U.S. patent application number 16/579375 was filed with the patent office on 2020-01-16 for orthopedic implants having gradient polymer alloys.
The applicant listed for this patent is Hyalex Orthopaedics, Inc.. Invention is credited to Vernon HARTDEGEN, Michael J. JAASMA, Lampros KOURTIS, David MYUNG, Jeffrey G. ROBERTS.
Application Number | 20200017676 16/579375 |
Document ID | / |
Family ID | 46637507 |
Filed Date | 2020-01-16 |
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United States Patent
Application |
20200017676 |
Kind Code |
A1 |
MYUNG; David ; et
al. |
January 16, 2020 |
ORTHOPEDIC IMPLANTS HAVING GRADIENT POLYMER ALLOYS
Abstract
Orthopedic implants having a bone interface member and a water
swellable IPN or semi-IPN with a stiffness, hydration, and/or
compositional gradient from one side to the other and physically
attached to the bone interface member. The invention also includes
an orthopedic implant system including an implant that may conform
to a bone surface and a joint capsule. The invention also includes
orthopedic implants with water swellable IPN or semi-IPNs including
a hydrophobic thermoset or thermoplastic polymer first network and
an ionic polymer second network, joint capsules, labral components,
and bone interface members. The invention also includes a method of
inserting an orthopedic implant having a metal portion and a
flexible polymer portion into a joint, including inserting the
implant in a joint in a first shape and changing the implant from a
first shape to a second shape to conform to a shape a bone.
Inventors: |
MYUNG; David; (Santa Clara,
CA) ; JAASMA; Michael J.; (San Francisco, CA)
; KOURTIS; Lampros; (Cambridge, MA) ; ROBERTS;
Jeffrey G.; (Germantown, TN) ; HARTDEGEN; Vernon;
(Collierville, TN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Hyalex Orthopaedics, Inc. |
Lexington |
MA |
US |
|
|
Family ID: |
46637507 |
Appl. No.: |
16/579375 |
Filed: |
September 23, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15394297 |
Dec 29, 2016 |
10457803 |
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16579375 |
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13347647 |
Jan 10, 2012 |
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15394297 |
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13219348 |
Aug 26, 2011 |
8883915 |
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13347647 |
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12499041 |
Jul 7, 2009 |
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13219348 |
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61377844 |
Aug 27, 2010 |
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61383705 |
Sep 16, 2010 |
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61078741 |
Jul 7, 2008 |
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61079060 |
Jul 8, 2008 |
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61095273 |
Sep 8, 2008 |
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61166194 |
Apr 2, 2009 |
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61431327 |
Jan 10, 2011 |
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61454957 |
Mar 21, 2011 |
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61566567 |
Dec 2, 2011 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61F 2/3877 20130101;
A61F 2002/30998 20130101; C08L 75/06 20130101; A61F 2/4225
20130101; C08G 18/7671 20130101; C08G 18/837 20130101; A61F 2/3859
20130101; C08G 18/831 20130101; A61F 2002/4256 20130101; C08G
2270/00 20130101; A61F 2/3872 20130101; C08G 18/44 20130101; C08F
220/14 20130101; A61F 2/30 20130101; C08G 77/38 20130101; A61F
2002/4205 20130101; C08L 33/02 20130101; A61F 2/442 20130101; A61F
2/32 20130101; A61F 2/30988 20130101; A61F 2002/4238 20130101; C08L
75/04 20130101; A61F 2/4081 20130101; A61F 2/4261 20130101; A61F
2310/00179 20130101; C08G 18/4854 20130101; A61F 2/3804 20130101;
A61F 2/3099 20130101; A61F 2/4202 20130101; C08F 236/06 20130101;
C08F 220/06 20130101; C08L 75/16 20130101; C08L 2205/04 20130101;
A61F 2/4241 20130101; A61F 2310/00011 20130101 |
International
Class: |
C08L 33/02 20060101
C08L033/02; C08G 77/38 20060101 C08G077/38; C08G 18/83 20060101
C08G018/83; C08G 18/44 20060101 C08G018/44; C08F 236/06 20060101
C08F236/06; C08F 220/14 20060101 C08F220/14; C08F 220/06 20060101
C08F220/06; A61F 2/30 20060101 A61F002/30; C08G 18/48 20060101
C08G018/48 |
Claims
1-17. (canceled)
18. An orthopedic implant comprising: a water swellable IPN or
semi-IPN member having a bearing surface and an attachment zone,
the water swellable IPN or semi-IPN member comprising a hydrophobic
thermoset or thermoplastic polymer first network and an ionic
polymer second network configured to exhibit a compositional
gradient between the bearing surface and the attachment zone,
wherein the attachment zone is configured to attach to bone and
comprises the hydrophobic first network and not the ionic polymer
second network.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 13/347,647, filed Jan. 10, 2012, which is a
continuation-in-part of U.S. patent application Ser. No.
13/219,348, filed Aug. 26, 2011, now U.S. Pat. No. 8,883,915, which
claims the benefit of U.S. Provisional Patent Application No.
61/377,844, filed Aug. 27, 2010 and of U.S. Provisional Patent
Application No. 61/383,705, filed Sep. 16, 2010. U.S. patent
application Ser. No. 13/219,348 is a continuation-in-part of U.S.
patent application Ser. No. 12/499,041. filed Jul. 7, 2009, now
abandoned, which claims the benefit U.S. Provisional Patent
Application No. 61/078,741, filed Jul. 7, 2008, U.S. Provisional
Patent Application No. 61/079;060, filed Jul. 8, 2008, U.S.
Provisional Patent Application No. 61/095,273, filed Sep. 8, 2008,
and U.S. Provisional Patent Application No. 61/166,194, filed Apr.
2, 2009. U.S. patent application Ser. No. 13/347,647 also claims
the benefit under 35 U.S.C. 119 of U.S. Provisional Patent
Application No. 61/431,327, filed Jan. 10, 2011, U.S. Provisional
Patent Application No. 61/454,957, filed Mar. 21, 2011, and U.S.
Provisional Patent Application No. 61/566,567, filed Dec. 2, 2011;
the disclosures of each of these prior applications is incorporated
herein by reference.
INCORPORATION BY REFERENCE
[0002] All publications and patent applications mentioned in this
specification are herein incorporated by reference to the same
extent as if each individual publication or patent application was
specifically and individually indicated to be incorporated by
reference.
FIELD OF THE INVENTION
[0003] The present invention pertains to semi- and fully
interpenetrating polymer networks, methods of making semi- and
fully interpenetrating polymer networks, articles useful in
orthopedics made from such semi- and fully interpenetrating polymer
networks, and methods of using such articles.
BACKGROUND OF THE INVENTION
[0004] Fully interpenetrating polymer networks (IPN'S) and
semi-interpenetrating polymer networks ("semi-IPN's") have been
created from a variety of starting materials and have been used
fora variety of applications. IPN's and semi-IPNs can combine the
beneficial properties of the polymers from which they are made and
can avoid some of the undesirable properties of their component
polymers.
[0005] Prior IPN's and semi-IPNs have been proposed for use in
biomedical applications, such as a coating for an implant or as
artificial cartilage. See, e.g., U.S. Patent Publ. No.
2005/0147685; U.S. Patent Publ. No. 2009/0035344; and U.S. Patent
Publ. No. 2009/008846. The utility of prior IPNs and semi-IPNs for
their proposed applications is limited by the properties of those
compositions, however. In addition, the starting materials and
processes of making such prior compositions limit not only the
resulting properties of the IPN or semi-IPN but also the commercial
viability of the manufacturing processes and the articles made in
such processes. Also, the mechanical properties of prior IPNs and
semi-IPNs are often limited by the mechanical properties of the
component polymers used, which in the case of most intrinsically
hydrophilic, water-swellable polymers, are usually quite low. For
example, the prior art has not described making a water-swellable
IPN or semi-IPN from commercially available hydrophobic thermoset
or thermoplastic polymers, such as polyurethane or ABS.
[0006] Finally, the utility of prior IPN and semi-IPN compositions
and the value of the articles formed from such compositions have
been limited by the inability to create IPN's and semi-IPNs with
desired characteristics, such as strength, lubricity and
wear-resistance.
[0007] The prior art has also not provided joint implants that
fully address the loss of motion and pain experienced by
individuals suffering from arthritis or other joint damage. When
less invasive methods fail, patients suffering from joint problems
can undergo total joint arthroplasty (TJA) or joint resurfacing.
