Titanium in Medicine

Springer-Verlag Berlin Heidelberg GmbH

Engineering ONLINE LlBRARY

http://www.springer.de/eng inel

D. M. Brunette P. Tengvall M. Textor P. Thomsen

Titanium in Medicine Material Science, Surface Science, Engineering, Biological Responses and Medical Applications

Springer

Prof. Dr. Donald M. Brunette University of British Columbia Faculty of Dentistry Vancouver Canada

Prof. Dr. Pentti Tengvall Linkoping University Department of Physics and Measurement Technology Linkoping Sweden

Dr. Marcus Textor Swiss Federal Institute of Technology (ETH) Department of Materials Zurich Switzerland

Prof. Dr. Peter Thomsen Goteborg University Institute of Anatomy & Cell Biology Goteborg Sweden

ISBN 978-3-642-63119-1

CIP-data applied for Die Deutsche Bibliothek - CIP-Einheitsaufnahme

Titanium in medicine : material science, surface science, engineering, biological responses and medical applications I ed.: Donald M. Brunette .... - Berlin ; Heidelberg ; New York; Barcelona; Hongkong; London ; Mailand ; Paris ; Singapur ; Tokio : Springer, 2001

(Engineering materials) ISBN 978-3-642-63119-1 ISBN 978-3-642-56486-4 (eBook) DOI 10.1007/978-3-642-56486-4

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is con­cerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, repro­duction on microfilm or in other ways, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its cur­rent version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law.

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Preface V

Preface

The editors would like to express their deep thanks to the many people involved in the realization of this book, in particular to

Ms. Lesley Weston, University of British Columbia, for her dedicated and profes­sional proof reading and correction of all the chapters, a task that was especially challenging for this book because English is a second language for many of the authors.

Agneta Askendal, Linkoping University, for a professional graphics analysis.

Christina Gretzer, Lena Emanuelsson and Anna Johansson, Laila Falk and Barbro Lanner, Goteborg University, Peter Revell and Anne Bowe, Royal Free and Univer­sity College Medical School, London, for help with a multitude of items during 1999-2000.

Lorenz Textor and Andreas Textor as well as Lukas Urech and Markus Muller, ETH Zurich, for bringing the manuscripts into camera-ready form and for design­ing the companion web-site «www.titaniuminmedicine.com» that will provide read­ers with opportunities to comment on the book and learn of new developments in the field. Ms. Milena Turek, ETH Zurich, for her careful and dedicated help with administrative items.

And last but not least to our wives Liz Brunette, Pia Tengvall, Sylvia Thomsen and Danielle Textor-Niquille for continuous support and patience during the three years of planning and production of this book.

Foreword

Erich Wintermantel

Swiss Federal Institute of Technology (ETH)

Department of Materials, Zurich, Switzerland]

Foreword VII

Titanium, although an abundant element in minerals, is not found in significant amounts in the human body. Nevertheless, the surface of titanium is among the most biocompatible ones known, and the metal has demonstrated such success in biomedical devices, including dental and orthopedic implants, that titanium for medical purposes promises to develop into a multibillion dollar market. With this in mind, it was obvious to invite experts from around the world to summarize our cur­rent knowledge of the material in a comprehensive book. The editors are to be con­gratulated for having provided such a fine result that summarizes a vast amount of work on this medically-important topic.

In my view, the usefulness of titanium and its alloys in medicine can be linked to some specific properties: • spontaneous formation in air and blood of a highly biocompatible dioxide passi­

vation film, providing surfaces that can support direct ongrowth of local tissues, • corrosion resistance against atmospheric and aggressive fluidic environments

that is helpful in long term implant applications, • the ability to influence redox reactions at the tissue interface in a way that can

modulate cell and tissue behavior, • the ability to be fabricated into structured surfaces, optimized in morphology

and porosity to living recipient tissues, • an improvement over stainless steel and cobalt-chromium alloys in cases where

Nuclear Magnetic Resonance Imaging (NMR) and Computed Tomography (CT) are required,

• lightness as it weighs 40% less than steel, making it a candidate for surgical instruments, such as those used in microsurgery and

• absence of allergic reactions in patients (so far). As the material can be processed as bulk material using conventional metal­

forming processes including casting, forging, detaching and cutting, it is suitable for load-transmitting implants as well as instruments. Moreover, titanium can be

1 present address: Zentralinstitut fiir Medizintechnik der TV Miinchen Boltzmannstrasse 15 D-85748 Garching

VIII Introduction

spray-coated onto less biocompatible surfaces or serve as carrier for bioactive sur­faces, e.g. hydroxyapatite in dental and orthopedic applications.

