BIOMATERIALS AND ARTIFICIAL

ORGAN

BM1303

S.Sudha
Lecturer
Dept of Biomedical Engg
UNIT I
INTRODUCTION TO BIOMATERIALS

During the last two decades, significant advances
have been made in thedevelopment of
biocompatible and biodegradable materials for
medicalapplications.
In the biomedical field, the goal is to develop and
characterize artificial materialsor, in other words,
spare parts for use in the human body to
MEASURE,RESTORE and IMPROVE physical
functions and enhance survival and qualityof life.

Whats a biomaterial?

1980 - Passive and inert point of view
Any substance or drugs, of synthetic or natural origin, which
can be used for any period alone or as part of a system and that
increases or replaces any tissue,organ or function of the body
1990 Active point of view
Non-living material used in a medical device and designed to interact
with biological systems

Classification of biomaterials

First generation: INERT
Do not trigger any reaction in the host: neither rejected
nor recognition do not bring any good result

Second generation: BIOACTIVE
Ensure a more stable performance in a long time or for the
period you want

Third generation: BIODEGRADABLE
It can be chemically degraded or decomposed by natural
effectors (weather, soil bacteria, plants, animals)

What is a biocompatible material?

Synthetic or natural material used in intimate
contact with living tissue (it canbe implanted,
partially implanted or totally external).

Biocompatible materials are intended to interface
with biological system toEVALUATE, TREAT,
AUGMENT or REPLACE any tissue, organ or
function ofthe body.

A biocompatible device must be fabricated from
materials that will not elicit an adverse biological
response

Mechanical Properties of Metals

How do metals respond to external loads?
Stress and Strain
Tension
Compression
Shear
Torsion
Elastic deformation
Plastic Deformation
Yield Strength
Tensile Strength
Ductility
Toughness
Hardness

Stress-Strain Behavior

Elastic deformation
Reversible: when the stress
is removed, the material
returns to the dimension it
had before the loading.
Usually strains are small
(except for the case ofplastics).
Plastic deformation
Irreversible: when the stress
is removed, the material
does not return to its
previous dimension.

Stress-Strain Behavior: Plastic
deformation

Plastic deformation:
stress and strain are not
proportional the
deformation is not
reversible deformation
occurs by breaking and
rearrangement of atomic
bonds (in crystalline
materials primarily by
motion of dislocations)

Typical mechanical properties of
metals

The yield strength and tensile strength vary with prior
thermal and mechanical treatment, impurity levels,
etc. This variability is related to the behavior of
dislocations in the material. But elastic
moduli are relatively insensitive to these effects.
The yield and tensile strengths and modulus of
elasticity decrease with increasing temperature,
ductility increases with temperature.

Mechanics of Materials

The point up to which the stress and strain are linearly
related is called the proportional limit.
The largest stress in the stress strain curve is called the
ultimate stress.
The stress at the point of rupture is called the fracture or
rupture stress.
The region of the stress-strain curve in which the material
returns to the undeformed state when applied forces are
removed is called the elastic region.
The region in which the material deforms permanently is
called the plastic region.
The point demarcating the elastic from the plastic region is
called the yield point. The stress at yield point is called the
yield stress.

Mechanics of Materials
The permanent strain when stresses are zero is called the
plastic strain.
The off-set yield stress is a stress that would produce a
plastic strain corresponding to the specified off-set strain.
A material that can undergo large plastic deformation
before fracture is called a ductile material.
A material that exhibits little or no plastic deformation at
failure is called a brittle material.
Hardness is the resistance to indentation.
The raising of the yield point with increasing strain is
called strain hardening.
The sudden decrease in the area of cross-section after
ultimate stress is called necking.