The joint is opened, damaged or diseased bone is removed and an
implant is placed in the joint. Implants made from metal, ceramic
and/or ultra-high molecular weight polyethylene (UHMWPE) have been
used in orthopedic joint arthroplasty or joint replacement for a
number of years. Surgeons have experience replacing one or both
sides of a joint. They can replace both sides with the same
material; if the material is metal then a metal-on-metal
articulation is created. They can replace each side of the joint
with a different material to create a mixed articulation, such as
metal-on-polyethylene.
[0008] Although a large number of patients undergo joint
replacement surgery each year (an estimated 540,000 patients in the
U.S. undergo knee arthroplasty annually), metal, ceramic, and
UHMWPE implants in joints can cause adverse local and remote tissue
responses. The responses may be due to inherent characteristics of
the implant, changes in the implant material over time, or release
of material from the implant. A prosthetic joint implant
experiences significant friction, motion, pressure, and chemical
changes over the course of many years. As time goes by, the implant
may corrode or may release ions or debris, such as metal ions or
wear particles. The ions or particles may remain in the joint area
or may travel through the blood to other parts of the body. The
implant or the debris or ions it releases may cause bone resorption
(osteolysis), inflammation, metal toxicity, pseudo-tumors, pain,
and other problems. In some cases, the implant may loosen and
require replacement, using a procedure called revision surgery. In
revision surgery, the old, unwanted implant is removed, additional
damaged or diseased joint and/or bone material is removed to create
a clean, strong surface for attaching the implant, and a new
implant is placed. Revision surgeries are expensive, painful,
sometimes result in dangerous and hard-to-treat infections, and
require long recovery and rehabilitation time.
[0009] More recently, hydrogel polymers have been suggested for use
in joint implants as alternatives to the metal, ceramic, and UHMWPE
implants. U.S. Patent Publ. No. 2004/0199250 by Fell describes a
knee prosthesis with a hydrogel coating portion and a high modulus
supporting portion for placement into a body joint without
requiring bone resection. U.S. Patent Publ. No. 2006/0224244 to
Thomas et al. describes a hydrogel implant for replacing a portion
of a skeletal joint. The implant has a hydrogel bearing surface
with high water content and lower strength and rigidity mounted to
a support substrate. U.S. Patent Publ. No. 2008/0241214 to Myung et
al. describes the attachment of a hydrogel polymer to a metal
assembly. The surface of the metal assembly is modified using an
inorganic material and the hydrogel polymer is attached using an
intervening polymer network. The assembly may be used as an
orthopedic implant. These hydrogel polymers, however, do not
perfectly recreate the original anatomy, shape, or strength of the
joint.
[0010] What are needed are materials and methods which overcome the
above and other disadvantages of known joint replacement or joint
resurfacing implants and procedures.
SUMMARY OF THE INVENTION
[0011] The mechanical properties desired for certain medical
applications are often outside the range of possibility of many
hydrophilic starting materials. Hence, one aspect of this invention
takes advantage of the high mechanical strength of hydrophobic
starting materials and combines those materials with certain ionic
polymers as a useful way to achieve the goal of high mechanical
strength in addition to other desirable properties. Thus, while the
prior art took water-swellable polymers and tried to make them
stronger, one aspect of this invention takes strong materials and
makes them more water-swellable.
[0012] For purposes of this application, an "interpenetrating
polymer network" or "IPN" is a material comprising two or more
polymer networks which are at least partially interlaced on a
molecular scale, but not covalently bonded to each other, and
cannot be separated unless chemical bonds are broken. A
"semi-interpenetrating polymer network" or "semi-IPN" is a material
comprising one or more polymer networks and one or more linear or
branched polymers characterized by the penetration on a molecular
scale of at least one of the networks by at least some of the
linear or branched macromolecules. As distinguished from an IPN, a
semi-IPN is a polymer blend in which at least one of the component
polymer networks is not chemically crosslinked by covalent
bonds.
[0013] A "polymer" is a substance comprising macromolecules,
including homopolymers (a polymer derived one species of monomer)
and copolymers (a polymer derived from more than one species of
monomer). A "hydrophobic polymer" is a pre-formed polymer network
having at least one of the following two properties: (1) a surface
water contact angle of at least 45.degree. and (2) exhibits water
absorption of 2.5% or less after 24 hours at room temperature
according to ASTM test standard D570. A "hydrophilic polymer" is a
polymer network having a surface water contact angle less than
45.degree. and exhibits water absorption of more than 2.5% after 24
hours at room temperature according to ASTM test standard D570. An
"ionic polymer" it defined as a polymer comprised of macromolecules
containing at least 2% by weight ionic or ionizable monomers (or
both), irrespective of their nature and location. An "ionizable
monomer" is a small molecule that can be chemically bonded to other
monomers to form a polymer and which also has the ability to become
negatively charged due the presence of acid functional groups such
carboxylic acid and/or sulfonic acid. A "thermoset polymer" is one
that does not melt when heated, unlike a thermoplastic polyther.
Thermoset polymers "set" into a given shape when first made and
afterwards do not flow or melt, but rather decompose upon heating
and are often highly crosslinked and/or covalently crosslinked. A
"thermoplastic polymer" is one which melts or flows when heated,
unlike thermoset polymers. Thermoplastic polymers are usually not
covalently crosslinked. A "polymer alloy" is an IPN or semi-IPN. A
"gradient polymer alloy" is a gradient IPN or semi-IPN (e.g. an IPN
or semi-IPN having a compositional gradient). "Phase separation" is
defined as the conversion of a single-phase system into a
multi-phase system; especially the separation of two immiscible
blocks of a block co-polymer into two phases, with the possibility
of a small interphase in which a small degree of mixing occurs. The
present invention includes a process for modifying common
commercially available hydrophobic thermoset or thermoplastic
polymers, such as polyurethane or ABS to provide new properties,
such as strength, lubricity, electrical conductivity and
wear-resistance. Other possible hydrophobic thermoset or
thermoplastic polymers are described below. The invention also
includes the IPN and semi-IPN compositions as well as articles made
from such compositions and methods of using such articles. The IPN
and semi-IPN compositions of this invention may attain one or more
of the following characteristics: High tensile and compressive
strength; low coefficient of friction; high water content and
swellability; high permeability; biocompatibility; and
biostability.
[0014] One aspect of the invention provides an orthopedic implant,
e.g. adapted to fit an acromioclavicular joint, an ankle joint, a
condyle, an elbow joint, a finger joint, a glenoid, a hip joint, an
intervertebral disc, an intervertebral facet joint, a labrum, a
meniscus, a metacarpal joint, a metatarsal joint, a patella, a
tibial plateau, a toe joint, a temporomandibular joint, or a wrist
joint, including a bone interface member having a bone contact
surface and a water swellable IPN or semi-IPN member having a
bearing surface and an attachment zone, the attachment zone being
attached to the bone interface member, the water swellable IPN or
semi-IPN member comprising a hydrophobic thermoset or thermoplastic
polymer first network and an ionic polymer second network
configured to exhibit a compositional gradient between the bearing
surface and the attachment zone. In some embodiments, the implant
the compositional gradient forms a stiffness gradient. In some
embodiments, one of the networks forms a hydration gradient from a
first portion of the implant to a second portion of the
implant.
[0015] In some embodiments, the bone interface member includes
metal (e.g. porous metal). In some embodiments, the bone interface
member includes a ceramic or polymer. In some embodiments, at least
a portion of the orthopedic joint is configured to change a shape
or to transiently bend during implant placement in a joint.
[0016] In some embodiments, in which the first network includes a
polyurethane, the implant includes a chemical linkage between the
IPN or semi-IPN member and the bone interfacing member (e.g. a
urethane linkage). In some embodiment, an attachment of the
attachment zone to the bone interface member is created by an
adhesive.
[0017] In some embodiments, the ionic polymer second network has a
fixed charge, and may further include carboxylic acid and/or
sulfonic acid groups.
[0018] In some embodiments a thickness of the IPN or semi-IPN is
less than 5 mm in a thickest region.
[0019] In some embodiments, the implant may further includes a
synthetic joint capsule and may include fluid. In some embodiments,
the implant may further include a labral component. In some
embodiments, the implant may have a shape of a cap, a cup, a plug,
a mushroom, a patch and/or a stem.
