Update on the research and development of magnesium-based biodegradable implants and their clinical translation in orthopaedics

doi:10.12336/biomatertransl.2021.03.003

Biomaterials Translational ›› 2021, Vol. 2 ›› Issue (3): 188-196.doi: 10.12336/biomatertransl.2021.03.003

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Update on the research and development of magnesium-based biodegradable implants and their clinical translation in orthopaedics

Ying Luo¹, Jue Wang², Michael Tim Yun Ong³, Patrick Shu-hang Yung³, Jiali Wang¹^,^*(), Ling Qin³^,^*()

1 School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, Guangdong Province, China
2 Hanglok-Tech Co., Ltd., Zhuhai, Guangdong Province, China
3 Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and The Chinese University of Hong Kong Shenzhen-Hong Kong Innovation and Technology Institute (Futian), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China

Received:2021-06-02 Revised:2021-07-20 Accepted:2021-08-12 Online:2021-09-28 Published:2021-09-28
Contact: Jiali Wang,Ling Qin E-mail:wangjli8@mail.sysu.edu.cn;qin@ort.cuhk.edu.hk
About author:Ling Qin, qin@ort.cuhk.edu.hk.
Jiali Wang, wangjli8@mail.sysu.edu.cn;
First author contact:
#Author Equally.

Abstract

Abstract:

Biodegradable magnesium (Mg) or its alloys are desirable materials for development into new-generation internal fixation devices or implants with high biocompatibility, adequate mechanical modulus, and osteopromotive properties, which may overcome some of the drawbacks of the existing permanent orthopaedic implants with regard to stress-shielding of bone and beam-hardening effects on radiographic images. This review summarises the current research status of Mg-based orthopaedic implants in animals and clinical trials. First, detailed information of animal studies including bone fracture repair and anterior cruciate ligament reconstruction with the use of Mg-based orthopaedic devices is introduced. Second, the repair mechanisms of the Mg-based orthopaedic implants are also reviewed. Afterwards, reports of recent clinical cases treated using Mg-based implants in orthopaedics are summarised. Finally, the challenges and the strategies of the use of Mg-based orthopaedic implants are discussed. Taken together, the collected efforts in basic research, translational work, and clinical applications of Mg-based orthopaedic implants over the last decades greatly contribute to the development of a new generation of biodegradable metals used for the design of innovative implants for better treatment of orthopaedic conditions in patients with challenging skeletal disorders or injuries.

Key words: ACL reconstruction, clinical translation, fracture model, magnesium, orthopaedic implants

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Figures/Tables 6

Figure 1. Flowchart of the literature search process.

Figure 2. Research status of ACL reconstruction. (A) HP Mg screws were applied for ACL reconstruction in a rabbit model. Reprinted from Wang et al.12 Copyright 2018, with permission from Elsevier. (B) ACL reconstruction conducted in fresh cadaveric knee joints using HP Mg interference screws. Reprinted from Song et al.16 (C) A bioabsorbable mono-crystalline Mg ring device used to repair the ruptured ACL of goats. Reprinted from Farraro et al.17 Copyright 2016, with permission from the Orthopaedic Research Society. (D) A WE43 Mg alloy stretch plate used for ACL reconstruction in Beagle dogs to support ligament grafts at the femoral ends (green arrowheads). Reprinted from Mao et al.18 Copyright 2018, with permission from American Chemical Society. ACL: anterior cruciate ligament; HP: high-purity; Mg: magnesium; Ti: titanium.

Figure 3. Research and development of Mg-based orthopaedic implants for fixation of fractures at low weight-bearing skeletal sites in different animal models. (A) High-purity Mg (HPM) screws used to fix femoral condylar fractures in rabbits. a: HPM screw; b: polymer screw; c: femoral condyle fracture; d: fixation of the fracture; e: schematic diagram showing the surgery. Scale bars: 2 mm. Reprinted from Han et al.19 Copyright 2015, with permission from Elsevier. (B) A Mg-Nd-Zn-Zr alloy screw for fixation of a femoral condyle fracture in a goat model. Reprinted from Kong et al.20 Copyright 2018, with permission from Elsevier. (C) Pure Mg screws and plates used to fix ulnar fractures in rabbits. Reprinted from Chaya et al.21 Copyright 2015, with permission from Elsevier. Mg: magnesium.

Figure 4. Research and development of Mg-based orthopaedic devices for fixation of fractures at high weight-bearing sites in various animal models. (A) The WE43 alloy screw used in the tibia fracture model of beagle dogs.23 Copyright Wiley-VCH Verlag GmbH & Co. KGaA. Reprinted with permission. (B) The HP Mg screw used to fix goat femoral neck fractures. The blue arrow indicates the femoral head. Reprinted from Huang et al.24 Copyright 2020, with permission from Elsevier. (C) The Mg2Ag intramedullary nails for femoral fractures in mice. Reprinted from Jähn et al.25 Copyright 2016, with permission from Elsevier. (D) The innovative Mg/Ti hybrid fixation device (blue arrow) to fix tibial fractures in rabbits. Scale bar: 10 mm. Adapted from Hou et al.26 Copyright 2018, with permission from Elsevier. Mg: magnesium; Ti: titanium.

Figure 5. Clinical studies of Mg-based screws in orthopaedics. (A) MAGNEZIX screws produced in Germany for the treatment of mild hallux valgus fractures. Reprinted from Windhagen et al.40 licensee BioMed Central Ltd. (B) Representative images of the MAGNEZIX screws applied for fixation of fractures at skeletal sites in children and adolescents. Red arrows indicate implants. Reprinted from Stürznickel et al.41 Copyright 2021, with permission from Elsevier. (C) Mg-based alloy screws composed of Mg-Ca-Zn alloy made in Korea for fixation of distal radius fractures. (D) HP Mg screws for fixation of vascularised autogenous bone flaps to treat vascular necrosis of the femoral head in China. Reprinted from Zhao et al.44 Copyright 2016, with permission from Elsevier. (E) JDBM screws (white arrows) for fixation of medial malleolar fractures in China. Reprinted from Xie et al.45 DF: distal femur; HP: high-purity; JDBM: Mg-Nd-Zn-Zr alloy; Mg: magnesium; PT: proximal tibia; UAJ: upper ankle joint.

Figure 6. The research and development strategies of novel magnesium-based implants and hybrid systems in orthopaedics. (A) Novel design of the structure of a magnesium-based interference screw for improved maximal torque. Reprinted from Luo et al.8 (B) Mg-containing hybrid devices for fixation of fractures at high weight-bearing skeletal sites. Adapted from Tian et al.47

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Update on the research and development of magnesium-based biodegradable implants and their clinical translation in orthopaedics

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