Titanium alloys have emerged as the most successful metallic material to ever be applied in the field of biomedical engineering. This comprehensive review covers the history of titanium in medicine, the properties of titanium and its alloys, the production technologies used to produce biomedical implants, and the most common uses for titanium and its alloys, ranging from orthopedic implants to dental prosthetics and cardiovascular devices. At the core of this success lies the combination of machinability, mechanical strength, biocompatibility, and corrosion resistance. This unique combination of useful traits has positioned titanium alloys as an indispensable material for biomedical engineering applications, enabling safer, more durable, and more efficient treatments for patients affected by various kinds of pathologies. This review takes an in-depth journey into the inherent properties that define titanium alloys and which of them are advantageous for biomedical use. It explores their production techniques and the fabrication methodologies that are utilized to machine them into their final shape. The biomedical applications of titanium alloys are then categorized and described in detail, focusing on which specific advantages titanium alloys are present when compared to other materials. This review not only captures the current state of the art, but also explores the future possibilities and limitations of titanium alloys applied in the biomedical field.

Biomedical Applications of Titanium Alloys: A Comprehensive Review

We report on two patients with fracture of a modular, tapered and distally fixed, uncemented titanium revision hip stem, not previously described. A failure analysis revealed that the cause of the fractures was the development of fatigue cracks in the mid-stem cobalt-chromium modular junction ending in corrosion-fatigue failure. No material defects or stress risers were found in any of the implants. The diameter of the mid-stem modular junction might be undersized for use in heavy and active patients. We also report a new way of detecting an undisplaced fracture at the modular junction, using the scout image from a computed tomography (CT) scan; a technique that can be used when plain radiographs are inconclusive.

Fatigue fracture in dual modular revision total hip arthroplasty stems: failure analysis and computed tomography diagnostics in two cases.

Study design This study was a retrospective cohort study. Objective To examine the criteria recommended in the literature for the school-based scoliosis screening program in Hong Kong. Summary of background data School-based screening for scoliosis has been a controversy. Objectors to the policy were concerned about the high over-referral and false-positive rates. Recommendations were then made for improvement, but the feasibility of these recommendations has not been studied. Methods The cohort consisted of students in Grade 5 in 1995/1996 or 1996/1997 who underwent scoliosis screening in Hong Kong. Participants who had an angle of trunk rotation (ATR) ≥15°, 2 or more moire lines, or presented significant clinical signs were referred for radiography. Screening histories and radiography records before the age of 19 years were extracted. The accuracy measures for different combinations of screening tests were examined. Results There were 115,178 students in the cohort, of which 3228 (2.8%) were referred for radiography. Among the 1406 students who displayed a curve ≥20° during screening, 257 (18.3%) were boys and 336 (23.9%) were identified as 16 years or older, ruling out the suggestion of screening only 10-year-old girls. The sensitivity and positive predictive value for the current referral criteria were 88.1% and 43.6%, respectively. The sensitivity would drop substantially if the use of moire topography (39.8%) or clinical signs (55.5%) were discarded. With the inclusion of these 2 tests, the clinical effectiveness measures were robust to the cutoff for ATR, unless it was set below 10°. Conclusion Selectively screening only premenarche girls was not feasible, as this screen would have missed a significant proportion of children with significant curvature. No refinement of the current protocol was necessary, although boys could be screened beginning at 12 years of age. The tandem use of ATR, moire topography, and clinical signs was recommended for future studies.

Referral criteria for school scoliosis screening: assessment and recommendations based on a large longitudinally followed cohort.

School scoliosis screening has been carried out around the world. The screen program has never been performed on Chongming Island, the third largest island in China and characterized less population exchange with the rest of China. This study was designed to examine scoliotic parameters in children from Chongming Island and determine whether the parameters differed from those of the published data. A total of 6824 children (3477 boys and 3347 girls) aged from 6 to 17 were recruited. The screen included Adam’s test and scoliometer measurements. Posteroanterior radiographic evaluation was performed if trunk rotation was 5° or more. One hundred seventy two were confirmed with Cobb angle of 10° or more; the prevalence was 2.52 %, higher in girls (3.11 %) than in boys (1.96 %) (p < 0.05). There was a weak positive correlation between prevalence and age. Majority curves were minor (from 10 to 19°). The most common thoracic curve was right curve (60.3 % of all thoracic curves), while the most common thoracolumbar (75.5 %) and lumbar curves (64.7 %) were left curves. The prevalence of scoliosis on Chongming Island was 2.52 %. This study indicates that epidemiology of scoliosis has regional variation, and genetic differences may contribute such difference.

/pdf/scoliosis-epidemiology-is-not-similar-all-over-the-world-a-5bq00kfhso.pdf

Scoliosis epidemiology is not similar all over the world: a study from a scoliosis school screening on Chongming Island (China).

Multiscale modeling of fatigue crack propagation in additively manufactured porous biomaterials

Fractures of the neck of the femoral component have been reported in uncemented total hip replacements, however, to our knowledge, no fractures of the neck of a cementless forged titanium alloy femoral stem coated in the proximal third with hydroxy-apatite have been reported in the medical literature. This case report describes a fracture of the neck of a cementless forged titanium alloy stem coated in the proximal third with hydroxy-apatite. The neck of the femoral stem failed from fatigue probably because of a combination of factors described analytically below.

/pdf/neck-fracture-of-a-cementless-forged-titanium-alloy-femoral-4chckggxvs.pdf

Neck fracture of a cementless forged titanium alloy femoral stem following total hip arthroplasty: a case report and review of the literature.

The aim of school screening is to identify most or all the individuals with unrecognized idiopathic scoliosis (IS) at an early stage when a less invasive treatment is more effective. However like other medical screening programs it has not escaped controversy about its value. The present study summarises the contribution of school screening in research of IS epidemiology, natural history and aetiology. Such contribution is beyond the original aim of school screening but is very important to expand our knowledge and adequately understand the pathogenesis of IS. The role of biological factors such as the menarche, the lateralization of the brain, the handedness, the thoracic cage, the intervertebral disc, the melatonin secretion, as well as the role of environmental factors such as the light and the impact of the geographical latitude in IS prevalence were studied in children referred from school screening. The present study provides evidence to support that school screening programs should be continued not only for early detection of IS but also as a basis for epidemiological surveys until we learn much more about the aetiology of IS.

School screening as a research tool in epidemiology, natural history and aetiology of idiopathic scoliosis.

Soft tissue tumors of the feet are uncommon and there have been very few reports of large series in the literature. These tumors continue to present the clinician with one of the most difficult problems in medicine. We present a case of a large multilobular noninfiltrating angiolipoma at the plantar surface of the forefoot. Only three cases occurring at the foot have been previously described. We report this new case due to unusual location of the tumor, the long duration (25 years) of its existence and the unique surgical approach for the tumor excision. Surgical excision is the treatment of choice and adjuvant radiotherapy is indicated in select cases.

/pdf/forefoot-plantar-multilobular-noninfiltrating-angiolipoma-a-562cszqe07.pdf

Forefoot plantar multilobular noninfiltrating angiolipoma: a case report and review of the literature

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Neck fracture of a cementless forged titanium alloy femoral stem following total hip arthroplasty: a case report and review of the literature.

School screening as a research tool in epidemiology, natural history and aetiology of idiopathic scoliosis.

Forefoot plantar multilobular noninfiltrating angiolipoma: a case report and review of the literature