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1.

0 INTRODUCTION

Biomaterials are materials of natural or man-made origin that are used to
direct, supplement, or replace the functions of living tissues of the human body
1
. The
use of biomaterials such as in artificial eyes, ears, teeth, and noses were found on
Egyptian mummies
2
. Over the centuries, advancements in synthetic materials,
surgical techniques, and sterilization methods have permitted the use of biomaterials
in many ways. Medical practice today utilizes a large number of devices and implants.
Biomaterials in the form of implants (sutures, bone plates, joint replacements,
ligaments, vascular grafts, heart valves, intraocular lenses, dental implants, etc.) and
medical devices (pacemakers, biosensors, artificial hearts, blood tubes, etc.) are
widely used to replace and/or restore the function of traumatized or degenerated
tissues or organs, to assist in healing, to improve function, to correct abnormalities,
and thus improve the quality of life of the patients.
3


In the early days all kinds of natural materials such as wood, glue and rubber,
and tissues from living forms, and manufactured materials such as iron, gold, zinc and
glass were used as biomaterials based on trial and error. The host responses to these
materials were extremely varied. Some materials were tolerated by the body whereas
others were not. Under certain conditions (characteristiccs of the host tissues and
surgical procedure) some materials were tolerated by the body, whereas the same
materials were rejected in another situation. Over the last 30 years considerable
progress has been made in understanding the interactions between the tissues and the
materials. It has been acknowledged that there are profound differences between non-
living (avital) and living (vital) materials. Researchers have coined the words
biomaterial and biocompatibility to indicate the biological performance of
materials. Materials that are biocompatible are called biomaterials, and the
biocompatibility is a descriptive term, which indicates the ability of a material to
perform with an appropriate host response, in a specific application
4
.

1
Marcel Dekker. (1992). Biological Performance of Materials: Fundamentals of Biocompatibility.
2
D.F Williams and J Cunningham. (1979). Materials in Clinical Dentistry. Oxford University Press,
Oxford, UK
3
J.B Park. (1984)Biomaterials Science and Engineering. Plenum Press, New York
4
D.F Williams. (1988) Consensus and definitions in biomaterials. C de Putter, K de Lange, K de Groot,
A.J.C Lee (Eds.), Advances in Biomaterials, Amsterdam, Elsevier Science. pp 1116
1

Clinical experience clearly indicates that not all off-the-shelf materials
(commonly used engineering materials) are suitable for biomedical applications. The
various materials used in biomedical applications may be grouped into (a) metals, (b)
ceramics, (c) polymers, and (d) composites made from various combinations of (a),
(b) and (c). Researchers also classfied materials into several types such as bioinert and
bioactive, biostable and biodegradable, etc
5
.

A large number of polymers are widely used in various applications. This is
mainly because they are available in a wide variety of compositions, properties, and
forms (solids, fibers, fabrics, films, and gels), and can be fabricated readily into
complex shapes and structures. However, they tend to be too flexible and too weak to
meet the mechanical demands of certain applications e.g. as implants in orthopedic
surgery. Also they may absorb liquids and swell, leach undesirable products (e.g.
monomers, fillers, plasticizers, antioxidants), depending on the application and usage.
Moreover, the sterilization processes (autoclave, ethylene oxide, and
60
Co irradiation)
may affect the polymer properties.Polymer composite materials provide alternative
choice to overcome many shortcomings of homogenous materials mentioned above.
The specific advantages of polymer composites are highlighted in the following.
6




The figure 1 shows the various applications of different polymer composite
biomaterials.

5
L.L Hench. (1991). Bioceramics: from concept to clinic. J. American Ceramic Society, 74, pp. 1487
1510
6
S Ramakrishna, J Mayer, E Wintermantel, and Kam W Leong. (2001). Composites Science and
Technology. 61(9), pp 1189-1224.
2

Figure 1: the various applications of different polymer composite biomaterials
The picture is taken from http://www.sciencedirect.com/science/article/pii/S0266353800002414





3
1.1 The definition of polymer

Polymers are chemical compound that are made of small molecules that are
arranged in a simple repeating structure to form a larger molecule.
7
From the word it
self poly means many and mer means unit. Therefore, the polymers are made by
linking small molecules (mers) through primarycovalent bonding in the main
molecular chain backbone with C, N, O, Si, etc. One exampleis polyethylene, which
is made from ethylene (CH2 =CH2), where the carbon atoms shareelectrons with two
other hydrogen and carbon atoms: CH2 -(CH2 CH2 )n CH2 , in which n
indicatesthe number of repeating units. Also note (in view of the monomer structure)
that therepeating unit is CH2 CH2 , not CH2 .
8


In order to make a strong solid, the repeating unit (n) should be well over
1,000. For example,the molecular weight (m.w.) of the polyethylene is over 28,000
grams per mole. This iswhy the polymers are made of giant molecules.

