plates
and screws.
• Vanadium steel is no longer used in implants since its corrosion resistance
is inadequate in vivo
• The first stainless steel utilized for implant fabrication was the 18-8 (type
302 in modern classification), which is stronger and more resistant to
corrosion than the vanadium steel.
• Later 18-8sMo stainless steel was introduced which contains a small
percentage of molybdenum to improve the corrosion resistance in
chloride solution (salt water). This alloy became known as type 316
stainless steel
• In the 1950s the carbon content of 316 stainless steel was reduced from
0.08 to a maximum amount of 0.03% (weight percent), and hence
became known as type 316L stainless steel
Advantage of SS 316 & 316L over other
grades of Steel
• Biocompatible
• These austenitic stainless steels cannot be
hardened by HT but can be hardened by cold
working
• possesses better corrosion resistance than any
other steels
• The inclusion of molybdenum enhances
resistance to pitting corrosion in salt water
 The 316L Stainless Steel
• (ASTM) recommends type
316L rather than 316 for
implant fabrication.
• The only difference in
composition between the
316L and 316 SS is the
maximum content of
carbon, i.e., 0.03% and
0.08%, respectively.
• So what makes 316L
special?????
Mechanical Properties & Corrosion
Resistance of 316L
 Assignment #3
Q) Why is Stainless Steel chosen instead of other
grades of Steel for use as a biomaterial? And
among Stainless Steel why is 316 L considered to
be the most suitable biomaterial? Justify your
answers with all possible reasons.
Q) Read Chapter #3 of Biomaterials by Sujata Bhat
and read chapter 1 of Biomaterials principles and
Applications by Joon B. Park
Q) What is sensitization of Steel. How can it be
restricted?
 Mechanical Properties & Corrosion
Resistance of 316L
• Even the 316L stainless steels may corrode inside the
body under certain circumstances in a highly stressed and
oxygen depleted region, such as the contacts under the
screws of the bone fracture plate. Thus, these stainless
steels are suitable for use only in Temporary implant
devices such as fracture plates, screws, and hip nails.
• Surface modification methods are widely used in order to
improve corrosion resistance, wear resistance, and fatigue
strength of 316L stainless steel
– anodization, passivation
– glow-discharge nitrogen implantation
 Deficiency Factors Responsible for
failure of SS implants
• Deficiency of Mo
• Use of sensitized steel
• Inadvertent use of mixed metals and
incompatible components
• Topography and metallurgical finish
• Improper implant and implant material
selection
 Co –Cr Alloys
• Co between Fe and Ni
• Forms solid solution with Cr
• Molybedum added to produce fine grains which
results in higher strength
• The chromium enhances corrosion resistance as
well as solid solution strengthening of the alloy.
• Metallic Co –used in beginning of the century but
was not very ductile or corrosion resistant
• 1930s – vitallium – 30% Cr, 7% W 0.5% C in Co
– Mostly for metallic dental castings
– To replace the more expensive gold alloys
– Larger partial denture castings
• Cast vitallium: dentistry and now recently in
artificial joints
• Wrought vitallium: stems of heavily loaded joints
suchh as femoral hip stems
• Cannot be considered even solely as tertiary or
quaternary systems – contain C, Mo, Ni, W, Fe
• E varies from 185 to 250 GN/m2 – roughly equal to
SS 316 and twice that of Ti
• The ASTM lists four types of CoCr alloys which are
recommended for surgical implant applications:
• (1) cast CoCrMo alloy (F75), (2) wrought CoCrWNi
alloy (F90), (3) wrought CoNiCrMo alloy (F562), and
(4) wrought CoNiCrMoWFe alloy (F563).
 Cast Alloy
• the alloy is cast by a lost wax (or investment casting)method which
involves making a wax pattern of the desired component
1. A wax model of the implant is made and a ceramic shell is built
around it
2. the wax is then melted out in a oven (100~150°C),
3. the mold is heated to a high temperature burning out any traces of
wax or gas-forming materials,
4. molten alloy is poured with gravitational or centrifugal force
5. the mold is broken after cooled
• The mold temperature is about 800~1000°C and the alloy is at
1350~1400°C.
• coarse ones formed at higher temperatures will decrease the
strength. However, a high processing temperature willresult in larger
carbide precipitates with greater distances between them, resulting
in a less brittle material. Again there is a complementary (trade-off)
relationship between strength and toughness.
• Forged Alloy
– More uniform microstructure
– Usually hot forged
– The superior fatigue and ultimate tensile strength of the
wrought CoNiCrMo alloy make it suitable for the
applications which require long service life without
fracture or stress fatigue. Such is the case for the stems of
the hip joint prostheses.
– Expensive – sophisticated press and tooling
• Porous coated Co-Cr implants
– Bone in growth applications
1.Sintered beads – gravity sintering
2.Plasma flame sprayed metal powders
3.Diffusion bonded
 Titanium based Alloys
• It was found that titanium
was tolerated in cat femurs,
as was stainless steel and
Vitallium® (CoCrMo alloy)
• Advantages
– Lightness (4.5 g/cm3) and
good mechanical properties
– Young’s modulus is half that
SS and Co-Cr
• Implies greater flexibility
• Disadvantages
– High cost and reactivity
 Ti Alloys
• One of the most widely used titanium alloys for
biomedical applications:Ti6Al4V
– The Ti6Al4V alloy has approximately the same fatigue
strength (550 MPa) as that of CoCr alloy
– Titanium alloys can be strengthened and mechanical
properties varied by controlled composition and
thermomechanical processing techniques.
– Ti exists in two allotropic forms: α- & β –phase
– The presence of Vanadium tends to form the α-β phase at
room temperature.
• Exact composition and thermal history determines its properties
 Nitinol
• Alloy of Ni-Ti
• Can be designed to change its shape or
dimensions in response to an increase in
temperature – small enough to be tolerated
by the adjacent tissues in which it is
embedded.
• FCC ---- Martensite
• It has good strain recoverability, notch
sensitivity and has excellent fatigue,
biocompatibility and corrosion resistance
 Applications
• Shape memory Stents
– a stent is a man-made 'tube' inserted into a
natural passage/conduit in the body to prevent, or
counteract, a disease-induced, localized flow
constriction.
 O2
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 E 2H2 OO2 +4H++4e-

