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BIOMEDICAL MATERIALS

Tristan Burg and Owen Standard


School of Material Science and Engineering
University of New South Wales

2001

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Biomedical Materials Teacher Reference


2001 Materials Science and Engineering - UNSW

1.

INTRODUCTION

2.

IDENTIFICATION OF DESIGN CONSTRAINTS


2.1
Fundamental Considerations
2.2
Nature of The Physiological Environment

3.

BIOMEDICAL MATERIALS (FUNCTIONAL PROPERTIES)


3.1
Biometals
3.2
Bioceramics
3.3
Synthetic Polymers

4.

DESIGN EXAMPLE
4.1
Bone and joint replacement
4.2
Cardoivascular devices
4.3
Dental Materials
4.4
Ophthalmology Materials

5.

THE FUTURE

6.

REFERENCES

7.

INTERNET LINKS

Front Page: Biomedical Devices Throughout the Body [1]

1.

INTRODUCTION

In this set of notes we will examine


a) important design constraints involved with biomaterials
b) introduction to materials selection
c)

consider design constraints of a number of biomedical devices and detail the


materials in use

The notes are directed towards the materials section of the Bioengineering Focus Module
of the NSW Engineering Studies Stage 6 Syllabus

It is not the aim of these notes to describe every biomedical material nor every
biomedical device.

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2001 Materials Science and Engineering - UNSW

2.

IDENTIFICATION OF DESIGN CONSTRAINTS

2.1

Fundamental Considerations

Biomaterials and biomedical devices are used throughout the human body (Figure 1).
Because human life and well being often depends on these devices there are stringent
controls and constraints placed upon the application of devices and the materials that can be
sued. When a prosthetic device is placed into the body, two aspects must be taken into
account:
1)

Functional Performance or Biofunctionality:

This concerns the effect of the physiological environment on the material/device The
material must satisfy its design requirements in service. The varied functions of
biomaterials include:
Load transmission and stress distribution eg bone replacement
Articulation to allow movement eg artificial knee joint
Control of blood and fluid flow eg artificial heart
Space filling eg cosmetic surgery
Electrical stimuli eg pacemaker
Light transmission eg implanted lenses
Sound Transmission eg cochlear implant

Figure 1: A) Cochlear Implants [2] , B) Hip Joint Prosthesis [3]


2)

Biocompatibility

This concerns the effect of the prosthetic device/material (and any degradation product) in
the body. The material must not degrade in its properties within the environment of the body
and must not cause any adverse reactions within the hosts body.

Biomedical Materials Teacher Reference


2001 Materials Science and Engineering - UNSW

2.2

Nature of The Physiological Environment

NaCl aqueous solution (0.9 M) containing organic acids, proteins, enzymes, biological
macromolecules, electrolytes and dissolved oxygen, nitrogen compounds, and soluble
carbonates
pH ~7.4 normal physiological extracellular fluid
Cells (eg. inflammatory cells and fibrotic cells) secrete a whole host of complex
compounds that may significantly affect an implanted biomaterial
Application dependent mechanical environment: static, dynamic, stress, strain, friction
Dependent on:
type of material
static/dynamic stresses
projected device life
interactions with other device components

Mechanisms of
Material Degradation:
corrosion
dissolution
chemical modification
swelling
leaching
wear

Material Properties
Adversely Affected:
strength
fracture toughness
stiffness (elastic modulus)
surface roughness
wear resistance
chemical stability

Figure 2: The effect of the pphysiological environment on materials/devices

Materials Selection
Biomedical Devices
Orthopaedic
Dental
Bone Cements
Vascular Devices
Cardiovascular Devices
Drug Delivery
Specialised Devices

Metals:

Ti alloys
CoCr alloys
Stainless Steel

Ceramics:

Bioinert (alumina, zirconia)


Bioactive (HAP, bioglasses)
Resorbable
(Ca-phosphates,
bioglasses)

Composites
Polymers:

soft, hard

Figure 3: Material selection for Functional Performance

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2001 Materials Science and Engineering - UNSW

3.