The elastomeric polymers were first developed for making synthetic rubbers
for militarypurpose. A good understanding and synthesis of various polymers were
accelerated sinceWorld War II. Figure 1 shows some history of some commercially
important polymers:

Figure 2: history of some commercially important polymers
(taken from 1984, wiley)





7
http://www.merriam-webster.com/dictionary/polymer
8
Polymeric implant materials
4
1.2 Polymerization

Polymerization is a process in which relatively small molecules,
called monomers, combine chemically to produce a very large chainlike or
network molecule called a polymer.
9
Polymerization can occur when the unit of
copolymers joined together, or when there is free radical to initiate the process and
also when there is cross-linkage between the monomers. By controlling the reaction
temperature, pressure, and time in the presence of catalyst(s), the degree to which
repeating units are put together intochains can be manipulated. There are two types of
polymerization, which are condensation (or step reaction polymerization) and
addition (or free radical polymerization).

In condensation polymerization, each step of the process is accompanied by
formation of a molecule of some simple compound often water.The chemical reaction
for condensation process is shown in figure 2:


Figure 3: chemical reaction for condensation
(taken from 1984, wiley)

In addition polymerization, monomers react to form a polymer without the
formation of by-products. Addition polymerizations usually are carried out in the
presence of catalysts, which in certain cases exert control over structural details that
have important effects on the properties of the polymer. The chemical reaction for
condensation process is shown in figure 3:



Figure 4: chemical reaction for addition
(taken from 1984, wiley)


The breaking of a double bond can be made with an initiator. This is usually a
free radical such as benzoyl peroxide. The initiation can be activated by heat,
ultraviolet light, and other chemicals. The free radicals (initiators) can react with
monomers and also another monomer. The process can continue on and this process is
called propagation. The propagation process can be terminated by combining two free
radicals, by transfer or by disproportionate processes, respectively.


9
http://www.britannica.com/EBchecked/topic/468745/polymerization
5
1.3 Types of polymer
There are many types of polymers including synthetic and natural polymers.
Natural polymers are proteins such as silk, collagen, and keratin, carbohydrates such
as cellulose, starch, glycogen and DNA. Other natural polymers are rubber
(hydrocarbon base) and silicones (alternating silicon and oxygen)
10
. Two types of
polymer:
Homopolymers - consist of chains with identical bonding linkages to each monomer
unit. This usually implies that the polymer is made from all identical monomer
molecules.
These may be represented as: - [A-A-A-A-A-A]-
Copolymers - consist of chains with two or more linkages usually implying two or
more different types of monomer units. These may be represented as:
- [A-B-A-B-A-B]-
Polymers are further classified by the reaction mode of polymerization, these include:
Addition Polymers - the monomer molecules bond to each other without the loss of
any other atoms. Alkene monomers are the biggest groups of polymers in this class.
Table 1 shows some example of the addition polymers:
Monomers name Chemical formula
Acrylonitrile CH2=CHCN
Ethylene CH2=CH2
Methyacrylate CH2=CHCOOCH3
Propylene CH2=CHCH3
Vinyl chloride CH2=CHCl
Table 1: example of the addition polymers
(taken from 1984, wiley)

Condensation Polymers - usually two different monomer combine with the loss of a
small molecule, usually water. Polyesters and polyamides (nylon) are in this class of
polymers. Polyurethane Foam in graphic. Figure 4 shows some example of the
condensation polymers:

10
Painter, Paul C.; Coleman, Michael M. (1997). Fundamentals of polymer science :
an introductory text. Lancaster, Pa.: Technomic Pub. Co. p. 1.

6

Figure 5: example of the condensation polymers
(taken from 1984, wiley)

1.4 Structure of polymers

1.4.1 Addition Polymers

Figure 6: Structure of polyethylene (addition polymer type)
The picture is taken from (C. Ophardt, 2003)
Polymers are long chain giant organic molecules are assembled from many
smaller molecules called monomers. Polymers consist of many repeating monomer
units in long chains. A polymer is analogous to a necklace made from many small
beads (monomers).
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Many monomers are alkenes which react by addition to their unsaturated
double bonds. The formation of polyethylene from ethylene (ethene) may be
illustrated in the figure 5.
The electrons in the double bond are used to bond two monomer molecules
together. This is represented by the red arrows moving from one molecule to the
space between two molecules where a new bond is to form.
Note that in the complete polymer, all of the double bonds have been turned
into single bonds. No atoms have been lost and you can see that the monomers have
just been joined in the process of addition. A simple representation is -[A-A-A-A-A]-.
Polyethylene is used in plastic bags, bottles, toys, and electrical insulation
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Figure 7: Structure of other addition polymer type (PVC, Polypropylene, Polystryrene)
The picture is taken from (C. Ophardt, 2003)
PVC (polyvinyl chloride): which is found in plastic wrap, simulated leather, water
pipes, and garden hoses, is formed from vinyl chloride (H
2
C=CHCl). The reaction is
shown in the graphic on the left. Notice how every other carbon must have a chlorine
attached.
Polypropylene: The reaction to make polypropylene (H
2
C=CHCH
3
) is illustrated in
the middle reaction of the graphic.Notice that the polymer bonds are always through
the carbons of the double bond. Carbon #3 already has saturated bonds and cannot
participate in any new bonds. A methyl group is on every other carbon.
Polystyrene: The reaction is the same for polystrene where everyother carbon has a
benzene ring attached.