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Er,H MM++e-
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Ecorr

Er,M ioH+/H2(Fe)
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For only those who are interested in knowing what a pourbaux diagrams looks like
Galvanic Corrosion
 Categories of
Biomaterials
Bioinert materials: do not
interact with biological
systems.
bone screws and plates, knee
prostheses and tooth
implants
Bioactive materials are
durable materials that can
bind chemically with the
surrounding bones and in
some cases even with soft
tissue
Biodegradable materials
degrade on implantation to
the body. Desirable is that the
material degrades at the
same rate at which the host
tissue regenerates
 Different Bioceramics
• Carbon, Yttria Stabilized Zirconia
• Articulating surfaces in joint replacements
• high surface finish and its excellent wear resistance, alumina
is often used for wear surfaces in joint replacement
prostheses. Such applications include femoral heads for hip
replacements and wear plates in knee replacements.
• Bone Spacers
• Porous alumina may also be used to replace large sections of
bone that have been removed for reasons such as cancer.
These may take the shape of rings that are concentric around a
metallic pin, inserted up the centre of the remaining bone
itself. The porous nature of these implants will allow new bone
to grow into the pores, effectively using the alumina as a
scaffold for new bone formation.
• Dental Applications
• Bioactive glass, Glass Ceramics, Hydroxy Apatite
• Hydroxy apatite, calcium phosphates
• Pyrolytic carbon
Problems:
• The method of fixation has suffered from limitations,
both theoretical and real.
– Bone cement can fragment and the formation of particles at the
cement
– bone interface can result in osteolysis and loosening.
– Osteolytic reactions have also been related to wear debris
– Differing metabolic activities
• Solution
– The bioactive properties of ceramics such as
hydroxyapatite, some calcium phosphates and various
types of bioactive glass, are well known.
– When placed in bone tissue, these materials promote
bone formation, and bond to bone at various rates.
– plasma-sprayed hydroxyapatite coatings.
 Calcium phosphate ceramics
• Include several materials which differ not only in their chemical
composition, but also in their specific surface area, crystal structure
and macro- and microporosity.
• There are differences due to variations in the calcium to phosphate
ratio; tricalcium phosphate, hydroxyapatite and tetracalcium
phosphate have Ca/P ratios of 1.5, 1.67 and 2 respectively, and
there are other materials with ratios in between these
• Plasma spraying can have a profound effect on the chemical and
physical characteristics of the deposited coating and few
commercial coatings are alike.
– Fortunately, the compositional and structural changes which result
from the spraying usually enhance the bone-forming properties of
hydroxyapatite, but at the price of increasing the rate of progressive
resorption of the coating with time. This would not necessarily be
detrimental if the function of the coating was simply to stimulate bone
formation
Calcium Phosphate Bioceramics
• There are several calcium phosphate ceramics that are considered
biocompatible. Of these, most are resorbable and will dissolve when
exposed to physiological environments. Some of these materials include,
in order of solubility:
• Tetracalcium Phosphate (Ca4P2O9) > Amorphous calcium Phosphate >
alpha-Tricalcium Phosphate (Ca3(PO4)2) > beta-Tricalcium Phosphate
(Ca3(PO4) 2) >> Hydroxyapatite (Ca10(PO4)6(OH)2)
• Unlike the other calcium phosphates, hydroxyapatite does not break down
under physiological conditions. In fact, it is thermodynamically stable at
physiological pH and actively takes part in bone bonding, forming strong
chemical bonds with surrounding bone. This property has been exploited
for rapid bone repair after major trauma or surgery.
• While its mechanical properties have been found to be unsuitable for
load-bearing applications such as orthopaedics, it is used as a coating on
materials such as titanium and titanium alloys, where it can contribute its
'bioactive' properties, while the metallic component bears the load. Such
coatings are applied by plasma spraying. However, careful control of
processing parameters is necessary to prevent thermal decomposition of
hydroxyapatite into other soluble calcium phosphates due to the high
processing temperatures.
 How do Bioactive and Resorbable Bioceramics help bone
formation
• The bioceramic provides the right environment for the new bone to
grow into.
• They also have a special chemical composition that allows a type
of cell called osteoblasts - responsible for bone production - to
attach to the ceramic’s surface, and start generating new bone.
The interconnected tiny holes within the bioceramic structure
facilitate the proliferation of the cell network, and the growth of
the bone, within the synthetic scaffold.
• The calcium content of the bioceramic provides the inorganic
component that new bone requires to develop its mineral-like
structure.
• The complex processes underlying bone’s astonishing capability to
regenerate are only partially understood.
• Each new finding in our research throws ten new questions that
need an answer, and so on. This is proving to be the major
impediment to the further development of bioceramics. At the
moment, they are improving only slowly, by trial and error: the
researchers slightly change the properties of the material, and then
study the biological response to the synthetic material.
 Turbostratic Stucture
• A type of crystalline structure where the basal planes
have slipped sideways relative to each other, causing
the spacing between planes to be greater than ideal.
• Pyrolytic carbon is an Key Properties
isotropic turbostratic form of
Biocompatible
carbon.
– The crystalline structure of
pyrolytic carbon has a Thromboresistant i.e.
distorted lattice structure with resists blood clotting
random unassociated carbon
atoms
Good durability
– This structure provides it with
isotropic properties (similar in
all directions) Good wear resistance
• It is formed by pyrolysis of a
hydrocarbon gas creating Good strength
random crystallization
• How is Pyrolytic Carbon ?
• It is usually formed in a fluidized bed furnace
– The bed consists of small ceramic particles and parts to be
coated
– A levitating gas creates required random motion of parts
within the bed
– Heating elements raise furnace temperature to 1200° -
1400°C
– An introduced hydrocarbon gas undergoes decomposition
at these temperatures creating free carbon that
recrystallizes on whatever surface it comes in contact with
first
Manufacturing of Pyrolytic Carbon
Applications
Pyrolytic carbon coatings are
made by co-depositing carbon
and silicon carbide onto
suitable substrates using
chemical vapour deposition
processes. Deposition is
carried out in a fluidised bed
furnace, fed with silicon
carrier gas and a hydrocarbon.
 Classification of Polymers
(Molecular Structure of the polymers)
1. Thermoplastics:
heating
(linear or branched polymers)
cooling
Melt
Melt