BIOMEDICAL MATERIALS (FUNCTIONAL PROPERTIES)

3.1 Biometals
Metals are widely used as biomaterials due to their strength and toughness. While the widely
used implant metals (stainless steel, titanium and cobalt alloys) are generally biocompatible,
some people are allergic to ions released from these metals. The major problem with metals
is the generation of fine wear particles in service that can lead to inflammation and implant
loosening.
3.1.1 Biometals CoCrMo Alloys
Similar to Co alloys used for turbine blades in early gas turbine engines (Stellite)
Used in both cast condition and wrought condition. However, the wrought condition
provides superior mechanical and chemical properties due to finer grain sizes and a more
homogenous microstructure
ASTM F 136-98 (as-cast)
y = 430-490 MPa
uts = 720-890 MPa
Elongation = 5-17%
Coherent stable passivation layer (~10 nm) gives excellent corrosion resistance
Excellent wear resistance

Problem: Potentially release harmful Co, Ni and Cr ions into the body

Figure 4: Microstructure of a Co-Cr-Mo alloy [4]

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2001 Materials Science and Engineering - UNSW

3.1.2 Biometals Ti Alloys


Commercially pure Ti used in dental implants
Ti6Al4V

investment cast hip and knee implants


wrought screws and fittings
dental implants
pacemaker housings

ASTM F 136-98 (wrought)


y = 760 MPa
uts = 825 MPa
Elongation = 8%
Coherent stable passivation layer (~10 nm) gives excellent corrosion resistance

Resistant to stress corrosion cracking and corrosion fatigue in body fluids

One of few materials that permits bone growth at the interface

However, titanium has unsatisfactory wear resistance and may produce wear debris

a)

b)

c)

Figure 5: Microstructure of Ti-6Al-4V. A) Widmanstatten a, B) Equiaxed a (white) and


transformed b (widmanstatten a, grey), C) Transmission Electron Microscope high
magnification image of the structure in B) [5]

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2001 Materials Science and Engineering - UNSW

3.1.3 Biometals 316 Stainless Steel


The addition of nickel causes the austenite structure to be maintained at room
temperature. Thus, this steel is known as an austenitic stainless steel.

Used in early hip implants for its good strength, ability to work harden, and pitting
corrosion resistance.

However due to potential long term release of Ni2+, Cr3+ and Cr6+ into the body, stainless
steels are restricted to temporary devices

Now used as screws, fittings, and wires for orthopaedics


ASTM F 138-97 (wrought)
y = 190-690 MPa
uts = 190-690 MPa
Elongation = 40-12%

Figure 6: Microstructure of an austenitic stainless steel [6]

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2001 Materials Science and Engineering - UNSW

3.2

Bioceramics

Ceramics are stiff, hard and chemically stable and are often used in situations where wear
resistance is vital. Of the large number of ceramics known, only a few are suitably
biocompatible. These ceramics can be grouped according to their relative reactivity in
physiological environment, (Figure 7). The main problem with ceramic components is that
they are brittle and relatively difficult to process.
A Resorbable Ceramics
B Bioactive Ceramics
C Bioinert Ceramics

Relative
Reactivity

Time (days)

Figure 7: Relative reactivity of bioceramics [7]


Table 1: Some typical room temperature properties of bioceramics and cortical bone.
Property
Density (g/cm3)
Grain Size (m)
Flexural Strength (MPa)
Fracture Toughness (MPa.m0.5)
Vickers Microhardness (GPa)
Young's Modulus (GPa)
Notes:

a
b
c
d

Mg-PSZ
5.7
50c
600
9
12
200

Y-TZP
6.0
0.5
1200
10
10
200

Al2O3a
3.90
7
400
5-6d
23
380

HAP
3.15
1
100
0.5
4
100

Boneb
1.7-2.0
60-160
2-12
0.2
3-30

ISO 6474:1981 requirements for surgical grade alumina


Human cortical bone
50 m cubic grains containing ~0.15 m metastable tetragonal grains
Typical values only. Not specified in ISO 6475:1981.

