Materi Biomaterial 2 2

Learn from yesterday, live for today, dream for tomorrow - - - Chicken Soup for the Soul
BIOMATERIALS FOR ORTHOPEDICS1

Brendamari Rodrguez, Annette Romero, Omar Soto and Oswaldo de Varorna 2
Abstract- Biomaterials deal with the material

aspects of the medical devices.
Biomaterials
scientist are concerned with the physical and
chemical properties of materials and their
suitability for a particular device. They are
concerned how these properties are altered by the
biological environment and how the materials may
affect the body. Here we shall discuss selected
biomaterials for orthopaedics.
Keywords- Biomaterials, orthopedics, joints,
artificial joints, 316L stainless steel, Titanium,
Cobalt-Chrome, Zirconium, ceramics, calcium
phosphate, calcium sulfate, materials.
materials are incorporated into the surrounding tissue, or

may even dissolve completely over a period of time.
Metals are typically inert, ceramics may be inert, active or
resorbable and polymers may be inert or resorbable. Table
1 shows examples of biomaterials [4].
Table 1. Types given of biomaterials [4].
Metals
Ceramics
Polymers
316L stainless
steel
Alumina
Ultra high
molecular
weight
polyethylene
(UHMWPE)
Zirconia
Co-Cr Alloys
Carbon
BACKGROUND
Titanium
Biomaterials improve the quality of life for an ever
increasing number of people each year. The range of
applications is vast and includes such things as joint and
limb replacements, artificial arteries and skin, contact
lenses, and dentures. This increasing demand arises from
an aging population with higher quality of life
expectations. The biomaterials community is producing
new and improved implant materials and techniques to
meet this demand, but also to aid the treatment of younger
patients where the necessary properties are even more
demanding. A counter force to this technological push is
the increasing level of regulation and the threat of
litigation. To meet these conflicting needs it is necessary
to have reliable methods of characterization of the
material and material/host tissue interactions. The main
property required of a biomaterial is that it does not illicit
an adverse reaction when placed into service [4].
BIOMATERIALS CLASSIFICATIONS
Biomedical materials can be divided roughly into three
main types governed by the tissue response. In broad
terms, inert (more strictly, nearly inert) materials illicit no
or minimal tissue response. Active materials encourage
bonding to surrounding tissue with, for example, new
bone growth being stimulated. Degradable, or resorbable
__________
1
This review article was prepared on May 14, 2004 for

the course on Mechanics of Materials I. Course
Instructor: Dr Megh Goyal, Professor in Biomechanical
Engineering, Mayaguez Puerto Rico 00681-5984. For
details contact: m_goyal@ece.uprm.edu or visit at:
http://www.ece.uprm.edu/~m_goyal/home.htm
2
The authors are in the alphabetical order.
3
The numbers in the parentheses refer to references in
the bibliography.
May 2004
Hydroxyapatite
Ti6Al4V
Polyurethane
(PE)
APPLICATIONS
The range of applications for biomaterials is large. The
number of different biomaterials is also significant.
Applications of biomaterials are discussed below:
1. Orthopaedic Applications
Metallic, ceramic and polymeric biomaterials are used in
orthopaedic applications. Metallic materials are normally
used for load bearing members such as pins and plates
and femoral stems etc. Ceramics such as alumina and
zirconia are used for wear applications in joint
replacements, while hydroxyapatite is used for bone
bonding applications to assist implant integration.
Polymers such as ultra high molecular weight
polyethylene are used as articulating surfaces against
ceramic components in joint replacements.
Porous alumina has also been used as a bone spacer to
replace large sections of bone which have had to be
removed due to disease, [4].
2. Dental Applications
Metallic biomaterials have been used as pins for
anchoring tooth implants and as parts of orthodontic
devices. Ceramics have found uses as tooth implants
including alumina and dental porcelains. Hydroxyapatite
has been used for coatings on metallic pins and to fill
large bone voids resulting from disease or trauma.
Polymers, have are also orthodontic devices such as plates
and dentures, [4].
Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez
GENERAL REQUIREMENTS
Orthopaedics, like many specialties, has developed

through a necessity to correct deformity, restore
function and alleviate pain. Orthopaedic surgeons
have developed an ability to prevent major losses of
bodily function and indeed they can prevent otherwise
inevitable death. They seek perfection of their art, by
ensuring that the patient reaches optimal condition in
the shortest period of time by the safest possible
method.
History is very important to an orthopaedic surgeon.
The Orthopaedic surgeon has once again been
presented with advancing technology. This technology
must be applied to the surgeon's practice, but it is best
applied only when the surgeon has an underlying
knowledge of the history of his art. He must be aware
of the way surgeons in the past have contributed to
orthopaedics and more importantly, of the mistakes
but they have made in the process. The surgeon who
makes a mistake that was made by someone before
him, is surely humbled and seen as poorly educated.
So is he who states that he has developed a technique
that no one has thought of before, because chances are
that it has been thought of in the past.
In order for orthopaedics to advance in an optimal
manner, it is clear that attention must be paid to a
history of orthopaedics. The past is our foundation for
future developments, we must build upon it so that we
too can act as a stable foundation for future
generations.
May 2004
Figure 1. Common sites of infection of bones and joints

[16] .
Figure1 shows common sites of infection of bones and
joints. It includes pyogenic and tuberculous infection of
joints, and osteomyelitis of bones, especially of the hands
and feet, and of subcutaneous bones such as the tibiae. In
cases when improvement cannot be gained through
physical therapy, nonsurgical treatments, or surgical
repairs, orthopedic surgeons often advised joint
replacement surgery in which the deteriorated joint is
removed and replaced with a man-made device. Figure 2
shows a bone plate to assist in the healing of a fracture in
the bone. The plate is generally removed once the bone has
healed and the bone can support loads without refracturing.
Artificial joints consist of a plastic cup made of ultrahigh
molecular weight polyethylene (UHMWPE), placed in the
joint socket, and a metal (titanium or cobalt chromium
alloy) or ceramic (aluminum oxide or zirconium oxide) ball
affixed to a metal stem. This type of artificial joint is used
to replace hip, knee, shoulder, wrist, finger, or toe joints to
restore function that has been impaired as a result of
arthritis or other degenerative joint diseases or trauma from
sports injuries or other accidents. Joint replacement surgery
is performed on an estimated 300,000 patients per year in
the U.S. In most cases, it brings welcome relief and
mobility after years of pain (Figure 3). After about 10
years of use, these artificial joints often need to be replaced
because of wear and fatigue-induced delamination of the
polymeric component. Institute engineers are developing
improved materials to extend the lifetime of orthopedic
implants such as knees and hips
Figure 2. Bone plate, introduced in the early 1900s to

assist in the healing of skeletal fractures, were among
the earliest successful biomedical implants [5].
Figure 3. Artificial knee joints are implanted in

patients with a diseased joint to alleviate pain and
restore function [5].
One might think that only surgeons and bioengineers
would be involved in improving the design and
performance of these implants. Not so. Materials and
design engineers (Figure 4) must consider the
physiologic loads to be placed on the implants, so they
can design for sufficient structural integrity. Material
choices also must take into account biocompatibility
with surrounding tissues, the environment and
corrosion issues, friction and wear of the articulating
surfaces, and implant fixation either through
osseointegration (the degree to which bone will grow
next to or integrate into the implant) or bone cement.
In fact, the orthopedic implant community agrees that
one of the major
May 2004
Figure 4. Senior Research Scientist Dr. Cheryl R.

Blanchard, Mechanical and Materials Engineering Division
of SwRI [5].
problems plaguing these devices is purely materials-related:
wear of the polymer cup in total joint replacements. The
wear problem plays out a biological disaster in the body.
Any use of the joint, such as walking in the case of knees or
hips, results in cyclic articulation of the polymer cup
against the metal or ceramic ball. Due to significant
localized contact stresses at the ball/socket interface, small
regions of UHMWPE tend to adhere to the metal or
ceramic ball. During the reciprocating motion of normal
joint use, fibrils will be drawn from the adherent regions on
the polymer surface and break off to form submicrometersized wear debris. This adhesive wear mechanism, coupled
with fatigue-related delamination of the UHMWPE (most
prevalent in knee joints), results in tiny polymer particles
being shed into the surrounding synovial fluid and tissues.
The biological interaction with small particles in the body
then becomes critical. The bodys immune system attempts,
unsuccessfully, to digest the wear particles (as it would a
bacterium or virus). Enzymes are released that eventually
result in the death of adjacent bone cells, or osteolysis.
Over time, sufficient bone is resorbed around the implant to
cause mechanical loosening, which necessitates a costly
and painful implant replacement, or revision. Since the
loosening is not caused by an associated infection, it is
termed "aseptic. The average life of a total joint
replacement is 8-12 years even less in more active or
younger patients. Because it is necessary to remove some
bone surrounding the implant, generally only one revision
surgery is possible, thus limiting current orthopedic implant
technology to older, less active individuals.
A relatively recent incident in the biomedical device field
serves to illustrate the importance of materials choice and
engineering
on
implant
performance.
The
temporomandibular joint (TMJ) provides all jaw mobility
and is crucial for chewing, talking and swallowing. This
joint can deteriorate from disease or trauma which, in
severe cases, necessitates replacement by an artificial joint.
For many years, less than optimum technologies existed for
TMJ implants. In the late 1970s, a TMJ replacement using
polytetraflouroethylene (PTFE) as the bearing counterface
was invented, and, in 1983, the inventors received FDA
approval to market the PTFE implant, which was called the
Interpositional Implant (IPI). In theory, PTFE would

seem an appropriate choice for an implant material, as
it exhibits a low coefficient of friction and has been
used extensively as a bearing surface in other
engineering applications. However, of the more than
25,000 PTFE TMJ implants received by patients,
failed.
The fibrillation and small particles are
characteristic of an adhesive wear mechanism, which
can result in surrounding bone loss and the need for
implant replacement (Figure 5).
Figure 5. These micrographs, taken at a magnification

of 20,000X on a scanning electron microscope,
illustrate the wear problem that occurs with an
artificial joint implant component (socket) constructed
of UHMWPE. At top is unworn UHMWPE. The
UHMWPE sample has undergone a friction and wear
test versus cobalt chromium (artificial joint ball
material) [5].
A low coefficient of friction of PTFE is due to
formation of a thin film of the material onto the
opposing bearing surface. Although this transfer film
acts as a lubricant, it also, by virtue of its formation,
subjects the material to an adhesive wear mechanism.
In the case of the PTFE TMJ implants, surrounding
tissues quickly became overwhelmed by wear debris,
and the immune system response result in osteolysis,
causing massive destruction of the joint and
surrounding tissues. For those people who received the
implants, this was truly a tragedy; many suffered
severe facial deformities, and most experienced
unbearable pain and were no longer able to chew,
swallow, or sleep. At the time the IPI was developed,
evidence did exist that PTFE was not an appropriate
implant material.
In the late 1950s, Dr. John Charnley, at Wrightington
Hospital in the U.K. pioneered the first total hip
replacements using PTFE as the cup bearing surface.
Dr. Charnley reported massive wear of the PTFE part
and early clinical failure as a result of aseptic
loosening. These findings, reported widely in the open
literature and in later reports from researchers testing
the IPI implant, should have been sufficient warning
that PTFE was not an appropriate material to use as a
load-bearing surface in the body. Work at SwRI is
addressing the wear problem in UHMWPE total joint
prostheses.
In collaboration with scientists at the University of
Texas Health Science Center at San Antonio funded
May 2004
by the National Science Foundation, SwRI scientists and

engineers are studying the wear process and biological
responses to wear debris. Results of these studies have led
to novel ideas for materials modification and development.
The Institute is also developing new composite materials to
defeat the fatigue-induced delamination observed in the
UHMWPE component of knee implants. Studies of wear
debris extracted from actual tissue samples of patients
whose implants failed as a result of aseptic loosening have
generated significant information regarding wear particle
size, shape, and surface morphology. Institute scientists
were the first to use the atomic force microscope (AFM) to
produce detailed, high resolution images of wear particles.
A few hundred nanometers in size, the UHMWPE wear
debris studied at SwRI sometimes exhibits a cauliflowerlike surface morphology. Scientists at the Health Science
Center will use similar particles to study the biological
response elicited by the particles. By combining wear
debris and cellular response studies, engineers and
biologists will be able to better understand implant failure
and to re-engineer implants to prevent future problems, [ 5,
16 ].
BONE GRAFT SUBSTITUTES

