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DE GRUYTER Current Directions in Biomedical Engineering 2020;6(3): 20203112 Jana Markhoff*, Niels Grabow Mini-Review Abstract: Biomaterials applied to replace or restore body 1.1 Wear and corrosion functions are exposed to different mechanical forces and Biomaterials are exposed to different mechanical forces and corrosion processes due to body fluids, which might result in corrosion processes due to body fluids, which might result in the generation of corrosion products, wear debris and parti- the generation of corrosion products, wear debris and parti- cles potentially leading to inflammation and inhibition or loss cles potentially leading to inflammation and inhibition or loss of function. This brief review will give a short overview of function. about the processes of wear generation and corrosion, the “Wear can be defined as an […] progressive loss of ma- occurrence of the respective wear products in different medi- terial from one or both surfaces in relative motion between cal applications and their biological influences. Wear and them.”  Besides corrosion, abrasion, adhesion, fatigue, corrosion are important factors that control and determine the erosion can be classified as wear processes.  During the long-term clinical performance of a biomaterial. process of abrasion (two- or three-body-wear) a hard rough Keywords: medical devices, biomaterial, wear debris, surface slides across a softer one. Two solid surfaces slide corrosion, particles, inflammation, fibrosis along each other during the process of adhesion and tend to plastic deformation of very small fragments, which is influ- https://doi.org/10.1515/cdbme-2020-3112 enced by the properties of the lubricant.  Fatigue wear occurs during excessive application of cyclic loading to the material.  Hardness, wear resistance and fracture tough- 1 Introduction ness determine the materials tendency to generate wear, which is further influenced by microstructural factors, lubri- The specific function of degenerated or traumatized tis- cant rheology and geometry. [7,8] Particles can be generated sues/organs can be replaced or restored using a broad range by fretting induced by small-amplitude oscillatory micro- of biomaterials applied in various forms of implants and motions.  Two-component implants can exhibit micro- medical devices in orthopaedic or dental surgery, as sutures gaps potentially invaded by body fluids (e. g. saliva) or mi- or ligament replacement, in the cardiovascular field, skin croorganisms producing a biofilm to act as lubricant, which wound healing or ophthalmologic and otologic applications. leads to friction.   Depending on the location and designated function (stress Corrosion can be described as a gradual degradation of distribution, articulation, blood flow, light/ sound/ load materials due to the electrochemical environment of body transmission) the material has to fulfil specific requirements fluids (e. g. blood, plasma, saliva) containing anions and (morphology, porosity, mechanics, surface functionalization) cations and dissolved oxygen.  Blood contains high levels and is exposed to various biological, chemical and mechani- of electrolytes and is therefore provoking accelerated materi- cal influences. [1–3] According to the type of tissue metals, al corrosion due to high ionic conductivity and anodic and ceramics, polymers and appropriate composites are used.  cationic reactions. Thereby, metallic materials react in differ- Host factors (e.g. gender, age, medical/physiological consti- ent and even galvanic manner in the corrosion process. [3,10] tution) play a crucial role for acceptance of the biomaterial The process of corrosion is influenced by present bacteria, just like the biocompatibility of the material.  pH, which is decreased around the implant as well as ther- modynamic forces and the kinetic barrier.  About -4 2.5 x 10 mm/year are mentioned as a tolerable corrosion rate for metallic implant systems.  Moreover, the presence ______ of wear accelerates the process of corrosion or occurs simul- *Corresponding author: Dr. Jana Markhoff: Institute for taneously (tribocorrosion), even synergistic interactions are Biomedical Engineering, University Medical Center Rostock, described. [3,9] The loss of structural integrity and function Friedrich-Barnewitz-Str. 4, 18119 Rostock, Germany, E-mail: email@example.com of the implanted biomaterial ensue. The rapid formation of a Prof. Dr. Niels Grabow: Institute for Biomedical Engineering, stable oxide layer at the surface or appropriate coatings might University Medical Center Rostock, Germany Open Access. © 2020 Jana Markhoff et al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 License. Jana Markhoff et al., Wear and corrosion in medical applications — 2 inhibit or at least delay corrosion, since corrosion is also ponent (abutment, crown), whose mismatch of mechanical associated with delayed wound healing.  Although, wear properties can be a reason for mechanical failure. [9,22] debris, ion release and aseptic implant loosening are mainly Investigating the influence of titanium particles from dental associated with joint prosthesis in orthopaedics  there are implants to mesenchymal stem cells (MSCs) and fibroblasts other applications of tribology in the biomedical field, too. in the process of peri-implantitis, Bressan et al.  stated a chain of events outgoing from the increased production of reactive oxygen species. Thereby, neutrophil cell recruitment 1.1.1 Orthopaedics resulted in ECM degradation due to higher levels of matrix metalloproteinases, which led to an altered differentiation of Corrosion has also been identified in stem-cement interfaces the MSCs and activation of osteolytic processes. Titanium of hip-implants, but also in bone plates and screws at the particles in the range from 9 - 54 nm diameters have been bone-stem and permanent implants of toe, finger, spinal or detected in peri-implantitis biopsies.  The corrosion of shoulder.  Stainless steel (SS) and commercial pure titani- endosseous implants is influenced by the acidic pH of local um used for internal fixation showed an 86 %-rate to corrode body fluids, temperature, plaque and food properties. Galvan- after one year of implantation with significantly increased ic corrosion is a common problem.  