The enormous need of orthopaedic (surgical) implants such as osteosynthesis plates is difficult to be fulfilled in developing countries commonly rely on imported ones. One of the alternatives is utilization of local resources, but only after they have been proven safe to use, to overcome this problem. Surface properties are some of the determining factors of safety for those implants. We have succeeded in developing prototype of osteosynthesis plate and the results indicate that Indonesian-made plates need improvement with regards to the surface quality of physical characterization.
Antibiotic-loaded bone cement has been used as prophylaxis against infection in total joint replacement surgery. Its effect on the mechanical strength of cement is a major concern as high dose of antibiotic was associated with a significant reduction in mechanical strength of bone cement. However, the cut-off antibiotic that weakens the mechanical strength of cement remains to be determined. This study was undertaken to observe the changes in the mechanical properties of bone cement with gradual increments of Cefuroxime antibiotic. Cefuroxime at different doses: 0, 1.5, 3.0 and 4.5gm were added to a packet of 40gm bone cement (Simplex P) and study samples were prepared by using third generation cementing technique. Mechanical impact, flexural and tensile strength were tested on each sample. Significant impact and tensile strength reduction were observed after addition of 4.5 gm of Cefuroxime. However, flexural strength was significantly reduced at a lower dose of 3.0 gm. The maximum dose of Cefuroxime to be safely added to 40mg Surgical Simplex P is 1.5gm when third generation cementing technique is used. Further study is needed to determine whether it is an effective dose as regards to microbiological parameters.
This finite element analysis is aimed at comparing relative stiffness of three different posterior instrumentation constructs: the Hospital Universiti Kebangsaan Malaysia Spinal Instrumentation System (HUKM-SIS), the Cotrell-Dubousset Instrumentation (CDI) and Harrington Instrumentation System (HIS), used in the treatment of adolescent idiopathic scoliosis (AIS). The constructs were tested under various loads using MSC Patran 2001 r2a. Under increasing flexion loads, there was a linearly corresponding increase in deflection magnitudes for all constructs on the load-deflection curve. The CDI was the stiffest construct under axial, forward flexion and extension loads, followed by the HUKM-SIS and HIS. Under lateral bending loads, the HUKM-SIS construct was the stiffest followed by CDI and HIS. The HUKM-SIS construct was stiffer than HIS under torsional loads. We conclude that multiple pedicle screws increase the stiffness of posterior instrumentation constructs under all loads and inter-segmental spinous processes wiring increase the stiffness against lateral bending.
Tricalcium phosphate/hydroxyapatite (TCP/HA), hydroxyapatite (HA), chitosan and calcium sulphate (CaSO4) were studied and evaluated for possible bone tissue engineered construct acting as good support for osteogenic cells to proliferate, differentiate, and eventually spread and integrate into the scaffold. Surface morphology visualized by SEM showed that scaffold materials with additional fibrin had more cell densities attached than those without, depicting that the presence of fibrin and collagen fibers were truly a favourite choice of cells to attach. In comparison of various biomaterials used incorporated with fibrin, TCP/HA had the most cluster of cells attached.
The present paper reports on the influence of sintering temperature on the porosity and strength of porous hydroxyapatite (HA). HA powder was first prepared by the sol-gel precipitation method using calcium hydroxide and ortho-phosporic acid. The fine HA powder, measuring <50 microm was then mixed into a slurry with the addition of binder agent, being a mixture of sago and PVA. A small amount of sodium dodecyl sulphate was also used as a foaming agent. Porous HA samples were then prepared via slip casting technique. The surface morphology of the sintered samples was observed under scanning electron microscopy at 20 kV and the compositions were determined via SEM-EDX. A universal testing machine was used to determine the compaction strength of the sintered samples.
Metal implants such as titanium, stainless steel and Co-Cr-Mo are used for load bearing purposes such as hip joint prostheses, fixing plates and dental root implants. For practical application, plasma-sprayed coatings of hydroxyapatite (HA) on metal implants are applied to promote early formation of strong bonds between metal implant and living bone. Plasma spray coating involves heating of HA material to a semi-molten or molten state and then propels its to a metal substrate. The plasma flame temperature is in the range of 6,000 degrees C to 16,000 degrees C but the surface temperature of the substrate rarely exceeds 150 degrees C. The HA materials are feed into the spray gun in the form of powders. Furthermore, this paper will discuss the processes of plasma-sprayed coating of HA on various types of metal implants.