In many cases, the loss of bone due to surgery, accidents or
normal aging requires the substitution of bone in order to
facilitate the rehabilitation of the patient. Figure 6 shows
two cases in which bone substitution is required.
a. Collapsed disc.
b. Non-Union
Figure 6. Examples where bone substitution is required

[24]
Nowadays, the need for bone substitutes includes
autograftings procedures, allograftings procedures or
synthetic bone substitutes. Autografting, which represents
about 58% of the current bone substitutes, involves
harvesting a bone from one location in the patients body,
usually taken from the pelvic region, and transplanting it
into another part of the same patient. Using this procedure,
when the autogenous grafts are available, typically
produces the best clinical results. This procedure has
obvious benefits, like the elimination of immunogenicity
problems. Autografting, however, has several associated
problems including the additional surgical costs for the
harvesting procedure, infection, pain at the harvesting site
and that the sample of the patients own bone that can be
taken is very small, among other things. The allografting
procedure consists in harvesting and processing bone from
a live or deceased donor and then transplanting it to the
patient. These implants are acellular and are less successful
than autografts implants for reasons attributed to
immuogenicity and the absence of viable cells that

become osteoblasts. Another disadvantage of
allografting is relate with transmitted disease. Due to
complications related to these procedures, bone graft
substitutes made with synthetics materials are
becoming very important in bone substitutions
procedures. The ideal bone graft substitute should be
osteogenic, biocompatible, bioabsorbable, able to
provide structural support, easy to use clinically, and
cost-effective. The bone grafts and their substitutes
can be divided according to their properties of
osteoconduction, osteoinduction, and osteogenesis.
Table 2 shows classifications of bone graft substitutes.
The synthetic material belongs to the osteoconductive
category. The osteoconductive synthetic grafts that
are used generally falls under the calcium sulphate and
calcium phosphate groups. They can be used as preset
and injectable materials. The next sections will
present a more detailed information about synthetic
bone graft, calcium sulphate and calcium phosphate
materials, [6, 7].
Table 2. Classification of Bone Graft Substitutes
Based on Properties [6].
Osteoconduction
Description
Provides a
passive porous
scaffold to
support of direct
bone formation
Osteoinduction
Induces a
differentiation of
stem cells into
osteogenic cells
Osteogenesis
Provides stem
cells with
osteogenic
potential, which
directly lays
down new bone
Provides more
than one of the
above
Combined
Figure 7. Schematic drawing of a vertebral body, on

which synthetic bone grafting (vertebroplasty) is performed
using the injection-suction method. Two needles are used,
one for injecting the synthetic bone material and the other
for developing an underpressure in the vertebral body. This
method reduces the risk of leakage into vessels or the
nerves in the spinal canal, [7].
Classes
Calcium
sulphate,
ceramics,
calcium
phosphate
cements,
collagen,
bioactive,
glass, synthetic
polymers
Demineralized
bone matrix,
bone
morphogenic,
proteins,
growth factors,
gene therapy
Bone marrow
aspirate
Figure 8. Fracture treated with synthetic bone graft and
internal fixation [7].
2. Synthetic Bone Grafts
Composites
1. Indications for Bone Substitutes

The main indications for bone substitutes will be in
spinal fusion, bone defects, osteoporotic fractures,
revision surgery and, recently, vertebroplasty
(injecting a vertebra with synthetic material).
Vertebroplasty using polymethylmethacrylate was first
introduced in France more than 15 years ago by
neurosurgeons, but its use is now spreading rapidly.
May 2004
This mini-invasive procedure for the treatment of vertebral

fractures in osteoporosis can reinforce fractured bone,
alleviate chronic pain and prevent further vertebral
collapse. Vertebroplasty is performed under biplanar
fluoroscopic control, CT or guided navigation (Figure 7)
[6, 7].
Synthetic materials can be made from different materials

that are biologically compatible materials. The synthetics
materials exhibits the property of being osteoconductives
materials, which mean being bone-stimulating materials.
Some of these materials can be mixed with bone marrow
aspirate to obtain osteoinductive properties (bone forming).
Some important characteristics of synthetic bone substitutes
are:
-
Its porosity (determines the amount of surface

area expose to bone tissue ingrowth). Porosity
alone is not adequate for bone ingrowth.
Resorption rate (ability to disappear so as

to be replaced by new bone).
Biocompatibility to prevent inflammatory

reactions, minimizing the interference
with bone induction.
Biodegradable so that the patients own

bone can replace the foreign substitute.
The osteoconductive synthetic grafts that are used

generally are made of calcium sulphate and calcium
phosphate materials. Hydroxyapatite synthetic bone ,
a derivate of calcium phosphate, is an important
material due to its biocompatibility. Figure 8 shows
an example of a fracture treated with injectable
synthetic bone and internal fixation [1, 6].
TITANIUM AND TITANIUM ALLOYS

Although Titanium has excellent heat and corrosion
resistance capabilities, it is extremely difficult to form
and machine into desired shapes. Also its extreme
chemical reactivity with air, combined with other
factors, has caused the cost of titanium components to
be very high. The only economical applications of
this material currently (until more efficient techniques
of working with it can be found) are in aerospace
applications where weight and temperature resistance
are very important, and in military applications, they
provide extreme corrosion resistance and durability.
Titanium is also used in biomedical applications such
as prosthetics and implants ( Figure 9) due to its
biological inertness.
There are several titanium alloys that have been
developed for use in the past four decades. These
alloys include Ti-6Al-4V (an alloy of titanium,
aluminum and vanadium), the most highly used alloy
of titanium and Ti-4Al-4Mo-2Sn-0.5Si (an alloy of
titanium, aluminum, molybdenum, tin, and silicon),
which was developed later and is used less
frequently. Table 3 presents some properties of the
titanium alloy Ti-6Al-4V [17].
Table 3. Properties of Ti-6Al-4V at 25C [22].

Property of the Ti-6Al-4V
Values of the Ti-6Al-4V
Density
4430
Poisson's Ratio
Elastic Modulus
GPa
Tensile Strength
MPa
Yield Strength
MPa
Elongation
%
Reduction in Area
%
Hardness
HRC
0.34
113.8
993
924
14
30
36
a. Physiological Behavior
These materials are classified as biologically inert
biomaterials or bioinert. As such, they remain essentially
unchanged when implanted into human bodies. The
human body is able to recognize these materials as
foreign, and tries to isolate them by encasing them in
fibrous tissues. However, they do not illicit any adverse
reactions and are tolerated well by the human body.
Furthermore, they do not induce allergic reactions such as
has been observed on occasion with some stainless steels,
which have induced nickel hypersensitivity in
surrounding tissues. The surface of titanium is often
modified by coating it with hydroxyapatite. Plasma
spraying is the only commercially accepted technique for
depositing such coatings. The hydroxyapatite provides a
bioactive surface (i.e. it actively participates in bone
bonding), such that bone cements and other mechanical
fixation devices are often not required [18].
b. Mechanical Suitability
Titanium and its alloys possess suitable mechanical
properties such as strength, bend strength and fatigue
resistance to be used in orthopaedics and dental
applications. This is why they have been employed in
load-bearing biomedical applications instead of materials
such as hydroxyapatite, which displays bioactive
behavior. Other specific properties that make it a
desirable biomaterial are density and elastic modulus. In
terms of density, it has a significantly lower density
(Table 4) than other metallic biomaterials, implying that
the implants will be lighter than similar items fabricated
out of stainless steel or cobalt chrome alloysHaving a
lower elastic modulus compared to the other metals is
desirable as the metal tends to behave a little bit more like
bone itself, which is desirable from a biomechanical
perspective. This implies that the bone hosting the
biomaterial is less likely to atrophy and resorb [18].
Figure 9.
Example of a titanium biomedical
applications [17].
May 2004
Table 4: Density and elastic modulus of selected

biomaterials [18].
Material
Density
Cortical Bone
Cobalt-Chrome alloy
316L Stainless Steel
CP Titanium
Ti6Al4V
~2.0 g.cm-3
~8.5 g.cm-3
8.0 g.cm-3
4.51 g.cm-3
4.40 g.cm-3
Elastic
Modulus
7-30 GPa
230 GPa
200 GPa
110 GPa
106 GPa
Figure 11. A total knee replacement prosthesis (photo

courtesy of Dr. Besim Ben-Nissan) [18].
CERAMICS
Figure 10. Implant components for a total hip

replacement (photo courtesy of Dr. Karlis Gross) [18].
c. Applications
Titanium is commonly used in orthopaedic implants such
as joint replacements and bone pins, plates and screws.
Figure 10 shows the various components of a total hip
replacement. On the left is the femoral stem made of a
titanium alloy. The long round section fits down into the
thigh bone or femur. The white section is a
hydroxyapatite coating to encourage bone bonding to the
implant. This section is also macrotextured to provide
surface features for the bone to mechanically interlock
with. The ball on top of the femoral stem is called the
femoral head. It is made of zirconia ceramic and fits into
the hip joint in the pelvis.
The hemispherical item on the right is the acetabular cup,
also made from titanium alloy. It is coated with porous
alumina ceramic, to allow bone ingrowth for stabilisation.
A ultra high molecular weight polyethylene (UHMWPE)
liner fits inside the acetabular cup and provides the
articulating surface for the femoral head.
Figure 11 shows a prototype total knee replacement
prosthesis, similar in design to many commercial
implants. It consists of titanium alloy upper and lower
structural components. A zirconia wear surface has
been fabricated for the upper section. Similar to the
hip prosthesis, this articulates against a UHMWPE
insert on the lower section. Other orthopaedic
applications for titanium-based materials include bone
pins, plates and screws, used for repairing broken
bones etc [18].
May 2004
For many years, ceramic materials were only useful in the

making of pottery and other artwork. They have since
evolved into one of the most important biomaterials used
today because of their beneficial properties. Ceramic
materials are nonmetallic, inorganic compounds that
exhibit great strength and stiffness, resistance to corrosion
and wear, and low density. These characteristics allow
ceramics to become prime candidates for a wide range of
biomedical applications. Ceramics are used in several
different fields such as dentistry, orthopaedics, and as
medical sensors. In dentistry, ceramics are commonly used
for implants such as crowns and dentures. The orthopedic
field utilizes ceramics for joint and bone segment
replacement and temporary bone repair devices. Ceramics
are also used as coatings for implants made of other
materials to provide a biocompatible interface with the
body [9].
1. Bone graft substitutes: Calcium phosphate
The first applications of calcium phosphate salts were
powders. The ceramic form first became available in the
1960s and was later evaluated as a bone graft substitute.
The synthetic hydroxyapatite is one of the most commonly
used calcium phosphate ceramics. Synthetic ceramics
provide an osteoconductive scaffold to which chemotactic,
circulating proteins and cells can migrate and adhere, and
within which progenitor cells can differentiate into
functioning osteoblasts. Ceramics do not supply osteogenic
cells as found in autograft. They do not have even the weak
osteoinductive potential found with allograft. However,
ceramics are readily available and bypass the known risks
of allograft-induced immunogenic response or disease
conveyance, as well as surgical complications from
retrieving bone from an autogenous second site. The
chemistry, architecture, shape, and positioning of the
ceramic material influence the speed and extent of
remodeling. Its bioresorbability depends on the amount of
surface area exposed, which is governed, in turn, by crystal
size, the form supplied, and density. A ceramic material
formed as a dense block exposes only a small surface area,
thus slowing or confining surfaces accessible for
resorption. Most calcium phosphates are classified as

resorbable biomaterials. This means that under
physiological conditions they will dissolve. Table 5
shows examples of calcium phosphate compounds.
The benefit of calcium phosphate biomaterials is that
the dissolution products can be readily assimilated by
the human body. Calcium phosphate is mainly used in
filling defects (for example, areas of bone loss such as
in tibial plateau fracture), in composite grafts to
supplement autograft, and at sites where compression
(rather than tension, bending, or torsion) is the
dominant mode of mechanical loading.
Variation in the properties of calcium phosphate
coatings has an effect on the bone-bonding mechanism
and the rate of bone formation. Both the composition
and the crystallinity of the calcium phosphate coating
are important parameters that determine its bioactivity
characteristics. Hydroxyapatite {Ca10[PO4]6[OH]2}
has the ability to bond to osseous and epithelial tissue.
Hydroxyapatite, with beneficial bone tissue growth
effects, is used as a coating material since it does not
have sufficient strength and toughness to be used by
itself as biomedical implants. Unlike other calcium
phosphates, hydroxyapatite does not break down
under physiological conditions.
Under normal
physiological conditions of pH 7.2, hydroxyapatite is
the stable calcium phosphate compound. This may
drop to as low as pH 5.5 in the region of tissue
damage, although this would eventually return to pH
7.2 over a period of time. Even under these conditions
hydroxyapatite is still the stable phase. It 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. Figure 12 shows bone ingrowth around
synthetic hydroxyapatite.
While its mechanical
properties have been found to be unsuitable for loadbearing applications, 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 [3, 6].
2. Calcium Sulphate (Plaster of Paris)