[0020] Yet another aspect of the invention provides an orthopedic
implant system including a first medical implant including a
water-swellable IPN or semi-IPN including a hydrophobic thermoset
or thermoplastic polymer and an ionic polymer, the first medical
implant have a bone contact surface configured to conform to a bone
surface and a hearing surface adapted to mate with a bearing
surface of another implant or a natural joint and a joint capsule
configured to enclose the bearing surface. In some embodiments, the
joint capsule includes a fluid.
[0021] In some embodiments, the system further includes a second
medical implant including a water swellable IPN or semi-IPN
including a hydrophobic thermoset or thermoplastic polymer and an
ionic polymer, the second medical implant having a bone contact
surface configured to conform to a bone surface and a bearing
surface, and the first medical implant may be configured for
placement in one side of a joint, the second medical implant is
configured for placement on a second side of the joint and the
bearing surfaces of the first and second medical implants are
configured to mate, and the joint capsule may be configured to
enclose the bearing surfaces of the first and the second medical
implants.
[0022] In some embodiments, the orthopedic implant system further
includes a bone interface member physically attached to the IPN or
semi-IPN, and the bone interface member includes the bone contact
surface and may be metal.
[0023] Yet another aspect of the invention provides a hip joint
implant including a water-swellable IPN or semi-IPN including a
hydrophobic thermoset or thermoplastic polymer and an ionic
polymer, the implant having a bone contact surface configured to
conform to a bone surface and a bearing surface, and a labral
component configured to enclose the bearing surface.
[0024] In some embodiments, the hip joint implant further includes
a joint capsule including fluid and configured to enclose the
bearing surface.
[0025] Yet another aspect of the invention provides a composition
of matter including a polyurethane-polyacrylic acid IPN or semi-IPN
including about 4% to about 90% (w/w) polyurethane, about 1% to
about 40% (w/w) electrolyte of polyacrylic acid, and about 3% to
about 80% water when analyzed at pH 7.4, 37.degree. C., in a 0.9%
aqueous salt solution. In some embodiments, the concentration of
polyurethane is from about 8% to about 55%, the composition of an
electrolyte of polyacrylic acid is from about 9% to about 22%,
and/or a concentration of water is from about 25% to about 80%.
[0026] Yet another aspect of the invention provides an orthopedic
implant including a water swellable IPN or semi-IPN having a
bearing surface and an attachment surface and including a
hydrophobic thermoset or thermoplastic polymer first network and an
ionic polymer second network, the bearing surface having a
coefficient of friction between 0.001 and 0.1, an equilibrium
compressive elastic modulus between 0.8 and 200 MPa, a water
content between 25% and 80%, a hydraulic permeability greater than
10.sup.-17m.sup.4/N sec, and a failure tensile strain greater than
10%. In some embodiments, the orthopedic implant has a failure
tensile strain greater than 50%.
[0027] Yet another aspect of the invention provides an orthopedic
implant including a polymer bearing member including a bearing
surface and an attachment zone (e.g. a feature suet as a cone, a
depression, a groove, a peg, a pillar, a pin, and a pyramid), and a
bone interface member attached to the attachment zone of the
polymer bearing member and including metal and open spaces in the
metal, the orthopedic implant being deformable-from a first shape
to a second shape to conform a bone interface member to a
bone-surface.
[0028] In some embodiments, the open spaces in the orthopedic
implant includes pores or slots in the metal. In some embodiments,
the orthopedic implant includes a plurality of metal members
attached to the attachment surface and separated from each
other.
[0029] In some embodiments, the bone interface member is physically
attached to the polymer bearing member, such as by a chemical
linkage between the polymer bearing member and the bone interfacing
member. In some embodiments, an attachment of the attachment zone
to the bone interface member is created by an adhesive.
[0030] In some embodiments, the polymer bearing member includes, a
water swellable IPN or semi-IPN, and may include a hydrophobic
thermoset or thermoplastic polymer first network and an ionic
polymer second network.
[0031] Yet another aspect of the invention includes a method of
inserting an orthopedic implant into a joint, the implant including
a metal portion and a flexible polymer portion having an attachment
zone and a bearing surface, the metal portion attached to the
attachment zone, the method includes the steps of inserting the
implant in a first shape into the joint and changing the implant
from the first shape to a second shape to conform to a shape of at
least a portion of a bone forming the joint. In some embodiments,
the method further includes the step of changing the implant from
the second shape back to the first shape after the first changing
step. In other embodiments, the method includes the step of
deforming the implant from an original shape to the first shape
prior to the changing step. In some embodiments in which the joint
is a hip joint and the implant is configured for placement on a
femoral head of a hip joint, deforming includes expanding a portion
of the implant to fit over the femoral head.
BRIEF DESCRIPTION OF THE DRAWINGS
[0032] The novel features of the invention are set forth with
particularity in the claims that follow. A better understanding of
the features and advantages of the present invention will be
obtained by reference to the following detailed description that
sets forth illustrative embodiments, in which the principles of the
invention are utilized, and the accompanying drawings of which:
[0033] FIGS. 1A-1D illustrate a method of forming an IPN or
semi-IPN according to one aspect of this invention.
[0034] FIG. 2 illustrates a composition gradient formed in an
article along a thickness direction.
[0035] FIG. 3 illustrates a composition gradient formed in an
article along a radial direction.
[0036] FIG. 4A illustrates a method of fabricating thermoplastic
gradient IPN according to the present invention.
[0037] FIG. 4B illustrates variation of gradient properties within
an IPN according to the invention.
[0038] FIG. 4C illustrates the variation of an ionic polymer across
a gradient IPN.
[0039] FIG. 5 illustrates a laminate structure or an IPN or
semi-IPN.
[0040] FIGS. 6A and 6B illustrate shaping of a gradient IPN
article.
[0041] FIGS. 7A-7D illustrate shape heating of an IPN.
[0042] FIGS. 8A-8D illustrate bonding of a gradient IPN article to
a surface.
[0043] FIGS. 9A-9D illustrate how an osteochondral graft implant
formed from an IPN or semi-IPN of this invention can be used to
replace or augment cartilage within a joint.
[0044] FIGS. 10A and 10B illustrate an osteochondral graft having
an opening to accommodate a ligament.
[0045] FIGS. 11A-11E show osteochondral grafts formed from an IPN
or semi-IPN of this invention that may be used singly or in any
combination needed to replace or augment cartilage within a knee
joint.
[0046] FIGS. 12A and 12B show osteochondral grafts formed from the
TPN's or semi-IPN's of this invention and shaped for use in a
finger joint.
[0047] FIGS. 13A and 13B show a labium prosthesis formed from an
IPN or semi-IPN of this invention for use in replacing or
resurfacing the labrum of the shoulder or hip.
[0048] FIG. 14 shows the use of an IPN or semi-IPN of this
invention as a bursa osteochondral graft, labium osteochondral
graft, glenoid osteochondral graft and humeral head osteochondral
graft.
[0049] FIG. 15 shows the use of an IPN or semi-IPN of this
invention as prostheses for resurfacing intervertebral facets.
[0050] FIG. 16A shows a prosthetic cartilage plug formed from a
gradient IPN composition of this invention.
[0051] FIGS. 16B-16D show embodiments in which porous surfaces are
formed on the cartilage plug. FIG. 16D is a bottom elevatational
view of the embodiment of FIG. 16C.
[0052] FIG. 17 shows an embodiment of a prosthetic cartilage plug
in which the stem is provided with helical ridges to form a screw
for fixation of the plug to bone.
[0053] FIGS. 18A and B are side and bottom elevational views of an
embodiment of a prosthetic cartilage plug having three stems for
press fit insertion into holes in the bone for fixation.
[0054] FIG. 19 shows an embodiment of a prosthetic cartilage plug
in which the exposed head portion is substantially the same
diameter as the stem.
[0055] FIG. 20 shows an embodiment of a prosthetic cartilage plug
in which the exposed head portion is narrower than the stem, and
the stem widens toward the base.
[0056] FIG. 21 shows an embodiment of a prosthetic cartilage plug
in which the stem has circumferential ridges to aid fixation.
[0057] FIG. 22 shows an embodiment similar to that of FIG. 19 that
adds a rough porous surface to the stem.
[0058] FIG. 23 shows an embodiment of an osteochondral graft formed
to physically grip the bone without additional fixation, such as
screws or stems.
[0059] FIG. 24 shows an embodiment of an osteochondral graft having
screw holes for screw fixation.
