EFFECT OF PHYSIOLOGICAL FLUIDS

1. EFFECT OF PHYSIOLOGICAL FLUIDS • Biocompatibility plays a very important role on deciding the life of biomaterials. • A completely "biocompatible" material would not • irritate the surrounding structures • provoke an inflammatory response • initiate allergic reactions • cause cancer BIOMATERIALS

2. EFFECT OF PHYSIOLOGICAL FLUIDS • A "biocompatible" material should also not have its • properties degraded from an attack by the body's immune • system. • The term biocompatible suggests that the material • described displays good or harmonious behavior in contact • with tissue and body fluids. • Water constitutes a major portion of the fluids and these • react with the surface of the materials. • The interaction of water or in general other fluids affects the • properties of materials. BIOMATERIALS

3. EFFECT OF PHYSIOLOGICAL FLUIDS • Water is the universal ether dissolving inorganic salts and • large organic macromolecules such as proteins. • Water suspends living cells as in blood and is the principal • constituent of all interstitial fluids. • It is believed that water is the first molecule to contact • biomaterials in any clinical application. • Due to water, the hydrophobic effect ,hydrophilic effect and • surface wetting effect occurs. BIOMATERIALS

4. EFFECT OF PHYSIOLOGICAL FLUIDS • The hydrophobic effect is related to the insoloubility of • hydrocarbons in water and is the fundamental of lipids. • In other words, the hydrophobic effect is the property that • nonpolar molecules like to self-associate in the presence of • aqueous solution. • The hydrophobic effect is the fundamental life giving • phenomena attributed to water. • Hydrocarbons are sparingly soluble in water because of the • strong self association of water. BIOMATERIALS

5. EFFECT OF PHYSIOLOGICAL FLUIDS The hydrophilic effect refers to a physical property of a molecule that can transiently bond with water (H2O) through hydrogen bonding. This is thermodynamically favorable, and makes these molecules soluble not only in water, but also in other polar solvents. The hydrophilic solutes exhibit Lewis acid or base strength comparable to or exceeding that of water, so that it is energetically favorable for water to donate electron density to or accept electron density from hydrophilic solutes instead of, or at least in competition with, other water molecules. BIOMATERIALS

6. EFFECT OF PHYSIOLOGICAL FLUIDS Generally speaking the free energies of hydrophilic hydration are greater than that of hydrophobic hydration. As in hydrophobic effect, size plays abig role in the salvation of hydrophilic ions. Small inorganic ions are completely ionized and lead to separately hydrated ions. BIOMATERIALS

7. EFFECT OF PHYSIOLOGICAL FLUIDS The interaction of water with the surfaces leads to surface wetting effect. The surface on which water spreads is called hydrophilic and those on which water droplets form is called hydrophobic. Thus hydrophobic surfaces are distinguished from hydrophilic by virtue of having no Lewis acid or base functional groups available for water interaction. BIOMATERIALS

8. EFFECT OF PHYSIOLOGICAL FLUIDS Structure and solvent properties of water in contact with surfaces between these extremes must then exhibit some kind of properties associated with the graded wettability observed with contact angles. If the surface region is composed of molecules that hydrate then the surface can adsorb water and swell or dissolve. At the extreme of water- surface interactions,surface acid or base groups can abstract hydroxyls or protons from water leading to water ionization on the surface. BIOMATERIALS

9. EFFECT OF PHYSIOLOGICAL FLUIDS • The surface energetics drives adsorption of water and then • in subsequent steps, proteins and cells interact with the • resulting hydrated surface. • Self association of water through hydrogen bonding is the • essential mechanism behind the water solvent properties. • As mentioned these interactions leads to the degradation of • the biomaterials. • It can be concluded that no theory explaining the biology of • materials can be complete with out accounting for the water • properties near surfaces. BIOMATERIALS