 Not crystallize Amorphous (amorphous region)

 Crystallize Semi-crystalline (crystalline and amorphous region)

Melting temperature (Tm) Glass transition temperature (Tg)

Glassy state  Ruberry state

 2. Elastomers:
Crosslinked Rubbery Polymers (low crosslink density)
 High extension (e.g. 3x to 10x) stress
 Intractable


3. Thermosets: heating
Networks Polymers (high crosslink density)

 Rigid Material stress

heating
 Degree of polymerization (DP, x)
The number of repeat unit in the polymer
chain
H H H H H H H H H H H H H H H H
DP= 8 R-C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C-- C-R
H H H H H H H H H H H H H H H H

The product of DP & molecular weight of a

repeat unit is the molecular weight of a
polymer chain
molecular weight of a chain = molecular weight of repeat unit X DP
H H
-C- -C-
H Cl n
Skeletal Structure
Branch point or
junction point
linear chain polymer branched chain
(two ends) polymer
Major differences in properties:
the melting point of linear
polyethylene is about 20 C higher
than branched chains
Network (crosslinked)
polymer
Degree of crosslinking or
crosslinked: no of junction
points per unit volume
No melting on heating
Nonsoluble in any solvent
 Homopolymer
Polymers whose structure ca be represented by a multiple
── A──
repetition of a single unit which may contain one or more n
species of monomer unit (structural unit)
-A-A-A-A-A-A-A-
A A A A A A A A A A A A A A

Copolymer
Polymers whose molecules contain two or
more different types of repeat unit -A-B-A-B-A-A-B-
A B A B A A B A B A B A A B

Statistical Copolymer
Sequential distribution of repeat units obeys the known statistical laws

Random Copolymer
distribution of repeat units is truly random

-A-B-A-B-A-A-B-A-B-B-B-A-A-B-A-A-A-B-B-A-B-
Alternating Copolymer:
Distribution of two types of repeat unit alternately along the polymer
chain
-A-B-A-B-A-B-A-B-A-B-A-B-A-B-A-B-
The properties of statistical, random and alternating coploymer are
generally intermediate to those of corresponding homopolymer
Bock Copolymer:
Linear copolymer in which repeat units exist only in long sequences
(blocks) of the same types
-A-A-A-A-A-A-A-A-B-B-B-B-B-B-B- AB di-block copolymer
-A-A-A-A-A-B-B-B-B-B-A-A-A-A-A- ABA tri-block copolymer
Graft Copolymer: Branched polymers in which the branches
have a different chemical structure to that
of the main chain
Properties:  characteristics of each of B-B-B-B-B-B-B-B-B
the constituent homopolymer
 Unique -A-A-A-A-A-A-A-A-A-A-A-A-A-A-A-A-A-
B-B-B-B-B-B-B-B-B
 Synthetic Biopolymers
• Importance of composition, mol. Wt, amount
of unreacted polymer, catalyst involved,
degree of crystallinity, additives on
biocompatibility, mechanical and other
properties
 List of the more important Polymers in
Biomedical Applications
• PE & PP
– UHMWPE (2 x 106 g/mol)
– Isotactic, syndiotactic, atactic forms
– Acetabular cups, knee joints, blood vessels, suture
• Perfluorinated Polymers
– PTFE: fixation of heart valves, impregnated into PET sutures, hearing
aids
• Acrylic Polymers
– PMMA: opthalmology, bone cement
– Additives such as barium sulfate or barium oxide important
– Composition of moldable dough determines short curing time and
other properties
• Hydrogels: intraocular lenses, cartilage material
 List of the more important Polymers in Biomedical
Applications
• Polyurethanes:
– urethane linkage: (-O-CO-NH-)
– Segmented polymers: soft and hard segments
– Aorta patch grafts, Blood tubings
– very good hydrolytic stability
– Polyamides
• Nylon
– Good fiber forming properties due to interchain hydrogen bonding of
intracardiac catheters
– Number and distribution of amide bonds determine properties such as
Tg etc
• Silicone rubber
– Alternate atoms of silicon & oxygen in main chain with organic side
groups attached to silicon – propers varied by careful compounding
– Catheters where PE, teflon more irratating to tissues, maxillofacial
surgery, nasal supports, Cosmetic surgeries, aesthetic surgeries.
 Polymerization 1