Although its external use for creation of hard setting
bandages dates back to the seventeenth century, the
first internal use of Gypsum (Plaster of Paris) to fill
bony defects was reported in 1892 by Dressmann.
The application of Plaster of Paris as a bone void
filler, and the use of antibiotic-laden plaster in the
treatment of infected bony defects has been supported
by various studies. Peltier reported the initial results
of its use and recommended it as a cheap,
bioabsorbable bone graft substitute. Calcium sulphate
May 2004
Table 5. Calcium phosphate compounds as biomaterials

[3].
Chemical
Name
Amorphous
calcium
phosphate
Dicalcium
Phosphate
Tricalcium
Phosphate
Tricalcium
Phosphate
Pentacalcium
Hydroxyl
Apatite
Tetracalcium
Phosphate
Monoxide
Abbr
Chemical
Formula
Phase
ACP
DCP
CaHPO4
Monetite
-TCP
Ca3(PO4)2
Ca/P
1.00
1.50
-TCP
Ca3(PO4)2
Whitlock
ite
HAp
Ca10(PO4)6(O
H)2
Hydroxy
apatite
1.67
TTCP
Ca4O(PO4)2
Hilgenst
ockite
2.00
1.50
Figure 12. Bone ingrowth around synthetic hydroxyapatite

[7].
(CaSO4) has long been used in its partially hydrated form.

When mixed with water, it initiates an exothermic reaction
that leads to recrystallization of the calcium sulfate into the
solid form. When it is mixed with The problem with this
reaction is that the recrystallization proceeds randomly,
producing crystals of varying size and shape as well as
multiple defects within the structure. This variability in the
crystalline structure causes significant variability in
solubility, mechanical properties, and porosity.
In
addition, it may resorb too rapidly, leading to fibrous
ingrowth instead of bony substitution. Medical grade
calcium sulfate is crystallized in highly controlled
environments producing regularly shaped crystals of
similar size and shape. It possesses a slower, more
predictable solubility and resorption. One such material is
OsteoSet (Wright Medical Technology, Arlington, Tenn),
which was approved by the FDA in 1996. The material is
available in 3- and 4.8-mm pellets that typically dissolve in
vivo within 30-60 days, depending on the volume and
location. The pellets are packaged in vials and are sterilized
by gamma irradiation. It also is available in a powdered
form, the OsteoSet Resorbable Bead Kit (Wright Medical
Technology, Arlington, Tenn), standard or fast cure (5

minutes setting time for fast cure kit compared to 20
minutes for the standard kit), thus maximizing the
surgical options for adding antibiotics and filling
defects with custom molded beads or shapes. The
chief advantage is that it can be used in the presence
of infection.
Because it is bioabsorbable, it has
inherent advantages over other antibiotic carriers, such
as polymethylmethacrylate, which become a nidus for
further infection after elusion of the antibiotics, thus
requiring a separate operation for removal from the
surgical site. When combined with the eradication of
dead space and the acidic environment created during
its resorption, the compound can be an effective
treatment for acute bony infections with bone loss.
The disadvantages of calcium sulphates are their weak
mechanical strength and rapid resorption within 612
weeks. For clinical use, injectable osteoconductive
grafts should ideally be biphasic with a compressive
strength >25 Mpa. Their injection time should be
between 2 and 6 min, with a setting time of less than
10 min [3, 6].
chemically than nickel. Cobalt dissolves in dilute sulphuric

acid, nitric or hydrochloric acid and is slowly attacked by
alkalis. The oxidation rate of pure cobalt is twenty five
times that of nickel. Cobalts ability as a whitening agent
against copper alloys is inferior to that of nickel. However,
small amounts in nickel-copper alloys will neutralise the
yellowish tinge of the nickel and make them whiter. Cobalt
imparts red-hardness to tool steels. It can harden alloys to
greater extent than nickel, especially in the presence of
carbon and can form more chemical compounds in alloys
than nickel. Natural cobalt is cobalt 59, which is stable and
non-radioactive, but other isotopes 54 to 64 are all
radioactive (table 6), emitting beta and gamma radiation.
Other isotopes not listed in table 1 have short half-lives.[3]
Table 6. Cobalt isotopes and their half-lives. [3]
Isotope
Cobalt 60
Half Life
5.3 years
Cobalt 58
72 days
Cobalt 57
270 days
Cobalt 56
80 days
3. Disadvantages of Ceramics
A shortcoming noted with ceramics used as standalone bone substitutes is the initial low resistance to
impact and fracture. Due to its brittle structure, use of
a ceramic material in conditions of torsional, impact,
or shear stress is limited. However, cancellous bone
grafts likewise contribute little immediate structural
support prior to union with the host site and
remodeling along lines of stress.
Another
disadvantage found with ceramic implants is the
difficulty of radiographic assessment of the ingrowth
into the defect site until partial resorption has occurred
[1].
Aplications:
Cobalt 60 has a number of applications. These include:
COBALT AND COBALT CHROME

Cobalt and Cobalt Chrome
Other uses for cobalt are:
Cobalt
Brandt discovered cobalt around 1735. It occurs in the
minerals cobaltite, smaltite and erythrite and is often
associated with nickel, silver, lead, copper and iron
ores, from which it is most frequently obtained as a
by-product. It is also present in meteorites. Cobalt is a
brittle, hard metal white in appearance resembling
nickel (and iron) but with a bluish tinge instead of the
yellow of nickel. It is rarer and more valuable than
nickel. It is diamagnetic and has magnetic
permeability approximately two thirds that of iron and
three times that of nickel. Cobalt exists as two
allotropes over a wide temperature range. The -form
a close-packed hexagonal crystal is stable and
predominates below approximately 417C
(782F),
and the -form a cubic crystal is stable and
predominates above this temperature until the melting
point. Although allied to nickel, it is more active
May 2004
Radiographic inspection
A gamma ray source
A tracer
A radiotherapeutic agent
Irradiation of plastics
A catalyst for the sulphonation of paraffin oil. In this
application the gamma rays emitted by the cobalt
cause the reaction of sulphur dioxide and liquid
paraffin.
In superalloys for aircraft gas turbine engines

It is a key elemental ingredient in magnet steels, by
which it increases residual magnetism and coercive
force and in nonferrous-base magnetic alloys
Cobalt is an important element in numerous glass-tometal sealing alloys as well as low expansion alloys
Alloys for dental and surgical applications because
they are not attacked by physiological fluids. An
example of which is Vitallium which is used to
replace bone. Such alloys are ductile enough to
permit anchoring of dentures on neighbouring teeth
and contain up to 65% cobalt
High-speed, heavy duty, high temperature cutting
tools, and dies
Gas turbine generators
Electroplating.
Cobalt salts are used as a source of brilliant permanent

blue colour in porcelain, glass, pottery, tiles and
enamels [22, 23].
Properties
Creep Resistance
One of the main attractions of cobalt-based alloys is
their excellent creep resistance. Materials creep due to
thermally-activated movement of dislocations through
a crystalline matrix. These alloys possess a matrix that
is resistant to this as cobalt has a good tolerance for
other elements in solid solution. These elements can
effectively strengthen the matrix. Their ability to do
this depends on factors such as:
The difference in atomic size between cobalt

and the solute
The effect of the solute on the stacking fault
energy
The diffusion rate of the solute into the cobalt
matrix
It has also been found that a matrix containing a larger

number of solutes is often better than one containing a
fewer number, hence the strengthening of the matrix is
also dependent on the amount of alloying elements
available to the go into solid solution, that have not
formed carbides, or for that matter intermetallics. The
key elements for this process are chromium, tungsten,
niobium and tantalum.
A second strengthening
mechanism also exists and involves the formation of
carbides and carbonitrides forming with chromium
(primarily),
tungsten,
molybdenum,
niobium,
tantalum, zirconium, vanadium and titanium. Carbides
formed include MC, M6C, M7C3, M23C6 and
sometimes M2C3, with the amount of each depending
on factors such as availability of elements to form
carbides, carbon content and thermal history. It is also
possible for nitrogen to substitute for carbon in these
structures. Optimum properties are produced when
carbides precipitate both intergranularly and
intragranularly. Intergranular precipitation prevents
gross sliding and grain boundary migration and can
form a skeleton if present in sufficient quantities,
while intragranular precipitation strengthens the
matrix by inhibiting the motion of dislocations.
Carbide distribution by solidifaction parameters such
as pouring temperature and cooling rate. As cast alloys
are rarely heat treated, carbides will generally only
form during prolonged exposure to operating
temperatures. Wrought materials on the other hand
may be hot worked. Further strengthening can be
induced by solution heat treatment between 11751230C and rapid cooling [22, 23].
Room Temperature Properties
RoomAs these alloys are generally used at elevated
temperatures, the room temperature properties are not
May 2004
relevant to the service conditions. They do however, play a

role for manufacturers e.g. tensile strength and ductility can
influence how much hot or cold working the material can
withstand and hardness influences machinablity. It should
also be noted that room temperature properties such as
elongation can be effected by the thermal history of the
material, i.e. amount of carbide precipitation, with more
precipitation leading to lower ductility. Also increased
exposure to high temperatures increases the hardness of
higher carbon alloys more so than lower carbon content
alloys.
It has been shown that cobalt-chrome alloys with veneering
capacity, such as WirobondC, represent an alternative to
alloys with a high gold content . As far as corrosion and
biocompatibility are concerned, both groups can be
designated as equivalent. In mechanical terms (modulus of
elasticity, heat resistance, thermal conductivity), cobalt
chrome is superior to alloys with a high gold content. In
terms of price, the cobalt chrome alloys again have an
advantage. Both alloys and alloy types display adequately
high shear bond strength. The experimental results show
higher values for the gold alloys, though whether this is of
clinical relevance is still a matter of debate [22, 23].
Properties
Cobalt 61.0% base metal
Casting temperature Higher, therefore cannot

be cast with all casting machines
Investment materials No investment materials

containing plaster may be used
because the required preheating temperature
would lead to decomposition of the investment
material. The decomposition products resulting
from this react strongly to the alloy melt flowing
in.
No investment materials containing graphite may
be used since chromium carbide would otherwise
be formed, leading to extreme hardening (HV 10
> 700).
Finishing Increased work requirement and

greater wear of the equipment (grinding stones,
milling units, etc.). Consequently the price
advantage (Wirobond C: approx. DM 0.82/g; Bio
PontoStar: approx. DM 33.00/g) is reduced, but
not eliminated.
Tensile strength Higher than gold alloys
Modulus of elasticity Approximately double,

which means that WirobondC has a
significantly higher load capacity with equal
modelling strength. This is of interest for longterm stability.
0.2% ductile yield Comparable, measure for the

permanent deformation (important with clasps)
Elongation limit Lower, not of crucial

importance for the finishing capacity for crown
and bridge alloys
Hardness Higher, difficult to finish
Coefficient of thermal expansion Comparable,

see also veneering capacity
Heat resistance Significantly higher, particularly

in comparison to palladium-free gold alloys, thus
10
more secure against distortion during

veneering process
Thermal conductivity Lower than with
gold alloys, therefore greater wearing
comfort for the patient [3, 22].
Cobalt vs. Stainless Steel 316L