Viscoelasticity

Definition: time-dependent material
behavior where the stress response of that
material depends on both the strain applied
and the strain rate at which it was applied!
Examples
biological materials
polymer plastics
metals at high temperatures

Elastic versus viscoelastic behaviors

For a constant applied
strain
An elastic material has
a unique material
response
A viscoelastic material
has infinite material
responses depending on
the strain-rate

Viscoelastic Hysteresis

Viscoelastic solid
some energy is dissipated with
dashpots (as heat)some energy is
stored in springs. Area in the
hysteresis loop is a function of
loading rate
For viscoelastic material, energy
is dissipated regardless of whether
strains(or stresses) are small or
large
Under repetitive loading, a
viscoelastic material will heat up
Wound healing

All wounds heal following a a specific
sequence of phases which may overlap
The process of wound healing depends on the
type of tissue which has been damaged and the
nature of tissue disruption
The phases are:
Inflammatory phase
Proliferative phase
Remodelling or maturation phase

The ways in which wounds heal

Three basic classifications exist:
Healing by primary intention
Two opposed surfaces of a clean, incised wound
(no significant degree of tissue loss) are held together.
Healing takes place from the internal layers outwards
Healing by secondary Intention
If there is significant tissue loss in the formation of the
wound, healing will begin by the production of
granulation tissue wound base and walls.
Delayed primary healing
If there is high infection risk patient is given antibiotics
and closure is delayed for a few days e.g. bites

Wound assessment


WOUND ASSESSMENT
Lab tests:
TcPO
2

Size, depth
& location
Wound bed:
necrosis
granulation
Surrounding skin:
colour, moisture,
Wound edge
Odour or
exudate
Signs of
infection
The healing process

Day 0 5
The healing response starts at the moment of injury
the clotting cascade is initiated
This is a protective tissue response to stem blood loss
The inflammatory phase is characterised by heat,
swelling, redness, pain and loss of function at the
wound site
Early (haemostasis)
Late (phagocytosis)
This phase is short lived in the absence of infection or
contamination



Granulation

Day 3 14
Characterised by the formation of granulation
tissue in the wound
Granulation tissue consists of a combination of
cellular elements including:
Fibroblasts, inflammatory cells, new capillaries
embedded in a loose extra-cellular collagen matrix,
fibronectin and hyularonic acid


Moist wound healing

Basic concept is that the presence of exudate will
provide an environment that stimulates healing
Exudate contains:
Lysosomal enzymes, WBCs, Lymphokines, growth factors..
There are clinical studies which have shown that
wounds maintained in a moist environment have
lower infection rates and heal more quickly


Factors affecting healing

Immune status
Blood glucose levels (impaired white cell function)
Hydration (slows metabolism)
Nutrition
Blood albumin levels (building blocks for repair, colloid osmotic
pressure - oedema)
Oxygen and vascular supply
Pain (causes vasoconstriction)
Corticosteroids (depress immune function)

Host Reactions to Biomaterials
Effect of the Implant on the Host
Local
Blood material interactions
Protein adsorption
Coagulation
Fibrinolysis
Platelet adhesion, activation, release
Complement activation
Leukocyte adhesion, activation
Hemolysis
Toxicity


Modification of normal healing
Encapsulation
Foreign body reaction
Pannus formation
Infection
Tumorgenesis
Systemic and remote
Embolization
Hypersensitivity
Elevation of implant elements in the blood
Lymphatic particle transport


Effect of the Host on the Implant

Physical mechanical effects
Abrasive wear
Fatigue
Stress corrosion, cracking
Corrosion
Degeneration and dissolution
Biological effects
Absorption of substances from tissues
Enzymatic degradation
Calcification

Temporal Variation of Inflammatory
Response


Activated by injury to
vascularized connective
tissue
Series of reactions
Various cells
Controlled by
endogenous and
autocoid mediators

UNIT II
Types of Metallic Implants

Stainless steel
Cobalt Based Alloys
Titanium Alloys

Stainless Steels

Fe 60-65 wt%, Cr 17-19 wt %, Ni 12-14 wt%
Carbon content reduced to 0.03 wt% for better The
most common stainless steel: 316Lresistance to in
vivo corrosion.
Why reduce carbon: Reduce carbide (Cr23C6)
formation at grain boundary. Carbide impairs
formation of surface oxide
Why add chromium: corrosion resistance by formation
of surface oxide.
Why add nickel: improve strength by increasing face
centered cubic phase (austenite)