11
Roiter, Y.; Minko, S. (2005). "AFM Single Molecule Experiments at the Solid-
Liquid Interface: In Situ Conformation of Adsorbed Flexible Polyelectrolyte Chains".
Journal of the American Chemical Society127 (45)

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1.4.2 Condensation Polymers


Figure 8: Structure of polyester (condensation polymer type)
The picture is taken from (C. Ophardt, 2003)

Polyesters such as PET (polyethylene terephthalate) are condensation
polymers. The formation of a polyester follows the same procedure as in the synthesis
of a simple ester
12
. The only difference is that both the alcohol and the acid monomer
units each have two functional groups - one on each end of the molecule. In this
polymer, every other repeating unit is identical.

PET is made from ethylene glycol and terephthalic acid by splitting out water
molecules (-H from alcohol and -OH from acid as shown in red on the figure). The
units are joined to make the ester group shown in green. A simple representation is -
[A-B-A-B-A-B]-.

Depending upon the processing a variety of products are possible. If cross
linked it is made into clear plastic soft drink bottles. It can also be made into textile
fibers known as Dacron and accounts for 50% of all fibers used to make clothing.
Blended with cotton, Dacron is made into no-iron clothes
13
.


12
Painter, Paul C.; Coleman, Michael M. (1997). Fundamentals of polymer science :
an introductory text. Lancaster, Pa.: Technomic Pub. Co. p. 1.
13
Roiter, Y.; Minko, S. (2005). "AFM Single Molecule Experiments at the Solid-
Liquid Interface: In Situ Conformation of Adsorbed Flexible Polyelectrolyte
Chains". Journal of the American Chemical Society127 (45)


9
This same polymer with the trade name of mylar when made as "tape" is
magnetically coated for use in tape recorders and videotape machines
14
.


Figure 9: Structure of polyamide (condensation polymer type)
The picture is taken from (C. Ophardt, 2003)
Polyamides such as nylon are also condensation polymers. The formation of a
polyamide follows the same procedure as in the synthesis of a simple amide. Again,
the only difference is that both the amine and the acid monomer units each have two
functional groups - one on each end of the molecule. In this polymer, every other
repeating unit is identical.
Nylon is made from 1,6-diaminohexane and adipic acid by splitting out water
molecules (-H from the amine and -OH from acid as shown in red on the figure
above). The units are joined to make the ester group shown in green. A simple
representation is -[A-B-A-B-A-B]-.
Nylon 66, discovered in 1931 by Wallace Cruthers at DuPont was the first completely
synthetic fiber produced. It was introduced to women in nylon stockings in 1939 to
immediate success. During World War II, nylon production went into making
parachutes and other items needed by the military.
Nylon is very similar to the protein polyamides in silk and wool, but is stronger. more
durable, more chemically inert, and cheaper to produce than the natural fibers.


14
Allcock, Harry R.; Lampe, Frederick W.; Mark, James E. (2003). Contemporary
Polymer Chemistry (3 ed.). Pearson Education. p. 21.

10


Figure 10: Structure of polyurethane (condensation polymer type)
The picture is taken from (C. Ophardt, 2003)
Polyurethanes are made from a dialcohol and diisocyanate monomers. The
isocyanate compounds contain the functional group (O=C=N-). A rearrangement
reaction leads to the formation of the urethane linkage. Technically polyurethane is
not a condensation polymer since no molecules are lost, but the functional group does
rearrange.
Hydrogen moves from the alcohol to the nitrogen, while the oxygen links to
the carbon. The urethane functional groups are similar to the amide group [1]. In
some applications the urethane polymer chains are further reacted to make cross-
links. Think of a chain link fence to get the idea of cross-linking chains together.
Polyurethane can be drawn into fibers used in upholstery. Soft polyurethane
foam can be used as padding in furniture and mattresses, while rigid foam is used as
insulation in buildings.