3.2.1 Bioceramics Bioinert Ceramics


Elicit minimal response from host tissue
Foreign body response = encapsulation
Undergo little physical/chemical alteration in vivo (i.e. extremely stable)
Types:

alumina (Al2O3)
partially stabilised zirconia (ZrO2)
silicon nitride (Si3N4)

Functional properties:

high compressive strength


excellent wear resistance
excellent bioinertness

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3.2.1.1 Bioceramics Bioinert Ceramics: Alumina


Alumina is a traditional bioinert material and has been used for the last ~30 years. It is a
highly stable oxide and is very chemically inert. It has very high wear resistance but
compared to metals, it has low fracture toughness and tensile strength which means that it
can be used in compression only. Applications of alumina include:
femoral head of total hip replacements (polycrystalline)
single crystal (sapphire) in dental implants

As mentioned ceramics generally have excellent wear resistance. This is ideal for
biomaterials as problems arising from wear of biomaterials include:
accelerated degradative processes
weakening of the material
production of shape changes that may affect function
production of biologically active particles (eg. may cause aseptic loosening)
wear particles further accelerate wear (3-body wear)

Coefficient of Friction

Wear Index

15
Metal-UHMWPE
10

5
Al2O3-Al2O3
0
1

10

100

1000

10000

Testing Time (hours)

0.15
Metal-UHMWPE
0.10
Al2O3-Al2O3
0.05
Natural Joint
0.00
1

10

100

1000

10000

Testing Time (hours)

Figure 8: Wear and friction of Alumina on Alumina [8]

Wear Mechanisms:
adhesive wear
abrasive wear
corrosive wear
surface fracture/fatigue wear

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3.2.1.2 Bioceramics Bioinert Ceramics: Partially Stabilised Zirconia


Zirconia (ZrO2) plus a metal oxide dopant (stabilising oxide MgO or Y2O3) forms the
ceramic known as partially stabilised zirconia (PSZ). PSZ exhibits excellent toughness
compared to other ceramics. This is because of a process known as transformation
toughening. This involves an energy absorbing phase change at the front of propagating
crack tip which slows the advancement of cracks. PSZ is used in hip joint prosthesis

Figure 9: Transformation toughening in PSZ [9]

Figure 10: Microstructure of PSZ [10]

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3.2.2 Bioceramics Bioactive Ceramics


Direct chemical bond with tissue and, in particular, bone
Surface-reactive ceramics but low solubility
Fixation of implants in the skeletal system
Hydroxyapatite (Ca10(PO4)6(OH)2) and bioglasses
Low mechanical strength and fracture toughness non-load bearing
Applications:

coatings on stainless steel, Ti, and CoCr for tissue ongrowth


bone filler for dental and maxillofacial reconstruction

3.2.3 Bioceramics Resorbable Ceramics


Chemically broken down by the body and resorbed
Chemicals produced as the ceramic is resorbed must be able to be processed through the
normal metabolic pathways of the body without evoking any deleterious effects
Control dissolution rate by composition and surface area (density)
Calcium phosphate ceramics, e.g., tri-calcium phosphate, Ca3(PO4)2
Application: bone repair such as maxillofacial and periodontal defects
Temporary scaffold or space-filler material which is gradually replaced by tissue
3.3 Synthetic Polymers
Polymers are widely used as implant materials as they have physical properties that are most
similar to the natural tissues. Use of polymers includes wound dressings, tendon
replacements, intraocular lens replacement and joint linings. The polymers that are widely
used include polyethylene, PET, PTFE and polyurethane and themselves are well tolerated
in the human body. However, additives and molecules released from polymer breakdown
can lead to allergic and inflammatory responses.
Table 2: Synthetic Polymers Selected Examples
Non-Degradable
Polyamides
sutures
Polycarbonates
device housings
Polyesters
vascular grafts
PVC
tubing, blood bags
Polyurethanes
tubing, coatings
Silicones
tubing, soft tissue reconst.
UHMWPE
hip & knee bearing surfaces

Biomedical Materials Teacher Reference


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Biodegradable
Polylactic/glycolic acid sutures
Polyorthoesters
bone plates
Polyorthoesters
bone plates
Cyanoacrylates
wound closure
Polylactic acid
tendon repair

12

Composition
Chemical Composition
Mwt and Mwt Distribution
Chain Structure
Cross-Linking
Additives
Polymerisation
Residual Monomers
Residual Catalyst

Properties
Mechanical Properties
Surface Chemistry/Energy
Crystallinity
Diffusion/Permeability
Morphology
Molecular Orientation