Stainless Sell 316L
Grade 316 is the standard molybdenum-bearing grade,
second in importance to 304 amongst the austenitic
stainless steels. The molybdenum gives 316 better
overall corrosion resistant properties than Grade 304,
particularly higher resistance to pitting and crevice
corrosion in chloride environments. It has excellent
forming and welding characteristics. It is readily brake
or roll formed into a variety of parts for applications in
the industrial, architectural, and transportation fields.
Grade 316 also has outstanding welding
characteristics. Post-weld annealing is not required
when welding thin sections.
Material non magnetic in the annealed condition, but can

become mildly magnetic following heavy cold working.
Annealing is required to rectify if necessary [3, 22, 23].
Mechanical Properties
Table 7. Mechanical properties of 316 grade stainless
steels.[3, 23]
Grade
316
316L
316H
Tensile
Str
(MPa)
min
515
485
515
Yield
Str
0.2%
Proof
(MPa)
min
205
170
205
Elong
(% in
50mm)
min
40
40
40
Hardness
Brinell
(HB)
max
Rock
well B
(HRB)
max
95
95
95
217
217
217
Note: 316H also has a requirement for a grain size of

ASTM no. 7 or coarser.
Physical Properties
Grade 316L, the low carbon version of 316 and is

immune from sensitisation (grain boundary carbide
precipitation). Thus it is extensively used in heavy
gauge welded components (over about 6mm). Grade
316H, with its higher carbon content has application at
elevated temperatures, as does stabilised grade 316Ti.
Table 8. Typical physical properties for 316 grade stainless

steels. [3, 23].
Characterised by high corrosion resistance in marine

and industrial atmospheres, it exhibits excellent
resistance to chloride attack and against complex
suphur compounds employed in the pulp and paper
processing industries. The addition of 2% to 3% of
molybdenum increases its resistance to pitting
corrosion and improves its creep resistance at elevated
temperatures. The low carbon content reduces the risk
of intergranural corrosion (Due to carbide
precipitation) during welding, reducing the need for
post weld annealing. Finally it displays good oxidation
resistance at elevated temperatures.
316/L/H
Stainless steel 316L cannot be hardened by thermal

treatment, but strength and hardness can be increased
substantially by cold working, with susequent
reduction in ductility.
Grade
Density
(kg/m3)
8000
Elastic
Modulus
(GPa)
193
Mean Co-eff of Thermal

Expansion (m/m/C)
0-100C
00315C 538C
15.9
16.2
17.5
Table 9. Possible alternative grades to 316 stainless steel

[3].
Grade
316Ti
316N
317L
904L
2205
Why it might be chosen instead of 316?

Better resistance to temperatures of around 600900C is needed.
Higher strength than standard 316.
Higher resistance to chlorides than 316L, but with
similar resistance to stress corrosion cracking.
Much higher resistance to chlorides at elevated
temperatures, with good formability
Much higher resistance to chlorides at elevated
temperatures, and higher strength than 316
Corrosion Resistance
It is now available with improved machinability (by
calcium injection treatment), which has little effect on
corrosion resistance and weldability while greatly
increasing feeds and/or speeds, plus extending tool
life.
Typical uses are: Architectural Components, Textile
Equipment, Pulp and Paper Processing Equipment,
Marine Equipment and Fittings, Photographic
Equipment and X-Ray Equipment etc..
May 2004
Excellent in a range of atmospheric environments and

many corrosive media - generally more resistant than 304.
Subject to pitting and crevice corrosion in warm chloride
environments, and to stress corrosion cracking above about
60C. Considered resistant to potable water with up to
about 1000mg/L chlorides at ambient temperatures,
reducing to about 500mg/L at 60C.
Stainless Steel 316 is usually regarded as the standard
marine grade stainless steel, but it is not resistant to
warm sea water. In many marine environments 316 does
11
exhibit surface corrosion, usually visible as brown

staining. This is particularly associated with crevices
and rough surface finish [22].
Thermal conductivity values for cobalt-based carbidehardened alloys such as HS 21 are typically about 15% of
those for pure cobalt [22, 23] .
Oxidation Resistance
Heat Resistance and Temperature Properties

Good oxidation resistance in intermittent service to
870C and in continuous service to 925C. Continuous
use of 316 in the 425-860C range is not
recommended if subsequent aqueous corrosion
resistance is important. Grade 316L is more resistant
to carbide precipitation and can be used in the above
temperature range. Grade 316H has higher strength at
elevated temperatures and is sometimes used for
structural and pressure-containing applications at
temperatures above about 500C.
316L displays good oxidation resistance in continuous
service up to 930 oC, and in intermittent service up to
870 oC. Due to its low carbon content it is also less
susceptable to carbide precipitation resulting in
intergranular corrosion when heated or slow cooled
through the temperature range 430 oC - 870 oC either
in service or during welding. There is however a
reduction in mechanical properties as temperature
increases [22].
Applications
Typical applications include:
Food preparation equipment particularly in

chloride environments.
Laboratory benches & equipment.
Coastal architectural panelling, railings & trim.
Boat fittings.
Chemical containers, including for transport.
Heat Exchangers.
Woven or welded screens for mining, quarrying

& water filtration.
Threaded fasteners.
Springs [22, 23].

Thermal Properties
Thermal expansion properties are similar to those of

nickel-based alloys.
May 2004
This property is almost entirely dictated by the chromium

content. Chromium contents in the range 20-25% are
usually sufficient to protect the alloy up to temperatures of
1100C. Although the chromium is responsible for the
formation of a protective oxide layer, it is susceptible to
attack from elements such as sulphur, vanadium and alkali
metal halides or oxides. These commonly come from
contaminatyed fuels and other sources. Sulphur penetration
caqn lead to the formation of sulphides within the alloy,
forming low melting point eutectics such as Co4S3 (melting
point 877C). Strengthening carbides may also be
preferentially attacked in some alloys [22, 23].
Cobalt Chrome:
Cobalt-chrome alloys are part of the group of non-precious
alloys, also referred to as preciousmetalfree alloys. The first cobalt-chrome alloy that was
introduced in dentistry in the1930s was an alloy used in
medical implantology, where it had already proven its
clinicaleffectiveness. It was used in the partial denture
technique and replaced steel in that field.
In dental usage the term steel became a synonym with
partial denture alloys consisting ofcobalt-chrome alloys.
However, this designation is misleading since steel refers to
iron alloyscontaining carbon. The frequently used
designation chrome-cobalt alloy is also incorrectbecause
by definition this would involve alloys on a chromium
base. What are meant arealloys on a cobalt base. Besides
being used as partial denture alloys, cobalt-chrome alloys
such as WirobondC (BEGO) can be utilised as crown and
bridge alloys for ceramic veneering. The acrylic veneering
of cobalt-chrome alloys generally displays more favourable
bond values than with precious-metal alloys.
Non-precious alloys have a negative reputation among
some dentists and dental technicians. Poor processability,
inadequate chemical and biological properties are cited as
reasons for this. This polarisation goes so far that
consideration is only given to alloys with a high gold
content, whose properties are applied to other preciousmetal alloys (on palladium or silver base and to alloys with
reduced gold content) without reflection, however. This
results in a distorted picture that does not accurately reflect
the non-precious alloys [3, 22, 23]. .
Composition
A carbon content of less than 0.02% ensures that no carbide
precipitation that would lead to brittleness of the marginal
areas of the seam occurs during laser welding. This would
then result in an increased risk of fracture. Highly pure
base metals are used to make alloys. However, there are no
100% pure metals. For example, platinum ores contain
palladium and sometimes also nickel impurities, cobalt is
accompanied by nickel (and conversely), etc. Complete
12
separation of the elements is never possible. The

relevant standards
stipulate a maximum nickel
content of 0.1 %.
Concentrations of greater than 0.1% have to be
declared. Alloys with less than 0.1% of nickelcan be
designated as nickel-free. The claim that a cobaltchrome alloy is absolutely nickel-free would be
objectively false and can only be understood on the
basis of marketing aspects. If a restoration made of a
cobalt-chrome alloy weighed 10 g (extremely large
bridge, partial denture), the entire restoration would
contain a maximum of 0.07 g (= 70 mg) of nickel. The
latter, however, is not only found on the alloy surface,
but is spread homogeneously throughout the
restoration. If one assumes that nickel is detached
from the alloy to the same extent as cobalt (which is
probable although nickel is nobler than cobalt), the
release of nickel will amount to approx. 0.00003
mg/cm (0.03 g/cm) in the first week and constantly
decline thereafter. If one compares this to the daily
uptake in food, i.e. approx. 0.19 0.90 mg, (190 900
g), toxicological or allergic stress appears very
improbable. In the case of alloys with veneering
capacity, the available area is additionally reduced
considerably due to the veneered ceramics [3].
Corrosion
As already explained in connection with the composition of
the alloy, chromium and molybdenum are important for
corrosion resistance. The latter can be tested with an
immersion test. Test objects are suspended in a solution
consisting of sodium chloride and lactic acid (0.1 mol/l
each) and the dissolved alloy components are determined
by means of a suitable analytical method (e.g. atomic
absorption spectrometry, AAS).
The ion quantities determined can then be compared to
other alloys By comparing the corrosion rates of
comparable and clinically proven alloys, conclusions can
be made concerning the behaviour of the alloy examined.
This study method is therefore suitable as a pre-clinical
screening test. It has been shown that cobalt-chrome alloys
display an ion release that is somewhat higher than that of
gold alloys, but is still on the same order of magnitude. It is
known that dental processing, such as casting, grinding or
ceramic veneering, may influence the corrosion
characteristics of dental alloys. In the case of cobaltchrome alloys, this influence are relatively small. This
means that such alloys are very rugged [3, 22, 23] .
Biocompatibility
Dental processing and mechanical values
Can be used for veneering crowns and bridges with
ceramics. The dental processing of cobalt-chrome
alloys is assessed as more unfavourable in comparison
to gold alloys. This is also reflected in the slightly
higher costs for the required instruments. This
partially offsets the price advantage of the alloy. This
opinion must be qualified, however. In the veneering
of frames the difference in the required processing
between gold and cobalt-chrome alloys with veneering
capacity is not very great. In the case of fully cast
crowns, the more difficult processing of the cobaltchrome alloys is a significant negative factor. It is
recommended, therefore, that the processing
instructions be followed. Each alloy has its specific
features that must be taken into account. This applies
to non-precious alloys as well as to precious-metal
alloys [3, 22, 23]. .
Veneerability
Due to the higher melting interval, non-precious alloys
are generally more heat-resistant than gold alloys. In
particular palladium-free gold alloys are sensitive here
since palladium is responsible for the heat resistance,
among other things. Heat resistance refers to the
ability of an alloy not to deform even in the hightemperature range (slightly below the solidus point),
i.e. not to distort under its own weight. With a
coefficient of thermal expansion of 14.2 [10 6 * K.
May 2004
The main components of cobalt-chrome alloys, cobalt,

chromium and molybdenum, are essential elements].
Therefore, they must be classified as more favorable in
principle, as elements that have no function in the human
body. For essential elements the human organism has
diverse ways of decomposition and utilization. There
appear to be certain threshold values, below which no
interaction takes place. However, these threshold values are
very individual and may be very low in specific cases since
there is verification of allergies to cobalt, chromium and
molybdenum. In the relevant literature, however, there is
no reference to the fact that cobalt-chrome alloys have
caused an allergy. This point is also supported by the use of
cobalt-chrome alloys for partial dentures for decades.
Alloys of this type were positively assessed back in 1936.
Thus, there is no clinical experience in this connection that
is older than that concerning gold alloys with veneering
capacity.
Allergies are usually verified by means of the patch test. It
must be emphasised here that this test itself is capable of
sensitising the subject. Therefore, in Norway, for example,
it is only permitted if there is justified suspicion of an
allergy. Furthermore, there is problem regarding suitable
test substances. For some elements there are still none, with
others the selection of unsuitable test substances may lead
to incorrect statements. Chromium allergies (for the dental
field), for example, should only be tested with chromates,
in which chromium is found with the oxidation number
+III. If one uses dichromate (here chromium has the
oxidation number +VI and acts as a strong oxidant), one
will obtain in all likelihood incorrect results. Chromium
with the oxidation number +III is released from dental
alloys due to corrosion processes. To avoid faulty
diagnoses, the patch test should only be conducted by
properly trained persons (dermatologists, allergists)
13
because the evaluation requires know-how and

experience [3, 22, 23] .
Table 10. Biomaterials Densities of Biomaterials and

Some Other Related Materials [3].
Material
Amalgam
Density
(g/cm3)
11.6
Alumina
3.85
Bone - cortical
~2.0
Calcium
hydroxide
cement
Chromium
Cobalt chrome
alloy
Fluorapatite
~1.90
Glass ionomer
cement
Gold
~2.10
Hydroxyapatite
3.16
Methyl
methacrylate
Mercury
0.94
7.19
~8.50
3.22
19.3
Material
Palladium
based
alloys
Porcelain
dental
Stainless
steel
316L
Titanium
Ti6Al4V
Tooth
dentine
Tooth enamel
UHMWPE
Vitreous
carbon
Zinc
phosphate
cement
Zirconia
Density
(g/cm3)
~10.8
~2.05
devices are minimally constrained. This term means the

parts of the knee are not rigidly attached to one another as
in a hinge. The successful designs use the ligaments of
the knee to hold the knee in place and merely resurface
the arthritic joint.
The figure 13 shows total condylar knee prosthesis as it
appeared in the 1980s with cobalt-chrome alloy femoral
component and high density polyethylene tibial
component.
This knee was developed by Install-Burstein and was the
standard for total knee replacement for many years.
8.0
4.51
4.40
2.14
This knee is still in use with a metal tibial tray, not shown
in this photo. The patellar button is also not
shown and is round and more than an inch across.
The patellar button is made of polyethylene plastic
also.
2.97
0.945
1.47
2.59
6.10
13.5
TOTAL KNEE REPLACEMENT