Stainless Steels

Good stainless steel:
Austenitic (face centered cubic)
No ferrite (body centered cubic)
No carbide
No sulfide inclusions
Grain size less then 100mm
Uniform grain size
Cobalt Based Alloys

Common types for surgical applications:
ASTM F75
ASTM F799
ASTM F790
ASTM F 562

Cobalt Alloys: ASTM F75

Co-Cr-Mo
Surface oxide; thus corrosion resistant
Wax models from molds of implants
Wax model coated with ceramic and wax
melted away
Alloy melted at 1400 C and cast into ceramic
molds.

Cobalt Alloys: ASTM F75

Three caveats:
Carbide formation corrosion. Solution:
annealing at 1225 C for one hour.
Large grain size reduced mechanical
strength
Casting defects stress concentration,
propensity to fatigue failure

Cobalt Alloys: ASTM F799,
ASTM F90

Cobalt Alloys: ASTM F799
Modified form of F75: hot forged after casting
Mechanical deformation induces a shear induced
transformation of FCC structure to HCP.
Fatigue, yield and ultimate properties are twice of F75.

Cobalt Alloys ASTM F90 :
W and Ni are added to improve machinability and fabrication
Mechanical properties similar to F75
Mechanical properties double F75 if cold worked

Titanium Based Alloys

Lighter
Good mechanical properties
Good corrosion resistance due to TiO2solid
oxide layer
Ti-6% wt Al-4% wt V (ASTM F136) is widely
used
Contains impurities such as N, O, Fe, H, C
Impurities increase strength reduce ductility


Titanium Alloys: ASTM F136

HCP structure transforms to
BCP for temperatures
greater than 882 C.

Addition of Al stabilizes
HCP phase by increasing
transformation temperature

V has the inverse effect.

ceramic
Any of various hard, brittle, heat-resistant and corrosion-
resistant materials made by shaping and then firing a
nonmetallic mineral,such as clay, at a high temperature
Clinical success requires:
Achievement of a stable interface with connective tissue
Functional match of the mechanical behavior of the implant
with the tissue to be replaced
Critical Issues:
Integrity of bioceramic
Interaction with the tissue

Hydroxyapatites (HA)


Chemically similar to mineral component of bones
It will support bone ingrowth and osseointegration
when used in orthopaedic, dental and maxillofacial
applications
Chemical formula: Ca5(PO4)3OH
Hexagonal Bravais lattice
The chemical nature of hydroxyapatite lends itself to
substitution; common substitutions involve carbonate,
fluoride and chloride substitutions for hydroxyl
groups

Uses for HA

Facial augmentation with hydroxyapatite has been
used for the following
corrections: Cheek, Chin, Jaw, Nose, Browbone.
Skeletal repair biomaterials
Ocular prosthesis
Hydroxyapatite from coral
The eye muscles can be attacheddirectly to this
implant, allowing it to move within the orbit-just like
the natural eye.

Calcium Phosphate Bioceramics

There are several calcium phosphate ceramics that are
consideredbiocompatible; most are resorbable and will
dissolve when exposed tophysiological environments.
Hydroxyapatite is thermodynamically stable at physiological
pH values; actively takes part in bone bonding, forming strong
chemical bonds with surrounding bone
Mechanical properties unsuitable for load-bearing applications
such as orthopaedics
Used as a coating on materials such as titanium and titanium
alloys,where it can contribute its 'bioactive' properties, while
the metallic component bears the load
Coatings applied by plasma spraying