[0060] FIG. 25 shows an embodiment of an osteochondral graft having
a screw hole and a screw head depression for screw fixation.
[0061] FIG. 26 shows an embodiment of an osteochondral graft having
a stem for insertion into a hole in the bone.
[0062] FIGS. 27A and 27B show embodiments of the composition of
this invention used to make two-sided lubricious implants.
[0063] FIGS. 28 and 29 show orthopedic implants that are attached
to surfaces of two bones, or other anatomic elements that move with
respect to each other, such as in a joint.
[0064] FIGS. 30A and 30B illustrate the integration of
osteochondral grafts and other implants of this invention into bone
over time.
[0065] FIGS. 31A-31C illustrate three possible configurations of
osteochondral implants to repair cartilaginous joint surface
according to this invention.
[0066] FIG. 32 shows the use-of a lubricious IPN or semi-IPN
composition of this invention to resurface the hull of a marine
vessel.
[0067] FIG. 33 shows the use of a lubricious thermoplastic or
thermoset IPN to modify interfacing surfaces of machine parts that
move with respect to each other.
[0068] FIG. 34 shows the use of a lubricious thermoplastic or
thermoset IPN to reduce fluid drag on the inner surface of a
pipe.
[0069] FIG. 35 is a photograph of a hydrated PEU/PAA semi-IPN
gradient material being held by a forceps.
[0070] FIG. 36 shows contact angle analysis in association with
Example 32.
[0071] FIGS. 37A and 37B show the PEU/PAA semi-IPN material subject
to Transmission Electron Microscopy analysis as associated with
Example 33.
[0072] FIG. 38 shows the PEU/PAA semi-IPN material subject to
Transmission Electron Microscopy analysis with a schematic diagram
associated with Example 34.
[0073] FIG. 39 shows the tensile stress-strain behavior of the
PEU/PAA semi-IPN material associated with Example 35.
[0074] FIG. 40 shows the thermagram of the PEU/PAA semi-IPN
material analyzed by DSC associated with Example 36.
[0075] FIG. 41 shows the results of thermal analysis of the PEU/PAA
Semi-IPN material analyzed by DSC associated with Example 36.
[0076] FIG. 42 shows the coefficient of friction of the PEU/PAA
semi-IPN material on PEU/PAA under static load associated with
Example 37.
[0077] FIG. 43 shows the coefficient of fiction of the PEU/PAA
semi-IPN material on metal under static load associated with
Example 38.
[0078] FIGS. 44A-44C show the results of wear testing of the
PEU/PAA semi-IPN material associated with Example 39 compared to
UHMWPE sample from a metal-on-UHMWPE wear test.
[0079] FIGS. 45A-45C show the results of wear testing of the
PEU/PAA semi-IPN material associated with Example 39.
[0080] FIG. 46 shows quantification of the results of wear testing
of the PEU/PAA semi-IPN material associated with Example 39.
[0081] FIG. 47 shows the swelling behavior of polyether urethane
and PEU/PAA semi-IPN in various aqueous and organic solvents
associated with Example 40.
[0082] FIGS. 48A and 48B show the results of the swelling of
polyether urethane and PEU/PAA semi-IPN in water and acetic acid
associated with Example 41.
[0083] FIG. 49 shows polyacrylic acid content in the PEU/PAA
semi-EPN as a function of the amount of acrylic acid in the
swelling solution associated with Example 42.
[0084] FIG. 50 shows the swelling of PEU/PAA semi-IPN as a function
of the amount of polyacrylic acid in the semi-IPN associated with
Example 43.
[0085] FIGS. 51A and 51B show the results of Dynamic Compression
testing of the PEU/PAA semi-IPN material as associated with Example
44.
[0086] FIG. 52 shows the results of the application of a multistep
stress relaxation compressive stress test to the PEU/PAA semi-IPN
material followed by relaxation as associated with Example 44.
[0087] FIG. 53 shows the results of the application of application
of compressive stress to the PEU/PAA semi-IPN material associated
with Example 44.
[0088] FIG. 54 shows a partial list of materials that have been
made in accordance with the present invention.
[0089] FIGS. 55A and 55B show a gradient polymer alloy (FIG. 55A)
and a porous metal device (FIG. 55B) before being joined.
[0090] FIG. 56 shows a gradient polymer alloy device with gradient
polymer and a porous metal device after joining according to one
aspect of the invention.
[0091] FIGS. 57A-57C and FIGS. 58A-58D show the steps of attaching
a cap-shaped (FIGS. 57A-57C) and a cup-shaped (FIGS. 58A-D) metal
implant having a gradient polymer alloy bearing surface to a
bone.
[0092] FIG. 59A shows both sides of a joint replaced with a metal
implant having a gradient polymer alloy bearing surface.
[0093] FIG. 59B shows a cross-section of the implant from FIG.
59A.
[0094] FIG. 60 shows a cap-on-cup total cartilage replacement in a
hip joint.
[0095] FIG. 61 shows a hip replacement system with cap-on cup
cartilage replacement implants such as the ones shown in FIG. 60, a
synthetic joint capsule component, labral components and lubricant
fluid according to one aspect of the invention.
[0096] FIG. 62 shows a cartilage replacement system with cap-on-cup
metal implants having gradient polymer alloy bearing surfaces.
[0097] FIG. 63 shows another embodiment of a metal implant having a
gradient polymer alloy bearing surface.
[0098] FIG. 64 shows a metal implant with expansion gaps and a
deformable polymer for placement in a joint in a body.
[0099] FIG. 65 shows an implant such as the one in FIG. 64 being
placed over a femoral head.
[0100] FIG. 66 shows an orthopedic implant with metal segments for
placement in a joint.
[0101] FIG. 67 shows another embodiment of an orthopedic implant
with metal segments for placement in a joint.
[0102] FIG. 68 shows a total cartilage replacement system, with
cap-on-cup cartilage replacement implants, a synthetic joint
capsule component, labral components, and lubricant fluid according
to one aspect of the invention.
[0103] FIG. 69 shows an integrated joint and joint capsule
replacement system according to one aspect of the invention.
[0104] FIGS. 70A and 70B show metal patches with gradient polymer
alloy bearing surfaces in a knee joint.
[0105] FIGS. 71A and 71C show metal caps, patches, and plugs with
gradient polymer alloy bearing surfaces.
[0106] FIGS. 72A-72F show a schematic diagram of an
interpenetrating polymer network.
[0107] FIG. 73 shows a polyurethane-polyelectrolyte IPN.
[0108] FIGS. 74A and 74B show a polyurethane-polyelectrolyte IPN
with a stiffness gradient from one side to the other side according
to one aspect of the invention.
[0109] FIG. 75 shows compositions of polyurethane-polyelectrolyte
compositions.
[0110] FIG. 76 is a graphical representation of the data shown in
FIG. 75.
[0111] FIG. 77 shows compositions of polyurethane-polyelectrolyte
systems produced.
[0112] FIG. 78 is a graphical representation of the data shown in
FIG. 77.
[0113] FIG. 79 shows characteristics of a gradient polymer such as
those described in FIGS. 74A-78 according to one aspect of the
invention.
DETAILED DESCRIPTION
[0114] The present invention includes a process for modifying
hydrophobic thermoset or thermoplastic polymers to confer upon them
qualities such as lubricity, permeability, conductivity, and
wear-resistance. Such hydrophobic polymers ordinarily do not soak
up water to any significant extent and are generally useful for
their mechanical strength, impermeability and insulating ability.
An exemplary list of common and commercially available hydrophobic
polymers modifiable by the process of this invention includes the
following: Acrylonitrile butadiene styrene (ABS),
Polymethylmethacrylate (PMMA), Acrylic, Celluloid, Cellulose
acetate, Ethylene-Vinyl Acetate (EVA), Ethylene vinyl alcohol
(EVAL), Kydex, a trademarked acrylic/PVC alloy, Liquid Crystal
Polymer (LCP), Polyacetal (POM or Acetal), Polyacrylates (Acrylic),
Polyacrylonitrile (PAN or Acrylonitrile), Polyamide (PA or Nylon),
Polyamide-imide (PAI), Polyaryletherketone (PAEK or Ketone),
Polyhydroxyalkanoates (PHAs), Polyketone (PK), Polyester,
Polyetheretherketone (PEEK), Polyetherimide (PEI), Polyethersulfone
(PES)--see Polysulfone, Polyethylenechlorinates (PEC), Polyimide
(PI), Polymethylpentene (PMP), Polyphenylene oxide (PPO),
Polyphenylene sulfide (PPS), Polyphthalamide (PPA), Polystyrene
(PS), Polysulfone (PSU), Polyvinyl acetate (PVA), Polyvinyl
chloride (PVC), Polyvinylidene chloride (PVDC), Spectralon,
Styrene-acrylonitrile (SAN), Polydimethylsiloxane (PDMS), and
Polyurethanes (PU). Other, less common and non-commercially
available (i.e. custom) polymers may also be used. A wide variety
of polyurethanes can be used with varying hard segment, soft
segment, and chain extender compositions, as will be described
herein.