Cleaning/Sterilisation
Autoclaving
Ethylene Oxide
Radation (UV or ionising)
Dry Heat

Performance
adsorption/swelling
surface reactions
oxidation reactions
leaching
wear
biological

Figure 11: Synthetic Polymers Considerations

The use of polymers as biomaterials started over 2500 years ago with collagen (found in
animal tissue) used as a surgeons thread. In the 1860s polymer dressings were applied to
wounds and in the 1930s experimental implantable polymer membranes were tested. In the
1970s the polymer polyglycolic acid (PGA) was developed as synthetic degradable sutures.
PGA was further developed over the next few decades and was used in implants that would
slowly release desired chemicals into the body and s scaffolding on which replacement
organs could be grown. Over 25 different types of cells have been grown on the polymer
scaffolds, and skin grown on these scaffolds has been successfully transplanted to heal
diabetic skin ulcers. It is hoped that in the future these scaffolds will be used to grow nerve
cells for use in spinal cord repairs, bone or cartilage cells for joint repairs, pancreatic cells to
make insulin for diabetics, and liver cells to make livers for transplantation.
Polymers are also used in many prosthetic devices as outlined in section 4.

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4.

DESIGN EXAMPLES

4.1 Bone and joint replacement


The objective of bone and joint replacement is to provide improved motion of the joint and
to replace damaged bone structures. The materials used are required to transmit and
withstand the stress applied to the structure, within the body environment, while interacting
with the existing bone such that the function of the bone and prosthetic is maintained over a
long period.

Figure 12: A) Hip joint prosthesis components [11], B) Joint Replacement design [12]
The materials used for these applications include metals ceramics and polymers. Metals
dominate the bulk of the implant structure while ceramics and polymers are typically used at
interfaces and articulating surfaces. The metals used include:
Stainless steels: Commonly austenitic 316L stainless steel, used for its good strength,
ability to work harden, and pitting corrosion resistance. However due to potential long
term release of Ni2+, Cr3+ and Cr6+ into the body, stainless steels are restricted to
temporary devices such as plates and screws.
Co-based alloys: High tensile strength, excellent corrosion resistance and excellent
fatigue strength make these alloys ideal for joint construction. They are used in the cast
or wrought condition but the wrought condition provides superior mechanical and
chemical properties due to finer grain sizes and a more homogenous microstructure.
However, with these alloys there is risk of release of Cr, Ni and Co ions into the body
during wear, corrosion and repassivation events.

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Titanium alloys: High strength, electrochemical corrosion resistance and benign


biological response mean titanium is widely used for load bearing orthopaedic
applications. Commercially pure titanium and Ti-6Al-4V is widely used. Structural
surgical implants are usually Ti-6Al-4V and are usually forged between 700-900oC to
produce fine equiaxed grains with at the primary grain boundaries.
The ceramics that are commonly used in bone and joint replacement include:
Alumina: This is used for the femoral head in many hip-joint prosthesis for its chemical
stability, biological inertness, and excellent friction and wear properties. However they
are susceptible to overloading due to low fracture toughness.
Zirconia: This is used in the form of partially stabilized zirconia and has been promoted
as an alternative to alumina due to its higher toughness the result of transformation
toughening. Zirconia also has excellent wear properties.
Of the polymers, PMMA is often used for bone cement as it is able to be injected between
the prosthesis and bone and able to transfer loading between the bone and prosthesis. Ultra
High Molecular Weight Polyethylene (UHMWPE) is used for the load bearing surface due
to its good wear resistance and low friction.

Figure 13: A) Forces at the hip joint, B) Knee joint prosthesis [13]
4.2 Cardiovascular devices
These are devices use to replace or supplement part of the cardiovascular system. The most
important aspect of these devices is Haemocompatibility the ability to maintain contact
with flowing blood without adverse reaction. It requires:
1) No leaching of toxic products
2) No generation of wear particles
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3) Chemical inertness
4) No chronic inflammatory response
Cardiovascular devices include:
4.2.1. Kidney dialysis machines
These machines use a semi-permeable membrane to purify the blood against artificial
liquids. Blood is fed via silicone or polyurethane elastomer catheters and into the dialyzer.
Inside the dialyzer PVC tubing holds the membranes (which can be cellulosic, Derivated
Cellulose or Synthetic) which is in contact with blood on one side and a non-toxic watery
solution on the other.