1. History
Development of the total knee followed the success of the
total hip replacement by Sir John Charnley in the 1960s.
He pioneered the use of the polyethylene stainless steel
joints fixed to bone with polymethlmethacrylate (PMMA)
plastic, often called "bone cement". Today most hip and
knee prosthesis are made of cobalt chrome alloy or of
titanium. The use of PMMA is fading and many joints
are being fixed to bone with new techniques that involve
bone ingrowth to the prosthesis. Bone cement still is used
widely in the knee with newer techniques to reduce its
failure rate. These include mixing under vacuum to
prevent air bubbles in the plastic. Bone cement is the
same chemistry as Plexiglas (TM) except that bone
cement is formed at room temperature and has barium
included allowing us to see it on x-rays.
2. Types
Hinge type prosthesis were used initially but had a high
rate of failure due to loosening from bone. The
unicompartmental knees replace only one part of the joint
and have not enjoyed the success of the three
compartments or total knee replacement. The modern
May 2004

Figure 13. Total condylar knee prosthesis [19].
3. The Surgery
Total knee replacement is best done in a highly sterile
operating room. These are done as the first case in the
day because activity in the room stirs up dust. The room
is cleaned thoroughly the day before. A clean air
filtration system removes airborne dust particles and
keeps the air movement horizontal. The surgical team
wears sterile gowns that cover the head. These "space
suits" protect the patient from debris that could strike the
surgeon's face or head and fall back to the wound. The
suits also protect the surgeon from contact with bloody
material from the bone saw used. Antibiotics are given
before surgery to reduce the risk of infection. Total knee
replacement requires about 90 minutes of time with the
wound open. This means 3 hours in the operating room in
14
most cases [19].
- High fracture toughness.

- Excellent wear resistance.
- High hardness.
- Excellent chemical resistance.
- High toughness.
- Very refractory.
- Good oxygen ion conductor.
The properties exhibited by zirconia ceramics depend upon
the degree and type of stabilisation and on the processing
used. Table 11 shows some mechanical properties of
zirconia [3].
Table 11. Mechanical properties of zirconia [3].
Figure 14. Surgical picture of a total knee before wound

closure [19].
Property
Partially
stabilised
Fully
Stabilised
Partially
stabilised
(plasma
sprayed)
5.6-5.7
Density
(g.cm-3)
Hardness Knoop (GPa)
Modulus of
Rupture
(MPa)
Fracture
Toughness
(MPa.m-1/2)
Youngs
modulus
(GPa)
Poissons ratio
Thermal
expansion
(10-6/K)
Thermal
Conductivity
(W/m.K)
5.7 - 5.75
5.56 - 6.1
10-11
10-15
700
245
6-80
2.8
1.3-3.2
205
100 -200
48
0.23
8-10.6
0.23-0.32
13.5
0.25
7.6-10.5
1.8-2.2
1.7
0.69-2.4
1. Limitations of Zirconia
Figure 15. Figure of the Bone Cutting at the knee
surgery [19].
ZIRCONIA
Zirconia as a pure oxide does not occur in nature but it
is found in baddeleyite and zircon (ZrSiO4) which
form the main sources for the material. Of the two of
these, zircon is
by far the most widespread but it is less pure and
requires a significant amount of processing to
yield zirconia. The processing of zirconia
involves the separation and removal of
undesirable materials and impurities - in the
case of zircon - silica, and for baddeleyite, iron
and titanium oxides. Typical properties of
zirconia are:
- High strength.
May 2004
To date, zirconias use has been limited by its loss of

strength and its subsequent cracking when subjected to
temperatures of 100-600C in the presence of water a
process known as hydrothermal degradation. Using state of
the art techniques and working at the nanoscale, the
research team has inhibited this process by adding trace
quantities of materials such as alumina to the zirconia,
without compromising its toughness. (One nanometer is
one thousand millionth of a metre.) Targeting of the added
materials prevents degradation from progressing into the
zirconia from its surface [3, 21].
2. Oxidized Zirconium
Orthopedic surgeons have traditionally delayed joint
replacement surgery in patients younger than 65 because
they did not expect the materials used to withstand the wear
placed on them for longer than 10 to 15 years. Global
medical device company Smith & Nephew Inc.'s
Orthopaedics Division, in Memphis, TN, has developed
15
Oxidized Zirconium in response to the medical

community's concerns with wear. Smith & Nephew
has patented the material for orthopedic use, and the
FDA has cleared Oxidized Zirconium for knee
implants. Eleven years in development, the Oxidized
Zirconium knee is considered an industry-defining
technology. Before this technology was developed,
nearly 600,000 total knee replacements are performed
each year globally. The annual total global knee
market is estimated to be $2 billion. Currently, most
knee implants are made from a cobalt-chrome alloy
that slides against a plastic (polyethylene) bearing.
The motion and friction caused by daily living can
damage the implant's surface and cause metal and
polyethylene wear debris, ultimately causing bone loss
and the need for another implant. Because Oxidized
Zirconium components are made of a metallic
zirconium alloy that is heated to convert the surface to
a ceramic (zirconia), the best of both worlds can be
achieved. In addition, Oxidized Zirconium contains
nondetectable traces of nickel, providing a solution for
the more than 20,000 candidates for total knee
replacement each year identified as acutely allergic to
this metal. Compared to cobalt chrome, Oxidized
Zirconium, in wear simulation testing, reduced the rate
of polyethylene wear by 85 percent [10].
JOINT REPLACEMENTS
Total joint replacements of the hip and knee have been
performed at St. Anthony Central Hospital since their
introduction in the 1970s. During these surgical procedures,
mechanical prostheses crafted of specialized metals,
ceramics and plastics are used to replace joints irreparably
damaged by illnesses (such as rheumatoid arthritis and
osteoarthritis) or injury-related conditions (such as vascular
necrotitis and post-traumatic arthritis). As new and better
designs and materials have become available, outcomes
have improved remarkably. Many people having total joint
replacement surgery are able to enjoy active, full lives. St.
Anthony Central Hospital nurses and therapists conduct a
total joint preparatory class twice each month so that those
having the surgery know what to expect before, during and
after the procedure. Topics covered include pain
management, prevention of complications and early
mobility [14].
1. Reconstructive Implants
Unique metalworking capabilities and machining
techniques, helped create an array of reconstructive
implants including large joint replacements, spinal
implants, and neurocranial and maxillofacial meshes.
3. Zirconium
Orthopedic surgeons at St. Anthony Central Hospital

are now pioneering a new knee-replacement prothesis
made of zirconium. Through a special process, this
metal is heated, then bombarded in an oxygenenriched environment to yield the second hardest
material known, exceeded only by diamonds. The net
effect is a femoral component that has the wear
characteristics of ceramics without their downside
brittleness. Friction is reduced by as much as eight
times, which means the replacement joint wears far
longer than previous metal models [14].
Hip Systems: First Product that actually is

near net shape of a forged hip (Figure 13)
and has continued to improve forging and
finishing processes for Cobalt Chrome and
Titanium hips and acetabular cups to meet
the needs for extending implant life.
4. Wear Simulation Comparison of a Zirconia and

a
Cobalt Chrome Femoral knee Implant
In recent years the major cause of long-term failure of
hip and knee total arthroplasties has been identified as
originating with wear particles produced at the
interface in the synthetic articulating surfaces.
Researchers have tested the hypothesis that a zirconia
(zirconium oxide) femur would produce less wear of
the counterfacing ultra-high molecular weight
polyethylene (UHMWPE) insert than a standard cobalt
chrome molybdenum femur of similar design.
Figure 13. Forged hip joint [15].
The results show a definite reduction in the average

steady-state wear rate and the total wear in UHMWPE
inserts articulating with the zirconia femurs compared
to those articulating with the cobalt-chrome femurs.
We speculate that this reduction was due to the
increased hardness, scratchresistance and smoothness
of the zirconia femurs [20].
May 2004
Knee Systems. The company known as

Tecomet's, has such an expertise in forging
Titanium, Cobalt Chrome, and Zirconium
which provides the solution to the
challenges set by complex designs of
femoral and tibial
components (Figure
14). In June 2001, the company successfully
16
manufactured the first ever forged

Zirconium Femoral Component [15].
materials such as titanium, zirconium, kovar, nickel and

cobalt super alloys enables us to create products with
demanding performance requirements, [15].
4. Technologies and Procedures
Figure 14. Femoral and tibial components [15].

2. Trauma Products
Metal implants remain the dominant form of trauma
fixation devices providing superior strength and
biocompatibility. Tecomet manufactures a variety of
quality trauma products to satisfy the medical
industry's need for versatile, cost effective designs.
Nail Systems. Trauma products for long

bones include internal fixation devices (IM
Nails). When the orthopedic industry
requested strong but lightweight systems,
Tecomet responded by developing a
proprietary metal forming process to
produce hollow titanium fluted nails.
Plate Systems. From forged plates for long

bone fixation to intricate photoetched
miniplates for hand surgery, maxillofacial
and neurocranial applications, Tecomet's
manufacturing and design services support
diverse product lines.
Maxillofacial and Neurocranial Mesh.

Advanced photochemical etching provides
the foundation for creating a wide variety of
metal reconstruction and fixation implants.
Flexible and rigid configurations of fine and
coarse meshes allow applications specific to
oral
and
maxillofacial
surgery,
otolaryngology, neurology, plastic surgery
and orthopedics, [15].
3. Capabilities
Tecomet excels as a technically strong problemsolving partner prepared to meet the toughest
challenges in manufacturing and product development.
Through involvement at design inception they have
earned a reputation for providing engineered solutions,
reducing product launch time and lowering cost.
Tecomet's origins are in refractory metals such as
molybdenum, tungsten, tantalum and columbium.
Extensive experience in forging, machining and the
development of technologies to process high strength
May 2004
The primary concern surgeons seem to have regarding