UNIT III
Polymeric Biomaterials

What is a polymer?
Long chain molecules that consist of a number of repeating units (mers)
Fabricated from monomers which change somehow in polymerization
Loss of H20, HCl or other molecule
Polymer properties are more complex than for simpler materials
Types of polymers
Biological polymers
DNA, cellulose, starch, proteins, rubber, etc
Often reconstituted to form usable polymer
Mainly collected from animals
Synthetic polymers
Fabricated from petroleum products (generally)
May be also a modified biological polymer
Most plastics and similar materials

Classification
examples examples examples
Thermoplastics

Thermosets

Elastomers or
Rubbers
Polymers
Classes of Polymers (I)
Thermoplastic polymers:
Long chains with very limited or no cross-linking
They behave in a plastic, ductile manner (above T
g
)
Melt when heated and are thus easily remolded and
recycled
Thermoset polymers:
Highly cross-linked, 3D network structures
Generally brittle (at most temperatures)
Decompose when heated and cant easily be reshaped
or recycled
Classes of Polymers (II)
Elastomers and rubbers
Large amounts of elastic deformation
Some (light) cross-linking
Typically, about 1 in 100 molecules are cross-
linked on average
Average number of cross-links around 1 in 30
yields a more rigid and brittle material (closer to
a thermoset)
Crosslinks allows material to return to
original shape without plastic deformation
elastomer
thermoset
Definitions

Oligomer- molecules with n<10 (less than ten monomers)
Degree of polymerization, P= number of monomer residues
per chain
Functionality: number of bonding sites per monomer.A
monomer must possess at least two bonding sites
Homopolymer
A-A-A-A-A-A-A-A
Copolymer
Random : A-B-A-A-A-B-B-A-B-B-B-A-B-B
Alternating : A-B-A-B-A-B-A-B-A-B
Block : A-A-A-A-A-B-B-B-B-B-B
Graft As with Bs on branches
Linear polymer- no branches
Branched polymer - multiple branches
Crosslinked polymer- links between branches

Polymer Basics

Polymerization process:
Initiation: I 2R (the active center which
acts as a chain carrier is created)
Propagation: RM1 + M RM2 (growth of
macromolecular chain)
Termination: kinetic chain is brought to halt

Synthesis Reactions:
Addition polymerization
Condensation polymerization
Source: Askeland & Phule p 677

PE (Polyethylene) PP (Polypropylene)

Used in high density form
astubing for drains and
catheters
Ultra high molecular weight
form used as acetabul
component in artificial hips
and other prosthetic joints
Has good toughness and
wear resistance
Resistant to lipid absorption

High rigidity
Good chemical resistance
Good tensile strength
Excellent stress cracking
resistance
Used for sutures and hernia
repair

PTFE (Polytetrafluoroethylene)
PVC(Polyvinylchloride)

Aka Teflon
Very hydrophobic
Good lubricity
Low wear resistance
Used for catheters and
vascular grafts (Gore-
Tex)

Made flexible and soft
bythe addition of
plasticizers
Not suitable for long
term use because
plasticizers can be
extracted by thebody
Used as tubing for
blood transfusions,
feeding anddialysis, and
blood storagebags

Elastomers - Entropy
If you stretch it far enough the chains will
line up straight enough to crystallize
Elastomer vs. Thermoplastic
Elastomers
Some amorphous polymer exhibit elastomeric behavior, yet
have no chemical crosslinks
Usually block copolymers possessing both rubbery
regions and stiff regions in the chain
Physical interactions between stiff chain regions act a
physical crosslinks
Rubbery regions allow large
deformations
Thermoplastic in nature; can be
melted since there are no chemical
crosslinks

