Table Of ContentTitanium in Medicine
Springer-Verlag Berlin Heidelberg GmbH
ONLINE LlBRARY
Engineering
http://www.springer.de/eng inel
D. M. Brunette
P. Tengvall
M. Textor
P. Thomsen
Titanium in Medicine
Material Science, Surface Science,
Engineering, Biological Responses and
Medical Applications
Springer
Prof. Dr. Donald M. Brunette
University of British Columbia
Faculty of Dentistry
Vancouver
Canada
Prof. Dr. Pentti Tengvall
Linkoping University
Department of Physics and Measurement Technology
Linkoping
Sweden
Dr. Marcus Textor
Swiss Federal Institute of Technology (ETH)
Department of Materials
Zurich
Switzerland
Prof. Dr. Peter Thomsen
Goteborg University
Institute of Anatomy & Cell Biology
Goteborg
Sweden
ISBN 978-3-642-63119-1
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Titanium in medicine : material science, surface science, engineering,
biological responses and medical applications I ed.: Donald M. Brunette .... -Berlin ; Heidelberg ;
New York; Barcelona; Hongkong; London ; Mailand ; Paris ; Singapur ; Tokio : Springer, 2001
(Engineering materials)
ISBN 978-3-642-63119-1 ISBN 978-3-642-56486-4 (eBook)
DOI 10.1007/978-3-642-56486-4
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Preface V
Preface
The editors would like to express their deep thanks to the many people involved in
the realization of this book, in particular to
Ms. Lesley Weston, University of British Columbia, for her dedicated and profes
sional proof reading and correction of all the chapters, a task that was especially
challenging for this book because English is a second language for many of the
authors.
Agneta Askendal, Linkoping University, for a professional graphics analysis.
Christina Gretzer, Lena Emanuelsson and Anna Johansson, Laila Falk and Barbro
Lanner, Goteborg University, Peter Revell and Anne Bowe, Royal Free and Univer
sity College Medical School, London, for help with a multitude of items during
1999-2000.
Lorenz Textor and Andreas Textor as well as Lukas Urech and Markus Muller,
ETH Zurich, for bringing the manuscripts into camera-ready form and for design
ing the companion web-site «www.titaniuminmedicine.com» that will provide read
ers with opportunities to comment on the book and learn of new developments in
the field. Ms. Milena Turek, ETH Zurich, for her careful and dedicated help with
administrative items.
And last but not least to our wives Liz Brunette, Pia Tengvall, Sylvia Thomsen and
Danielle Textor-Niquille for continuous support and patience during the three years
of planning and production of this book.
Foreword VII
Foreword
Erich Wintermantel
Swiss Federal Institute of Technology (ETH)
Department of Materials, Zurich, Switzerland]
Titanium, although an abundant element in minerals, is not found in significant
amounts in the human body. Nevertheless, the surface of titanium is among the
most biocompatible ones known, and the metal has demonstrated such success in
biomedical devices, including dental and orthopedic implants, that titanium for
medical purposes promises to develop into a multibillion dollar market. With this in
mind, it was obvious to invite experts from around the world to summarize our cur
rent knowledge of the material in a comprehensive book. The editors are to be con
gratulated for having provided such a fine result that summarizes a vast amount of
work on this medically-important topic.
In my view, the usefulness of titanium and its alloys in medicine can be linked to
some specific properties:
• spontaneous formation in air and blood of a highly biocompatible dioxide passi
vation film, providing surfaces that can support direct ongrowth of local tissues,
• corrosion resistance against atmospheric and aggressive fluidic environments
that is helpful in long term implant applications,
• the ability to influence redox reactions at the tissue interface in a way that can
modulate cell and tissue behavior,
• the ability to be fabricated into structured surfaces, optimized in morphology
and porosity to living recipient tissues,
• an improvement over stainless steel and cobalt-chromium alloys in cases where
Nuclear Magnetic Resonance Imaging (NMR) and Computed Tomography (CT)
are required,
• lightness as it weighs 40% less than steel, making it a candidate for surgical
instruments, such as those used in microsurgery and
• absence of allergic reactions in patients (so far).
As the material can be processed as bulk material using conventional metal
forming processes including casting, forging, detaching and cutting, it is suitable
for load-transmitting implants as well as instruments. Moreover, titanium can be
1 present address:
Zentralinstitut fiir Medizintechnik der TV Miinchen
Boltzmannstrasse 15
D-85748 Garching
VIII Introduction
spray-coated onto less biocompatible surfaces or serve as carrier for bioactive sur
faces, e.g. hydroxyapatite in dental and orthopedic applications.
Despite of the need for life cycle engineering of parts made from titanium and
titanium alloys, the potential of this material has still been underestimated. It will
doubtlessly have a major impact on future generations of medical devices and
implants including traditional applications in dentistry, orthopaedics and the car
diovascular system. Moreover, titanium dioxide is available as various powders and
configurations and is a promising material as cell carriers or tissue scaffold in tissue
engineering.
This book will help readers to obtain a comprehensive insight into current
worldwide research in titanium and widen their horizons regarding future medical
applications for the benefit of patients. May it be of utmost help to the scientific,
engineering and medical communities.
L~~~~~ The photograph shows an original STH femoral
component of an artificial hip joint, one of the
first made of titanium alloy, fabricated in the
late seventies. This femoral component was a
non-modular, all titanium device that turned out
to have an insufficient resistance of the femoral
ball against abrasive wear caused by third-body
particles. Subsequent designs of titanium alloy
femoral stems were fabricated as modular com
ponents with the ball made of cobalt-chromium
alloy, alumina or zirconia, attached by a Morse
taper connection and showing improved abra
sion resistance.