Classification of Polymerization Reaction

Monomer: A species must be capable of being linked to two (or more)
other species by chemical reaction (Functionality of two or higher)
1.Condensation (step reaction) polymerization: Step polymerization
In the polymer, there are fewer atoms in repeat units than monomers
(Carothers, comparison of formula of monomer and repeating unit)
reaction of many monomers into a polymer chain with elimination of
small by products molecules
It involves the condensation reaction between two polyfunctional
molecules to produce one larger molecule. (polymerization mechanism)
Monomer is rapidly consumed in early stages
+  +  + 
+ 

Step-growth
+
polymerization
 Polymerization 3

Linear Step polymerizationreactions of difunctional monomers

It involves successive reactions between pairs of mutually–reactive functional group
monomers Species with mutually-reactive functional groups

Functionality: the number of functional polymers

groups present on the molecule
O O
Easter linkage
OH-CH2-CH2-OH+ HOC— —COH
Ethylene glycol Terephthalic acid
O O
HOC— —COCH2-CH2-OH + H2O
Nonlinear Polymers:
reactions of monomers of functionality greater than two

Trifunctional monomers branched polymer Network polymers

Terephthalic acid + glycerol (OH-CH2-CH(OH)CH2-OH nonlinear polymer

 Polymerization 2
2. Addition (chain reaction) polymerization : chain polymerization
In the polymer, there is identical formula of repeat units and
monomers (Carothers)
addition of many monomers into a polymer chain without elimination
of small by products molecules.
It involves the chain reactions, in which the chain carrier may be a
free radical (any substance with an unpaired electron), an ion (cation
or anion), reaction of monomer with reactive end group

Monomer is being consumed

Chain-growth steadily throughout reaction
polymerization
H H H H H H H H H H H H H H H H

R-C--C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C- -C-- C-R

H H H H H H H H H H H H H H H H
 Chain Polymerization
Free-Radical Polymerization 1

Initiation Propagation Termination

Free-Radical: An independently-existing specie, which possess an

unpaired electron, normally highly reactive & short lifetime
Free-Radical Polymerization
The chain polymerizations in which each polymer molecule grows by
addition of monomer to a terminal free-radical reactive site (active
center)

+ + + +
Active center is transferred to newly-created chain end upon addition of new monomer

CH2=CR1R2 CH2=CHX vinyl polymer

X = -H, ─ , -F, -COOCH3,-Cl, -OCOCH3
 The main polymer Manufacturing
Techniques
• Bulk
• Melt
• Solution
• Suspension
• Interfacial
• Emulsion
 Manufacturing and Secondary operations for
biomaterials
• Castings, Forging & HTs
Liquids are normally poured into moulds to be cast to
be cast into ingots for fabrication of medical devices
The cast products are then processed in a number of
ways depending on the desirable mechanical
properties.
These include:
– Drawing, Pressing, Forging, machining, Precipitation
hardening, Tempering and other HTs
• Other Processes include those through:
– Powder Metallurgy
– Sol gel
– CIP, HIP, SPS, reaction bonding etc
 SPS

• Spark plasma sintering a novel technique used to

sinter ceramics, metals and composites within a few
minutes and to obtain densities greater than 99.9%
 Surface Improvements
• These include mostly:
1. Anodization
2. Flame Spraying
3. Surface alloying/Electroplating
4. PVD & Ion Plating
5. Grinding/Polishing/Sand Blasting
6. Plasma Polymerization
 Biomaterials Case Study

Q.1) Conduct a case study on one Biomedical

Device/Implant. Your study should include
– Name and function of the implant
– A proper study for selection of materials for that
implant
– State the material you have finally selected and
give your reasoning:
• Include details/important properties of the material
• Effectiveness in the application you have chosen
• Any Advantages or Drawbacks of the material
• Production methods
• Mention the name of any company if it is currently
being manufactured in industry
 Nanomaterials Assignment
Q) Explain the following and their application through
nanotechnology. You must include information about
the materials involved and how they are being used
for their particular applications.
Nano/biosensors Drug delivery
Quantum dots Endofullerenes
Interconnect materials Nanobots
Diamondoid Structures
Hydrogen Storage & Clean Energy
Biocompatibility

Biological response
Biocompatibility tests
Sterilization Issues
 Biocompatibility
• Arises from differences between living and
non-living materials
• Bioimplants trigger inflammation or foreign
body response
• New biomaterials must be tested prior to
implantation according to FDA regulation
• WWII: Validated biocompatibility of several
materials including PMMA
Biomaterial-Tissue Interactions
 Definitions
• Neutrophil- common leucocyte of the blood- short-lived phagocytic cell
• Lymphocyte- small cell in blood- recirculates through tissues and back
through lymph --polices body for non-self material-- recognizes antigens
through surface receptors
• Antigen- produces antibody- stimulate adaptive immune response
• Antibody- Serum globulins with wide range of specificity for different
antigens-- bind to surface
• Monocyte- largest nucleated cell of blood-develops into macrophage
when it migrates to tissues
• Macrophage- phagocyte--scavenger cell-- of tissues
• Lysozyme- enzyme secreted by macrophages- attack cell wall of bacteria
“natural antibiotic”
• Mast Cell- large tissue cell which releases inflammatory mediators--
increases vascular permeability-- allows complement to enter tissues from
blood
• Complement- a series of enzymes in blood- when activated produce
inflammatory effects
Wear-Mediated Osteolysis