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2.0 INTRODUCTION TO BIOACTIVE MATERIAL
2.1 Tissue attachment of biomaterials
The mechanism of tissue attachment of an implant is directly related to the
tissue response at the implant interface. No material implanted in living tissues is
inert. All materials elicit a response from the host tissue. According to the different
types of implant-tissue attachment, biomaterials are classified into four types of tissue
attachments. Table 2 shows the types of tissue attachment of biomaterials:
Type of implant Type of attachment Example

Nearly inert Mechanical interlock
(morphological fixation)
Metals, Alumina, Zirconia,
Polyethylene(PE)
Porous lngrowth of tissues into
pores (biological fixation)
Hydroxyapatite (HA), HA
coated porous metals
Bioactive Interfacial bonding with tissues
(bioactive fixation)
Bioactive glasses, HA,
Bioactive glass-ceramics

Resorbable Replacement with
tissues
Tricalcium phosphate,
Polylactic acid (PLA)

Table 2: types of tissue attachment of biomaterials
The info is obtained from: Wanpeng Cao and Larry L. Hench. (1995). Bioactive
materials. Ceramics International 22 (1996) 493-507, Elsevier Science Limited and
Techna S.r.1.














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2.2 Bioactive material
A bioactive material is one that elicits a specific biological response at the
interface of the material which results in the formation of a bond between the tissues
and the material. This definition was given by Hench, who initiated this subject of
research with his colleagues in the early 1970s.
15
The surface chemistry of implants
needs to be optimized to meet the requirements of aged, diseased and damaged
tissues. Biocompatibility, or tissue tolerance, is not enough. A general theory of
biomaterials was expressed by Hench and Ethridge in 1982 as:
16

a) An ideal implant material performs as if it were equivalent to the host tissue.
b) Axiom 1. The tissue at the interface should be equivalent to the normal host
tissue.
c) Axiom 2. The response of the material to physical stimuli should be like that
of the tissue it replaces.
These axioms are interdependent. A stable interfacial bond between tissue and
implant must be achieved in order to obtain an equivalent physical response, and
controlled physical stimuli is necessary for a stable interface to be produced. This
general theory requires that a biomaterial have both biochemical compatibility and
biomechanical compatibility. So, besides bioactivity, a match in physical and
mechanical properties is also essential for an implant to replace bone.
They discovered that certain compositions of glasses in the system SiO
2
, CaO,
Na
2
O and P
2
O
5
were able to form a bond with bone once they are implanted. In fact,
when these glasses were put in contact with biological fluids, a layer of
hydroxyapatite (HA) analogue to the mineral phase of bones was deposited on their
surface. Collagen molecules were incorporated into this layer, and a biological bond

15
Hench LL, Splinter, RJ, Allen WC, Greenlee TK. Bonding mechanisms at the interface of ceramic
prosthetic materials. J. Biomed. Mater. Res. Symp.1971; 2 (Part I): 117141
16
Hench, L. L. &Ethridge, E. C., Biomaterials: An Interfacial Approach. Academic Press, New
York,1982.

13
could be formed. Later work by Wilson and Nolletti showed that a bond with soft
tissue could be achieved too, if the speed of apatite formation was high enough.
17

The use of synthetic materials as a way to replace damaged tissues has been
studied and practiced for a long time. The initial goal was focused on finding an ideal
biomaterial that would promote minimum response from the body. This initial idea of
"bioinertness" was progressively realized not to be enough for many applications.
Moreover, it was observed that even the most "inert" material would provoke some
type of reaction from the body, expressed by the formation of a thin non-adherent
fibrous capsule that would prevent higher levels of interaction between tissue and
biomaterial
18
. Nevertheless, fixation of the implant in place is desired in many
applications and then adhesion in the biomaterial-tissue system needs to be achieved.
Several ways to promote adhesion were then investigated, such as use of plates, pins
and screws (mechanical interlock) growth of tissue through a porous biomaterial
(biological fixation) fixation due to a cementation or polymerization reaction and use
of biodegradable pins or sutures
19
.
Another way to promote fixation was demonstrated in the late sixties. In this
case, coupling between tissue and material was promoted by an integration process.
This integration process is based on the processing of a group of reactions on the
material surface that will lead to the formation of a dynamic high-strength interphase.
In this interphase, both inorganic and organic species are combined through physical-
chemical and biochemical interactions. Materials that promote this type of interaction
with living tissues by forming chemical linkages are called bioactive materials.
Bioactive glasses and hydroxyapatite are examples of this type of material
20
.
In the early 1970s bioceramics began to be used in certain implant
applications, which depended on the fact that a smooth oxide ceramic surface,

17
Wilson J, Nolletti D. In Handbook of Bioactive Ceramics. Yamamuro T, Hench LL, Wilson J
Editors. CRC Press, Boca Raton, FL. 1990: 283.
18
Hench, L. L. and Wilson, J. (1993). An Introduction to Bioce-ramics, World Scientific.
19
Hench, L. L. and West, J. K. (1996). Life Chem. Report. 13, pp187.
20
Orfice, Rodrigo L., Hench, Larry L., & Brennan, Anthony B.. (2000). In vitro bioactivity of
polymer matrices reinforced with a bioactive glass phase. Journal of the Brazilian Chemical
Society, 11(1), 78-85. Retrieved January 11, 2014, from
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-
50532000000100014&lng=en&tlng=en. 10.1590/S0103-50532000000100014.