metal-on-metal implant procedures is elevated serum
chromium levels. To date, there have been no reports of
cobalt toxicity in patients with elevated levels of serum
cobalt in association with metal-on-metal total hip
replacements, says Josh Jacobs, MD, of Rush Memorial
University of Chicago Hospitals. However, Jacobs adds
that the literature is incomplete and the necessary studies
have not been conducted to determine whether these
elevated levels are a long-term concern. The advantage of
the metal-on-metal implant is its longevity, which
minimizes the need for a later revision.
The ceramic-on-ceramic implants have enjoyed popularity
outside the United States for years; however, they are
associated with higher incidents of fracture. James T.
Caillouette, MD, attending surgeon at Hoag Memorial
Hospital, Newport Beach, Calif, and an assistant clinical
professor at the University of California at Irvine, observes,
There was a nexus of unfortunate events surrounding the
FDA [approval] proceedings. They were trying to protect
us. Under the circumstances, the incidents that fostered
concern at the FDA were comparatively minute in terms of
the number of procedures that occur without
complications.
Metal-on-cross-linked polyethylene shows promise,
according to orthopedic surgeon Richard A. Berger, MD, of
Rush Memorial University of Chicago Hospitals. But there
is some evidence in the presence of abrasive particles that
wear may, in fact, be accelerated with cross-linked
polyethylene. Some studies have indicated that the wear
debris caused by repeated contact between the articulating
surfaces has been a lingering clinical concern. The most
cost-effective procedure is cross-linked polyethylene on a
chrome cobalt head, says Berger. It's [the procedure]
most [physicians and patients] are choosing across the
country.
The latest FDA-approved innovation in hip arthroplasty is
the oxidized zirconium implant, a new material that
combines the advantages of scratch resistance and
extremely low wear but without the potential for fracture or
high metal ion levels. Oxidized zirconium femoral heads
are made from zirconium metal that has been oxidized such
that the surface of the implant is a ceramic zirconia. The
oxidized surface has proven to be extremely hard and
abrasion resistant. These laboratory tests have validated
that oxidized zirconium resists abrasion, minimizes wear,
and has no demonstrable risk of breakage or delamination,
[2].
17
5. Biologically Compatible
Suboptimal alignment of hip prosthesesfor example,
excessive vertical positioning of the acetabular
componentincreases wear, especially near the
periphery of the component. Anatomic restoration of
the hip center of rotation and offset and avoidance of
impingement are associated with decreased wear.
Optimal surgical technique involves stable fixation to
minimize interfacial motion and avoidance of residual
particles that could potentially contribute to third body
wear. But not all new techniques have built on the
materials and methods first pioneered in the 1960s.
Recent studies of positive outcomes of hip procedures
using noncemented tapered stems have made them
among the most favored of orthopedic physicians.
Fresno, Calif-based orthopedist D. Kevin Lester, MD,
who specializes in minimally invasive hip procedures,
and is an assistant clinical professor at the University
of California, San Francisco, is an enthusiastic
proponent of the cementless tapered titanium femoral
prosthesis. The cementless, collarless hip implant is
totally compatible with a minimally invasive
procedure, and has zero failures due to loosening, and
12% chance of improvement, he says. With improved
materials and techniques have come less invasive
procedures, which have aided in the success of hip
arthroplasty,[2].
6. Orthopedic Biomaterials
8. Characteristics of Materials Used in Orthopedics

a. Fracture fixation :
i. Stainless steel
Producing a material that can function intimately with

living tissue, with minimal adverse reaction, is quite a
challenge for engineers and scientists. Biomaterials
are designed to perform specific functions in the body
and, at times, are used to replace parts of living
systems. Some common implants include knee and
hip joint replacements, spinal implants, and bone
reinforcement devices. Also popular are artificial
heart valves, soft tissue replacements, and a variety of
dental implants. Each of these devices must be
constructed of special materials that are uniquely
suited for their respective tasks. Properties such as
mechanical integrity, corrosion resistance, and
biocompatibility must be evaluated for any
biomaterials, [8].
7. Materials for knee replacements
Unlike hip replacement devices there is currently little
choice in materials for knee replacements. A three
year European Community funded a program to
explore the use of ceramic materials in knee
arthroplasty has demonstrated that ceramic on
polyethylene combinations reduce polyethylene wear
compared to existing metal on polyethylene bearings.
Product features include:
Metal backed ceramic femoral component.

Zyranox zirconia on polyethylene
bearing.
May 2004
Existing, clinically proven fixation methods.

Patented braze technique for joining ceramic to
metal.
Ceramic resurfacing available for any current
knee system [12].
Iron based alloy containing chromium, nickel,

molybdenum. Usually annealed, cold worked or
cold forged for increased strength. A range of
strength and ductilities can be produced.
Strong.
Cheap.
Relatively ductile therefore easy to alter shape.
Useful in contouring of plates and wires during
operative procedures.
Relatively biocompatible.
The chromium forms an oxide layer when dipped
in nitric acid to reduce corrosion and the
molybdenum increases this protection when
compared to other steels.
Can still undergo corrosion if carbon gets to the
surface.
High Youngs modulus - 200 GPa (10 that of
bone) so can lead to stress shielding of
surrounding bone which can cause bone
resorption.
Used in plates, screws, external fixators, I.M.
nails.
Composition of 316L Stainless Steel: Iron- 60%,
Chromium- 20% (major corrosion protection),
Nickel14%
(corrosion
resistance),
Molybdenum- 3% (protects against pitting
corrosion), Carbon- 0.03% (incr. strength),
Manganese,
Silicon,P,S,3%
(control
manufacturing problems).
ii. Titanium and its alloys
Excellent resistance to corrosion .

Youngs modulus approximately half that of
stainless steel, therefore less risk of stress
protection of bone, stress riser at end of plate or
nail.
More expensive than stainless steels.
Poorer wear characteristics than others, therefore
not considered suitable as a load bearing surface
these days.
Can be brittle i.e. less ductile than stainless steel,
but more ductile titanium alloys being produced.
Can be as strong as stainless steels.
Used in plates, screws, I.M. nails, external
fixators. Useful in halos as more MR scan
compatible than other metals.
18
iii. Adhesives
Not common in orthopaedics but potentially

useful in small fragment fixation,
controversial.
Need to 1. Have sufficient bond strength 2.
Be able to bond to moist surfaces 3. Permit
healing across the bond line 4. Be
sterilisable.
Bone cement does not count as an adhesive.
Cyanoacrylate-Experiments
on
rabbits
produced poor results, long term fate not
addressed.
Fibrin- Conclusions of experiments are that
fibrin adhesives are only suitable for fracture
fragments with considerable inherent
stability or being non load bearing.
iv. Biodegradable polymers
Potential advantages
o Hardware removal not necessary,
reducing morbidity and cost.
o Stiffness of polymer decreases as
stiffness of fracture callus
increases.
o Can possibly be used in future for
controlled release of antibiotics or
stimulants to healing .
Requirements
o Adequate mechanical strength for
the application
o sufficient strength over a sufficient
period of time to maintain enough
stability for the fracture to heal
and prevent loss of reduction
o Degradability into products that
are mot harmful.
Examples
o Polyglycolic acid
o Polylactic acid
o Copolymers
Only about 1/20th the stiffness and strength
of stainless steel
Used in ankle fractures with poor results
Used in phalangeal fractures with better
results
b. Materials Used in Joint Replacement Surgery

i. Stainless Steel
Now rarely used in new designs

Because Youngs modulus high, need to be
inserted with a lower modulus polymer
cement for fixation, to prevent stress
shielding of the surrounding bone.
May 2004
ii. Cobalt Chrome
30-60% cobalt, 20-30% chromium,7-10%

molybdenum + nickel.
Stronger and more corrosion resistant than
stainless steel.
Youngs modulus higher than stainless steel (250
cf 200 GPa). Stress shielding a theoretical risk.
Usually fixed with cement.
iii. Titanium Alloys
Most common combination is Ti6Al4V

Strong and corrosion resistant
Youngs modulus 110GPa (less than cobalt
chrome & stainless steel), therefore often used for
cementless joint replacements.
Poorer wear characteristics.
Ultimate Strength: Stainless Steel > Titanium;
Yield Strength (permanent deformation):
Titanium > Stainless Steel
Ti13Zr13Nb is stronger and has lower Youngs
modulus.
Theoretically, may favour bone apposition and
bone ingrowth more than cobalt chrome, but no
difference found clinically.
iv. Polyethylene
UHMWPE- Ultra high molecular weight

polyethylene. A polymer of ethylene.
Molecular weight 2-6 million.
90% success rates at 15 years with metal on
polyethylene (therefore the gold standard).
The weak link of any total joint replacement.
Osteolysis produced due to polyethylene wear
debris causes aseptic loosening.
Submicron particles found in periprosthetic
tissues when polyethylene wear present.
Factors affecting polyethylene wear:
o Material polymorphism - Ziegker
process
used
to
produce
polymerisation.
Consolidation
produced by Ram extrusion or
compression moulded. Component
machined from these blocks. Bankston
et al - linear wear rate 0.05mm /year for
compression moulded, 0.11mm / year
for ram extruded.
o Gamma sterilisation in air produces
chain scission by oxidation. Companies
now vacuum pack and sterilise the
implants.
o Thin polyethylene- increases wear, due
to increased fatigue wear if thickness
less than 6-8mm.
o Polyethylene should not directly touch
bone in hip replacement- increases
wear.
19
Conformity- increased conformity

reduces stresses ( particularly
relevant in TKR
Materials used- Titanium bearing
surface increases wear, ceramics
reduce wear.
Size of femoral head:
Large femoral head,
causes increased sliding
distance at joint surface
and
so
increased
adhesive
wear.
Therefore
increased
volumetric wear (Theory
behind Charnley's LFA
22mm head).
Small femoral head
causes increased stresses
(increased fatigue wear
or penetrative wear)
Trade off ideal femoral
head size is 28mm.
Reduced offset of femoral
prosthesis causes increased fatigue
wear, as joint reaction force
higher.
Three body wear:
Due to cement particles,
metallic particles.
Can be reduced by
careful
surgical
technique.
Can be increased with
modularity of implants.
vi. Hydroxyapatite coating of THR
vii. Bone cement
v. Ceramics
Strong ionic bonds between the metallic and

nonmetallic components.
Very strong.
Very stiff.
Very biocompatible.
Very
hard,
therefore
good
wear
characteristics.
But very brittle.
Also difficult to process due to very high
melting points therefore expensive.
Bioinert e.g. Alumina, Zirconia, used for
surface replacement.
Bioactive e.g. hydroxyapatite and glassused for coating joint replacements for osseo
integration between bone and implant.
Ca10 (PO4)(OH)2 coated onto metal surface,

usually onto a porous surface
Usually 50-150m thick. (Too thin can be
resorbed, too thick can flake off during insertion
of implant).
Is thought to be osteoconductive
Not known how long it takes to resorb and how
stable the implant is after resorption
Good results at 5 years (99% survival) according
to Norwegian Arthroplasty register
Some worry about increased three body wear on
polyethylene
The particles of HA may also stimulate
osteolysis.
Polymethylmethacrylate introduced 30 years ago

No other fixation principle has given better long
term results
Polymerised methyl methacrylates
mixed from powder polymer and liquid monomer
in theatre usually in a vacuum to reduce porosity
and increase strength. Powder also contains
catalyst ( benzoyl peroxide).
Xray contrast medium (barium sulphate)
Colour (chlorophyll)
Stronger in compression than tension, weakest in
shear
Exothermic reaction producing heat, can lead to
bone necrosis
Leakage of monomer during polymerisation may
induce endothelial damage locally leading to
thrombus formation and distal hypotension
through effects in pulmonary vascular bed
Cementing techniques have changed from finger
packing to retrograde filling with a cement gun
under maximal pressurisation - has not been
evaluated in randomised clinical studies
Controversy about type of bond between implant
and cement- should it be maximal with
roughening of implant surface or minimal with a
polished surface [11].
COMPARISON OF PROPERTIES BETWEEN

STAINLESS STEEL 316L WITH OTHER
BIOMATERIALS
Table 12 shows a comparison of properties between
stainless steel 316 L with the materials studied in this
research
May 2004
20
Table 12. Properties of biomaterials [22, 23].