Wear particles from the

replacement head and
liner cause
inflammation that can
lead to pain, bone loss,
and ultimately revision
surgery
wear
particles

bone loss

Archibeck, MJ; Jacobs, JJ; Roebuck, KA; Glant, TT. Journal of Bone & Joint Surgery, 2000
 Inflammation
• Inflammation is the reaction of vascularized living
tissue to injury.
• The inflammation process includes a sequence of
events that can heal the implant site.
• This is done through the generation of new tissue via
its native cells or the formation of fibroblastic scar
tissue.
Some processes during inflammation
• Enhanced permeability of vasculature
• Fluid, proteins, blood cells escape vascular system into the
injured tissue
• Blood clotting --thrombosis is possible
• Cell response--neutrophils (24-48 hrs)
• Monocytes macrophages (months )
 Acute vs Chronic Inflammation
• Inflammation almost always occurs.
• Distinguished not only by the time course of the
inflammatory response, but also by Cellular
interactions
• Acute inflammation, which is typical of early
phases of the inflammatory response, involves
neutrophil leukocytes as the principal cellular
effectors.
• Chronic inflammation, which tends to occur over
a longer time, involves monocytes, macrophages,
lymphocytes
 Inflammation
What are the signs of Inflammation?
• The inflammatory reaction is normally characterized by
5 distinct signs, each of which is due to a physiological
response to tissue injury.
– Pain (due to chemicals released by damaged cells)
– Swelling or Edema (due to an influx of fluid into the
damaged region)
– Redness (due to vasodilatation- the widening of blood
vessels)
– Heat (due to an increase in blood flow to the area)
– Loss of function (due to increased swelling and pain)
The macrophage is a key cell in the
inflammation process as it can produce a
large number of biologically active products
including proteases, complement
components, coagulation factors, growth
factors and cytokines (proteins that regulate
immune response).
Biological Response
 Granulation Tissue
• Granulation tissue is the fibrous connective tissue
that occurs in healing wounds. Granulation tissue
typically grows from the base of a wound and is
able to fill wounds of almost any size it heals.
• Granulation tissue is composed of tissue matrix
supporting a variety of cell types, most of which
can be associated with one of the following
functions:
– extracellular matrix,
– immune system, or
– vascularisation
 Types of granulation tissue
• Extracellular matrix
– The extracellular matrix of granulation tissue is created
and modified by fibroblasts. Initially, it consists of a
network of Type III collagen, a weaker form of the
structural protein that can be produced rapidly. This is later
replaced by the stronger, long-stranded Type I collagen, as
evidenced in scar tissue.
• Immunity
– The main immune cells active in the tissue are macrophages and
neutrophils. These work to phagocytize old or damaged tissue, and
protect the healing tissue from pathogenic insult. This is necessary
both to aid the healing process and to protect against invading
pathogens, as the wound often does not have an effective skin barrier
to act as a first line of defence.
• Vascularization
– It is necessary for a network of blood vessels to be established as soon
as possible to provide the growing tissue with nutrients, to take away
cellular wastes, and transport new leukocytes to the area. Fibroblasts,
the main cells that deposit granulation tissue, depend on oxygen to
proliferate and lay down the new extracellular matrix.
 Granulation tissue process
•Within 24 hrs of implantation, healing
initiated by the action of monocytes and
macrophages.
•Fibroblasts reproduce and form
granulation tissue (pink, granular
appearance)
•Neovascularization involves the
generation, maturation, and organization
of into capillary tubes.
•Fibroblasts are active in the synthesis of
Collagen etc.
•Granulation tissue may be observed
within 3-5 days of implantation of a
biomaterial—it is often accompanied by
wound contraction.
 Foreign Body Reaction
• Indicated by the presence of multinucleated
foreign body giant cells and the components of
granulation tissue (macrophages, fibroblasts, and
capillaries)
• Surface of the biomaterial will often determine
the composition of the foreign body response
 Surface structure important for
biocompatibility
• High surface to volume ratio of
fabrics and porous structures
can result in higher ratios of
macrophages than a smooth
component made of the
identical material but can also
encourage tissue ingrowth --this
is observed in vascular grafts.
 Fibrosis and Encapsulation
• The final stage of the foreign body response and healing process
is the development of a fibrous encapsulation
• Repair involves two separate processes: replacement of tissue by
parenchymal cells of the same type or replacement by connective
tissue that constitute the fibrous capsule.
• These processes are controlled by the growth capacity of the
cells in the tissue receiving the implant, the persistence of the
tissue framework and degree of injury.
 Host can affect the implant
• Physically
• Abrasive, adhesive,
delamination wear
• Fatigue and Fracture
• Stress Corrosion cracking
• General corrosion
• Biologically
• Absorption of substances
from the tissues
• Enzymatic degradation
• Calcification
Some Host Factors:
• Age and health status
• Immunological/metabolic
status
• Choice of surgeon:
minimize tissue damage
and contamination,
proper implantation
 Implant Factors
• Bulk properties: chemical composition, structure, purity
and presence of leachables.
• Surface properties: smoothness, COF, geometry,
hyrophilicity, surface charge
• Mechanical properties: match properties of
component being replaced, such as elastic modulus.
Stability and fixation.
• Long-term structural integrity: design for fatigue and
fracture loading, wear, creep, and stress corrosion
cracking
Bioactivity spectra for bioceramics
 Biocompatibility testing
• Cell toxicity
• Thromobogenecity
• Inflammatory response
• Animal tests
• Clinical trials
• FDA regulations
• ASTM/ISO standards
 Sterility
• Definition: the state in which the probability
of any one bacterial endospore surviving is 10
or lower
• Minimizes bacterial contamination
• Reduces likelihood for infection
• Can alter the material surface and bulk structure
• Shelf Aging-- Post Sterilization --Manufacturing issues-- what
is the best sterilization method? What is shelf life for the
device?
Pre-Surgical Implant Life
 Sterilization Schemes
• Eto Gas
• Steam
• Autoclaving
• E-beam radiation
• Gamma Radiation
 Gamma Radiation
• Advantages:
• deeply penetrating
• no residuals
• no post-sterilization treatment
• crosslinking- good for wear resistance