14
especially AlzOs, elicited very little tissue reaction and provided good wear
characteristics for a bearing surface. In 1969, the concept of a bioactive material was
discovered. Since then, the field of ceramics has expanded enormously to include
many new compositions of glasses, glass-ceramics and ceramics.
A bioactive material creates an environment compatible with osteogenesis
(bone growth), with the mineralizing interface developing as a natural bonding
junction between living and non-living materials. This concept has now been
expanded to include a large number of bioactive materials with a wide range of rates
of bonding and thickness of interfacial bonding layers. They include bioactive glasses
such as Bioglass, bioactive glass-ceramics such as Ceravital, A/W glass-ceramics and
machineable glass-ceramics, dense calcium phosphate ceramics such as synthetic
hydroxyapatite (HA), bioactive composites such as PE-HA mixtures, and a series of
bioactive coating materials. For the various bioactive materials, the mechanism of
bonding, the time dependence of bonding, the strength of the bonding, and the
thickness of bonding zone are different. The rate of development of the interfacial
bond can be referred to as the level of bioactivity.
21

2.3 Definition of bioactive polymeric materials
Bioactive polymer are synthetic or artificial polymers substituted with specific
chemical functional groups carried by the macromolecular chain that are designed to
develop specific interactions with living systems. When a polymeric material is
exposed to a biological environment, there is a natural tendency to induce different
reactions such as blood coagulation, complement activation and cell interactions.
Polymer scientists have synthesized a large number of polymers and have evaluate
their behavior when they are in contact with biomolecules, viruses, bacteria, body
fluids, cells and whole organisms.
Bioactive polymers are used to repair, restore or replace damaged or diseased
tissue or to interface with the physiological environment. They are basically three
main types of polymers used in a biological environment.
i) Polymer used as biomaterials, such as in organ replacement and bone surgery.

21
Wanpeng Cao and Larry L. Hench. (1995). Bioactive materials. Ceramics International 22 (1996)
493-507, Elsevier Science Limited and Techna S.r.1.

15
ii) Polymers serve as matrices in devices that permit control release of anactive
substance over along period of time.
iii) Soluble polymers are synthetic polymers that themselves display
biologicalactivities.

3.0 FEATURES OF BIOACTIVE POLYMERS
Some of important properties should be required for bioactive polymers are as follows

i) Biocompatibility
Acceptance of an artificial important by the surrounding tissue and by the body as a
whole.

ii) Physical, Chemical & Mechanical Properties
These must be capable with the proposed and for example, in the design of heart, the
flexing characteristics of the polymer have often been overlooked.
.
iii) Polymer Purity
Industrial reins are highly variable in nature from manufacture to manufacturer. A
variety of other materials incidental to the polymer process suchas residual initiators,
initiator fragments, solvents, plasticizers, trapped freeradicals, inhibitors, lubricants,
heat sand light stabilizers, fillers, parting agents, anti oxidants, degradation products,
curing agents, residual monomers and allow molecular weight oligomers may be
present. There may be variations in the molecular weight and in the mol. Wt.
distribution, as well linkages and branching.

iv) Ease of fabrication
The desired device should be capable of fabrication without damages in properties,
surface characteristics, crystallinity, surface oxidation, or contamination by
processing aids such as oils, solvents or like that.




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v) Stability
Bioactive polymers should not be adversely affected by the normal physiological
environment. No biodegradation that could compromise function over the short or
long term should occur, and no process should release toxic to the environment.

vi) Tolerability
Bioactive polymers should not exhibit toxic or irritant qualities, or elicit adverse
physiological responses locally or systemically. Toxicity can also be affected by the
rate of release of the substance and the biological processing and removal of the
substance.

vii) Sterilizability
The physical, chemical, mechanical and biochemical characteristics of the device or
material must not undergo any change during sterilization. This is often not as easy as
it may seem. Light, heat, radiation, or chemical treatment may beused during this
process.

viii) Foreign body reaction
The polymer should cause only minimal, if any, foreign body interaction,
inflammation, encapsulation or cell change response in the surrounding tissue. Italso
should not cause tissue or other reaction remote from the site of implantation and
should be free of response.

