In brief

Bone Cement

The present work describes a technique to develop silver nanoparticles decorated calcium titanate–titania (AgNPs-CT-TiO₂) nanostructured layer over Ti6Al4V alloy powder by simple chemical and heat treatment approach. The NaOH solution and heat treatment form a uniform porous nano-network morphology of sodium titanate and subsequent calcium nitrate treatment transforms it into calcium titanate along with rutile TiO₂. However, simultaneous treatment with calcium and silver nitrate solution allows the incorporation of both calcium and silver ions over the nano-network morphology leading to the formation of AgNPs decorated calcium titanate along with anatase TiO₂ (AgNPs-CT-TiO₂@Ti6Al4V) that collectively induces biocompatibility towards MG 63 osteoblast-like cells as well as antimicrobial activity against Staphylococcus aureus. Thus modified AgNPs-CT-TiO₂@Ti6Al4V alloy powders were subsequently blended with polymethyl methacrylate to develop a composite scaffold using NaCl as a porogen. This composite could be used as a scaffold or bone cement in various bone tissue engineering applications.

Some additives had provided the expansion capacity to the polymethylmethacrylate (PMMA) bone cement and also reduced its maximum reaction temperature. However, the corresponding modified bone cement displayed inferior simulated body fluid (SBF) absorption capacity and expansion behavior, the mechanism of SBF absorption and the trend of expansion stress were ignored additionally. In this study, a homogeneous distribution of poly (methyl methacrylate-co-acrylic acid) [P(MMA-AA)] microspheres led to the formation of microchannels that favored the delivery of SBF to the interior, causing an increased absorption capacity and enhanced expansion behavior before solidification of the bone cement, with the maximum equilibrium absorption ratio and the expansion ratio reaching 27.3 % and 26.3 %, respectively, at an AA content of 50 %. In addition, the expansion stress induced by the expansion behavior experienced a gradual increase from the 0 s to 2590s, followed by a sharp climbed in a short period ranging from 2590s to 2900s, finally reaching maximum stress of 82.1 MPa. Furthermore, the expansion stress within the maximum value could be obtained by controlling the AA content in the P(MMA-AA) bone cement. With the above characteristics, the prepared P(MMA-AA) bone cement has potential applications as a filling and adhesive material in arthroplasties, vertebroplasties, joint replacements, bone screws, and dentistry.

The purpose of this multi-phase explorative in vivo animal/surgical and in vitro multi-test experimental study was to (1) create a 3 wt%-nanostrontium hydroxyapatite-enhanced calcium phosphate cement (Sr-HA/CPC) for increasing bone formation and (2) creating a simvastatin-loaded poly(lactic-co-glycolic acid) (SIM-loaded PLGA) microspheres plus CPC composite (SIM-loaded PLGA + nanostrontium-CPC). The third goal was the extensive assessment of multiple in vitro and in vivo characteristics of the above experimental explorative products in vitro and in vivo (animal and surgical studies).

Physical and chemical properties of the prepared Sr-HA/CPC were evaluated. MTT assay and alkaline phosphatase activities, and radiological and histological examinations of Sr-HA/CPC, CPC and negative control were compared. X-ray diffraction (XRD) indicated that crystallinity of the prepared cement increased by increasing the powder-to-liquid ratio. Incorporation of Sr-HA into CPC increased MTT assay (biocompatibility) and ALP activity (P < 0.05). Histomorphometry showed greater bone formation after 4 weeks, after implantation of Sr-HA/CPC in 10 rats compared to implantations of CPC or empty defects in the same rats (n = 30, ANOVA P < 0.05).

After SEM assessment, the produced composite of microspheres and enhanced CPC were implanted for 8 weeks in 10 rabbits, along with positive and negative controls, enhanced CPC, and enhanced CPC plus SIM (n = 50). In the control group, only a small amount of bone had been regenerated (localized at the boundary of the defect); whereas, other groups showed new bone formation within and around the materials. A significant difference was found in the osteogenesis induced by the groups sham control (16.96 ± 1.01), bone materials (32.28 ± 4.03), nanostrontium-CPC (24.84 ± 2.6), nanostrontium-CPC-simvastatin (40.12 ± 3.29), and SIM-loaded PLGA + nanostrontium-CPC (44.8 ± 6.45) (ANOVA P < 0.001). All the pairwise comparisons were significant (Tukey P < 0.01), except that of nanostrontium-CPC-simvastatin and SIM-loaded PLGA + nanostrontium-CPC. This confirmed the efficacy of the SIM-loaded PLGA + nanostrontium-CPC composite, and its superiority over all materials except SIM-containing nanostrontium-CPC.