Styrene butadiene styrene (SBS)
Thermosets
Disadvantage
Thermosets are difficult to re-form
Advantages in engineering design applications
1. High thermal stability and insulating properties
2. High rigidity and dimensional stability
3. Resistance to creep and deformation under load
4. Light-weight
Crosslinking of thermosets
10-50% of the mers in a chain are crosslinked
Heat treatment, vulcanization processes link existing
chains
Two part chemistries (resin and curing agent) are mixed
and react at room temp or elevated temperatures
multi-functional end groups
Polymers as Biomaterials
Hydrogels
swellable materials, usually acrylic copolymers, e.g. poly(2-
hydroxyethyl methacrylate): PHEMA
More in lecture 10
Piezoelectric materials
materials that generate transient electrical charges on their
surfaces upon mechanical deformation, e.g. polyvinylidene
fluoride, collagen
Resorbable materials
Resorbed with time, e.g. polyglycolic and polylactic acid
More in lecture 11
Fluorinated Polymers
PTFE
Plain or expanded (Gore-Tex)
Vascular grafts, sutures, middle ear prostheses
Fluorocarbons
High affinity for oxygen
Blood substitutes
Vinylidene Fluoride (PVDF)
Piezoelectric
Actuators, nerve guidance
PTFE unsuccessful in
joint replacements
Polymethyl methacrylate
PMMA
A hydrophobic linear chain polymer that is transparent,
amorphous and glassy at room temperature (also known as
plexiglass or lucite)
Good light transmittance, toughness, and stability
A good material for intraocular lenses and hard contact lenses
Also used as a bone cement
Polyethylene
PE
High density form (HDPE)
Used for tubing in catheters and drains
High molecular weight form (UHMWPE)
Contact surface in artificial hips, knees
Good toughness, resistance to fat and oils, and low
cost
Polyethylene Glycol
PEG
Short chain neutral hydrophilic polymer
Shown to repel cells due to surface energy
Used for coatings non-thrombogenic
Wound healing: polymerization on the wound
Microencapsulation and drug delivery
Biological Polymers
Many cellular and extracellular materials are
polymers
Polysaccharides (made from monosaccharides)
Cellulose
Alginate
Proteins (made from amino acids)
Collagen
Actin
Fibrin
Nucleic Acids (made from nucleotides)
DNA
RNA
More in lecture 12
Silicones
Silicone polymers
e.g. Polydimethylsinoxane (PDMS)
No carbon backbone silicone and oxygen instead
Elastomers (with crosslinks)
Silicones as biomaterials
Very low T
g
Excellent flexibility and stability
Used in catheters, pacemaker leads,
vascular grafts, and breast and
facial implants
High oxygen permeability - membrane
oxygenators
Common clinical applications and types of polyCommon clinical
applications and types of polymers
used in medicine

Polymers In Specific Applications
65
application properties and design
requirements
polymers used
dental stability and corrosion resistance,
plasticity
strength and fatigue resistance,
coating activity
good adhesion/integration with
tissue
low allergenicity
PMMA-based
resins for
fillings/prosthesis
polyamides
poly(Zn acrylates)
ophthalmic gel or film forming ability,
hydrophilicity
oxygen permeability
polyacrylamide gels
PHEMA and
copolymers
orthopedic strength and resistance to
mechanical restraints and fatigue
good integration with bones and
muscles
PE, PMMA
PL, PG, PLG
cardiovascular fatigue resistance, lubricity,
sterilizability
lack of thrombus, emboli formation
lack of chronic inflammatory
response
silicones, Teflon,
poly(urethanes),
PEO
drug delivery appropriate drug release profile
compatibility with drug,
biodegradability
PLG, EVA,
silicones, HEMA,
PCPP-SA
sutures good tensile strength, strength
retention
flexibility, knot retention, low
tissue drag
silk, catgut, PLG,
PTMC-G
PP, nylon,PB-TE
UNIT IV
Soft Tissue Implants

Attempts have been made to replace or augment most
of the soft tissues in the body
Connective tissues: skin, ligament, tendon, cartilage
Vascular tissue: blood vessels, heart valves
Organs: heart, pancreas, kidney
Other: eye, ear, breast
Most soft tissue implants are constructed from
synthetic polymers
Possible to choose and control the physical and mechanical
properties
Flexibility in manufacturing
"Soft tissue implants" can also be designed for soft
tissue repair