Material
Modulus
of
elasticity
( GPa )
Shear
modulus
of
elasticity
( GPa )
82
Poissons
ratio
Yield
stress
Mpa
0.27-0.30
min170
413
Stainless
steel
Cobalt
chrome
Zirconium
Titanium
200
200
100-120
70
39-45
0.22
0.33
Calcium
Sulfate
Calcium
Phosphate
18-21
6-10
.305
2000
7601000
-------
18-21
7-13
.315
-------
230
.30
SUMMARY
The most common materials used in
orthopedics are: titanium, zirconium, cobalt-chrome,
calcium phosphate, and calcium sulfate and stainless
steel 316-L. Titanium is used primarily for the
loading faces which include the pin structure,
fabrication of plates and femoral stems. The Modulus
of Elasticity of Titanium is much lower than Stainless
Steel 316-L, having a numerical difference in value
which ranges from 80-100 GPa. The Shear Modulus
of Elasticity is also lower than the particular value of
Stainless Steel 316-L, this difference is about 37 GPa.
The difference in Poissons Ratio is just about 3
decimal units, but the yield stress of Titanium is much
more higher in comparison to that of Stainless Steel
316-L. The difference expressed is more than 600
MPa for the yield stress. In conclusion Stainless Steel
316-L is much stronger, but that is not always good
because stress rises at end of plate or nail. Titanium
possesses a lower ultimate strength than Stainless
Steel 316-L but its yield strength is much more, this is
what causes permanent deformation of the material,
and Stainless Steel is easily expected to recover its
normal state than Titanium and its Alloys.
Cobalt-Chrome which is a cobalt alloy has a
Modulus of Elasticity 230 GPa, when compared to the
Modulus of elasticity of Stainless Steel gives us a
difference of 30 GPa. In this particular case cobalt
chromes Modulus of elasticity is higher than Stainless
Steel. The Poissons Ratio of both are very similar,
they both are near 0.30. The yield stress that cobalt
can support is 413 Mpa. When compared to Stainless
Steel 316-L the difference obtained is near to 243
Mpa. In conclusion, this material seems to be better
than Stainless Steel 316-L, but the only disadvantage
is the price and the facility to find it.
Zirconiums Modulus of Elasticity is 230
GPa which is very close to the Modulus of Elasticity
of Stainless Steel. The Shear Modulus of Elasticity is
70 GPa, when compared to Stainless Steel 316-L it
gives a difference of 12 GPa. The Poissons Ration of
zirconium is 0.33 and the difference between both is
May 2004
only from 3 to 4 units. The materials seem similar but the

yield stress of both materials is different. Zirconium has a
2,000 Mpa yield stress value and stainless steel has only
170 MPa. This particular property gives the material is the
maximum stress it could hold and return to its original
state.
In the Bone Grafting face, the predominant
materials are calcium sulfate and calcium phosphate. The
Modulus of Elasticity of calcium phosphate is in the range
from 18-21 MPa. This material compared to stainless steel
316-L has a differential value of more that 180 MPa which
clearly states that is not as elastic as stainless steel, which
by definition makes it much more brittle. The Shear
Modulus of Elasticity of Calcium Phosphate is about 7-13
GPa, and the differential value is more than 68 GPa. The
Poissons Ratio fluctuates in the same range. The yield
stress, which is the ability of the material to recover or to
return to its normal state, has a value so low that is not
taken into consideration. The yield stress of the Stainless
Steel 316-L is much more dominant.
Calcium sulfate has very similar properties as
calcium phosphate, which also makes it very brittle. The
Modulus of Elasticity of calcium sulfate ranges from 1821GPa which compared to Stainless Steel 316-L the
difference in values is very close to that of calcium
phosphate which is in the range from 170-180 MPa. By
definition calcium sulfate is a very brittle material. The
difference in numerical values of the Shear Modulus of
Elasticity also fluctuates from 68 GPa and over. The
Poissons Ratio is almost in the same range, and has a
numerical value of 0.315. Since the material is so brittle
the yield stress is not taken into much consideration, as in
the comparison with calcium phosphate, stainless Steel is
much more dominant in this precise property.
As observed in bone grafting the materials used
are brittle but very strong and stiff, because of this they are
used in joint replacement and osseo integration between
bone and implant, some sort of a refilling process, and not
as Stainless Steel which is used in other orthopedic surgery
processes.
ACKNOWLEDGEMENTS
Our thanks to Dr. Megh R. Goyal for his guidance.
REFERENCES
1.
2.
http://www.orthobluejournal.com.
Szpalski,
Marek and Gunzburg, Robert.
Applications of Calcium Phosphate-Based
Cancellous Bone Void Fillers in Trauma Surgery.
http://www.orthopedictechreview.com/issues/ma
yjune03/pg36.htm .
Gordon II, MA, W.A. A Technical Evolution.
21
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
http://www.azom.com.
Azom-Metals,
Ceramics
,Polymers,
Composites An Engineer Resource. 2004. A
to Z of Material.
www.azom.com
Biomaterials: An Overview.
http://www.suri.org/3pubs/ttoday/fall95/imp
lant.htm
Blanchard, Cheryl R. Biomaterials: Body
Parts of the Future.
http://www.orthobluejournal.com
Parikh, Shital N. Bone Graft Substitutes in
Modern Orthopedics.
http://www.karger.com/gazette/65/lidgren/ar
t_5_0.htm
Lindgren, Lars. Bone Substitutes.
http://www.cheresources.com/newparts.sht
ml. Building New Body Parts.
http://www.biomed.tamu.edu
http://www.goodsamdayton.com/knee.htm
Good Samaritan Hospital First in Area to
Introduce New Technology for Knee
Implants.
http://www.orthoteers.co.uk/Nrujp~ij33lm/o
rthomat. htm
Implants & Materials in Orthopedics.
http://www.bioceramics.com/knee1.htm
Knee Replacements
Hasting,G.W and D.F. Williams.,1980.
Mechanical Properties of Biomaterials.
John Wiley & Sons.
http://www.stanthon4central.org
Total Joint Replacement.
http://www.orthosupplier.com/players/4b.ht
m Tecomet
http://www.worldortho.com/history.html
Brakoulias, Vlasios. The History of
Orthopedics.
17.http://www.ae.msstate.edu/vlsm/material
s/alloys/titanium.htm.
Titanium Alloys and Their Classification.
www.azom.com
Titanium and Titanium Alloys as
Biomaterials.
http://www.ucbones.com/total_knee_replace
ment.htm
Total Knee Replacement
http://www.jbjs.org/ORS_2001/pdfs/1101
Wear Simulation Comparison of a Zirconia
and a Cobalt Chrome Femoral Knee
Implants.
www.azom.com
Zirconia (ZrO2) Is Zirconia a Viable
Alternative to Steel.
http://www.efunda.com
www.matweb.com
http://www.btec.cmu.edu/reFramed/tutorial/
mainLayoutTutorial.html
The Need for Bone Substitutes
May 2004
GLOSSARY
Alignment - Positioning the femur and tibia so as to allow
proper
articulation
at
the
knee
joint.
Allograft - A graft (occasionally bone) taken from a human
being
and
implanted
in
another.
Alloy - A mixture of two or more metals.
Anatomic - Relating to the structure of an organism. Often
used to describe a prosthesis, which closely resembles or
duplicates the shape and size of a normal part of the body.
Anatomic Axis - The axis formed by an imaginary line
down the center of the femoral canal. Usually 5-7 degrees
off
the
mechanical
axis.
Ankylosis
The
fusion
of
a
joint.
Arthrodesis - Surgical fixation of a joint.
Articulating Surface - Implant or bone surfaces which
touch each other. Typically used in referring to the
polyethylene tibial surface or patellar surface.
Autograft - A graft (sometimes bone) taken from a patient
and reimplanted in another part of his/her own body.
AVN - Avascular necrosis (particularly death of bone
through
lack
of
blood
supply).
Biocompatibility - Referring to the degree of tissue or

systemic reaction caused by a foreign material in the body.
Biomechanics - Relating to the forces that act on the joint,
and
their
effect
on
the
joint.
Bone Ingrowth - The process of bone growing into the
pores of a porous implant for enhanced fixation.
Bone resorption - A remodeling of bone due to a lack of
stress through an applied load. A common result of stress
shielding, where bone located in an area that is shielded
from stress is absorbed by the surrounding bone that is
under stress. Also called Stress Relief Osteoporosis.
Calcaneous
The
heel
bone
Calcar - An area in the media region of the proximal femur
which is characterized by very dense cortical bone.
Caliper - An instrument used to determine thickness,
diameter,
or
width.
Cancellous Bone - Spongy bone composed of a loose
latticework of bony traveculae and bone marrow within the
inerspace found in the enlarged ends of long bone.
Cannulated - An open-ended passageway through which a
wire
or
pin
may
be
passed.
Cast - The giving of shape to metal by pouring it in liquid
form into a mold and allowing it to solidify.
Closed Procedure - Done with the use of image
intensification but without the need of an incision at the
fracture
site.
Collateral Ligaments - The strong stabilizing ligaments
located on both the medial and lateral sides of the knee.
Comminuted Fracture - One in which there are several
definite disruptions in the bone, creating two or more
fragments
Compartment - A combination of two surfaces which
articulate
with
each
other.
Compression - Adjustment of an external fixator to
provide closer bone-to-bone contact at a fracture site; or the
application of centrally directed forces (forces applied
towards the middle of the instrumented areas.
Contracture - Abnormal shortening of muscle tissue,
22
rendering the muscles highly resistant to stretching.

Cortex - The outer surface of a bone or organ.
Countersink - Instrument used to form a flaring
depression around the top of a drilled hole. Insertion
of an implant beneath the cortical surface of the bone.
Cruciate ligaments - Two strong stabilizing
ligaments which cross between the condyles of the
knee. The anterior cruciate ligament runs from the
back of the femur to the front of the tibia. The
posterior cruciate ligament runs from the front of the
femur to the back of the tibia.
Deformity - A change in shape or form.
Delayed union - An abnormal lag in the reunion of
fractured
parts
of
a
bone.
Diaphysis - The shaft of a long bone, as distinguished
from
the
extremities
and
outgrowths.
Dislocation - Displacement of two bones from their
normal
location
at
a
joint.
Distal - Situated or directed farther away from the
center of the body or some part of the body.
Distraction - A type of dislocation in which the bones
of a joint have been separated without damage to their
ligament.
Endoprosthesis - Repair of the femoral head only
where
the
acetabulum
is
left
intact.
Endosteum - Membrane lining bone in the medullary
cavity.
Epiphyseal Growth Plates - The ends of long bones
at which growth in length mainly takes place.
Epiphysis - Pertaining to the end of long bones,
usually
wider
than
the
shaft.
Eversion - The act of turning outward; opposite of
inversion.
Exchange Nailing - A procedure where an existing
IM nail is removed and replaced by a new nail.
Extension - The act of extending or straightening a
limb.
FDA - Food and Drug Administration. A federal

agency which regulates the sale and distribution of
surgical
implants.
Fatigue Strength - The ability of a material to
withstand
cyclic
stress.
Femoral Head - The "ball" portion of the hip joint,
located at the proximal end of the femur.
Femur - The long bone between the hip and the knee.
Fibula - The long thin outer bone of the lower leg.
Fixation - The process of making an object hold firm
or
fast.
Flexion - The act of flexing or bending a joint so that
the bones forming it are brought toward each other.
Fracture Callus - An unorganized meshwork of
woven bone developed on the pattern of the original
fibrin clot, which is formed following fracture of a
bone.
Frontal Plane - A plane which divides the body into
dorsal and ventral parts. Also called the coronal plane.
Fusion - The joining together of two structures (such
as the joint space between the femur and the tibia).
May 2004
Humerus - The upper arm bone.
Image Intensification - Fluoroscopic radiographic

monitoring of fracture site and procedure while in progress.
The x-ray machine is commonly referred to as a C-Arm
because
of
the
shape
of
the
machine.
Infrapatellar ligament - A ligament located directly below
the
patella.
Intercondylar notch - An indentation between the two
condyles
of
the
distal
femur.
Interfragmental compression - To apply compression to
two or more bone fragments using bone screws.
Interlocking nail - An intramedullary nail that is designed
to accept cross-screws both proximally and distally to
improve rigidity and rotational stability in early fracture
healing. Screws can be phased out to improve load sharing.
Intracondylar notch - The recess between the femoral
condyles of the knee joint which housed the two cruciate
ligaments.
Intradedullary - Within the medullary, or narrow,
cancellous
canal
region
of
a
long
bone.
Intramedullary Canal - The marrow cavity of a bone.
Intraoperative
Performed
during
surgery.
Ligament - A tough band of white fibrous connective

tissue that links two bones together at a joint.
Malleable - Capable of being extended or shaped by
pressure.
Malunion - Growth of fractured bone fragments in a faulty
position,
forming
an
imperfect
union.
Marrow
Soft
central
part
of
a
bone.
Mechanical axis - The axis formed by a line which passes
through the center of the hip, the center of the knee, and the
center
of
the
ankle.
Medial - Situated or directed toward the midline of the
body
or
one
of
its
parts.
Medial malleolus - A protuberance on the lower end of the
tibia
at
the
ankle.
Medullary canal - The inner portion of a bone which is
filled
with
bone
marrow.
Modularity - Referring to an implant system where a
specific component is made up of two or more detachable
parts.
Modulus of elasticity - A measure of the ability of material
to return to its original shape without any permanent
deformation
when
stress
is
applied.
Moment - The tendency of a force to produce a rotation at
a
certain
point.
Nonunion - Failure of fractured bone to heal completely.
Oblique - Slanting; between horizontal and vertical in
direction.
Osteochondritis dissecans - A degenerative process to the
articular cartilage by which a separation of the articular
cartilage from the sub-chondral bone occurs.
Patella (kneecap) - A sesamoid bone (a bone contained
within a tendon) that essentially acts as a "pulley
23
mechanism" to complete patella femoral joint.