[0115] One aspect of the invention takes advantage of a
characteristic of some modifiable thermoset or thermoplastic
hydrophobic polymers: the presence of ordered and disordered
(amorphous) domains within the polymer. For example, some
hydrophobic thermoset or thermoplastic polymers such as
polyurethanes are phase-separated, containing first domains of hard
segments and second domains of soft segments, with the two domains
exhibiting different solubility properties with respect to
interpenetration of monomers. In polyurethanes, the hard segments
are disposed primarily within the ordered domains and the soft
segments are disposed primarily within the disordered (amorphous)
domains. (The starting polymer may contain more than two domains,
of course, without departing from the scope of the invention.) This
difference in properties between the two domains of the
phase-separated polymer enables the process of this invention to
impart new properties to the polymer that can extend throughout the
bulk of the material, or throughout only a portion of the material,
e.g., in a particular region or in a gradient. For example, a
non-lubricious polymer can be made lubricious; an otherwise
non-conductive polymer can be made conductive; and an otherwise
non-permeable polymer can be made permeable. Moreover, the process
can be performed repeatedly to introduce more than one new property
to the starting polymer.
[0116] In some embodiments, phase separation in the polymer allows
for differential swelling of one or more separated phases within
the polymer with, e.g., a solvent and/or monomer, which is then
used to impart new properties. According to the invention, for
example, lubriciousness can be introduced to an otherwise
non-lubricious material by adding and polymerizing ionic monomers.
In one embodiment, a polymer material with high mechanical strength
and a lubricious surface can be made from an otherwise
non-lubricious, hydrophobic polymer and a hydrophilic polymer
derived from ionizable, vinyl monomers. By converting otherwise
hydrophobic materials into biphasic materials with both solid and
liquid (water) phases, the present invention addresses a need in
the art for lubricious, high strength materials-for use in medical,
commercial, and industrial applications.
[0117] FIGS. 1A-D illustrate the process with respect to a
thermoplastic polyurethane-based polymer containing a network of
hard segments 10 (shown as open rectangles) and soft segments 12
(shown as lines). In FIG. 1B, the soft segments 12 are swollen with
vinyl-based monomer 14 (shown as circles) and optional solvent,
along with an initiator and cross-linker (not shown), while mostly
not affecting the hard segment material. This swelling process is
not dissolution of the polymer; the hard segments act as physical
crosslinks to hold the material together as the soft segments are
imbibed with the monomer(s) and optional solvent(s). After
polymerization, and cross-linking of the monomers, a second network
16 (shown as dark lines in FIGS. 1C and 1D) is formed in the
presence of the first network to create an IPN in which the second
polymer (i.e., the polymerized monomer) is primarily sequestered
within the soft, amorphous domain of the first polymer. Despite
some degree of molecular rearrangement and further phase
separation, the hard segments largely remain ordered and
crystalline, providing structure and strength to the material.
[0118] The new properties provided by this IPN depend on the
properties of the polymerized monomers that were introduced and on
any optional post-polymerization processing. Examples of such new
properties include lubriciousness, conductivity, hardness,
absorbency, permeability, photoreactivity and thermal reactivity.
For example, as shown in FIG. 1D, after optional swelling in a
buffered acqueous solution, the second network of the IPN of FIG.
1C becomes ionized 18, and the IPN is water-swollen and lubricious.
Thus, hydrophilicity (i.e., water absorbency) can be introduced
into an otherwise hydrophobic material. A hydrophobic polymer
material such as polyurethane or ABS can be infiltrated with
various ionic polymers such as polyacrylic acid and/or
poly(sulfopropyl methacrylate) such that it absorbs water.
[0119] In addition to absorbency, various levels of permeability
(water, ion, and/or solute transport) can be introduced into an
otherwise non-permeable material. For example, a hydrophobic
polymer material such as polyurethane or ABS can be infiltrated
with an ionic polymer such as polyacrylic acid and/or
poly(sulfopropyl methacrylate) so that it absorbs water, as
described above. This hydration of the bulk of the material allows
for the transport of solutes and ions. The transport of solutes and
ions and permeability to water is made possible by phase continuity
of the hydrated phase of the IPN. This is useful in various
applications, including drug delivery, separation processes, proton
exchange membranes, and catalytic processes. The permeability can
also be utilized to capture, filter, or chelate solutes as a liquid
flows over or through the material. Furthermore, because of this
permeability, the materials of the present invention can be
bestowed with increased resistance to creep and fatigue relative to
their component hydrophobic polymers due to their ability to
re-absorb fluid after sustained or repetitive loading.
[0120] Conductivity can be introduced into another wise
non-conductive material. For example, an insulating polymer
material such as polyurethane can be infiltrated with a conductive
polymer (a polyelectrolyte) so that at least part of the hybrid
material is conductive to electric current.
[0121] The invention also includes the alteration of chemical
groups of the second polymer and the use of tethering points in the
second polymer for another polymer, molecule or biomolecule. Also,
any of the domains can be doped with any number of materials, such
as antioxidants, ions, ionomers, contrast agents, particles,
metals, pigments dyes, biomolecules, polymers, proteins and/or
therapeutic agents.
[0122] The first polymer can be additionally crosslinked or
copolytherized with the second polymer if, for example, acryloxy,
methacryloxy, acrylamide, allyl ether, or vinyl functional groups
are incorporated into one end or both ends of the polyurethane
prepolymer and then cured by UV or temperature in the presence of
an initiator. For instance, a polyurethane dimethacrylate or
polyurethane bisatrylamide can be used in the first network by
curing in the presence of a solvent (such as dimethylacetamide) and
then evaporating the solvent. The addition of chemical crosslinks
(rather than just physical crosslinks) to the IPN adds a level of
mechanical stability against creep or fatigue caused by continuous,
dynamic loading.
[0123] In addition, a multi-arm (multifunctional) polyol or
isocyanate can be used to create crosslinks in the polyurethane.
In, this case, a fully interpenetrating polymer network is created
(rather than a semi-interpenetrating polymer network). The result
is a composite material with the high strength and toughness of
polyurethane and the lubricious surface and biphasic bulk behavior
of the poly(acrylic acid). Alternatively, other crosslinking
methods can be used, including but not limited to gamma or
electron-beam irradiation. These features are especially important
for bearing applications such as artificial joint surfaces, or as
more biocompatible, thrombo-resistant, long-term implants in other
areas of the body such as the vascular system or the skin. Being
swollen with water also allows imbibement with solutes such as
therapeutic agents or drugs for localized delivery to target areas
of the body.
[0124] In another embodiment of the present invention, the first
polymer can be linked to the second polymer. For example,
polyurethane can be linked through a vinyl-end group. Depending on
the reactivity ratio between the end group and the monomer being
polymerized, different chain configurations can be yielded. For
instance, if the reactivity of the monomer with itself is much
greater than the end group with the monomer, then the second
polymer will be almost completely formed before the addition of the
first polymer to the chain. On the other hand, if the reactivity of
the monomer and the end group are similar, then a random
grafting-type copolymerization will occur. The monomers and end
groups can be chosen based on their reactivity ratios by using a
table of relative reactivity ratios published in, for example, The
Polymer Handbook. The result of these will be a hybrid
copolymer/interpenetrating polymer network.
[0125] Any number or combinations of ethylenically unsaturated
monomers or macromonomers (i.e., with reactive double bonds/vinyl
groups) can be used alone or in combination with various solvents
and selectively introduced into one or more of the phases of the
polymer as long as at least 2% of such monomers is ionizable, i.e.,
contains carboxylic acid and/or sulfonic acid functional groups.