• Disadvantages:
• chain cleavage, loss of molecular weight and higher
crystallinity
• embrittlement
 Oxygen aids in high reactivity towards free radical
generation in radiation sterilization schemes
• R --g --> R.} initiation
• R. --O2--> RO2. } propagation
• RO2. --RH-> RO2H + R. }
• RO2H --RH-> RO. + . OH } chain branching
• RO. --RH-> ROH + R. }
• .OH --RH-> H O + R.
2
• RO2H, RO2., R. -----> scission and crosslinking
• 2RO2. ----> RO2R + O2} termination

Increased crystallinity and density

Increased oxidation levels
Loss of fatigue, fracture and wear properties
 Crystallinity and Density Evolution
60 0.98
Density (g/cc)
Unsterilized n=18
50 0.97
Sterilized in N2
0.96 Sterilized in Air
40
0.95
30
% Crystallinity 0.94
20 0.93
0 1 2 3 4
Aging Time (Weeks)
10

0
Nonsterile Sterile
 Remedies and Current Trends
• Sterilization with EtO and gas plasma
• 5 year mandate shelf life
• Gamma radiation in inert atmosphere, oxygen
barrier
Biomechanical properties
F(t)
F(t) F(t)

Material properties of device materials and

tissues.
Stress, strain, and constitutive relationships.
 Basic testing for determination of
material properties
• Elastic modulus
• Yield strength
• Ultimate tensile
strength
• Fracture Strength
• Toughness
• Ductility
• Engineering vs. True
Stress-Strain testing
 Types of Behavior
• Elastic
• Non-linear elastic
• Visco-elastic
• Plastic
• Isotropic vs. Anisotropic

• Brittle (fracture before

yield)
• Ductile (yield before
fracture)
Viscoelastic and Anisotropic
Mechanical Behavior
 Stress and Strain
• In biomedical devices it is necessary to
consider 3-D states of loading
• Stress is typically thought of as a force acting
on an area and strain as the change in size and
shape--stress is cause and strain is effect
• In 3-d loading we must recognize stress and
strain as tensor quantities
 Stress
• Stress relates a force vector to the plane it
acts upon (defined by its normal)
• Different planes have different stress vectors
that can be resolved into its normal and shear
components
• Tensors
 Orthopedics