Sutures

Used to repair incisions and lacerations
Important characteristics for sutures::
Tensile strength
Flexibility
Non-irritating

Tissue Adhesives

Used for repair of fragile, non-suturable tissues
Examples: Liver, kidney, lung
The bond strength for adhesive closed tissues
is not as strong after 14 days as for suture
closed tissues

Percutaneous Implants

Refers to implants that cross the skin barrier
In contact with both the outside environment and the
biological environment
Used for connection of the vascular system to external
"organs"
Dialysis
Artifical heart
Cardiac bypass
Also used for long term delivery of medication or nutrition
(IV)
Main Problems:
Attachment of skin (dermis) to implant difficult to maintain
through ingrowth due to rapid turnover of cells
Implant can be extruded or invaginated due to growth of
skin around the implant
Openings can also allow for the entrance of bacteria, which
may lead to infection

Artifical Skin

Is actually a percutaneous implant -- contacts both
external and biological environments
No current materials available for permanent skin
replacement
Design ideas:
Graft should be flexible enough to conform to wound bed
and move with body
Should not be so fluid-permeable as to allow the underlying
tissue to become dehydrated but should not retain so much
moisture that edema (fluid accumulation) develops under
the graft

Artificial Skin - Possibilities

Polymeric or collagen-based membrane
Some are too brittle and toxic for use in burn victims
Flexibility, moisture flux rate, and porosity can be controlled
Fabrics and sponges designed to promote tissue ingrowth
Have not been successful
Immersion of patients in fluid bath or silicone fluid to prevent
early fluid loss, minimize breakdown of remaining skin, and
reduce pain
Culturing cells in vitro and using these to create a living skin
graft
Does not require removal of significant portions of skin

Soft Tissue Augmentation

Generally used for reconstructive or cosmetic
enhancement
Functions include one or more of the following
Space filler
Mechanical support
Fluid carrier or storer
Common applications for soft tissue augmentation
are:
Maxillofacial implants
Eye and ear implants
Fluid transfer implants
Breast implants

Maxillofacial implants

Designed to replace or enhance hard or soft tissue in the jaw and
face
Intraoral prosthetics (implanted) are used to reconstruct areas that
are missing or defective due to surgical intervention, trauma, or
congenital condition
Must meet all biocompatibility requirements
Metals such as tantalum, titanium, and Co-Cr alloys can be used to
replace bony defects
Polymers are generally used for soft tissue augmentation
Gums, chin, cheeks, lips, etc.
Injectable silicone had been examined for use in correcting facial
deformities; however, it has been found to cause severe tissue
reactions in some patients and can migrate
Extraoral prosthetics (external attachment) should:
Match the patients skin in color and texture
Be chemically and mechanically stable
Not creep, change colors, or irritate skin
Be easily fabricated
Have been fabricated out of numerous polymers

Fluid Transfer Implants

May be designed as permanent implants to treat
chronic problems
Hydrocephalus
Build up of cerebrospinal fluid in the brain
Can result in brain damage if pressure becomes too high
Treated by draining the fluid to the vascular system or
abdominal cavity
Uses a permanent shunt from the ventricles of the brain,
under the skin, to the receiving tissue
Tubing is made of silicone rubber made radiopaque to allow
for observation with x-rays
Ear Infections
"Tubes" in the ears are drainage tubes designed to remove
fluid from the middle ear
Constructed from teflon or other inert materials
Not permanent implants (removed after several years)
Orthopaedic Soft Tissue
Replacement of cartilage, ligaments, and tendons
Difficult to obtain fixation with bone
Screws or pins involve stress concentrations and the possibility of
corrosion
Strength of anchorage depends on thickness of cortical bone at
attachment site
In many cases autographs are used - may be patellar tendon for
ACL reconstruction
Allographs - cryo-preserved, fresh-frozen, or freeze dried
specimens taken from cadavers
Often attached to treated bony insertion sites which can be used as bone
grafts (See Figure 6)
Preservation and cold sterilization procedures may adversely affect
properties of implants
Available from tissue banks

