Human tissue is structured mainly of self-assembled polymers (proteins) and ceramics (bone minerals), with metals present as trace elements with molecular scale functions. However, metals and their alloys have played a predominant role as structural biomaterials in reconstructive surgery, especially orthopedics, with more recent uses in non-osseous tissues, such as blood vessels. With the successful routine use of a large variety of metal implants clinically, issues associated with long-term maintenance of implant integrity have also emerged. This review focuses on metallic implant biomaterials, identifying and discussing critical issues in their clinical applications, including the systemic toxicity of released metal ions due to corrosion, fatigue failure of structural components due to repeated loading, and wearing of joint replacements due to movement. This is followed by detailed reviews on specific metallic biomaterials made from stainless steels, alloys of cobalt, titanium and magnesium, as well as shape memory alloys of nickel–titanium, silver, tantalum and zirconium. For each, the properties that affect biocompatibility and mechanical integrity (especially corrosion fatigue) are discussed in detail. Finally, the most critical challenges for metallic implant biomaterials are summarized, with emphasis on the most promising approaches and strategies.

Metallic implant biomaterials

Biodegradable metals are breaking the current paradigm in biomaterial science to develop only corrosion resistant metals. In particular, metals which consist of trace elements existing in the human body are promising candidates for temporary implant materials. These implants would be temporarily needed to provide mechanical support during the healing process of the injured or pathological tissue. Magnesium and its alloys have been investigated recently by many authors as a suitable biodegradable biomaterial. In this investigative review we would like to summarize the latest achievements and comment on the selection and use, test methods and the approaches to develop and produce magnesium alloys that are intended to perform clinically with an appropriate host response.

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Degradable biomaterials based on magnesium corrosion

A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease☆

Recent advances on the development of magnesium alloys for biodegradable implants.

Increased use of reconstruction procedures in orthopedics, due to trauma, tumor, deformity, degeneration and an aging population, has caused a blossom, not only in surgical advancement, but also in the development of bone implants. Traditional synthetic porous scaffolds are made of metals, polymers, ceramics or even composite biomaterials, in which the design does not consider the native structure and properties of cells and natural tissues. Thus, these synthetic scaffolds often poorly integrate with the cells and surrounding host tissue, thereby resulting in unsatisfactory surgical outcomes due to poor corrosion and wear, mechanical mismatch, unamiable surface environment, and other unfavorable properties. Musculoskeletal tissue reconstruction is the ultimate objective in orthopedic surgery. This objective can be achieved by (i) prosthesis or fixation device implantation, and (ii) tissue engineered bone scaffolds. These devices focus on the design of implants, regardless of the choice of new biomaterials. Indeed, metallic materials, e.g. 316L stainless steel, titanium alloys and cobalt chromium alloys, are predominantly used in bone surgeries, especially in the load-bearing zone of prostheses. The engineered scaffolds take biodegradability, cell biology, biomolecules and material mechanical properties into account, in which these features are ideally suited for bone tissue repair and regeneration. Therefore, the design of the scaffold is extremely important to the success of clinical outcomes in musculoskeletal surgeries. The ideal scaffolds should mimic the natural extracellular matrix (ECM) as much as possible, since the ECM found in natural tissues supports cell attachment, proliferation, and differentiation, indicating that scaffolds should consist of appropriate biochemistry and nano/micro-scale surface topographies, in order to formulate favorable binding sites to actively regulate and control cell and tissue behavior, while interacting with host cells. In addition, scaffolds should also possess a similar macro structure to what is found in natural bone. This feature may provide space for the growth of cells and new tissues, as well as for the carriers of growth factors. Another important concern is the mechanical properties of scaffolds. It has been reported that the mechanical features can significantly influence the osteointegration between implants and surrounding tissues, as well as cell behaviors. Since natural bone exhibits super-elastic biomechanical properties with a Young's modulus value in the range of 1–27 GPa, the ideal scaffolds should mimic strength, stiffness and mechanical behavior, so as to avoid possible post-operation stress shielding effects, which induce bone resorption and consequent implant failure. In addition, the rate of degradation and the by-products of biodegradable materials are also critical in the role of bone regeneration. Indeed, the mechanical integrity of a scaffold will be significantly reduced if the degradation rate is rapid, thereby resulting in a pre-matured collapse of the scaffold before the tissue is regenerated. Another concern is that the by-products upon degradation may alter the tissue microenvironment and then challenge the biocompatibility of the scaffold and the subsequent tissue repair. Therefore, these two factors should be carefully considered when designing new biomaterials for tissue regeneration. To address the aforementioned questions, an overview of the design of ideal biomimetic porous scaffolds is presented in this paper. Hence, a number of original engineering processes and techniques, including the production of a hierarchical structure on both the macro- and nano-scales, the adjustment of biomechanical properties through structural alignment and chemical components, the control of the biodegradability of the scaffold and its by-products, the change of biomimetic surface properties by altering interfacial chemistry, and micro- and nano-topographies will be discussed. In general, the concepts and techniques mentioned above provide insights into designing superior biomimetic scaffolds for bone tissue engineering.

Biomimetic porous scaffolds for bone tissue engineering

http://lbmd.coe.pku.edu.cn/PDF/2009biomaterials01.pdf

In vitro corrosion and biocompatibility of binary magnesium alloys

http://lbmd.coe.pku.edu.cn/PDF/2010biomaterials.pdf

Corrosion of, and cellular responses to Mg-Zn-Ca bulk metallic glasses

http://lbmd.coe.pku.edu.cn/PDF/2010actabiomater02.pdf

Corrosion fatigue behaviors of two biomedical Mg alloys - AZ91D and WE43 - In simulated body fluid.

In vitro and in vivo changes to PLGA/sirolimus coating on drug eluting stents.

/pdf/in-situ-formation-of-ti-mo-biomaterials-by-selective-laser-2u3dwmoi.pdf

In-situ formation of Ti-Mo biomaterials by selective laser melting of Ti/Mo and Ti/Mo2C powder mixtures: A comparative study on microstructure, mechanical and wear performance, and thermal mechanisms

Shengping Zhong

Papers

In vitro corrosion and biocompatibility of binary magnesium alloys

Corrosion of, and cellular responses to Mg-Zn-Ca bulk metallic glasses

Corrosion fatigue behaviors of two biomedical Mg alloys - AZ91D and WE43 - In simulated body fluid.

In vitro and in vivo changes to PLGA/sirolimus coating on drug eluting stents.

In-situ formation of Ti-Mo biomaterials by selective laser melting of Ti/Mo and Ti/Mo2C powder mixtures: A comparative study on microstructure, mechanical and wear performance, and thermal mechanisms