Lecture Outline:
Introduction
Wolff’s Law
Orthopedic Tissues
Structure-Function
Performance, Failure and Disease
Temp. Internal External Implants
Joint replacements
 Introduction
• Among the various functions of
the skeleton is the requirement
that it should bear load. This
accounts for its:
– shape, mass and material
properties
• A lot of the properties are derived
from the chemical composition:
– Collagen & other molecules give
TS
– HAP is responsible for resistance
to compression
• Overall mech. behavior in
particular is subject to other
factors such as:
– Volume fraction, mech props
orientation and interfacial bonding
• In vivo activties
– osteogenic & osteoclastic
– Balance between forces and
Wolff’s Law
• Orthopedic surgery range from
bone grafting to THR.
• Most prevalent diseases:
– Osteoarthritis
– Muscoskeletal Disorders
• An engineers attention can be
initially focused into the
success of two basic criteria:
– Proper design
– Material Selection
 Some other things to look out for
• Assuming correct surgical procedures, no infection, proper design and
negligible corrosion other common problems include:
– Mismatch of E
– Formation of fibrous tissue around the implant
– Restriction of vascular system
• All implants must transmit forces from one part to another part of the
skeleton. The mechanical problems resulting from this force transmission
include:
– Mechanical reliability
– Response of the bony tissue to the stresses & strains created by insertion of
the implant
– Mechanics of the interface between implant and bone
• Augmentation in anyone or combination of these problems may result in
the following complications leading to failure:
– Sufficent pain requiring removal
– Mech. Failure of implant
– Fracture of bone
Wolff ’s law of bone remodeling
Bone can adapt to a new mechanical
environment by changing the equilibrium
between osteogenesis and osteoclasis. These
processes will respond to changes in the static
and dynamic stress applied to bone; that is, if
more stress than the physiological is applied,
the equilibrium tilts toward more osteogenic
activity. Conversely, if less stress is applied the
equilibrium tilts toward osteoclastic activity
 Fibrous Matrix/Connective Tissue
Types
• Adipocytes: fat cell-protection and energy storage
• Chondrocytes: cartilage cells
• Fibroblasts: Produce fibers and hyaluronic acid
• Macrophages: “big eaters” phagoctyize and active
immune response
• Mast cells: release histamines/heparin after
injury
• Osteocytes: osteoblasts build bone while
osteoclasts remove the bone
• Plasma cells: lymphocytes that produce
antibodies
 Fibrous Matrix/Connective Tissue
Types
Collagen Fibers Elastic Fibers
• White fibers • Yellow fibers
– Tough fibers – Branching fibers
– Not stretchy – Stretchy – elastic
Hyaluronic Acid
• Reticular Fibers – Colloidal gel
– White fibers – Tissue Fluid
– Same collagen protein HAP
– Thinner, branched fibers – 50% of bone is composed of
– Reticular = network modified HAP
– Bioactive: osseointegration
and bone ingrowth
 Classification of bone
• According to their shape: long, short, flat & irregular.
• Long bones:
– Consist of elongated shaft of cylindrical compact bone with 2
extremities having spongy or cancellous bone.
– Arm, forearm, high and leg
• Short bones
– have no shaft but consist of smaller masses of spongy bone
surrounded by a shell of compact bone
– Wrist and ankle
• Flat bones are consist of two layers of cancellous bone.
– Found in scapula, innominate bone and bones of the skull
• Irregular bones cannot be placed in any of the above
categories and include vertebrae and some of the bones of
the face
 Last set of biological terminologies-- -hopefully 
• Cartilage
– Cartilage is a stiff yet flexible connective tissue found in many areas in the bodies of
humans and other animals, including the joints between bones, the rib cage, the ear,
the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral
discs. It is not as hard and rigid as bone but is stiffer and less flexible than muscle.
– Cartilage is composed of specialized cells called chondrocytes that produce a large
amount of extracellular matrix composed of Type II collagen fibers, abundant ground
substance rich in proteoglycan, and elastin fibers. Cartilage is classified in three
types, elastic cartilage, hyaline cartilage and fibrocartilage, which differ in the relative
amounts of these three main components.
– Unlike other connective tissues, cartilage does not contain blood vessels. The
chondrocytes are supplied by diffusion, helped by the pumping action generated by
compression of the articular cartilage. Thus, compared to other connective tissues,
cartilage grows and repairs more slowly.
– It has 2 main functions
1. Maintenance of shape (ear, nose tip)
2. Provide bearing surfaces at joints
• Tendon
– A tendon is a tough band of fibrous connective tissue that usually connects
muscle to bone and is capable of withstanding tension. Tendons are similar
to ligaments and fascia as they are all made of collagen except that ligaments join
one bone to another bone, and fascia connect muscles to other muscles.
• Muscle
– contain contractile tissues/filaments that move past each other and change the size of
the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to
produce force and cause motion. Muscles can cause either locomotion of the organism
itself or movement of internal organs.
• Synovial Fluid
– Synovial fluid is a viscous, non-Newtonian fluid found in the cavities of synovial joints.
With its yolk-like consistency ("synovial" partially derives from ovum, Latin for egg), the
principal role of synovial fluid is to reduce friction between the articular cartilage of
synovial joints during movement.
• Ligament
– In its most common use, a ligament is a band of tough, fibrous dense regular connective
tissue comprising attenuated collagenous fibers. Ligaments connect bones to other
bones to form a joint. They do not connect muscles to bones; that is the job of tendons.
Some ligaments limit the mobility of articulations, or prevent certain movements
altogether.
 Non Surgical, Surgical, Internal, External
• Each fracture pattern and location results in a unique combination of characteristics
(“fracture personality”) that require specific treatment methods. The treatments can
be non-surgical or surgical.
• Examples of non-surgical treatments are immobilization with casting (plaster or resin)
and bracing with a plastic apparatus.
• The surgical treatments are divided into external fracture fixation, which does not
require opening the fracture site, or internal fracture fixation, which requires opening
the fracture.
• With external fracture fixation, the bone fragments are held in alignment by pins
placed through the skin onto the skeleton, structurally supported by external bars.
With internal fracture fixation, the bone fragments are held by wires, screws, plates,
and/or intramedullary devices. All the internal fixation devices should meet the
general requirement of biomaterials, that is, biocompatability, sufficient strength
within dimensional constraints, and corrosion resistance. In addition, the device should
also provide a suitable mechanical environment for fracture healing. From this
perspective, stainless steel, cobalt-chrome alloys, and titanium alloys are most suitable
for internal fixation. Detailed mechanical properties of the metallic alloys are discussed
in the chapter on metallic biomaterials. Most internal fixation devices persist in the
body after the fracture has healed, often causing discomfort and requiring removal.
• Hence surgical treatments make use of one or more of the following:
– Pins, wires, screws, intramedullary nails
 Temp Fixation Devices
• Temp. fixation devices vs permanent prosthesis devices
• The purpose of temp. fixation devices is to stablilze
fractured bone until natural healing processes have
restored sufficent strength so that the implant can be
removed
• Pins, nails, wires screws, plates, intramedullary devices
• Bone plates are used for joining bone fragments together
during healing of load bearing bones. The plate provides
rigidity for fixation of the fracture. (screws are used with
them to fix them)
• One major drawback of healing by rigid plate fixation is
the weakening of the underlying bone such that refracture
may occur during the removal of the bone plate.
• Resorbable material for bone plates….
• An intramedullary rod, also known as
an intramedullary nail (IM nail) or Küntscher nail, is a metal
rod forced into the medullary cavity of a bone. IM nails have
long been used to treat fractures of long bones of the body.
– Advantage of an intramedullary device is that it can be nailed through
a small incission. Blood supply is limited by vitality of bone is not
damaged. A solid reunion is achieved by this method. Removal is done
after an year or two for proper healing
– Steel continues to be the material of choice for these nails, owing to
its strength, but more recently titanium has gained popularity due to
its advantages over steel. However the biggest problem with the
earlier designs was the failure to prevent collapse or rotation in
inherently unstable fractures. This was addressed by the introduction
of the concept of 'locking' of the nails using bolts on each end of the
nail, leading to emergence of locked IM nailing, which is the standard
today.
• Incases of spinal deformity internal & external fixation
 Intramedullary Nails

