Patent Application
20240001006
Pedicle Screw loosening occurs in 1-15% of cases and in up to 60% of osteoporotic procedures. Yuan, Global Spine Journal, 1-8, 2021. Prinz reports that about 40% of cases of screw loosening showed a subclinical biofilm on the screw. Prinz, J. Neurosurg. Spine, 31, 424-9, 2019. Similarly, Agarwal reports that about 72% of cases of screw loosening showed a subclinical biofilm on the screw. Agarwal, Spine Surg Relat. Res., 2021, 5, 2, 104-8. Therefore, there is a desire to prevent bacterial infection-related biofilm development on pedicle screws.
The literature reports that implant surfaces that contain sharp points function to puncture and kill invading bacteria. For example Zhao, ACS Biomat Sci Eng., 2021 Jun. 14; 7(6):2268-2278 reports that one sharp surface displays good bactericidal activity against both Escherichia coli (98.6±1.23%) and Staphylococcus aureus (69.82±2.79%), which is attributed to a hybrid geometric nanostructure, i.e., the pyramidal structures of ˜23 nm in tip diameter formed with tall clustered wires, and the sharper sheets of ˜8 nm in thickness in-between these nanopyramids. Zhao explains that this nanostructure displays a unique mechano-bactericidal performance via the synergistic effect of capturing the bacteria cells and penetrating the cell membrane. Zhao further provides a good review of the “sharp” literature, reporting that previous attempts with using sharp-tipped implants provided bacterial kill rates of between about 40% and 90%.
The best bacterial kill rate reported thus far appears to be that of Ye, Bioactive Materials 15, 2022, 173-184, who developed alumina-coated ZnO rods. Ye reports that, driven by the equivalent adhesive force of S. aureus, the top-flat nanorods deform cell envelops, showing a bacteriostatic rate of 29% owing to proliferation-inhibited manner. The top-sharp nanorods puncture S. aureus, showing a bactericidal rate of 96% for the longer, and 98% for the shorter that simultaneously exhibits fair osseointegration in bacteria-infected rat tibias, identifying top sharpness as a predominate contributor to mechano-puncture activity. Thus, top-sharp nanorods are desirable for killing bacteria at an optimal rate. Although Ye demonstrates that nanorod tips forming a conical angle of less than about 138 degrees are useful for puncturing and killing bacteria, Ye actual conical angle that produced the high killing rate was only about 50 degrees. Therefore, it is clear that extremely sharp tips are best for killing bacteria. Because Ye worked with alumina-coated ZnO nanorods and it is believed that alumina-coated ZnO is not an FDA approved biomaterial, there remains a need for a technology that can produce a sharp tipped nanorods with an FDA approved biomaterial.
Sjostrom discloses a titanium substrate having titania nanorods with pyramidal-shaped tips (made with a process including bubbling 50 sccm acetone). Sjostrom, Materials Letters, 167, 22-26, 2016 at 25. However, FIG. 1a of Sjostrom discloses a tip density of such pyramids of only about 1-2 tips/um2, a density that is very low.
It has been noted by the present inventor that the literature has fairly consistently reported the production of sharp titania nanorods having conical tips by simply contacting a fluorine-doped tin oxide (FTO) substrate with a heated acidic solution comprising a titania precursor capable of hydrolysis to titanium dioxide. In particular, the literature has reported this technology in at least the following articles:
It is believed that the desirable sharp conical tip result reported in Table I can be replicated with titanium-based implants by simply replacing the FTO substrate reported in the literature with a titanium-based implant. Such a replacement will produce a novel titanium implant having conically tipped nanorods that may be as lethal as the Ye technology in killing undesirable bacteria.
There is reason to believe that such a replacement will lead to the desired result. In particular, there is reason to believe that titania can epitaxially grow on titanium dioxide substrates. For example, Biapo used TTIP as a titania precursor and grew titania nanorods on a substrate having a titanium dioxide seed layer. Biapo, ACS Appl Mat. Interfaces, 2019, 11, 38, 35122-31. Because titanium-based implants commonly have a native titania layer thereon, the requisite titania seed layer is present.
Further it is appreciated that the areal density of conical nanorods of the substrates in this Table I body of work can be much higher than that disclosed on Sjostrom. For example, Wang I in FIG. 1B discloses nanorod densities on the substrate of about 100 nanorods/um2. In contrast, FIG. 1a Sjostrom discloses a tip density of its pyramids of only about 1-2 tips/um2.
Therefore, in accordance with the present invention, there is provided a biomedical implant having a surface having nanorods comprising at least 50% titania extending therefrom, wherein the nanorods terminate in a substantially conical tip, wherein the nanorods have a density on the implant surface of at least 10 nanorods/um2.
For the purposes of the present invention, nanorods with pyramidal-shaped tips are considered to have conical tips, as that is their appearance in an SEM side-view photo thereof.