The human fibroblast MRC-5 cells incubated with PHB granules (TM) added at a final concentration of 4 mg/ml showed a time-course pattern of survival. The percentages of dead cells obtained were at the rate of 3.8% after 7 days, respectively. When the MRC-5 cells grown in different material, using the test concentration of 4 mg/ml PCM, they were found to show a similar time-course increasing pattern of death as that obtained with PHB. However, the death was noted in the cells incubated for 7 days, the death rates obtained was 40.54% respectively.
Defects were created in the mandible of a rabbit model whereby the right side was implanted with hydroxyapatite (HA) while the left side was left empty to act as control. Both the implant and control sites were evaluated clinically and histologically at 4,12,20,22 weeks. Decalcified sections were studied under confocal laser scanning microscope. No reactive cells were evident microscopically in all sections. There was bone ingrowth as early as 4 weeks when viewed by the topographic method. Enhancement of osteoconduction was evident by the presence of abundant capillaries, perivascular tissue and osteoprogenitor cells of the host. At 22 weeks, the implanted defect showed mature bone formation filling almost the whole field. This study demonstrated that the dense HA exhibits excellent biocompatibility as noted by the complete absence of reactive cells. It also promotes osteoconduction.
A study was conducted to investigate the effectiveness of freeze-dried bovine pericardium (FDBP) as a biomaterial in diaphragmatic herniorrhapy in dogs. Eight adult dogs were randomly selected and divided into two equal groups. In FDBP group, a diaphragmatic defect was induced and repaired with an identical size of FDBP. In the control group, a diaphragmatic wall was incised at three-side border creating a flap and sutured. Grossly, only mild intrathoracic adhesion was observed for most of the animals, and no herniation occured. Microscopically, the biomaterial incorporated into the host's tissue by ingrowth of young muscle fiber and massive new blood vessel formation in between the fibrous tissue.
The main objective of the study was to determine the biodegradability, resorption and osteoconductivity potency of coral implant. Coral blocks (CORAGRAF) were prepared from sea coral Porites species. The blocks were implanted in the right mandible of rabbit model. Implants were harvested at 2 and 4 weeks intervals and subjected for light and scanning electron microscopy. Dense hydroxyapatite (DHA) was implanted in the left mandible as a control. The results of this study demonstrated that CORAGRAF is a good implant material that can accelerates bone healing and be resorbed in an acceptable time. The mechanisms of the resorption seemed to be the same (crumbling process), a first step where the edge of the coral become powdery then a second step which could be phagocytosis and dissolution in extracellular fluid.
The present in vitro evaluation indicated that the value added hydroxyapatite (HA) was more toxic than pure HA but the toxicity of value added HA was slight compared to the positive control. In this testing, the conclusion can be made that value added HA is less biocompatible than commercialized pure HA. This toxicity may be caused by both the particle size and degradation (leaching). Further studies should be carried out to determine whether there is particle size effect or leaching effect when using powder as compared to the block materials. The in vivo evaluation should be done to assess the reaction to this value added HA as compared to the pure HA.
Mutagenicity of CORAGRAF (natural coral) and REKAGRAF (hydroxyapatite) was tested in Ames test with and without an external metabolic activation system (S9). The test revealed no mutagenic activity of both locally produced osseous substitutes.
Metallic materials implanted into bone defects are generally encapsulated by a fibrous tissue. Some metallic materials such as titanium and tantalum, however, have been revealed to bond to the living bone without forming the fibrous tissue, when they were subjected to NaOH solution and heat treatments. Thus treated metals form bone tissue around them even in muscle, when they take a porous form. This kind of osteoconductive and osteoinductive properties are attributed to sodium titanate or tantalate layer on their surfaces formed by the NaOH and heat treatments. These layers induce the deposition of bonelike apatite on the surface of the metals in the living body. This kind of bioactive metals are useful as bone substitutes even highly loaded portions, such as hip joint, spine and tooth root.