10. BIOLOGICAL RESPONSES • The Biological environment is surprisingly harsh and can • lead to rapid or gradual breakdown of many materials. • Superficially, one might think that the neutral pH, low salt • content, and modest temperature of the body would • constitute a mild environment. • However, many specialized mechanisms are brought to • bear on implants to break them down. • These are mechanisms that have evolved over millennia • specifically to rid the living organism of invading foreign • substances and they now attack our contemporary • biomaterials. BIOMATERIALS

11. BIOLOGICAL RESPONSES • The biological response can occur both in extravascular and • intravascular system. • The former deals with the changes outside the blood or lymph • vessel and the latter deals with in the blood vessels. • Let us consider that, along with the continuous or cyclic stress • many biomaterials are exposed to, abrasion and flexure may • also take place. • This occurs in an aqueous, ionic environment that can be • electrochemically, active to metals and plasticizing (softening) • to polymers. BIOMATERIALS

12. BIOLOGICAL RESPONSES • Then, specific biological mechanisms are invoked. • Proteins adsorb to the material and can enhance the corrosion rate of metals. • Cells secrete powerful oxidizing agents and enzymes that are directed at digesting the material. • The potent degradative agents are concentrated between the cell and the material where they act undiluted by the surrounding aqueous. BIOMATERIALS

13. BIOLOGICAL RESPONSES • To understand the biological degradation of implant • materials, synergistic pathways should be considered. • Swelling and water uptake can similarly increase the number • of site for reaction. • Degradation products can alter the local pH, stimulating • further reaction. • Hydroxyl polymers can generate more hydrophilic species, • leading to polymer swelling and entry of degrading species • into the bulk of the polymer. • Cracks might also serve as sites initiating calcification. BIOMATERIALS

14. BIOLOGICAL RESPONSES • Biodegradation is a term that is used in many contexts. • It can be engineered to happen at a specific time after implantation, or it can be un unexpected long-term consequent of the severity of the biological Degradation is seen with metals, polymers, ceramics and composites. • Biodegradation as a subject is broad in scope and rightfully should command considerable attention for the bio materials scientist. BIOMATERIALS

15. BIOLOGICAL RESPONSES Most biomaterials of potential clinical interest typically elicit the foreign body reaction (FBR) a special form of non specific inflammation. The most prominent cells in the FBR are macrophages, which attempt to phagocytose the material degradation are often difficult. The inflammatory cell products that are critical in killing microorganisms can damage tissue adjacent to foreign bodies. BIOMATERIALS

16. BIOLOGICAL RESPONSES • Tissue interactions can be modified by, • changing the chemistry of the surface. • inducing roughness or porosity to enhance physical binding to the surrounding tissues. • incorporating a surface-active agent to chemically bond the tissue. • using a bioresorbable component to allow slow replacement by tissue to simulate natural healing properties . BIOMATERIALS

17. BIOLOGICAL RESPONSES • The nature of the reaction is largely dependent on the • chemical and physical characteristic of the Implant. • For most inert biomaterials, the late tissue reaction is • encapsulation by a rel­atively thin fibrous tissue capsule • (Composed of collagen and fibroblasts). BIOMATERIALS

18. CLASSIFICATION OF BIOMATERIALS • Biomaterials can be divided into three major classes of materials: • Polymers • Metals • Ceramics (including carbons, glass ceramics, and glasses). BIOMATERIALS

19. METALLIC IMPLANT MATERIALS • Metallic implants are used for two primary purposes. • Implants used as prostheses serve to replace a portion of • the body such as joints, long bones and skull plates. • Fixation devices are used to stabilize broken bones and • other tissues while the normal healing proceeds. BIOMATERIALS

20. METALLIC IMPLANT MATERIALS • Though many metallic implant materials are available commercially. The three main categories of metals which are used for orthopedic implants • Stainless steels • Cobalt-chromium alloys • Titanium alloys • will be discussed in detail. BIOMATERIALS

21. METALLIC IMPLANT MATERIALS • The Metallic implant materials that are used should have the following characteristic features: • Must be corrosion resistant • Mechanical properties must be appropriate for desired • application • Areas subjected to cyclic loading must have good fatigue • properties BIOMATERIALS