Artificial Orthopaedic Soft Tissues

Ligament Augmentation Devices (LAD's)
Artificial materials used to take some of the stress normally applied to a
ligament while healing occurs
May or may not be resorbable
Gore-Tex: non-resorbable
PDS: resorbable plastic
Contradictory results exist in the literature as to the effectiveness of
LAD's
Ligament scaffolds
Made of polyester or other polymers
Used to induce tissue ingrowth
May be implanted alone or with a section of tissue (fat pat, fascia lata,
piece of tendon) to increase rate of ingrowth
Region of fixation for artifical ligaments or reconstructions
with LAD's for the ACL deviates from normal more than for
reconstructions with patellar tendon alone
Fibrous tissue instead of normal transition from ligament to bone

Total Hip Replacement
A prosthetic hip that is implanted in a similar
fashion as is done in people. It replaces the painful
arthritic joint.
The modular prosthetic hip replacement system
used today has three components the femoral
stem, the femoral head, and the acetabulum. Each
component has multiple sizes which allow for a
custom fit.
The components are made of cobalt chrome
stainless steel and ultra high molecular weight
polyethylene. Cementless and cemented prosthesis
systems are available.
Common Causes of Hip Pain and
Loss of Hip Mobility
Osteoarthritis
Usually occurs after age
50 and often in an
individual with a family
history of arthritis. In this
form of the disease, the
articular cartilage
cushioning the bones of
the hip wears away. The
bones then rub against
each other, causing hip
pain and stiffness.
Operation
Removing the Femoral Head
Once the hip joint is
entered, the femoral
head is dislocated from
the acetabulum.
Then the femoral head
is removed by cutting
through the femoral
neck with a power
saw.
Reaming the Acetabulum
After the femoral head is
removed, the cartilage is
removed from the
acetabulum using a
power drill and a special
reamer.
The reamer forms the
bone in a hemispherical
shape to exactly fit the
metal shell of the
acetabular component.
Inserting the Acetabular Component
A trial component, which is
an exact duplicate of your
hip prosthesis, is used to
ensure that the joint will be
the right size and fit for the
client.
Once the right size and shape
is determined for the
acetabulum, the acetabular
component is inserted into
place.
Preparing the Femoral Canal
To begin replacing the
femoral head, special rasps
are used to shape and scrape
out femur to the exact shape
of the metal stem of the
femoral component.
Once again, a trial
component is used to ensure
the correct size and shape.
The surgeon will also test
the movement of the hip
joint.
Inserting Femoral Stem
Once the size and
shape of the canal
exactly fit the
femoral component,
the stem is inserted
into the femoral
canal.
Attaching the Femoral Head
The metal ball that
replaces the femoral
head is attached to
the femoral stem.
The Completed Hip Replacement
Client now has a new
weight bearing surface to
replace the affected hip.
Before the incision is
closed, an x-ray is made to
ensure new prosthesis is in
the correct position.
Treatment by Kinesiologist
-Early Postoperative Exercises-
Regular exercises to restore your normal hip motion
and strength and a gradual return to everyday
activties.
Exercise 20 to 30 minutes a day divided into 3
sections.
Increase circulation to the legs and feet to prevent
blood clots
Strengthen muscles
Improve hip movement

UNIT V
Artificial heart valve

An artificial heart valve is a device implanted
in the heart of a patient with heart valvular
disease. When one of the four heart valves
malfunctions, the medical choice may be to
replace the natural valve with an artificial
valve. This requires open-heart surgery.
Types of heart valve prostheses
There are two main types of artificial heart valves: the
mechanical and the biological valves.
Mechanical heart valves
Percutaneous implantation
Stent framed
Not framed
Sternotomy/Thoracotomy implantation
Ball and cage
Tilting disk
Bi-leaflet
Tri-leaflet
Biological heart valves
Allograft/isograft
Xenograft