(Reproduced by permission of Prof. Harry
McKellop, The J. Vernon Luck Sr. M.D. Ortho
paedic Research Center, Los Angeles Ortho
paedic Hospital, USA)
Editors' Introduction IX
Editors' Introduction
This book «Titanium in Medicine» was planned to be a state-of-the-art textbook
providing scientific and technical in-depth information in a form that was suitable
for use in education as well as a reference book on titanium for biomedical applica
tions. The need for a text like this arises from the rapid expansion of knowledge on
titanium. This knowledge is widely scattered as articles featuring titanium appear
in journals of numerous disciplines from cell biology through medicine to the
physical sciences. The result is that both newcomers to the area of biomedical
devices as well as those already active in the field can easily miss developments in
topics not directly involved in their work. However the diversity of material rele
vant to titanium in medicine presents a challenge to the editors both in the selection
of authors and in the adoption of a coherent organization.
As many excellent scientists investigate titanium and its applications in medi
cine, the choice of authors was difficult, but we tried to achieve a balance between
those working in basic science departments at universities where basic knowledge
is produced and those in industry or clinics where that knowledge is applied.
Although most of the contributors have worked for many years in specific topics
related to Titanium in Medicine, we also included a few younger investigators in
order to present fresh perspectives and newly developed technologies. Finally we
also solicited contributions from both European and North American investigators
so that various research traditions would be represented.
The book is organized with an introductory section (Part I) in which senior bio
materials scientists give an overview and perspectives that come from long experi
ence in the field. Part II and Part III contain 11 chapters that are largely based on
physical material sciences and technologies and contain basic information on the
materials properties as well as methods for the modification of titanium surfaces.
The emphasis on surface properties arises from the importance of surface texture
and chemistry for implant performance, but also from the likelihood that future
improvements in titanium devices will be a result of interfacial modifications. Part
IV is devoted to cell and tissue responses to titanium and includes sections on vari
ous cell populations and tissue fluids that encounter titanium implants, including
blood, soft tissues and bone as well as titania carriers for cell culture. Part V con
centrates on clinical applications, including contributions from authors involved in
the design and production of titanium devices. Their perspective entails under
standing the advantages and disadvantages of titanium relative to the more com
monly-used materials in orthopedics, stainless steel and cobalt-chromium alloys.
Clinical applications are presented from the disciplines of orthopedics, dentistry,
cardiology and cardiovascular surgery, and audiology. Part V closes with a discus
sion on the processes involved in obtaining approval of implanted devices by gov
ernmental regulatory bodies.
X Introduction
Emphasis has been given to cross referencing between the chapters, directing
the interested reader to basic chapters where a particular aspect is treated in more
detail or to more applied chapters where the information provided is relevant to the
performance of titanium in a given medical situation. At the same time, the editors
have deliberately accepted a certain amount of redundancy particularly when it
helps the line of argument within a chapter to flow smoothly or where complemen
tary views on a given topic are presented.
At a time when most working scientists routinely use the Internet for informa
tion services, we thought it was important that useful world-wide-web sites from
academia and industry be listed in an Appendix and we also provide the email
addresses and web-sites for the contributors. In this way we hope to make it conve
nient for readers to obtain updated information, such as the most recent publica
tions. Since a compilation of web-site addresses is never complete and needs
regular updates in order to remain useful, a web-site
http://www.titaniuminmedicine.com
has been created to allow the reader to provide further contact addresses as well as
general feedback on the book. Finally as the range of disciplines is wide, the num
ber of acronyms that may be unfamiliar to readers might be large and confusing,
and we have included an appendix of abbreviations that are standard throughout
the book.
Our aim has been to produce a book that can serve as a reference of value both
to the newcomer to the field of titanium in medical applications as well as to those
more familiar with the topics. Although all the editors have worked extensively in
various aspects of titanium in medicine, one of the most frequent comments made
as we discussed the chapters in the book was "I learnt a lot from that chapter". We
hope that the readers experience a similar satisfaction. Suggestions for additions or
changes for possible future editions of the book will be most welcome.
Donald M. Brunette Pentti Tengvall Marcus Textor Peter Thomsen
Contents XI
Contents
Part I
Introductory Survey
1. A Perspective on Titanium Biocompatibility ....................... 1
Buddy D. Ratner
2. Titanium for Medical Applications .............................. 13
David F. Williams
Part II
Metallurgy and Fabrication; Surface and Technological Properties
3. Metallurgy and Technological Properties of Titanium
and Titanium Alloys .......................................... 25
Howard L. Freese, Michael G. Volas, J. Randolph Wood
4. Titanium-Nickel Shape Memory Alloys in Medical Applications ...... 53
Peter Filip
5. Characterization of Titanium Surfaces ........................... 87
Janos Voros, Marco Wieland, Laurence Ruiz-Taylor,
Marcus Textor, Donald M. Brunette
6. The Corrosion Properties of Titanium and Titanium Alloys ........ 145
Rolf Schenk
7. Properties and Biological Significance of
Natural Oxide Films on Titanium and Its Alloys .................. 171
Marcus Textor, Caroline Sittig, Vinzenz Frauchiger, Samuele Tosatti,
Donald M. Brunette
Part III
Surface Engineering
8. Mechanical, Thermal, Chemical and Electrochemical
Surface Treatment of Titanium ...........•........•....•...... 231
Jukka Lausmaa
9. Sol-Gel Coatings on Titanium ................................. 267
Laurent-Dominique Piveteau
10. Physical and Chemical Vapor Deposition and
Plasma-assisted Techniques for Coating Titanium ................ 283
Roger Thull, David Grant