Metal ions have been corrosion grades for SS  and distinct inflammation and detected in the implant surrounding gingiva and bone.  tissue reactions in the surrounding soft tissue with high amounts of particles . Spinal fixation devices made of SS were examined regarding the generation of particles in vivo 1.1.3 Cardiovascular implants and showed up to 22.3 x 10 particles per gram in some spec- imen.  Within 57 retrieved thoracolumbar spine implants Artificial heart valves or ventricular assist devices (VAD; wear occurred in 75% and corrosion in 39% of the implants e. g. pumps) involve moving components and are therefore after at least one year. Thereby, 58 % of SS implants were able to produce mechanical wear and friction. Further, a affected compared to titanium. Corrosion was mainly present blood caused fluid-friction is generated at the surface of at the interfaces between the single implant components.  cardiovascular devices, also a friction between device and Thomson et al.  examined the biocompatibility of soft tissue.  Mechanical heart valves (MHVs) and bio- particles from ligament prosthesis in vitro and in vivo reveal- prosthetic heart valves (BHV) underlie different loading ing no cytotoxicity, but an inflammatory potential of high forces being higher in MHVs; which are associated with concentrations at least in vitro. impact wear and friction wear.  The bearing wear rate measured in a VAD was less than 1.46 µm per year, but the applied measurement procedure was strongly restricted.  1.1.2 Dentistry Nitinol as shape-memory alloy is used for minimal-invasive applications in heart valve therapy. Nitinol wires have been (Artificial) tooth wear is affiliated to the processes of attrition tested regarding their wear resistance performing an acceler- (tooth-tooth contact), erosion (tissue dissolution by acidic ated wear test (up to 20 Hz, 200 million cycles) to imitate the substances) and abrasion (interaction between teeth and other effects of long-term wear (5 years) that led to an increase of materials) and also delamination and fatigue. [17,18] Li- local corrosion rates.  tonjua et al.  name a material loss of 50 to 68 µm/year of The biomaterial properties of stents might cause resteno- enamel in natural teeth indicating dependence from the stud- sis, e.g. in case of drug-eluting stents and peripheral vessels. ied population and age. The same forces have to be assumed  Generation of metallic debris and alteration of mechani- affecting artificial dentures and dental composites. Turssi et cal properties due to in vivo stress corrosion can lead to ma- al.  showed a volumetric loss between 0.4 to 1.6 mm³ terial fatigue and stent fracture as shown in retrieval analysis when applying 80 N at a frequency of 1.9 Hz for 105 cycles of explanted stents made of nitinol. [3,26] Especially, in the to five different dental resin composites, while the upper overlapping area of stents fretting wear is observed.  limit of the physiological chewing frequency are 2 Hz. Ar- Wear has been detected in an explanted vascular stent-graft secularatne et al.  measured an average coefficient of for endovascular aneurysm repair, which might lead to blood friction values in the range 0.03 - 0.09 after comparing dif- leakage.  Nickel ions from shape memory alloys are ferent resin materials under 2 - 10 N with 66 cycles/min and further associated with allergic reactions.  The usage of artificial saliva lubricant. Just to name a few studies. Oral biodegradable magnesium materials could elude the problem implants are made of a metal (abutment) and a ceramic com- of corrosion-induced cracking and fatigue.  Jana Markhoff et al., Wear and corrosion in medical applications — 3 Wear studies regarding heart valves, cardiovascular ad- 2 Conclusion vices or stents are barely published. Nevertheless, presence of wear should not be excluded since tribological processes Biocompatibility studies of biomaterials are mainly con- occur. ducted using bulk materials or scaffolds, although it has been shown that particles and ions of the same material cause cytotoxicity and inflammation in comparison , therefore 1.2 Consequence of wear and wear and corrosion are important factors that control and corrosion determine the long-term clinical performance of a biomateri- al.  Although, wear and corrosion levels might seem Cellular effects depend on the material, but also on parti- trivial in particular applications, there is a necessity for the cle size as well as morphology, chemistry and number, which usage and establishment of tissue and application specific differ between materials and applications.  Fibrils and methods and a combination of physical, chemical and biolog- specific morphologies of particles are associated with an ical ones to measure and value even low concentrations. increased cellular reaction , as are smaller particles.  Particles in the range of 0.24 - 7.2 μm are considered to be Author Statement notably reactive and inflammatory.  Research funding: Financial support by RESPONSE "Part- The peri-prosthetic environment hosts different tissue- nership for Innovation in Implant Technology" is gratefully specific cell types. Proteins attach to the surface of particles acknowledged. Conflict of interest: Authors state no conflict and ions allowing their internalization into cells.  Particle of interest. Informed consent: Informed consent is not appli- contact, phagocytosis or pinocytosis of particles (size 150 nm cable. Ethical approval: The conducted research is not related - 10 µm) cause the release of various mediators (interleukins, to either human or animals use. growth factors, chemokines).  Monocytes and macro- phages play a major role in recognition of particles causing recruitment, proliferation, as well as differentiation and matu- References ration of precursor cells via cytokines and pro-inflammatory  Patel NR, Gohil PP. A Review on Biomaterials: A Review mediators.  Within this particle-mediated cascade present on Biomaterials: Scope, Applications & Human Anatomy cells mutually inhibit or activate each other provoking in- Significance. 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Current Directions in Biomedical Engineering – de Gruyter
Published: Sep 1, 2020
Keywords: medical devices; biomaterial; wear debris; corrosion; particles; inflammation; fibrosis
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