Various blend ratios of high-density polyethylene (HDPE) and ultra high molecular weight polyethylene (UHMWPE) were prepared with the objective of determining their suitability as biomaterials. In the unfilled state, a blend of 50/50 (HDPE/UHMWPE) ratio by weight was found to yield optimum properties in terms of processability and mechanical properties. Hydroxyapatite (HA) was compounded with the optimum blend ratio. The effects of HA loading, varied from 0 to 50wt% for both filled and unfilled blends were tested for mechanical properties. It was found that the inclusion of HA in the blend led to a remarkable improvement of mechanical properties compared to the unfilled blend. In order to improve the bonding between the polymer blend and the filler, the HA used was chemically treated with a coupling agent known as 3-(trimethoxysiyl) propyl methacrylate and the treated HA was mixed into the blend. The effect of mixing the blend with silane-treated HA also led to an overall improvement of mechanical properties.
The paper presents the effect of sintering temperature on the physical properties of porous hydroxyapatite (HAp In this study, the HAp was prepared using polymeric sponge techniques with different binder concentrations. The sintering process was carried out in air for temperature ranging from 1200 degrees C to 1600 degrees C. Different physical properties namely density and porosity were observed at different sintering temperatures. The HAp prepared with higher PVP binder showed a slightly decreased in apparent density with increasing sintering temperature, while those HAp prepared with lower PVP showed a slightly increase in apparent density with increasing sintering temperature. The total porosity was found to be approximately constant in the whole sintering temperature range. However, closed porosity decreases with increasing sintering temperature for HAp prepared by lower binder concentration. On the other hand, the HAp prepared by higher binder concentrations showed increasing closed porosity with increasing sintering temperature. Other features such as the influence of sintering temperatures on grain and strut would also be presented in this paper.
There is a great demand of Hydroxyapatite (HA) material in Orthopaedics and Dental applications due to its similarity to human bone. However, the lack of availability and due to high import cost of this material in Malaysia, research in producing synthetic HA locally is therefore timely. The use of local resources as the raw materials for the production of HA is also desirable in reducing the overall cost of HA. In this study, two HA materials were synthesised from different starting precursors, i.e. commercial pure Ca(OH)2 (HAS) and Ca(OH)2 directly from a local natural limestone deposit (HAL). Whereas a commercially available HA "Captal 60" (HAC) was used as reference. The synthesised powders obtained were fired at 1000 degrees C and at 1250 degrees C. Characterisation evaluations on bulk properties were carried out using XRD, SEM-EDX, ICP and FTIR. The results indicate that both HAS and HAL are comparable to HAC even at 1000 degrees C. Thus, the local natural limestone can be used to form HA. However, the overall appearance of these materials are quite different (HAC - blue, HAS - greenish and HAL - light green). The reasons for this and the subsequent mechanical and bioactive effects of these materials are currently being investigated.
The paper presents a method of producing synthetic Hydroxyapatite (HA) Ca10(PO4)6(OH)2 and other apatites for biological use by solid-state reaction. The solid-state reaction involves mix-grinding dry powders of beta-tricalcium phosphate powder (TCP) and either calcium hydroxide (Ca(OH)2) or calcium carbonate (CaCO3) or combination thereof, from pure commercial chemicals or derived from natural limestone or from seashells, of total calcium/phosphorus molar ratio between 1.5 to 2.0, to particle size of less than 10 microns, and firing the resultant powder to temperature between 600 degrees C - 1250 degrees C in atmosphere or in controlled atmospheric condition. The resultant apatites formed were characterised using XRD, SEM-EDX and FTIR. The presented reaction process was found to be much simpler compared to conventional methods of producing synthetic apatites since it involves only dry mix-grinding of the reactants before firing at high temperatures based on the required levels of purity. It can also produce synthetic apatites with good reproducibility in a shorter time. Thus the presented method has a great industrial value.
Hydroxyapatite is a calcium phosphate bioceramic that has been shown by many authors to be biocompatible with bioactive properties. It is widely accepted as the best synthetic material available for surgical use as a bone graft substitute. HA granules produced by AMREC-SIRIM from local materials underwent 5 types of sterilisation techniques with different ageing periods. Samples were tested for chemical and phase composition and microbial contamination before and after being sterilised. From the microbiological tests done, none of the unsterilised positive control yielded a positive culture. Results from X-Ray diffraction studies found that all the sterilisation techniques did not chemically degrade or structurally change the HA granules significantly.