4.0 MATERIALS USED AS BIOACTIVE POLYMERS
The following materials using as bioactive polymers.
i) Polyetherurhaneurea (PEUU)
ii) Silicons
iii) TFE polymers
iv) PVC
v) Polyolefins
vi) Polycarbonate
vii) PMMA
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viii) Polyesters
ix) Cellulose
x) Polyvinyl alcohol
xi) Epoxy resins

5.0 ADVANTAGES & DISADVANTAGES
The major advantages and few disadvantages of bioactive polymers are as follows
Advantages
1. The bioactive polymers must be capable of good response from bodysurrounding body
tissue.
2. They will not cause of inflammation.
3. They will not produce infection.
4. They will not responsible for thrombogenesis.
5. No adverse immunological response or neoplasm induction or promotion.
6. The artificial heart and valve, kidney, lung saves the life of the patient byimproving the
function of organ.
Disadvantages
1. Sometimes growth of bacteria takes place on the surface of implant.
2. Implant will be cause of cancer due to foreign body reaction.
3. Bioprosthetic valve fail due to calcification (Calcium from the bloodstream form
deposits on the implant).
4. Bioprosthetic valves are also susceptible to mechanical fatigue. Artificial heart, kidney,
lung is more expensive and also involves great risk of life





18
6.0 THE USE OF BIOACTIVE POLYMERIC MATERIALS IN
BIOMEDICAL ENGINEERING

The uses of bioactive polymeric material in Biomedical Field
- Hip and Joint Prosthesis
- Finger Joint Prosthesis
- Bone Cement for Joint Prosthesis Fixation.
- Soft Lens and Rigid Lens

6.1 Hip and joint prosthesis
Hip joint replacement is surgery to replace all or part of the hip joint with a man-made
(artificial) joint. The artificial joint is called a prosthesis. Total hip replacement is
most commonly used to treat joint failure caused by osteoarthritis. Other indications
include rheumatoid arthritis, avascular necrosis, traumatic arthritis,protrusioacetabuli,
certain hip fractures, benign and malignant bone tumors, arthritis associated with
Paget's disease, ankylosing spondylitis and juvenile rheumatoid arthritis. The aims of
the procedure are pain relief and improvement in hip function. Hip replacement is
usually considered only after other therapies, such as physical therapy and pain
medications, have failed.

Material used in hip and joint prosthesis
1. Metal-on-Metal
One option for total hip replacement is a metal-on-metal prosthesis. This implant
consists of a metal socket, a metal ball that goes into the socket and a metal stem that
goes into the thigh bone. The metal-on-metal prosthesis reduces your risk of
dislocation following surgery. Also, your new hip will have a low wear rate, which
increases its longevity. However, when the ball and socket rub together during
movement, some pieces of metal may come off and damage nearby bone and other
tissue. This can be painful and possibly lead to implant failure
22
.
19

Figure 11: example of metal-on-metal

2. Metal-on-Polyethylene
The most common type of hip replacement implant is the metal-on-polyethylene
prosthesis, which consists of a ball and stem made of metal and a socket made of
polyethylene, a type of plastic. Highly cross-linked polyethylene is a newer type of
plastic that produces less wear at the hip joint compared to traditional polyethylene.
However, highly cross-linked polyethylene does not have the same fracture-resistant
properties as traditional implants. Also, the particles coming off of the cross-linked
polyethylene may be more biologically active. These bioactive particles can lead to
inflammation and possible bone changes, potentially resulting loosening or failure of
the new hip.

3. Ceramic-on-Polyethylene
For younger patients, a ceramic-on-polyethylene prosthesis may be a preferred choice
because of its durability. This type of prosthesis includes a ball made of ceramic
material and a polyethylene socket. The main benefit of this type of prosthesis is
reduction in joint wear compared to a metal-on-polyethylene prosthesis. The ceramic
material remains better lubricated than other prosthetic materials. This type of hip
prosthesis is more costly than others
23
.
20

Figure 12: example of Ceramic-on-Polyethylene


1. Ceramic-on-Ceramic
Another prosthetic option is the ceramic-on-ceramic hip implant. Your hip
replacement will include a ceramic ball and a socket with ceramic lining. Because all
material is ceramic, this type of prosthetic has the lowest wear rate out of any device.
Also, fewer particles are released from the prosthesis during movement and the
particles are not as biologically active as those from other types of implants. A
potential drawback of this implant is a risk for fracture of the ceramic head and
socket. Squeaking is another issue with a ceramic-on-ceramic prosthetic. This can be
a nuisance and increase your chance of a revision surgery
24
.
21

