Introduction

Oxide-based alumina (Al2O3) is used to manufacture femoral heads for total hip arthroplasty (THA). Silicon nitride (Si3N4) is a non-oxide ceramic used to make spinal implants. Ceramic materials are believed to be bioinert, (i.e., stable under hydrothermal conditions). Indeed, clinical data have shown 15–20 year longevity of Al2O3 bearings in THA. In this work, we examined the surfaces of Al2O3 and Si3N4 after exposure to physiologic conditions to see if these ceramics are truly inert.

Introduction

In total hip arthroplasty (THA), polyethylene (PE) liner oxidation leads to material degradation and increased wear, with many strategies targeting its delay or prevention. However, the effect of femoral head material composition on PE degradation for ceramic-PE articulation is yet unknown. Therefore, using two different ceramic materials, we compared PE surface alterations occurring during a series of standard ceramic-PE articulation tests.

Introduction

The in vivo evolution of surface material properties is important in determining the longevity of bioceramics. Fracture toughness is particularly relevant because of its role in wear resistance. Some bioceramics, such as zirconia (ZrO2) undergo in vivo phase transformation, resulting in a marked reduction in toughness and commensurate increased wear. Here, we investigated the effect of accelerated aging on the surface toughness of alumina (Al2O3), zirconia-toughened alumina (ZTA), and silicon nitride (Si3N4) femoral heads, in order to identify the optimal ceramic material for in vivo implantation and long-term durability.

Introduction

Silicon nitride (Si3N4) is a ceramic material presently implanted during spine surgery. It has a fortunate combination of material properties such as high strength and fracture toughness, inherent phase stability, scratch resistance, low wear, biocompatibility, hydrophilic behavior, easier radiographic imaging and resistance to bacterial biofilm formation, all of which make it an attractive choice for orthopaedic applications beyond spine surgery. Unlike oxide ceramics, (e.g., alumina or Al2O3) the surface chemistry and topography of Si3N4 can be precisely engineered to address in vivo demands. Si3N4 can be manufactured to have an ultra-smooth, or highly fibrous, or porous morphology. Its chemistry can be varied from that of a silica-like surface composed of silanol moieties to one which is predominately comprised of silicon-amine functional groups.

Silicon nitride spinal fusion cages have been successfully used in the treatment or correction of stenosis, disc herniation, trauma, and other deformities of the spinal column since 2008. To date over 14,000 devices have been implanted with perioperative and postoperative complication rates of less than 0.2%. This remarkable achievement is due in part to the material itself. Silicon nitride is an ideal interbody material, possessing high strength and fracture toughness, inherent phase stability, biocompatibility, hydrophilicity, excellent radiographic imaging, and bacterial resistance. These characteristics can lead to implants that aid in prevention of nosocomial infections and achieve rapid osteointegration. In this paper, we will review the various in vitro and in vivo studies that demonstrate silicon nitride's effective bacteriostatic and osteointegration characteristics, and compare these to the two most common cage materials – titanium and poly-ether-ether-ketone (PEEK). Human case studies will be also reviewed to contrast the clinical performance of these biomaterials. In comparison to the traditional devices, silicon nitride shows lower infection rates, higher bone apposition, and essentially no fibrous tissue growth on or around the implant. To better understand the mechanisms underlying these benefits, surface characterization studies using scanning electron microscopy coupled with XPS chemical analyses, sessile water drop techniques and streaming zeta potential measurements will be reported. Data from these studies will be discussed in relation to the physiochemical reasons for the observed behavior. Silicon nitride is a non-oxide ceramic in its bulk; but possesses a protective Si-N-O transitional layer at its surface. It will be shown that the chemistry and morphology of this layer can be modified in composition, thickness and structure resulting in marked changes in chemical species, surface charge, isoelectric points and wetting behavior. It is postulated that the needle-like grain structure of silicon nitride coupled with its enhanced wettability play important roles in inhibiting biofilm formation, while its surface chemical environment consisting of silicon diimide Si(NH)₂, silicic acid Si(OH)₄, and derivatives of ammonia, NH₃, NH₄OH, lead to improved bone reformation and bacteriostasis, respectively. Few materials have this combination of properties, making silicon nitride a unique biomaterial that provides improved patient care and outcomes with low comorbidities.