Types of mechanical heart valves
Design challenges of heart valve
prostheses
A replaceable model of Cardiac
Biological Valve Prosthesis.
Thrombogenesis /
haemocompatibility
Mechanisms:
Forward and backward flow
shear
Static leakage shear
Presence of foreign material (i.e.
intrinsic coagulation cascade)
Cellular maceration
Valve-tissue interaction
Wear
Blockage
Getting stuck
Dynamic responsiveness
Failure safety
Valve orifice to anatomical orifice
ratio
Trans-valvular pressure gradient
Minimal leakages
Replaceable Models of Biological
Valves

Artificial limb

An artificial limb is a type of prosthesis that
replaces a missing extremity, such as arms or
legs. The type of artificial limb used is
determined largely by the extent of an
amputation or loss and location of the missing
extremity. Artificial limbs may be needed for a
variety of reasons, including disease,
accidents, and congenital defects.
Lower Limb Prosthesis
Components of the
Prosthesis
Socket- Forms the
connection between the
residual limb and the
prosthesis.
Sleeve- Provides suction
suspension for prosthesis.
Shank (pylon)- Transfers
weight from socket to the
foot-ankle.
Foot-ankle- Absorbs shock
and impact and provides
stability.

Dental implant

A dental implant is an artificial tooth root
replacement and is used in prosthetic dentistry
to support restorations that resemble a tooth or
group of teeth. There are several types of
dental implants. The major classifications are
divided into osseointegrated implant and the
fibrointegrated implant. Earlier implants, such
as the subperiosteal implant and the blade
implant were usually fibrointegrated
WHAT IS A DENTAL IMPLANT?
Dental implant is an artificial titanium fixture
(similar to those used in orthopedics)
which is placed surgically into the jaw bone to
substitute for a missing tooth and its root(s).
Surgical Procedure
STEP 1: INITIAL SURGERY
STEP 2: OSSEOINTEGRATION PERIOD
STEP 3: ABUTMENT CONNECTION
STEP 4: FINAL PROSTHETIC RESTORATION
Success Rates
lower jaw, front 90 95%
lower jaw, back 85 90%
upper jaw, front 85 95%
upper jaw, back 65 85%


First Implant Design by Branemark
All the implant designs are obtained by the
modification of existing designs.

John Brunski
C
o
m
p
a
r
i
s
o
n

o
f

I
m
p
l
a
n
t

S
y
s
t
e
m
s

Astra Tech.
ITI
Bicon
Perfectly elastic large displacement non-linear
contact finite element analysis for different
insertion depths.

Perfectly Elastic Finite Element Results
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
0.47 0.49 0.51 0.53 0.55 0.57 0.59
Vertical Position
C
o
n
t
a
c
t

P
r
e
s
s
u
r
e

(
P
)

p
s
i
Interference depth: 0.002 in
Interference depth: 0.004 in
Interference depth: 0.006 in
Contact pressure increases linearly with insertion depth.


Elastic-plastic large displacement non-linear
contact finite element analysis for different
insertion depths
Stress
(MPA)
% Strain
Bilinear Isotropic Hardening Model
Contact Pressure Distribution for Different
Insertion Depths
Elastic-Plastic Finite Element Results
0
50000
100000
150000
200000
250000
300000
0.45 0.47 0.49 0.51 0.53 0.55 0.57 0.59
Vertical Position
C
o
n
t
a
c
t

P
r
e
s
s
u
r
e

(
P
)

p
s
i
Interference depth: 0.004 in
Interference depth: 0.006 in
Interference depth: 0.008 in
Interference depth: 0.010 in
Contact pressure increases non-linearly with larger
insertion depths.
FUTURE WORK
Comparison of different implant designs in
terms of stress distribution in the bone due to
occlusal loads.

Modeling non-homogenous bone material
properties by incorporating with CT scan data.

Comparison of different implant-abutment
interfaces