Figure 14: Artificial kidney (dialysis) [12,14]


4.2.2. Blood Oxgenators :
These machines replace the natural gas transfer function of the lungs during cardiac surgery.
The gas transfer may be via bubble oxygenators or via membrane technology
4.2.3. Vascular Grafts:
These are tubular prosthesis used to replace or bypass the vascular system (in most cases
arteries) that have been weakened by disease or injured in trauma. They are also used where
shunts are required to allow rapid removal and infusion of large volumes of blood, eg for
haemodialysis. The materials used require adequate mechanical strength to withstand years
of pulsating blood pressure, haemoocompatibility, biocompatibility to connective tissue and
resistance to bacterial adhesion. Originally these grafts were biologically sourced
(transplants). However the need for large diameter prosthesis led to the development of
synthetic materials (introduced in 1952). These are knitted or woven fabrics, of tailored
porosity, made from polyester, PET and expanded PTFE.
4.2.4. Cardiac Valves:
These were introduced in 1960 (the Starr-Edwards caged ball valves, Figure 15) to replace
heart valves damaged by disease or infection. The valves may be mechanical or

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bioprosthetic. The mechanical valves consist of a supporting skeleton for the valve with a
sutureable sewing ring to allow attachment and a valve occluder which may be a disc,
shutter or ball. Mechanical valves are extremely reliable over the long term but require the
recipient to maintain anticoagulent therapy to avoid clotting. The metal frame for the device,
and the disc shaped occluders are usually a Ti-alloy or CoCrMo. To avoid mechanical
failures at the welds, current devices are machined from a single block of metal. The
common ball shaped occluder is a silicone elastomer developed to be resistant to swelling.
However, titanium balls have been used with densities designed to match blood. The knitted
fabric on the sewing ring is often PET or PTFE. Coatings of carbon are often used on the
valve prothesis due to carbons excellent hemocompatibility, fatigue resistance, wear
resistance and high fracture strength. Bioprosthesic valves also have a sewing ring and rigid
skeleton but the valves themselves are manufactured from xenograft tissue of bovine or
porcine origin. These have the advantages of reduced coagulation but their mechanical
properties can deteriorate with time.

Figure 15: Caged Ball Cardiac Valves [11]


4.2.5. Cardiac Assist devices:
These are devices used to augment or replace the cardiac pumping function. They are often
used to buy timeuntil a suitable donor heart can be found. Clotting and infection have long
been problematic for these devices. A total artificial heart for permanent heart replacement,
without skin penetrating control wires, has receently been developed by Abiomed.

Figure 16: Example total heart replacement prosthesis [13,15]

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Within the artificial heart, polyurethanes are typically used for pump bladders as they can be
used to make durable flexible membranes, critical for such a component. They are
occasionally laminated with reinforcing carbon fibres. Butyl rubbers are often layered inside
polyurethane to create an impermeable layer. PET is used to form the blood contacting inlet
and outlet connectors due to its excellent bio and haemocompatibility. Machined and cast
epoxies, amides (Kevlar), polycarbonate, polyurethane and titanium have all been used for
the housings for the devices.

Figure 17: Materials used in heart replacement devices [12]


4.2.6. Pacemakers:
These are used to promote ventricular contraction via electrical stimulation. Current
pacemakers consist of a battery inside a laser welded metal case, from which one or two
sheathed wires extends. The wires act as both sensing and stimulating electrodes. Silicone
has been widely replaced by polyurethane as insulation on the wires due to the ability to
create smaller diameter leads and its improved biocompatibility. Titanium is used for the
casing due to its biocompatibility while platinum and platinum-iridium electrodes are used
for their biocompatibility and resistance to galvanic corrosion.
4.3 Dental Materials
Materials for tooth replacement require biocompatibility, acceptable strength and hardness
for the mechanical action of the teeth and the ability to be formed into the exact (often
complex) shape required. In addition they are required to match the natural tissues in colour
and translucency. Tooth replacements consist of an implant that is fixed into the bone and a
crown or denture superstructure. The implants are made from either alumina (both
polycrystalline and single crystal) or commercially pure titanium (excellent bone
compatibility). These materials are used for their inertness in the body and excellent
biocompatibility. To aid the promotion of a strong bone implant interface, porous surfaces,
glass ceramic coatings and calcium phosphate ceramics are all used to promote bone growth
into the implant surface.
The crown is made of ceramic materials. The ceramics used are known as dental porcelains
and are a borosillicate or feldspathic glass with dispersed crystalline components. These
ceramics are used for their high hardness and excellent wear resistance as well as the ability
to tailor the colour and translucency of the natural tooth. If the crown must be fused to a
metal, the metal must not only have biocompatibility within the oral cavity but also match
the thermal expansion of the porcelain to minimise stresses. The metal alloys used that fit
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the criteria are based on gold, gold palladium, silver palladium, copper palladium and nickel
chromium alloy systems.