22. STAINLESS STEEL • Stainless steel is the predominant implant alloy. • This is mainly due to its ease of fabrication any desirable variety of mechanical properties and corrosion behavior. • But, of the three most commonly used metallic implants namely • Stainless steel • Cobalt chromium alloys • Titanium alloys, • Stainless steel is least corrosion resistant. BIOMATERIALS

23. STAINLESS STEEL • The various developments which took place in the development of steel in metallic implants are discussed below. • Stainless steel (18Cr-8 Ni) was first introduced in surgery in • 1926 • In 1943, type 302 stainless steel had been recommended to • U.S. Army and Navy for bone fixation.Later 18-8sMo stainless • steel (316), which contains molybdenum to improve corrosion • resistance, was introduced. • In the 1950s, 316L stainless steel was developed by reduction • of maximum carbon content from 0.08% to 0.03% for better • corrosion resistance. BIOMATERIALS

24. CONSTITUENTS OF STEEL BIOMATERIALS

25. STAINLESS STEEL • The chromium content of stainless steels should be least • 11.0% to enable them to resist corrosion. • Chromium is a reactive element. • Chromium oxide on the surface of steel provides excellent • corrosion resistance. • The AISI Group III austenitic steel especially type 316 and • 316L cannot be hardened by heat treatment but can be • hardened by cold working. • This group of stainless steel is non-magnetic and • possesses better corrosion resistance than any of the • others. BIOMATERIALS

26. STAINLESS STEEL • The inclusion of molybdenum in types 316 and 316L • enhances resistance to pitting corrosion. • Lowering the carbon content of type 316L stainless steels • makes them more corrosion resistant to physiological saline • in human body. • Therefore 316L is recommended rather than 316 for implant • fabrication. BIOMATERIALS

27. STAINLESS STEEL • The Stainless steels used in implants are generally of two types: • Wrought • Forged • Wrought alloy possesses a uniform microstructure with fine • grains. • In the annealed condition it possesses low mechanical • strength.Cold working can strengthen the alloy. • Stainless steels can be hot forged to shape rather easily • because of their high ductility. • They can also be cold forged to shape to obtain required • strength. BIOMATERIALS

28. APPLICATIONS OF SS STEEL BIOMATERIALS

29. STAINLESS STEEL • Electroplating has been shown to be generally superior to a • mechanical finish for increasing corrosion resistance which • can also be produced by other surface treatments such as • passivation with HNO3. • The reason why stainless steel implants failed , indicates a • variety of deficiency factors like • deficiency of molybdenum • the use of sensitized steel BIOMATERIALS

30. COBALT CHROMIUM ALLOYS • The two basic elements of Co-based alloys form a solid • solution of upto 65 wt % of CO and 35 wt % of Cr • To this Molybdenum is added to produce finer grains which • results in higher strength after casting or forging • Cobalt is a transition metal of atomic number 27 situated • between iron and nickel in the first long period of the • periodic table. • The chemical properties of cobalt are intermediate between • those of iron and nickel. BIOMATERIALS

31. COBALT CHROMIUM ALLOYS • The various milestones in the development of cobalt chromium alloys are discussed below. • Haynes developed a series of cobalt-chromium and cobalt- • chromium-tungsten alloys having good corrosion resistance. • During early 1930s an alloy called vitallium with a composition • 30% chromium, 7% tungsten and 0.5% carbon in cobalt was • found. • Many of the alloys used in dentistry and surgery, based on the • Co-Cr system contain additional elements such as carbon, • molybdenum, nickel, tungsten BIOMATERIALS

32. COBALT CHROMIUM ALLOYS • Chromium has a body centered cubic (bcc) crystal structure • and cannot therefore have a stability of the phase of cobalt. • The solubility of the former in the latter increases rapidly as • the temperature is raised. • Metallic cobalt started to find some industrial use at the • beginning of this century but its pure form is not particularly • ductile or corrosion resistant. • The various milestones in the development of cobalt • chromium alloys are discussed below. BIOMATERIALS