Despite of the need for life cycle engineering of parts made from titanium and titanium alloys, the potential of this material has still been underestimated. It will doubtlessly have a major impact on future generations of medical devices and implants including traditional applications in dentistry, orthopaedics and the car­diovascular system. Moreover, titanium dioxide is available as various powders and configurations and is a promising material as cell carriers or tissue scaffold in tissue engineering.

This book will help readers to obtain a comprehensive insight into current worldwide research in titanium and widen their horizons regarding future medical applications for the benefit of patients. May it be of utmost help to the scientific, engineering and medical communities.

L~~~~~ The photograph shows an original STH femoral component of an artificial hip joint, one of the first made of titanium alloy, fabricated in the late seventies. This femoral component was a non-modular, all titanium device that turned out to have an insufficient resistance of the femoral ball against abrasive wear caused by third-body particles. Subsequent designs of titanium alloy femoral stems were fabricated as modular com­ponents with the ball made of cobalt-chromium alloy, alumina or zirconia, attached by a Morse taper connection and showing improved abra­sion resistance. (Reproduced by permission of Prof. Harry McKellop, The J. Vernon Luck Sr. M.D. Ortho­paedic Research Center, Los Angeles Ortho­paedic Hospital, USA)

Editors' Introduction IX

Editors' Introduction

This book «Titanium in Medicine» was planned to be a state-of-the-art textbook providing scientific and technical in-depth information in a form that was suitable for use in education as well as a reference book on titanium for biomedical applica­tions. The need for a text like this arises from the rapid expansion of knowledge on titanium. This knowledge is widely scattered as articles featuring titanium appear in journals of numerous disciplines from cell biology through medicine to the physical sciences. The result is that both newcomers to the area of biomedical devices as well as those already active in the field can easily miss developments in topics not directly involved in their work. However the diversity of material rele­vant to titanium in medicine presents a challenge to the editors both in the selection of authors and in the adoption of a coherent organization.

As many excellent scientists investigate titanium and its applications in medi­cine, the choice of authors was difficult, but we tried to achieve a balance between those working in basic science departments at universities where basic knowledge is produced and those in industry or clinics where that knowledge is applied. Although most of the contributors have worked for many years in specific topics related to Titanium in Medicine, we also included a few younger investigators in order to present fresh perspectives and newly developed technologies. Finally we also solicited contributions from both European and North American investigators so that various research traditions would be represented.

The book is organized with an introductory section (Part I) in which senior bio­materials scientists give an overview and perspectives that come from long experi­ence in the field. Part II and Part III contain 11 chapters that are largely based on physical material sciences and technologies and contain basic information on the materials properties as well as methods for the modification of titanium surfaces. The emphasis on surface properties arises from the importance of surface texture and chemistry for implant performance, but also from the likelihood that future improvements in titanium devices will be a result of interfacial modifications. Part IV is devoted to cell and tissue responses to titanium and includes sections on vari­ous cell populations and tissue fluids that encounter titanium implants, including blood, soft tissues and bone as well as titania carriers for cell culture. Part V con­centrates on clinical applications, including contributions from authors involved in the design and production of titanium devices. Their perspective entails under­standing the advantages and disadvantages of titanium relative to the more com­monly-used materials in orthopedics, stainless steel and cobalt-chromium alloys. Clinical applications are presented from the disciplines of orthopedics, dentistry, cardiology and cardiovascular surgery, and audiology. Part V closes with a discus­sion on the processes involved in obtaining approval of implanted devices by gov­ernmental regulatory bodies.

X Introduction

Emphasis has been given to cross referencing between the chapters, directing the interested reader to basic chapters where a particular aspect is treated in more detail or to more applied chapters where the information provided is relevant to the performance of titanium in a given medical situation. At the same time, the editors have deliberately accepted a certain amount of redundancy particularly when it helps the line of argument within a chapter to flow smoothly or where complemen­tary views on a given topic are presented.

At a time when most working scientists routinely use the Internet for informa­tion services, we thought it was important that useful world-wide-web sites from academia and industry be listed in an Appendix and we also provide the email addresses and web-sites for the contributors. In this way we hope to make it conve­nient for readers to obtain updated information, such as the most recent publica­tions. Since a compilation of web-site addresses is never complete and needs regular updates in order to remain useful, a web-site

http://www.titaniuminmedicine.com

has been created to allow the reader to provide further contact addresses as well as general feedback on the book. Finally as the range of disciplines is wide, the num­ber of acronyms that may be unfamiliar to readers might be large and confusing, and we have included an appendix of abbreviations that are standard throughout the book.

Our aim has been to produce a book that can serve as a reference of value both to the newcomer to the field of titanium in medical applications as well as to those more familiar with the topics. Although all the editors have worked extensively in various aspects of titanium in medicine, one of the most frequent comments made as we discussed the chapters in the book was "I learnt a lot from that chapter". We hope that the readers experience a similar satisfaction. Suggestions for additions or changes for possible future editions of the book will be most welcome.