Figure 18: The Branemark titanium implant system [12]


Shape memory alloys such as nitonal (Ti-55Ni) are being promoted in the dental field as self
adjustable braces. These alloys can be deformed at low temperature but regain their original
shape upon heating. These alloys are also being trailed in hip implants (shape memory
grooves increase adhesion to bone) and for the removal of clots from arteries.
4.4. Ophthalmology Materials
This concerns biomaterials for the eye. The two main uses of biomaterials in this field are
for contact lenses and for intraocular lenses.
4.4.1. Contact lenses
These are used to correct defects in vision resulting from a loss of ability to focus light onto
the retina. For contact lenses the requirements of the material are that it must have: excellent
optical properties, excellent biocompatibility, wetability, gas permeability, resistance to
degradation and adequate mechanical properties. While the optical properties are of utmost
importance the wetability and gas permeability are vital to the maintenance of a tear film
over the cornea and health of the eye.
The type of lens is defined by its construction material. Hydrogel soft lenses use a polymer
(poly(hydroxyethylmethacrylate)) otherwise known as polyHEMA. Rubbery soft lenses are
made of silicone rubbers and flouropolymers and are often surface treated to improve
wetability. Rigid lenses consist of PMMA, this has excellent optical properties and
biocompatibility but poor oxygen permeability. Gas permeable rigid lenses have been
developed from a range of polymers to combine the good mechanical properties of the rigid
lens with the desirable gas transport.

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4.4.2. Intraocular lenses (IOL)


Intraocular lenses (IOL) are used to repair problems associated with reduction in
translucency of the lenses, otherwise known as cataracts. The clouded lens is surgically
extracted and replaced with an IOL. IOLs have two component, a central optically clear
membrane (usually PMMA), and an attachment area to provide stability (usually
polypropylene). Silicones and hydrogels have also been trialed for the clear membrane.

Figure 19: Cornea Replacement [16]


5. The Future
It is expected that the field of biomaterials will continue to expand. However there are a
number of materials engineering challenges that must be overcome. These include
1) The development of new polymeric materials that can reproduce the effects of biological
structures. Such materials would need the potential to be processed cheaply and in large
quantities.
2) Interface design so that the implant can be securely attached and compatible with cell
growth but also allow removal if infection or poor performance is experienced.
6.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

SELECTED REFERENCES
Hill, D., Design Engineering of Biomaterials for Medical Devices, John Wiley and
Sons, Chichester, 1998
Cochlear Website: http://www.cochlear.com
Queen Mary University of London Webpage: http://www.materials.qmw.ac.uk/implant/
CO-MO Alooy see OWEN
Polmear, I.J., Light Alloys: Metallurgy of the Lighrt Metals: Third Edition, Arnold
London, 1995
Schlenker, B.R., Introduction to Materials Science: SI Edition, John Wiley & Sons,
Milton, 1974
Ceramic - owen
Ceramic - Owen
PSZ Owen
Almath Crucibles Ltd Website: http://www.almath.vispa.co.uk/zirconia.htm
Witkin, K.B. ed., Clinical Evaluation of Medical Devices: Principles and Case
Studies, Humana Press, Totowa, 1998

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12.
13.
14.
15.
16.
15.
16.
17.
18.
19.

20.
21.
22.
23.
24.

25.

26.