Other monomers include but are not limited to dimethylacrylamide,
acrylamide, NIPAAm, methyl acrylate, methyl methacrylate,
hydroxyethyl acrylate/methaerylate, and any vinyl-based monomer
containing sulfonic acid groups (e.g. acrylamido methyl propane
sulfonic acid, vinyl sulfonic acid, 3-sulfopropyl acrylate (or
methacrylate), 2-methyl-2-propene-1-sulfonic acid sodium salt 98%,
or any monomers in which sulfonic acid is conjugated (allyl ethers,
acrylate/methacrylates, vinyl groups, or acrylamides). The monomer
can also include any monomers containing carboxylic acid groups
conjugated to allyl ethers, acrytate/methacrylates, vinyl groups,
or actylamides. In addition, the monomers can be used in
combination, such as both carboxyl acid and sulfonic acid
containing monomers, to create a carboxylate/sulfonate copolymer.
The pendant functional groups on polymers resulting from these
monomers and monomer combinations can be subject to subsequent
chemical reactions to yield other functionalities to the final
polymer.
[0126] In one embodiment, a preformed, thermoplastic polymer may be
immersed in acrylic acid (or in a solution of acrylic acid
(1%-100%) or other vinyl monomer solution) along with about 0.1%
v/v crosslinker (e.g., triethylene glycol dimethacrylate or N,N
methylene bisacrylamide) with respect to the monomer and about 0.1%
v/v photoinitiator (e.g. 2-hydroxy-2-methyl propiophenone) with
respect to the monomer. The acrylic acid solution can be based on
water, salt buffer, or organic solvents such as dimethylacetamide,
acetone, ethanol, methanol, isopropyl alcohol, toluene,
dichloromethane, propanol, dimethylsulfoxide, dimethyl formamide,
or tetrahydrofuran. The polymer may be swollen by the monomer due
to solvation of the soft segments in the polymer. The monomer
content in the swollen polymer can range from as little as about 1%
to up to about 90%.
[0127] The monomer-swollen polymer may then be removed, placed in a
mold made of glass, quartz, or a transparent polymer, then exposed
to UV light (or elevated temperature) to initiate polymerization
and crosslinking of the monomers. Alternatively, instead of using a
mold, the monomer-swollen polymer can be polymerized while fully or
partially exposed to air or an inert atmosphere (e.g., nitrogen or
argon), or alternatively in the presence of another liquid such as
an oil (e.g., paraffin, mineral, or silicone oil). For medical
applications, it is passible that polymerization step can be
performed in vivo without a mold.
[0128] Depending on the initiator used, exposure to UV light, IR,
or visible light, a chemical, electrical charge, or elevated
temperature leads to polymerization and crosslinking of the
ionizable monomers within the hydrophobic polymer. As an example,
acidic monomers (e.g. acrylic acid) are polymerized to form an
ionic polymer within a preformed thermoplastic, hydrophobic matrix,
forming an interpenetrating polymer network ("IPN"). Solvents can
be extracted out by heat and convection or by solvent extraction.
Solvent extraction involves the use of a different solvent (such as
water) to extract the solvent from polymer, while heat or
convection relies upon evaporation of the solvent. Depending on the
pKa of the ionic polymer (e.g., pKa of PAA=4.7), an acidic pH would
leave the ionic polymer more protonated while a more basic pH would
leave it more ionized.
[0129] Swelling of the IPN in aqueous solution such as phosphate
buffered saline (or other buffered salt solution) at neutral pH
will lead to ionization of the poly(acrylic acid) and further
swelling with water and salts. The resulting swollen IPN will have
a lubricious surface conferred by the hydrophilic, charged
poly(acrylic acid) and high toughness and mechanical strength
conferred by the thermoplastic. In the case of a polyurethane-based
IPN, the IPN will have a structure in which crystalline hard
segments in the polyurethane act as physical crosslinks in the
first network, while chemical crosslinks will be present in the
second network.
[0130] The materials can also be crosslinked after synthesis using
gamma radiation or electron beam radiation. In one example,
polyurethane/polyacrylic acid can be synthesized and then
crosslinked by gamma irradiation, for instance with doses of, for
example, 5, 10, 15, 20, or 25 kGy. In this case, the polymerization
of polyacrylic acid would be done in the absence of a crosslinker,
and after formation of the polymer blend (physical IPN), the
material would be exposed to gamma radiation. This would have the
dual purpose of sterilizing and crosslinking the polyurethane. It
is known in the art that crosslinking of poly(acrylic acid)
hydrogels using gamma irradiation shows a dose-dependence to the
crosslinking of the polymer. This process can also be applied to
other combinations of first and second network polymers, e.g.,
polyurethane and polymethyl methacrylate, ABS and polyacrylic acid,
etc.
[0131] In addition to the starting thermoset and thermoplastic
hydrophobic polymers identified above, modifications to and
derivatives of such polymers may be used, such as sulfonated
polyurethanes. In the case of the polyurethanes, the polyurethane
polymer can be a commercially available material, a modification of
a commercially available material, or be a new material. Any number
of chemistries and stoichiometries can be used to create the
polyurethane polymer. For the hard segment, isocyanates used are
1,5 naphthalene diisocyanate (NDI), isophorone isocyanate (IPDI),
3,3-bitoluene diisocyanate (TODI), methylene bis (p-cyclohexyl
isocyanate) (H.sub.12MDI), cyclohexyl diiscocyanate (CHDI), 2,6
tolylene diisocyanate or 2,4 toluene diisocyanate (TDI), hexamethyl
diisocyanate, or methylene bis(p-phenyl isocyanate). For the soft
segment, chemicals used include, for example polyethyleneoxide
(PEO), polypropylene oxide (PPO), poly(tetramethylene oxide)
(PTMO), hydroxy terminated butadiene, hydroxybutyl terminated
polydimethylsiloxane (PDMS), polyethylene adipate,
polycaprolactone, polytetramethylene adipate, hydroxyl terminate
polyisobutylene, polyhexamethylene carbonate glycol, poly (1,6
hexyl 1,2-ethyl carbonate, and hydrogenated polybutadiene. Any
number of telechelic polymers can be used in the soft segment, if
end-groups that are reactive with isocyanates are used. For
instance, hydroxyl- or amine-terminated poly(vinyl pyrrolidone);
dimethylacrylamide, carboxylase or sulfonated polymers, telechelic
hydrocarbon chains (with hydroxyl and/or amine end groups),
dimethylolpropionic acid (DMPA), or these in combination with each
other or with other soft segments mentioned above (e.g., PDMS) can
be used. Ionic soft segments (or chain extenders) such as
dihydroxyethyl propionic acid (DMPA) (or its derivatives) can be
used to make a water-dispersible polyurethane, so long as the ionic
chain extender does not comprise more than 2% of the material.
[0132] Chain extenders include, for example, 1,4 butanediol,
ethylene, diamine, 4,4'methylene bis (2-chloroaniline) (MOCA),
ethylene glycol, and hexane diol. Any other compatible chain
extenders can be used alone or in combination. Crosslinking chain
extenders can be used containing isocyanate-reactive endgroups
(e.g. hydroxyl or amine) and a vinyl-based functional group (e.g.
vinyl, methacrylate, acrylate, allyl ether, or acrylamide) may be
used in place of some or all of the chain extender. Examples
include 1,4 dihydroxybutene and glycerol methacrylate.
Alternatively, crosslinking can be achieved through the use of a
polyol such as glycerol which contains greater than two hydroxyl
groups for reaction with isocyanates.
[0133] In some embodiments, at least 2% of the hydrophilic monomers
in the second network is ionizable and anionic (capable of being
negatively charged). In one such embodiment, poly(acrylic acid)
(PAA) hydrogel is used as the second polymer network, formed from
an aqueous solution of acrylic acid monomers. Other ionizable
monomers include ones that contain negatively charged carboxylic
acid or sulfonic acid groups, such as methacrylic acid,
2-acrylamido-2-methylpropanesulfonic acid, sulfopropyl methacrylate
(or acrylate), vinyl sulfonic acid, or vinyl-conjugated versions of
hyaluronic acid, heparin sulfate, and chondroitin sulfate, as well
as derivatives, or combinations thereof. The second network monomer
may also be positively charged or cationic. These other monomers
can also be in a range of 1%-99% in either water or organic
solvent, or be pure (100%). One embodiment of the monomer used to
form the second network can be destributed by the following
characteristics: (1) it is capable of swelling the polyurethane,
(2) capable of polymerizing, and (3) is ionizable.