A 16 year old boy sustained a compound fracture of the left tibia with 6 cm of bone loss (A). He was hit by car
while riding a bicycle. Once the wound was cleaned, the skin was closed and the fracture stabilized with an
intramedullary nail (B). After a few days, an external fixator was applied, and a bone transport over the nail was
carried out (C). Healing occurred without any further intervention (D) and he returned to unrestricted activities
including sports
 Joint Replacements
• Joints are salvaged whenever possible and implants
are used only as a last resort
• Routine replacements include:
– Knee, elbow, wrist and hip joints
– Hip implants how the greatest acceptance (high success rates of greater than
90% for the first 10 years)
• One of the major problems with artificial joints is
related to the loosening of implants.
– Symtoms of early loosening include pain with the onset of walking. As loosening
worsens pain can increase to the point of requiring removal of the device
– Mechanical stability of bone cement at implant-bone interface- - -> as the
deive loosens greater loads are applied to the total joint implant, which can
lead to fracture of implant
– Bioglass: direct chemical bonding of implant to bone – this interfacial bond
makes it possible for mechanical stresses to be transferred across the interface
in a manner that prevents the fracture of the interface even when the implant
is loaded to failure.
 Total hip replacements
• It consists of a femoral component that is a ball mounted
on a shaft and an acetabular component having a socket
into which ball is placed
• Different combination are used metal-metal, metal-
HMWPE, ceramic-HMWPE, ceramic-ceramic are used but
their merits are arguable
• Several designs with different stem lengths are available.
• The prosthesis for total hip replacement consists of a
femoral component and an acetabular component). The
femoral stem is divided into head, neck, and shaft. The
femoral stem is made of Ti alloy or Co–Cr alloy (316L
stainless steel was used earlier) and is fixed into a reamed
medullary canal by cementation or press fitting. The
femoral head is made of Co–Cr alloy, alumina, or zirconia.
Although Ti alloy heads function well under clean
articulating conditions, they have fallen into disuse
because of their low wear resistance to third bodies, e.g.,
bone or cement particles. The acetabular component is
generally made of ultra-high-molecular-weight
polyethylene (UHMWPE).
 Monolithic or Modular
• The implants can be monolithic when they consist of
one part, or modular when they consist of two or more
parts and require assembly during surgery.
• Monolithic components are often less expensive, and
less prone to corrosion or disassembly.
• However, modular components allow customizing of
the implant and during future revision surgeries, for
example, modifying the length of an extremity by using
a different femoral neck length after the stem has been
cemented in place, or exchanging a worn polyethylene
bearing surface for a new one without removing the
well-functioning part of the prosthesis from the bone.
 Knee Joint
• Anatomy of the knee joint is a lot
more complicated because of its
loading pattern
• 3 long bones: femur, tibia, fibula
and a smaller bone patella (consult
Sujata)
• The bones are held together by
ligaments.
• The joint capsule is filled with
synovial fluid that bathes the
articulate surface of each bone
and maintains a low coefficient of
friction between the two surfaces
• Synovial fluid is essentially a
dialysate of blood plasma with
added hydaluronic acid
• Issues of
– Implant loosening
– Bone loss (check Joon B. Park
underheading of hip implants)
Miscellaneous examples of prostheses for total joint replacement: (a) ankle, (b) socket-
ball shoulder joint, (c) hinged elbow joint, and (d) encapsulated finger joint.
 Dental Materials
• Polymers, composites, ceramics and metal
alloys
• Although several metal alloys are in wide use
due to their good mechanical properties, they
show a slow and progressive decrease in their
applications
• Teeth is made of 2 portions: crown and root
• Teeth are composed mainly of enamel and
dentin
– Enamel: is the hardest substance found in the
body and consists almost entirely of calcium
carbonate
– Dentin is similar to that of regular compact
bone in its organic matrix and mineral
Dental operators, require materials that are easy
to manipulate and shape, where the
chemistry of any reactions that need to occur
are predictable or controllable
• Impression materials
Serves as a mold to cast your material into
– mostly plaster of paris with other polymers, acrylics etc
• Fillings/Restorative Materials
– Dental restorative materials are specially fabricated materials, designed for use
as dental restorations (fillings), which are used to restore tooth structure loss,
usually resulting from but not limited to dental caries (dental cavities).
– Amalgam fillings, (also called silver fillings) are a mixture of mercury (from 43%
to 54%) and powdered alloy made mostly of silver, tin, zinc and copper
commonly called the amalgam alloy.
– Glass Ionomers: These fillings are a mixture of glass powder and an organic acid
(silicate glass powder and polyacrylic acid). They are tooth-colored
– Light cured composites
• Endosseous implants
– Is extracted into the site of missing or extracted teeth to restore original
function
– Many designs to achieve immediate and long term stabilization and fixation.
– Post is covered with appropriate crown after 1-4 month fixation
– Materials: CoCr, Ti, Ti-6%Al4%V alloy + efforts to coat implants with various
porous ceramics