Materials Science and Technology Volume 14, Medical and Dental Materials. Edited
by D.F. Williams. VCH Publishers Inc., New York, 1992
Skalak, R & Chien, S., Handbook of Bioengineering, McGraw-Hill Book Company,
New York, 1987
Kidney Dialysis Foundation Website: http://kdf.org.sg/aboutkidney.html
Abiomed Website: http://www.abiomed.com
Old Dominion Eye Foundation Website: http://www.odeb.org/html/cornealtransplant.htm
J. Black and G. Hastings, Handbook of Biomaterial Properties. Chapman and Hall,
U.K., 1998.
MRS Bulletin, Volume XVI, Biomedical Materials. Materials Research Society,
Pittsburgh, 1991.
L.L. Hench and E.C. Ethridge, Biomaterials: An Interfacial Approach. Academic
Press, New York, 1982.
Biocompatibility of Clinical Implant Materials. Edited by D.F. Williams. CRC Press,
Boca Raton, 1981.
S.F. Hulbert, J.C. Bokros, L.L. Hench, J. Wilson, and G. Heimke, Ceramics in
Clinical Applications: Past Present and Future: pp.189 - 213 in High Tech Ceramics.
Edited by P. Vincenzini. Elsevier, Amsterdam, 1987.
L.L. Hench, Bioceramics: From Concept to Clinic, J. Am. Ceram. Soc., 74 [7] 1487
- 510 (1991).
L.L. Hench, Bioceramics, J. Am. Ceram. Soc., 81 [7] 1705-27 (1998).
S.F. Hulbert, L.L. Hench, D. Forbers, and L.S. Bowman, History of Bioceramics,
Ceram. Int., 8, 131-140 (1982).
Bioceramics of Calcium Phosphate. Edited by K. de Groot. CRC Press, Boca Raton,
1983.
CRC Handbook of Bioactive Ceramics, Volume 2: Calcium Phosphate and
Hydroxylapatite Ceramics. Edited by T. Yamamuro, L.L. Hench, and J. Wilson.
CRC Press, Boca Raton, 1991.
M.N. Rahaman, Ceramic Processing and Sintering. Marcel Dekker Inc., New York,
1995.
Wise, D.L., Trantolo, D.J., Lewandrowski, K-U, Gresser, J.D., Cattaneo, M.V. &
Yaszemski, M.J. eds., Biomaterials Engineering and Devices: Human Applications:
Volume 1, Humana Press, Totowa 2000, pp. 137-142

27.. Williams,D.F. & Roaf, R., Implants in Surgery, W.B. Saunders Company Ltd,
London, 1973, pp 303-356
28.

Silver, F.H. & Christiansen, D.L., Biomaterials Science and Biocompatibility,


Springer-Verlag, New York, 1999, pp. 19-25, 327-330

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7. Internet Links
Useful Biomaterial Link Pages
http://www.surrey.ac.uk/MME/Research/BioMed/links.html
http://www.bmes.alfred.edu/links.html
http://www.ems.psu.edu/MATSE/faculty/vogler.html
http://www.umist.ac.uk/MatSci/useful/matsites.htm
http://www.bmen.tulane.edu/BMEFAQ/#s4
http://books.nap.edu/books/0309039282/html/103.html
http://www.bae.ncsu.edu/bae/research/blanchard/www/465/textbook/otherprojects/artificial/i
ndex.html
http://enuxsa.eas.asu.edu/~btowe/courses/bme201/study.html
http://www.salspolymer.com/history/polymers8.htm
http://www.beyonddiscovery.org/beyond/beyonddiscovery.nsf/web/polymers?OpenDocume
nt
Cochlear Implants
http://www.cochlear.com/rcs/cochlear/publisher/web/home_static/index.jsp
http://www.zak.co.il/deaf-info/old/ci-faq.html
http://www.listen-up.org/implant.htm#manu
http://www.houstonent.com/index02.htm
Hip Prosthesis
http://www.materials.qmw.ac.uk/implant
Heart Prosthesis
http://school.discovery.com/homeworkhelp/worldbook/atozpictures/lr000617.html
http://www.tmc.edu/thi/tah.html
Ophthalmology Materials
http://www.odeb.org/html/cornealtransplant.htm
Kidney replacement
http://kdf.org.sg/aboutkidney.html

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