[0134] Other embodiments use a co-monomer in addition to the ionic
polymer that may be non-ionic, such as acrylamide, methacrylamide,
N-hydroxyethyl, acrylamide, N-isopropylacrylamide,
methylmethacrylate, N-vinyl pyrrolidone, 2-hydroxyethyl
methacrylate, 2-hydroxyethyl acrylate or derivatives thereof. These
can be copolymerized with less hydrophilic-species such as
methylmethacrylate or other more hydrophobic monomers or
macromonomers. These can also be polymerized alone or copolymerized
with the aforementioned hydrophilic and/or ionizable monomers.
[0135] Crosslinked linear polymer chains (i.e., macromolecules)
based on these monomers may also be used in the second network, as
well as biomacromolecules (linear or crosslinked) such as proteins
and polypeptides (e.g., collagen, hyaluronic acid, or chitosan).
The choice of the second material will depend on the target
application, for instance in orthopaedic applications, hyaluronic
acid may be useful because it is a major component of joint
cartilage. In addition, biological molecules may carry certain
benefits such as intrinsic biocompatibility or therapeutic (e.g.,
wound healing and/or antimicrobial) properties that make them
useful as material components.
[0136] Any type of compatible cross-linkers may be used to
crosslink the second network in the presence of any of the
aforementioned first networks such as, for example, ethylene glycol
dimethacrylate, ethylene glycol, diacrylate, diethylene glycol
dimethacrylate (or diacrylate), triethylene glycol-dimethacrylate
(or diacrylate), tetraethylene glycol dimethaerylate (or
diacrylate), polyethylene glycol dimethacrylate, or polyethylene
glycol diacrylate, methylene bisacrylamide,
N,N'-(1,2-dihydroxyethylene) bisacrylamide, derivatives, or
combinations thereof. Any number of photoinitiators can also be
used depending on their solubility with the precursor
solutions/materials. These include, but are not limited to,
2-hydroxy-2-methyl-propiophenone and
2-hydroxy-1-[4-(2-hydroxyethoxy) phenyl]-2-methyl-1-propanone. In
addition, other initiators such as benzoyl peroxide, 2-oxoglutaric
acid, azobisisobutyronitrile, or potassium persulfate (or sodium
persulfate) can be used. For instance, benzoyl peroxide is useful
for temperature-initiated polymerizations, while
azobisisobutyronitrile and sodium persulfate are useful as radical
initiators.
[0137] In another embodiment, a solvent can be used as a "trojan
horse" to deliver monomers that otherwise would not mix (or
solubilize with) the polymer to one (or more) phases of the
polymer. The solvent must be carefully chosen based on the specific
qualities and phases of the polymer and monomers. For instance,
acetic acid is capable of swelling but does not dissolve many
polyurethanes. Therefore, acetic acid can be used to carry other
monomers such an acrylamide solution, that otherwise would not
enter polyurethane, into the bulk of the polyurethane. This allows
the acrylamide to be polymerized inside one phase of the
polyurethane. The acetic acid can then be washed out leaving behind
a polyurethane with one or more new properties. Other solvents that
can be used include, but are not limited to, dichloromethane,
methanol, propanol, butanol, (or any alkyl alcohol), acetone,
dimethylacetamide, dimethylformamide, dimethylsulfoxide,
tetrahydrofuran, diethylether, or combinations of these. Taking
into account the solubilities in the phases of the polymer,
solvents with varying degrees of swelling of one can be chosen.
Solubilities of the solvents and components of the material to be
swollen can be obtained from polymer textbooks such as The Polymer
Handbook or can be measured experimentally.
[0138] The present invention can be used to form a
bulk-interpenetrated coating on, a polymeric material. This coating
is inextricably entangled with the underlying polymer matrix, and
is in contrast to conventional surface coatings in which a material
is grafted or tethered to a surface. In one example of a
bulk-interpenetrated coating, a thermoplastic polymer is coated on
one or more sides or is immersed in, an ionizable monomer such as
acrylic acid in the presence of a photoinitiator and a crosslinking
agent. The thermoplastic is then placed in a mold and then exposed
to an initiator (e.g., UV light or heat) for a predetermined period
of time. The mold can be fully or partially transparent and/or
masked to facilitate regionally specific curing of the monomer. The
modified material is then immersed in buffered saline solution to
neutralize the ionic polymer and render the surface lubricious and
hydrophilic. The modified plastic can then be further remolded by
application of heat, solvent, and/or pressure and then shaped to
the desired dimensions. The modified plastic can then be bonded to
various surfaces such as metal, glass, plastic, or other materials
by applying heat or solvent (such as acetone) to the unmodified
plastic surface and bringing the surface in contact with the
surface of interest.
[0139] Among the applications of the invention are the creation of
hydrophilic, lubricious sidings or coatings to reduce drag and/or
biofilm formation and/or barnacle formation in marine vessels,
diving or swimming suits, other water crafts or water-borne
objects, or pipes. In addition, the invention can be used as a
method for making bearings and moving parts for applications, such
as engines, pistons, or other machines or machine parts. The
invention can also be used in artificial joints systems or
long-term implants in other areas of the body, such stents and
catheters for the vascular or urinary system or implants, patches,
or dressings for the skin.
[0140] FIGS. 2 and 3 illustrate how the invention can be used to
create a composition gradient within a Starting homopolymer. In
FIG. 2, a gradient is formed in material 20 along a thickness
direction, with the IPN formed on one side 22 and extending in a
diminishing concentration to another side 24, e.g., substantially
only homopolymer. In FIG. 3, the IPN concentration gradient is
radial within material 30, with the outer surface 32 being the
highest concentration of IPN and the center or core 34 having the
lowest concentration of IPN. A reverse gradient can also be made in
the case of a cylinder or a sphere, with the IPN disposed in the
core of the shape and the hydrophobic polymer being disposed in the
Outer aspect of the shape. This is useful in creating a conductive
semi-IPN wire that is encapsulated within an insulating hydrophobic
material via a gradient composition.
[0141] FIG. 4A illustrates a method of fabricating a thermoplastic
gradient IPN according to the present invention. One side of the
thermoplastic. material 40 is imbibed with a monomer solution 42
along with a photoinitiator (not shown) and a crosslinker (not
shown), and then the monomer is polymerized and crosslinked (e.g.,
with UV light 44) within the thermoplastic to form a gradient IPN
46. Increasing the pH to neutral 47 and introducing salt 48 into
the surrounding fluid leads to ionization of the 2nd polymer
network. Alternatively, non-ionic monomers can be used as the basis
in a part (to form a copolymer). The non-ionic polymer would not be
ionized by the buffer solution, but would still create a
hydrophilic surface. Either type of monomer system can be used in
conjunction with either water or an organic solvent.
[0142] In one embodiment, a TP/PAA IPN can be created in a gradient
if polyurethane ("PU") is swollen in AA on one side only or if the
swelling time is limited such that diffusion of the monomers
through the bulk of the TP is not complete. This is especially
useful in the creation of osteochondral grafts for orthopaedic
joint replacement materials. For instance, in the case of a
cartilage replacement material, one side of the material is made
lubricious and water swollen, while the other remains a solid (pure
thermoplastic). In between is a transition between a TP/PAA IPN and
TP, with decreasing PAA content from one surface to the other.
Alternatively, bulk materials with a TP/PAA IPN outer aspect and
PU-only "core" can be made if the diffusion of AA into the TP is
precisely controlled by timing the infiltration of the monomers
into the bulk. The differential swelling that results from this
configuration can lead to remaining stresses (compressive on the
swollen side, tensile on the non-swollen side) that can help
enhance the mechanical and fatigue behavior of the material. In the
case of a material with a thickness gradient, the base of
thermoplastic-only material can be used for anchoring, adhering, or
suturing the device to the anatomical region or interest. This base
can be confined to a small area or be large (e.g., a skirt) and can
extend outward as a single component or multiple components (e.g.,
straps). The internal stresses built up within the thermoplastic
during processing or after swelling can be reduced by
temperature-induced annealing. For instance, temperatures of 60-120
degrees Celsius can be used for various times (30 minutes to many
hours) to anneal the polymer, and the heat can be applied in an
oven, by a hot surface, by radiation, or by a heat gun. The
thermoplastic can later be crosslinked using, for example, gamma or
electron beam radiation.