Figure 13: ceramic on ceramic hip implant

6.2 Finger joint implant
Patients suffering from finger joint pain or dysfunction due to arthritis and traumatic
injury may require arthroplasty and joint replacement. This intervention is indicated
for the finger joints when medical management has failed to relieve the pain or when
the digit deformity is interfering with hand function and activities of daily living
(ADL). Surgical procedures can greatly improve function and relieve pain, allowing
patients to maintain independence and improve their quality of life.
The goals of implant arthroplasty of the finger joints are pain relief, correction of
deformity, and improvement in the function and appearance of the hand. Many
prosthetic implants have been designed for the replacement of MCP and PIP joints.
The most popular finger implant is the Swanson prosthesis, a single piece of silicone
that acts as a flexible space. Several silicone finger joint prostheses designs have
Ontario Health Technology Assessment Series
Patients suffering from finger joint pain or dysfunction due to arthritis and traumatic
injury may require arthroplasty and joint replacement. This intervention is indicated
for the finger joints when medical management has failed to relieve the pain or when
the digit deformity is interfering with hand function and activities of daily living
22
(ADL). Surgical procedures can greatly improve function and relieve pain, allowing
patients to maintain independence and improve their quality of life.

For patients with metacarpophalangeal (MCP) deformities, surgical options include
synovectomy, intrinsic release/transfer, extensor tendon relocation, arthrodesis, and
implant arthroplasty. Relatively few surgical options exist for the painful arthritic
interphalangeal (PIP) joints. Currently, patients with arthritis of the PIP joints have 2
surgical optionsarthrodesis or implant arthroplasty
25
.Arthrodesis provides excellent
pain relief and stability. However, it sacrifices finger function in exchange for these
benefits.

The goals of implant arthroplasty of the finger joints are pain relief, correction of
deformity, and improvement in the function and appearance of the hand. Many
prosthetic implants have been designed for the replacement of MCP and PIP joints.
The most popular finger implant is the Swanson prosthesis, a single piece of silicone
that acts as a flexible space
26
. Several silicone finger joint prostheses designs have
tried to improve upon the Swanson prosthesis.

Material use in Finger Implant

Figure 14: Artificial joint
The artificial joints as shown in figure 14 are available for the finger. These silicone
implants are used by hand surgeons primarily to replace the MCP joint, which are
commonly referred to as your knuckles. The implant, or prosthesis (prosthesis
meaning artificial body part), acts as a spacer to fill the gap created when the arthritic
surfaces of the MCP joint are removed.
23

Figure 15
To perform a joint replacement of the MCP joint, the surgeon first makes an incision
in the back of the hand over the joints or between the first and middle finger and
between the ring and little finger as shown in figure 15.

Each joint that needs to be replaced is then opened so that the surgeon can see the
joint surfaces. The cartilage is removed from both joint surfaces to leave two surfaces
of bone as shown in figure 16.

Figure 16: arthtitic joint surfaces removed
Next, a small cutting tool called a burr is used to make holes in the bones of the finger
joint as shown in figure 17.
24

Figure 17: initial opening made in metacarpal
The artificial finger joint has a stem on each side that is inserted into the canals
created in the bone of the finger and the metacarpal joint as shown in figure 18.


Figure 18: artificial joint inserted
The surgeon then completes the operation by using the tendons and ligaments around
the joint to form a tight sack to hold the implant in place. The skin is sutured together
and a splint is applied. Patient will probably be in a splint, brace, or cast for six
weeks
27
.[DepuuSynthes Joint Reconstruction]





25
6.3 Cemented Fixation
Most knee replacements done today are cemented into place. Cemented fixation has a
generally excellent track record and may last more than 20 years. The longevity and
performance of a knee replacement depends on several factors, including activity
level, weight, and general health.

Cemented fixation relies on a stable interface between the prosthesis and the cement
as well as a solid mechanical bond between the cement and the bone. Metal alloy
components rarely break, but they can occasionally come loose from the bone. Two
processes, one mechanical and one biological, can contribute to loosening.

During natural movement, the knee is subject to considerable loads and stresses,
which the prostheses must transfer to the underlying bone. Because the hard
subchondral bone of the shinbone (tibia) is removed during a knee replacement, loads
are absorbed by the softer cancellous bone and the peripheral cortical bone that
remains. If loads are heavier than the underlying bone can bear over a long period, the
prosthesis will begin to sink into or loosen from its attachment to the bone.
Additionally, if the load applied to the knee during walking is uneven, one side of the
implant may lift off the bone as the other side is pressed into it, resulting in uneven
wear of the polyethylene liner between the metal components. This wear creates
debris particles of polyethylene that can trigger a biologic response and further
contribute to loosening of the implant and sometimes to bone loss around the implant.
The microscopic debris particles are absorbed by cells around the joint and initiate an
inflammatory response from the body, which tries to remove them. This inflammatory
response can also cause cells to remove bits of bone around the implant, a condition
called osteolysis. As wear continues, so does the bone loss. The bone weakens, and
the loosening of the implant from bone increases. Despite these recognized failure
mechanisms, the bond between cement and bone is generally very durable and
reliable. Cemented fixation has been used successfully in all patient groups for whom
total knee replacement is appropriate, including young and active patients with
advanced degenerative joint disease
28
. [Chu KT, Oshida Y, Hancock EB, Kowolik
MJ, Barco T, Zunt SL]