Preferably, the bulk material of the implant comprises at least 50% titanium, and is more preferably Ti6Al4V, which comprises about 90% titanium. However, it may also be commercially pure titanium.
In some embodiments, there is provided a biomedical implant having a surface having nanorods consisting essentially of titania extending therefrom, wherein the nanorods terminate in a substantially conical tip.
Preferably, the conical tip forms a cone angle of no more than 90 degrees, more preferably no more than 60 degrees, most preferably no more than 45 degrees.
In some embodiments, the implant is a spinal implant, preferably a pedicle screw or an interbody fusion cage. In other embodiments, the implant is selected from the group consisting of a hip implant (such as an acetabular cup or a femoral insert); a knee implant (such as a tibial tray or a femoral stem), a shoulder implant and a trauma implant (such as a plate or a nail).
In some embodiments, the nanorods have an average mid-height diameter of between about 50 nm and 300 nm.
In some embodiments, the nanorods have an average length of between about 500 nm and about 3000 nm.
In some embodiments, the nanorods extend substantially in the same direction. That is, at least 85% of the nanorods extends extend at an angle of between 45 degree and 135 degrees from the implant surface.
Wang I discloses nanorod densities on the substrate of about 100 nanorods/um2, respectively. Therefore, assuming the nanorods of Wang I can be replicated on titanium-based substrates, in some embodiments, the titania nanorods have a density on the implant of at least 10 nanorods/um2, preferably at least 25 nanorods/um2, more preferably at least 50 nanorods/um2, most preferably at least 75 nanorods/um2. It is believed that these greater densities will produce more effective bacterial killing rates than the lower pyramid-tipped densities of Sjostrom.
Although the implants having the conical tips are preferred, it is nonetheless believed that the jagged tips having step edges are also useful for killing bacteria. Therefore, in some embodiments, there is provided a biomedical implant having a surface having nanorods comprising titania extending therefrom, wherein the nanorods terminate in a substantially jagged tip having step edges. Preferably, the nanorods consist essentially of titania.
In some embodiments, there is provided a method of making a biomedical implant comprising the steps of:
In some embodiments, the titania precursor is selected from the group consisting of titanium butoxide, titanium tetraisopropoxide (TTIP) and titanium tetrachloride, and is preferably titanium butoxide.
In one article involving the hydrothermal synthesis of titania with TTIP as the titania precursor, Yamazaki discloses alpha-hydroxy acids such as lactic acid and glycolic acid as “structure-directing agents”. Yamazaki, ACS Omega, 2021, 6, 31557-65. Therefore, in some embodiments, an alpha-hydroxy acid is added to the aqueous acidic solution comprising the titanium precursor as a way of directing formation of the conical tips.
It is noted that there are some commercial pedicle screws (e.g., Nanovis) having titania nanotubes, thereby demonstrating that titania nanostructures have the strength to withstand screw insertion. It is further noted that the literature on titania nanotubes generally reports SEM pictures showing the nanotubes closely packed together. Because the technology disclosed in Table I generally produces nanorods with a fair amount of spacing therebetween, the question is raised as to whether the nanorods of the present invention will have sufficient strength to withstand screw insertion. Therefore, in accordance with the present invention, there is provided a biomedical implant having titania nanorods extending therefrom, wherein the nanorods having a spacing therebetween, and wherein the spacing is filled with a coating. It is believed the coating will provide mechanical strength to the implant and protect the nanorods it envelops during screw insertion. Preferably, the coating is a resorbable polymeric coating, such as polyglycolic acid. In other embodiments, the coating comprises calcium phosphate such as hydroxyapatite.
This prophetic example reports a recipe for making the inventive biomedical implant and essentially adopts the technology disclosed in Wang I for making titania nanorods, but with a titanium alloy replacing FTO.
In particular, 12 mL of deionized water was mixed with 12 mL of concentrated hydrochloric acid (mass fraction 36.5-38%). The mixture wa stirred under ambient conditions for 5 minutes before adding 0.4 mL of titanium butoxide (Beijing Chemical Co.). After stirring for another 5 minutes, the mixture was placed in a Teflon-lined stainless steel autoclave of 45 mL volume. Then, a Ti6Al4V spinal pedicle screw, ultrasonically cleaned for 60 minutes in a mixed solution of deionized water, acetone and 2-propanol (volume rations 1:1:1) was placed at an angle against the wall of the Teflon liner. The hydrothermal synthesis was conducted at 150° C. for 20 hours in an electric oven. After the synthesis, the screw as taken out, rinsed extensively in deionized water and dried in ambient air.
This prophetic example essentially follows Prophetic Example I above, but then further anneals the resulting nanorod-laden pedicle screw at 450° C. for 30 minutes.