Pelvis - A basin or basin-like structure.
Percutaneous - Effected through the skin.
Periosteum - A thick fibrous membrane covering the
surface of bone except at points of articulation.
Posterior cruciate ligament - An internal ligament of
the knee joint originating from the medial femoral
condyle and inserting into the notch of the posterior
tibia. Function: stabilizes the tibia on the femur
Primary - A procedure where an implant is implanted
where there has not previously been an implant.
Pronate
To
turn
palm
down.
Prone
Lying
with
face
downward.
Prosthesis - An artificial substitute for a missing part
of
the
body.
Radiolucent - Permitting the passage of x-rays.
Radiopaque - Not permitting the passage of x-rays.
Radius
A
bone
in
the
forearm.
Range of motion - The arc created by the flexion of a
limb at the joint, usually expressed by degrees.
Reamer - An instrument used to enlarge or shape a
drilled hole; such as the intramedullary canal of a long
bone.
Reduction - The restoration of a dislocated part of the
body
to
its
normal
position.
Reproducible - A procedure or instrument system that
is designed to achieve the same basic results from all
surgeons
and
in
all
cases.
Resection - The surgical removal of part of a bone.
Retractor - An instrument used to expose tissue or
bone.
Retroversion - A backward turning; opposite of
anteversion.
Rongeur - Biting forceps for cutting bone.
Rotation - Turning about an axis or a center.
Tensile stress -Stress generated by a force which tends to

elongate
or
stretch
a
body
or
structure.
Tibia -The inner and larger bone of the lower leg.
Tibial plateau -The upper end of the tibia capped with
articular cartilage, articulating with the femur, making up
the
lower
half
of
the
knee
joint.
Tibial spine -A projection on the top surface of some tibial
components between the two halves of the tibial plateau.
Tibiofemoral -Pertaining to both the tibia and the femur.
Titanium -A metallic element used to make surgical
implants. Titanium is very biocompatible and offers a
lower modulus of elasticity than many other metals.
Torque -A force that produces or tends to produce rotation
or torsion. It is a measurement of an instrument's capacity
to do work or to continue to rotate under resistance to
rotation. It is expressed in inch-ounces or inch-pounds.
Torsion -Act of twisting or condition of being twisted.
Torsional stress -Stress generated by a force which tends
to
rotate
or
twist
a
body
or
structure.
Trocar -A sharp obturator used to assist the insertion of the
bushings
through
soft
tissue.
Trochanter -Either of the two processes below the neck of
the femur. The greater trochanter is a broad, flat process at
the upper and lateral surface of the femur to which several
muscles are attached. The lesser trochanter is a short
conical process projecting medially from the base of the
neck
of
the
femur.
Tuberosity -A large rounded eminence on a bone.
Valgus - Deformity in bone, such as when the knees are

close together (knock-knee), with the ankle space
increased.
Bent
outward.
Varus - Deformity in bone, such as when knees are bowed
out, and the ankles are close in. Turned inward.
Sawbones - A plastic replica of a bone which is used

for testing, practicing or demonstrating a surgical
procedure
Segmental Fracture - Divides a long bone into more
than two roughly cylindrical segments (also a specific
type
of
comminuted
fracture).
Soft Tissue - Any of the tissues other than bone that
surround or are within the joint, including muscles,
tendons,
ligaments,
etc.
Stability - The degree of resistance to forces tending
to cause motion or change of motion.
Stress - A force or action placed on a surface or
material.
Stress riser - A point or area where stress is
concentrated due to an uneven distribution of stress. If
an implant fails, it fails at a stress riser.
Subluxation - A partial dislocation of a joint, so that
the bone ends are misaligned but still in contact.
Tap -Instrument used to cut threads into the bone for a
bone
screw.
Tendon -A tough band of white fibrous connective
tissue that links a muscle to a bone.
Tensile strength -A measure of resistance to tensile
stress.
May 2004
24
Appendix I: NUMERICAL EXERCISES

Exercises:
Chapter 1, Problem 1.2-4
A circular aluminum tube of length L=400mm is
loaded in compression by forces P (see figure 1). The
outside and inside diameters are 60mm and 50 mm,
repectvely. A strain gage is placed on the outside of
the bar to measure normal strains in the longitudinal
direction.
(a) If the measured strain is =540 x 10 -6, what is the
shortening of the bar?
(b) If the compressive stress in the bar is intended to
be 40MPa, what should be the load P?
Discussion
For the application in the biomechanics in orthopedics,
the geometry of the tube could be considered circular
(ideal behavior) and the material is titanium. The
material changed because the bones of the body are
not made of aluminium, but as we learn, a metal as
titanium could be implanted. The dimensions as
length and diameters could be the same, because the
anatomy of the body allows these dimensions. The
forced of compression would be the compression of
another two bones in connection, with the weight of
the body within. According to the changes made the
question (a) could be rephrase with different value and
the part (b) could stay the same.
Discussion
For the application of this problem in the biomechanics in
orthopedics, the geometry could be considered circular, as
stated for ideal behavior. The material would be changed
for the zirconium alloy that is also used in the orthopedics
applications. The load could be the weight of the body and
the base the floor where the load is applied. The load could
be of P=150 lb. The diameters could be changed for
diameters less than 3 in, assumed as 2 in. The Ez=2.9 x 107
psi is the modulus of elasticity of zirconium, and having a
length of 10 in.
According to the new values and new changes the question
should be arranged.
P = 150 lb
d = 2 inch
E = 2.9 * 107 Psi
F=p
= P/A
= 47.75 Pa
Figure 1
= 550 10
Chapter 2, problem 2.4-17

A trimetallic bar is uniformly compressed by an axial force
P=2000 lb applied through a rigid end late (see figure 2).
The bar consists of a circular steel core surrounded by brass
and copper tubes. The steel core has a diameter 0.4in., the
brass tube has outer diameter 0.6in., responding moduli of
elasticity are Es=15 x 106psi, and Ec=18 x 106 psi.
Calculate the compressive stress s, b, and c in the steel,
brass, and copper respectively, due to the force P.
L = 400 mm = 0.4 m
= PL/EA
= (150)(10)/( 2.9 * 107)(12)
= 1.65 *10-5 inch
d in = 50 mm = 0.05 m
d out = 60 mm = 0.06 m
PL
= EA
= LL
o
= Lo = 2.20 10
= 0.220mm
If , = 40 MPa
P=?
)(
P = 40 MPa / 4 0.06
P = 0.0346 MPa
P = 34.6 KN
May 2004
0.05

A stepped shaft ABC consisting of two solid circular
segments is subjected to torques T1 and T2 acting in
opposite directions, as shown in the figure. The larger
segment of the shaft has a diameter d1=2.5 in. and length
L1= 25 in.; the smaller segment has diameter d2= 2.0 in.
and length L2= 18 in. The material is steel with shear
modulus G=11 x 106 psi.
If the torques is T1=9000lb-in. and T2=4000lb-in., calculate
the following quantities: (a) the maximum shear stress max
in the shaft, and (b) the angle of twist C (in degrees) at end
C.
25
Discussion
For the application in the biomechanics in orthopedics,
the geometry of the tube could be considered circular
as ideal behavior. The differences in diameters could
be seen in the arms bones which vary in dimensions
and are fixed to the shoulder. The length of the shaft
should be change in order to be more truthful with the
anatomy of the body. The torques applied in the shaft
could be seen as two different torques applied to the
different parts of the arm at the same time. The
material is titanium with modulus of elasticity known
(see table 3).
According to the new values and new changes the
question should be arranged.

Beam ABCD represents a reinforced-concrete foundation
beam that supports a uniform load of intensity q1=2100
lb/ft (see figure). Assume that soil pressure on the
underside of the beam is uniformly distributed with
intensity q2.
(a) Find the shear force VB and bending moment MB at
point B.
Discussion
For the application in the biomechanics in orthopedics, the
geometry of the tube is not taken into consideration for the
analysis. The load supported would be suggested as the
weight supported by a foot. The load applied and
uniformly distributed would be q1 =150 lb/ft and the length
of the foot will be 1 ft. The load applied as q2 could be
considered as the uniformly load exerted by the floor when
the weight load is applied.
According to the new values and new changes the question
should not be arranged.
T1 = 10lb in
T2 = 15lb in
6
G = 11 10 psi
d1 = 2.5in
q2(7) = q1(1)
d 2 = 2.0in
q2 = 21.43 lb/ft
L1 = 9.0in
Vb, Mb in b
L 2 = 10in
T
= T T = 15 10 = 5lb in
AB
1
2
16(5)
= 80 = 1.63 psi
I AB = 16T3 =
3
49.09
d
( 2.5)
Vb = (21.43) (3)
= 21.43lb
a)Mb = (21.43)(3)(1.51) = 96.44 lb-ft
TBC = T2 = 15lb in
16(15)
= 240 = 9.55 psi
TBC = 16T3 =
3
25.13
d
( 2)
(5lb in )(9in )
TL =
AB = GI
(11106 psi )( / 32)( 2.54)
P
6
= 42,18445
= 1.067 10 rad
,
471
.
67
AB
(15lb in )(10in )
TL =
= GI
BC
(11106 psi )( / 32)( 24)
P
BC
max
C
7
= 17 ,27815
rad
,759.59 = 8.68 10
=
BC
= 9.55 psi
= AB +
May 2004
BC
= 1.935 10
rad
26

Materi Biomaterial 2 2

Загружено:

Сведения о документе

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Materi Biomaterial 2 2

Загружено:

Авторское право:

Доступные форматы

Learn from yesterday, live for today, dream for tomorrow - - - Chicken Soup for the Soul

BIOMATERIALS FOR ORTHOPEDICS1

Abstract- Biomaterials deal with the material

materials are incorporated into the surrounding tissue, or

This review article was prepared on May 14, 2004 for

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

Orthopaedics, like many specialties, has developed

Figure 1. Common sites of infection of bones and joints

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

Figure 2. Bone plate, introduced in the early 1900s to

Figure 3. Artificial knee joints are implanted in

Figure 4. Senior Research Scientist Dr. Cheryl R.

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

Interpositional Implant (IPI). In theory, PTFE would

Figure 5. These micrographs, taken at a magnification

by the National Science Foundation, SwRI scientists and

BONE GRAFT SUBSTITUTES

Figure 6. Examples where bone substitution is required

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

immuogenicity and the absence of viable cells that

Figure 7. Schematic drawing of a vertebral body, on

1. Indications for Bone Substitutes

This mini-invasive procedure for the treatment of vertebral

Synthetic materials can be made from different materials

Its porosity (determines the amount of surface

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

Resorption rate (ability to disappear so as

Biocompatibility to prevent inflammatory

Biodegradable so that the patients own

The osteoconductive synthetic grafts that are used

TITANIUM AND TITANIUM ALLOYS

Table 3. Properties of Ti-6Al-4V at 25C [22].

Values of the Ti-6Al-4V

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

Table 4: Density and elastic modulus of selected

Figure 11. A total knee replacement prosthesis (photo

Figure 10. Implant components for a total hip

For many years, ceramic materials were only useful in the

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

resorption. Most calcium phosphates are classified as

2. Calcium Sulphate (Plaster of Paris)

Table 5. Calcium phosphate compounds as biomaterials

Figure 12. Bone ingrowth around synthetic hydroxyapatite

(CaSO4) has long been used in its partially hydrated form.

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

Technology, Arlington, Tenn), standard or fast cure (5

chemically than nickel. Cobalt dissolves in dilute sulphuric

COBALT AND COBALT CHROME

Other uses for cobalt are:

In superalloys for aircraft gas turbine engines

Applications of Engineering Mechanics in Medicine, GED University of Puerto Rico, Mayaguez

Cobalt salts are used as a source of brilliant permanent

The difference in atomic size between cobalt

It has also been found that a matrix containing a larger

relevant to the service conditions. They do however, play a

Cobalt 61.0% base metal

Casting temperature Higher, therefore cannot

Investment materials No investment materials

Finishing Increased work requirement and

Tensile strength Higher than gold alloys

Modulus of elasticity Approximately double,

0.2% ductile yield Comparable, measure for the

Elongation limit Lower, not of crucial

Hardness Higher, difficult to finish