Donald M. Brunette Pentti Tengvall Marcus Textor Peter Thomsen

Contents XI

Contents

Part I Introductory Survey

1. A Perspective on Titanium Biocompatibility ....................... 1 Buddy D. Ratner

2. Titanium for Medical Applications .............................. 13 David F. Williams

Part II Metallurgy and Fabrication; Surface and Technological Properties

3. Metallurgy and Technological Properties of Titanium and Titanium Alloys .......................................... 25 Howard L. Freese, Michael G. Volas, J. Randolph Wood

4. Titanium-Nickel Shape Memory Alloys in Medical Applications ...... 53 Peter Filip

5. Characterization of Titanium Surfaces ........................... 87 Janos Voros, Marco Wieland, Laurence Ruiz-Taylor, Marcus Textor, Donald M. Brunette

6. The Corrosion Properties of Titanium and Titanium Alloys ........ 145 Rolf Schenk

7. Properties and Biological Significance of Natural Oxide Films on Titanium and Its Alloys .................. 171 Marcus Textor, Caroline Sittig, Vinzenz Frauchiger, Samuele Tosatti, Donald M. Brunette

Part III Surface Engineering

8. Mechanical, Thermal, Chemical and Electrochemical Surface Treatment of Titanium ...........•........•....•...... 231 Jukka Lausmaa

9. Sol-Gel Coatings on Titanium ................................. 267 Laurent-Dominique Piveteau

10. Physical and Chemical Vapor Deposition and Plasma-assisted Techniques for Coating Titanium ................ 283 Roger Thull, David Grant

XII Introduction

11. Production of Microfabricated Surfaces and Their Effects on Cell Behavior ................................. 343 Nicolas A.F. Jaeger, Donald M. Brunette

12. Thermal Spray Coatings on Titanium .......................... 375 Heiko Gruner

13. Biochemical Modification of Titanium Surfaces .................. 417 Shou-Jun Xiao, Gregory Kenausis, Marcus Textor

Part IV Biological Performance

14. Proteins at Titanium Interfaces ................................ 457 Pentti Tengvall

15. Principles of Cell Behavior on Titanium Surfaces and Their Application to Implanted Devices ......................... 485 Donald M. Brunette

16. Titanium in Soft Tissues ...................................... 513 Kajsa-Mia Holgers, Marco Esposito, Mia Kiilltorp, Peter Thomsen

17. The Titanium-Bone Cell Interface In Vitro: The Role of the Surface in Promoting Osteointegration ............ 561 Barbara D. Boyan, David D. Dean, Christoph H. Lohmann, David L. Cochran, Victor L. Sylvia, Zvi Schwartz

18. The Titanium-Bone Interface In Vivo ........................... 587 Cecilia Larsson, Marco Esposito, Haihong Liao, Peter Thomsen

19. Titanium Ceramics for Cell-Carriers and for Medical Applications .. 649 Erich Wintermantel, Karl-Ludwig Eckert, Ning-Ping Huang, Marcus Textor, Donald M. Brunette

Part V Medical Applications

20. Design and Engineering Criteria for Titanium Devices ............ 673 Beat Gasser

21. Titanium for Hip and Knee Prostheses .......................... 703 Markus Windler, Ralf Klabunde

22. Wear of Titanium 6-4 Alloy in Laboratory Tests and in Retrieved Human Joint Replacements ........................ 747 Harry A. McKellop, Tord Rostlund, Edward Ebramzadeh, Augusto Sarmiento

Contents XIII

23. Titanium as Implant Material for Osteosynthesis Applications ...... 771 Stephan M. Perren, Ortrun E.M. Pohler, Erich Schneider

24. Titanium for Dental Applications (I) ............................ 827 Marco Esposito

25. Titanium for Dental Applications (II): Implants with Roughened Surfaces ..•.......................... 875 Daniel Buser

26. Titanium in Cardiac and Cardiovascular Applications ............. 889 Christian Olin

27. Titanium in Audiology .•..........•.......................... 909 Kajsa-Mia Holgers, Bo Hakansson

28. Regulatory Aspects in the Use of Titanium-based Materials for Medical Applications ..................•............••..... 929 Karl-Gustav Strid

Part VI Appendices

Appendix A Color Figures .................................................. 949

Appendix B Biographies of Editors and Authors .......•....•......•.....•..... 971

Appendix C Abbreviations ..•..............................•....•.....•.... 995

Appendix D World-Wide-Web Sites (URL Addresses) ...........••....•....••... 999

Appendix E Index .............................•......•................... 1005

AppendixF Spectacles for Stereo-View of Color Figures (App. A) ......•..................... insert at end of book