33. COBALT CHROMIUM ALLOYS • Cobalt based alloys are used in one of three forms • Cast, • Wrought • Forged BIOMATERIALS

34. COBALT CHROMIUM ALLOYS • Cast alloy: The orthopedic implants Co-Cr alloy are made by investment casting.In an investment casting process,the various steps which are involved are • a wax model of the implant is made and ceramic shell is built • around the wax model • When wax is melted away, the ceramic mold has the shape • of the implant • The ceramic shell is not fired is obtained the required the • mold strength • Molten metal alloy is then poured in to the shell, cooling, the • shell is removed to obtain metal implant. BIOMATERIALS

35. COBALT CHROMIUM ALLOYS Wrought alloy: The wrought alloy possess a uniform microstructure with fine grains. Wrought Co-Cr –Mo alloy can be further strengthened by cold work. Forged Alloy: The Co-Cr forged alloy is produced from a hot forging process. The Forging of Co-Cr –Mo alloy requires sophisticated press and complicated tooling. These factors make it more expensive to fabricate a device from a Co-Cr-Mo forging than from a casting. BIOMATERIALS

36. COBALT CHROMIUM ALLOYS BIOMATERIALS

37. TITANIUM BASED ALLOYS • The advantage of using titanium based alloys as implant materials are • low density • good mechano-chemical properties • The major disadvantage being the relatively high cost and reactivity. BIOMATERIALS

38. TITANIUM BASED ALLOYS • Titanium is a light metal having a density of 4.505g/cm3 at • 250C . • Since aluminum is a lighter element and vanadium barely • heavier than titanium, the density of Ti-6% Al-4% V alloy is • very similar to pure titanium. • The melting point of titanium is about 16650C although • variable data are reported in the literature due to the effect • of impurities. BIOMATERIALS

39. TITANIUM BASED ALLOYS • Titanium exists in two allotropic forms, • the low temperature -form has a close-packed hexagonal • crystal structure with a c/a ratio of 1.587 at room temperature • Above 882.50C -titanium having a body centered cubic • structure which is stable • The presence of vanadium in a titanium-aluminium alloy tends to form - two phase system at room temperature. • Ti-6 Al-4V alloy is generally used in one of three conditions wrought, forged or cast. BIOMATERIALS

40. TITANIUM BASED ALLOYS • Wrought alloy • It is available in standard shapes and sizes and is annealed • at 7300C for 1-4 hours, furnace cooled to 6000C and air- • cooled to room temperature. • Forged alloy • The typical hot-forging temperature is between 900°C and • 930°C.Hot forging produces a fine grained -structure with a • depression of varying  phase. A final annealing treatment • is often given to the alloy to obtain a stable microstructure • without significantly altering the properties of the alloy. BIOMATERIALS

41. TITANIUM BASED ALLOYS • Cast alloy • To provide a metallurgical stable homogenous structure castings are annealed at approximately 8400C . • Cast Ti-6 Al-4V alloy has slightly lower values for mechanical properties than the wrought alloy. Titanium and its alloys are widely used because they show • exceptional strength to weight ratio • good mechanical properties. The lower modulus is of significance in orthopedic devices since it implies greater flexibility. BIOMATERIALS

42. TITANIUM BASED ALLOYS • To improve tribiological properties of Titanium there are four general types of treatments made. • Firstly, the oxide layer may be enhanced by a suitable oxidizing treatment such as anodizing • Secondly, the surface can be hardened by the diffusion of interstitial atoms into surface layers • Thirdly, the flame spraying of metals or metal oxides on to the surface may be employed • Finally, other metals may be electroplated onto the surface BIOMATERIALS

43. TITANIUM BASED ALLOYS BONE SCREWS USED FOR IMPLANTATION BIOMATERIALS