Joint prostheses components of warm-forged and surface treated Ti-6Al-7Nb alloy]

In 1978 development of a TiAl alloy with the inert alloying element niobium was initiated. In 1984, the optimal composition was found to be Ti-6Al-7Nb (Protasul-100). This custom-made alloy for implants has the same alpha/beta micro-structure and equally good mechanical properties as Ti-6Al-4V. The corrosion resistance of Ti-6Al-7Nb is better than that of pure titanium and Ti-6Al-4V, due to the very dense and stable passive layer. Since 1985, highly stressed anchoring stems of various hip prosthesis designs have been manufactured from hot-forged Ti-6Al-7Nb/Protasul-100. Polished surfaces of hip, knee or wrist joints made of Ti-6Al-7Nb intended to articulate with polyethylene are surface-treated by the application of a very hard, 3-5 microns thick titanium nitride coating (Tribosul-TiN), or by oxygen diffusion hardening (Tribosul-ODH) to a depth of 30 microns.     

Polymer-based composite hip prostheses

A composite hip prosthesis (CHP) made from poly(ether-imide) reinforced with carbon and glass fibres was manufactured and characterized. The main objective of the study was to evaluate the effect of fibre organization on the mechanical properties of the composite femoral implant and compare with the bone. A stacking sequence of drop-off plies of carbon/glass fibres reinforcing poly(ether-imide) (PEI) constitutes a symmetrical and balanced CHP. The hip was manufactured according to the finite element modelling (FEM) design and using the compression moulding and water-jet technologies. The measured stress-strain data according to tensile, flexural and torsional tests showed agreement with the numerical calculation. Young's modulus and the strength in tension are uniform along the stem axis (40 GPa and 600 MPa, respectively) while the elastic modulus in bending varies from 10 to 60 GPa in the tip-head direction. The composite stem showed a linear load-displacement relation up to 4500 N without breaking. Mechanical behaviour of the CHP is compared to that of a canine femur. Comparison with metal prostheses has also been undertaken. CHPs control stress-strain distributions, and hence the mechanical signals to bone, through a material-structure design.     

Results of reaugmentation with MISTI prostheses after failure of smooth silicone prostheses.

In 1988 and 1989, we replaced smooth silicone double-lumen implants with Molecular Impact Surface Textured Implants (MISTIs) in 28 of our patients. Of these, 20 had experienced recurrent capsular contracture and sought an alternative prosthesis that would provide long-term relief from this problem, and 8 simply wanted larger prostheses. Among the reaugmentation patients who had experienced recurrent contractures, 4 have had problems with the texturized implants; 1 developed an infection, and 3 developed unilateral fibrosis within weeks of surgery. The infection was resolved with antibiotics, and the fibrosis was resolved with capsulectomy, biweekly methylprednisolone irrigation in the surgical pocket, and lenticular suction drainage over a 3-week period. After a 2-year follow-up, these 4 problematic patients have remained soft and asymptomatic following their treatment, and the remaining 16 patients have remained soft and asymptomatic since their surgery.     

Microbial biofilms on facial prostheses

The composition of microbial biofilms on silicone rubber facial prostheses was investigated and compared with the microbial flora on healthy and prosthesis-covered skin. Scanning electron microscopy showed the presence of mixed bacterial and yeast biofilms on and deterioration of the surface of the prostheses. Microbial culturing confirmed the presence of yeasts and bacteria. Microbial colonization was significantly increased on prosthesis-covered skin compared to healthy skin. Candida spp. were exclusively isolated from prosthesis-covered skin and from prostheses. Biofilms from prostheses showed the least diverse band-profile in denaturing gradient gel electrophoresis (DGGE) whereas prosthesis-covered skin showed the most diverse band-profile. Bacterial diversity exceeded yeast diversity in all samples. It is concluded that occlusion of the skin by prostheses creates a favorable niche for opportunistic pathogens such as Candida spp. and Staphylococcus aureus. Biofilms on healthy skin, skin underneath the prosthesis and on the prosthesis had a comparable composition, but the numbers present differed according to the microorganism.     

Expandable tumor prostheses in children

Any surgical resection in the lower extremities in children will cause a leg length discrepancy from physeal resection. To avoid the resulting functional deficit, leg length discrepancy must be reconciled with surgical techniques to approximate equal leg lengths at skeletal maturity. Currently there are several manufacturers who offer options for prosthetic reconstruction with expandable implants. These implants can be expanded to a length projected on the basis of three factors: the length of bone resected, the anticipated future growth of the contralateral extremity, and the estimated discrepancy of limb length at skeletal maturity. In this article, we review the basic principles and guidelines for prediction of remaining bone growth and planning lengthening in children, and present the currently available expandable prostheses and the evolution performed over time.     

The life of neurological prostheses

Reliable and long-lived prostheses for the amelioration of certain neurological conditions can probably, from a technical point of view, be made widely available. Their achievement seems to be not so much a matter of microelectronics' high technology as of materials science, particularly a proper understanding of adhesion, and possibly of new materials technology.