Skjöldebrand Charlotte, Tipper Joanne L, Hatto Peter, Bryant Michael, Hall Richard M, Persson Cecilia
Uppsala University, Department of Materials Science and Engineering, Uppsala, Sweden.
University of Technology Sydney, School of Biomedical Engineering, Sydney, Australia.
Mater Today Bio. 2022 Apr 30;15:100270. doi: 10.1016/j.mtbio.2022.100270. eCollection 2022 Jun.
Hip and knee joint replacements are common and largely successful procedures that utilise implants to restore mobility and relieve pain for patients suffering from e.g. osteoarthritis. However, metallic ions and particles released from both the bearing surfaces and non-articulating interfaces, as in modular components, can cause hypersensitivity and local tissue necrosis, while particles originating from a polymer component have been associated with aseptic loosening and osteolysis. Implant coatings have the potential to improve properties compared to both bulk metal and ceramic alternatives. Ceramic coatings have the potential to increase scratch resistance, enhance wettability and reduce wear of the articulating surfaces compared to the metallic substrate, whilst maintaining overall toughness of the implant ensuring a lower risk of catastrophic failure of the device compared to use of a bulk ceramic. Coatings can also act as barriers to inhibit ion release from the underlying material caused by corrosion. This review aims to provide a comprehensive overview of wear-resistant coatings for joint replacements - both those that are in current clinical use as well as those under investigation for future use. While the majority of coatings belong predominantly in the latter group, a few coated implants have been successfully marketed and are available for clinical use in specific applications. Commercially available coatings for implants include titanium nitride (TiN), titanium niobium nitride (TiNbN), oxidized zirconium (OxZr) and zirconium nitride (ZrN) based coatings, whereas current research is focused not only on these, but also on diamond-like-carbon (DLC), silicon nitride (SiN), chromium nitride (CrN) and tantalum-based coatings (TaN and TaO). The coating materials referred to above that are still at the research stage have been shown to be non-cytotoxic and to reduce wear in a laboratory setting. However, the adhesion of implant coatings remains a main area of concern, as poor adhesion can cause delamination and excessive wear. In clinical applications zirconium implant surfaces treated to achieve a zirconium oxide film and TiNbN coated implants have however been proven comparable to traditional cobalt chromium implants with regards to revision numbers. In addition, the chromium ion levels measured in the plasma of patients were lower and allergy symptoms were relieved. Therefore, coated implants could be considered an alternative to uncoated metal implants, in particular for patients with metal hypersensitivity. There have also been unsuccessful introductions to the market, such as DLC coated implants, and therefore this review also attempts to summarize the lessons learnt.
髋关节和膝关节置换术是常见且大多成功的手术，通过植入物来恢复患有骨关节炎等疾病患者的活动能力并缓解疼痛。然而，从承载表面和非关节界面（如模块化部件）释放的金属离子和颗粒会导致超敏反应和局部组织坏死，而聚合物部件产生的颗粒与无菌性松动和骨质溶解有关。与块状金属和陶瓷替代品相比，植入物涂层有可能改善其性能。与金属基底相比，陶瓷涂层有可能提高抗划伤性、增强润湿性并减少关节表面的磨损，同时保持植入物的整体韧性，确保与使用块状陶瓷相比，设备灾难性故障的风险更低。涂层还可以作为屏障，抑制由于腐蚀从底层材料释放离子。本综述旨在全面概述用于关节置换的耐磨涂层——包括当前临床使用的涂层以及正在研究以供未来使用的涂层。虽然大多数涂层主要属于后一组，但一些涂层植入物已成功上市，可用于特定临床应用。用于植入物的市售涂层包括氮化钛（TiN）、钛铌氮化物（TiNbN）、氧化锆（OxZr）和氮化锆（ZrN）基涂层，而当前的研究不仅集中在这些涂层上，还包括类金刚石碳（DLC）、氮化硅（SiN）、氮化铬（CrN）和钽基涂层（TaN和TaO）。上述仍处于研究阶段的涂层材料已被证明在实验室环境中无细胞毒性并能减少磨损。然而，植入物涂层的附着力仍然是一个主要关注领域，因为附着力差会导致分层和过度磨损。然而，在临床应用中，经过处理以形成氧化锆膜的锆植入物表面和TiNbN涂层植入物在翻修次数方面已被证明与传统钴铬植入物相当。此外，在患者血浆中测得的铬离子水平较低，过敏症状得到缓解。因此，涂层植入物可被视为未涂层金属植入物的替代品，特别是对于对金属过敏的患者。市场上也有不成功的产品推出，如DLC涂层植入物，因此本综述还试图总结经验教训。
