Current status and future potential of wear-resistant coatings and articulating surfaces for hip and knee implants

Charlotte Skjöldebrand, Joanne L. Tipper, Peter Hatto, Michael Bryant, Richard M. Hall, Cecilia Persson*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

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.

Original languageEnglish
Article number100270
Number of pages14
JournalMaterials Today Bio
Volume15
Early online date30 Apr 2022
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
Funding from the European Union's Seventh Framework Program (FP7/2007–2013), grant agreement GA-310477 (Life-Long Joints) and the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 812765 (NU-SPINE).

Publisher Copyright:
© 2022 The Authors

Keywords

  • Biomaterials
  • Ceramics
  • Coatings
  • Joint implants
  • Surface layers
  • Wear resistance

ASJC Scopus subject areas

  • Biotechnology
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering
  • Molecular Biology
  • Cell Biology

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