26
Material use in cemented fixation
Bone cement (PMMA)

Figure 19: example of PMMA
Polymethyl methacrylate has been used as self-polymerising bone cement in
orthopaedics since the 1960s. Acrylic bone cement is the only material currently used
to fill the irregular space between prosthesis and bone during total hip replacements
(THR). Its main function is to transfer body weight and service loads from the metal
prosthesis to the bone and/or increase the load carrying capacity of the prosthesis-
bone cement-bone system. However, the cement is not without its drawbacks. The
main one is the role that it has been postulated to play in the aseptic loosening and,
hence, clinical life of the arthroplasty. In turn, this role is directly related to the
mechanical properties of the cement, especially the resistance to fracture of the
cement in the mantle at the cement-prosthesis interface or the cement-bone interface.
It has been observed that mixing procedures play a significant role in governing the
quality of the bone cement produced. A high degree of porosity is found to be present
in cement that is inadequately mixed. These pores act as stress raisers and initiating
sites for cracks, rendering the cement susceptible to early fatigue failure
28
.[ Dr.
Nicholas Dunne]




27
6.4 Contact Lenses

Figure 20: Example of soft lens
1. Soft lens
In 1998, silicone hydrogels became available. Lenses are mainly silicone acrylates.
These lenses were made from silicone and methacrylic acid polymers. The silicone
provides increased oxygen permeability, while the methacrylic acid is present for
wettability and optical clarity. Because silicone allows more oxygen permeability than
water, the oxygen permeability of silicone hydrogels is not tied to the water content of
the lens. Lenses have now been developed with so much oxygen permeability that
they are approved for overnight wear (extended wear). Lenses approved for daily
wear are also available in silicone hydrogel materials.
Disadvantages of silicone hydrogels are that they are slightly stiffer and the lens
surface can be hydrophobic, and thus, less "wettable." These factors can influence the
comfort of the lens. New manufacturing techniques and changes to multipurpose
solutions have minimized these effects. A surface modification processes called
plasma coating alters the hydrophobic nature of the lens surface. Another technique
incorporates internal rewetting agents to make the lens surface hydrophilic. A third
process uses longer backbone polymer chains that results in less cross linking and
increased wetting without surface alterations or additive agents.
Another material used is fluorosilicone acrylates. These would normally be the
material of first choice in a new RGP fit. These are fluorinated monomers combined
with silicone acrylates. The #uorine helps to improve wettability while maintaining
high oxygen transmission. These materials show less protein deposition but can be
prone to lipid deposits
29
. [Santos, L, Rodrigues, D, Lira, M, Oliveira, R, Real
Oliveira, ME, Vilar, EY &Azeredo, J]
28
2. Rigid lenses

Figure 21: example of rigid lenses
Glass lenses were never comfortable enough to gain widespread popularity. The first
lenses to do so were lenses made from polymethyl methacrylate (PMMA or
Perspex/Plexiglas). PMMA lenses are commonly referred to as "hard" lenses. A
disadvantage of these lenses is that they do not allow oxygen to pass through to the
cornea, which can cause a number of adverse clinical events.
Starting in the late 1970s, improved rigid materials which were oxygen-permeable
were developed. Lenses made from these materials are called rigid gas permeable or
'RGP' lenses.
A rigid lens is able to replace the natural shape of the cornea with a new refracting
surface. This means that a spherical rigid contact lens can correct for astigmatism.
Rigid lenses can also be made as a front-toric, back-toric, or bitoric. This is different
from a spherical lens in that one or both surfaces of the lens deliver a toric correction.
Rigid lenses can also correct for corneal irregularities, such as keratoconus. In most
cases, patients with keratoconus see better through rigid contact lenses than through
glasses. Rigid lenses are more chemically inert, allowing them to be worn in more
challenging environments than soft lenses
30
. [Hollingsworth JG, Efron N (June
2004).]








29

7.0 CONCLUSION

Based on the reading from the other research that been done by a lots of
people, we can conclude that bioactive polymeric material have a lot of application in
biomedical field. However, this type of material still have some disadvantages on its
uses. So far, based on all the material being study, all the material have its own
disadvantages when come to biomedical field. The researcher all over the world only
have an option to lower the disadvantages and its bad effect to human body.
The application that we discussed in this report was some of the common
application of bioactive polymeric material in biomedical field. There was also a lot
of other application for this kind of material.
We also have discussed about what are the meaning of bioactive polymeric
material and its structure also. Based on this we can compare between the normal
polymeric material and bioactive polymeric material.



















30

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