[0143] FIG. 4B illustrates how the properties of gradient IPN's can
vary to produce the desired composition. FIG. 4C illustrates how
the concentration gradient of the hydrophobic polymer and the ionic
polymer can vary across the thickness (between the two surfaces) of
a gradient IPN. The composition gradient yields a property gradient
in which the IPN is hydrated and more compliant on one side, and
less hydrated (or not hydrated) and stiff on the other.
[0144] Articles made from the IPN's and semi-IPN's of this
invention may also be formed in a laminate structure, as
illustrated in FIG. 5. In one example, the IPN structure 50 is
comprised of a hydrophilic polymer (P) such as poly(acrylic acid)
that is interpenetrating a first thermoplastic (TP1) such as
polyether urethane, which is formed on top of a second
thermoplastic (TP2) such as polycarbonate urethane. Both TP1 and
TP2 can be themselves comprised of multiple layers of various
hardnesses and properties. In addition, many more than two
thermoplastic layers can be used, and one or more of the
thermoplastics can be crosslinked. Finally, non-thermoplastic
elements can be incorporated into this construct.
[0145] Articles formed-from the gradient or homogeneous IPN's and
semi-IPN's of this invention may be shaped as desired. FIGS. 6A and
6B illustrates shaping of a gradient IPN article, This process may
also be used to shape a homogeneous IPN or semi-IPN.
[0146] As shown in FIGS. 6A and 6B, heat 61 can be used to
re-anneal the physical crosslinks in the polymer (e.g., the hard
segments in the polyurethane) in the thermoplastic side 50 of the
gradient IPN to lead to different desired curvatures after bending
(e.g., over a mold or template) and cooling. FIGS. 6A and 6B
illustrate both convex 62 and concave 64 curvatures on the
thermoplastic side of the gradient IPN. Other shapes may be formed,
of course, as desired. The use of thermoplastic facilitates molding
of a device to a desired shape by, for example, injection molding,
reactive injection molding, compression molding, or alternatively,
dip-casting. The molded device can then be subjected to subsequent
network infiltration and polymerization steps to yield the new IPN
material.
[0147] Shaping of IPN and semi IPN articles according to this
invention maybe formed in situ, such as within a human body. For
example, FIGS. 7A and 7B illustrate heating 71 of a thermoplastic
gradient IPN 70 to enable it to wrap around the curvature of a
femoral head 72. FIGS. 7C and 7D illustrate the application of heat
74 to a thermoplastic gradient IPN 73 to enable it to adapt to the
curvature of a hip socket 75.
[0148] Shaped or unshaped IPN and semi-IPN articles made according
to this invention may be attached to other surfaces. FIGS. 8A-8D
shows how a bonding agent 81 such as a solvent, cement, or glue can
be used to attach the thermoplastic gradient IPN article 80 to a
surface 82 at a bonded interface 83. Addition of the solvent, for
example, causes the material to dissolve locally, and after contact
with a surface and drying of the solvent, thermoplastic adheres to
the surface. This method can be used to create "paneling" Of the
present invention Of various objects, including but not limited to
marine vessel hull surfaces. A "coating" can be applied by vacuum
forming the material over the contours of the vessel or a part of
the vessel. A similar approach can be used to attach a gradient IPN
to bone surfaces in joints.
[0149] The composition of this invention, formed, e.g., by the
method of this invention, may be used in a variety of settings. One
particular use is as artificial cartilage in an osteochondral
graft. The present invention provides a bone-sparing arthroplasty
device based on an interpenetrating polymer network that mimics the
molecular structure, and in turn, the elastic modulus, fracture
strength, and lubricious surface of natural cartilage. Emulating at
least some of these structural and functional aspects of natural
cartilage, the semi-IPNs and IPNs of the present invention form the
basis of a novel, bone-sparing, "biomimetic resurfacing"
arthroplasty procedure. Designed to replace only cartilage, such a
device is fabricated as a set of flexible, implantable devices
featuring lubricious articular surfaces and osteointegrable
bone-interfaces.
[0150] In principle, the device can be made for any joint surface
in the body. For example, a device to cover the tibial plateau will
require an analogous bone-preparation and polymer-sizing process.
For a device to cover the femoral head in the hip joint, a cap
shaped device fits snugly over the contours of the femoral head.
For a device to line the acetabulum, a hemispherical cup-shaped
device stretches over the lip and can be snapped into place in the
socket to provide a mating surface with the femoral head. In this
way, both side's of a patient's hip joint can be repaired, creating
a cap-on-cap articulation. However, if only one of the surfaces is
damaged, then only one side may be capped, creating a
cap-on-cartilage articulation. In addition, the materials of the
present invention can be used to cap or line the articulating
surfaces of another joint replacement or resurfacing device
(typically comprised of metal) to serve as an alternative bearing
surface.
[0151] To create a cap-shaped device using the present invention
for the shoulder joint (also a ball-and-socket joint), a process
similar to that of the hip joint is used. For instance, a shallow
cup can be created to line the inner aspect of the glenoid.
Furthermore, devices for other joints in the hand, fingers, elbow,
ankles, feet, and intervertebral facets can also be created using
this "capping" concept. In one embodiment in the distal femur, the
distal femur device volume follows the contours of the bone while
sparing the anterior and posterior cruciate ligaments.
[0152] In one embodiment of prosthetic cartilage formed according
to this invention, a polyether urethane device pre-formed with
shore hardness of 75 D is injection molded. This device is then
solution casted in a Vitamin E-containing solution containing
polyether urethane formulated to a dry shore hardness of 55 D
(e.g., 25% Elasthane.TM. 55 D in dimethylacetamide). The casted
layer may then be dried in a convection oven to remove the solvent.
The device may then be immersed in a solution of acrylic acid,
photoinitiator, and crosslinker for 24 hours, and then placed over
a glass mold and exposed to UV light. The resulting device may then
be soaked and washed in phosphate buffered saline. This process is
used to create either convex or concave devices for arthroplasty
applications. The injection-molded pre-form has on one of its sides
a plurality of spaces (pores or features) that make capable of
being anchored to bone with traditional orthopaedic bone
cement.
[0153] In another embodiment of the device, a polycarbonate
urethane pre-formed with surface features on one side is
fabricated, followed by dip-casting of one of its sides in a
solution of polyether urethane and then subjected to a process
similar to the one above. In still another embodiment, a polyether
urethane pre-form of shore hardness 55 D (e.g., Elasthane.TM. 55 D)
is injection molded, followed by immersion in a monomer solution as
above. After curing of the second polymer network, the device is
dip-casted on one side with polycarbonate urethane of shore
hardness 75 D. In any of these embodiments, additional surface
features can be added to the bone interface side of the device
through a number of means, including but not limited to machining
(lathe and end-mill), solution casting, solvent-welding, ultrasonic
welding, or heat-welding.
[0154] Porous polycarbonate urethane IPN and semi-IPN structures
may be made according to this invention. Particles (size range:
250-1500 .mu.m) of polycarbonate urethane, including but not
limited to Bionate.RTM. 55D, Bionate.RTM. 650, and Bionate.RTM.
750, may be sintered in a mold using heat (220-250.degree. C.),
pressure (0.001-100 MPa) , and/or solvent for 10-30 min.
The-structures will have a final pore size of 50-2000 .mu.m,
porosity of 15-70%, and a compressive strength exceeding 10 MPa.
The final structures will have porosity to promote tissue
ingrowth/integration for medical and veterinary applications. This
construct can be used alone or with an overlying bearing surface
made from any Of the lubricious polymers described in this
invention. This material could be used as a cartilage replacement
plug in joints of the body where cartilage has been damaged, as
described below.
[0155] The composition of this invention, made, e.g., according to
the method of this invention, may be used as a fully or partially
synthetic osteochondral graft. The osteochondral graft consists of
a lubricious cartilage-like synthetic bearing layer that may be
anchored to porous bone or a synthetic, porous bone-like structure.
The bearing layer has two regions: a lubricious surface layer and a
stiff, bone anchoring layer. In one embodiment, the top, lubricious
region of the bearing layer consists of an interpenetrating polymer
network that is composed of two polymers. The first polymer may be
a hydrophobic thermoplastic with high mechanical strength,
including but not limited to polyether urethane, polycarbonate
urethane, silicone polyether urethane, and silicone polycarbonate
urethanes, or these materials with incorporated urea linkages, or
these materials with incorporated urea linkages (e.g. polyurethane
urea). The second polymer may be a hydrophilic polymer derived from
ionizable, vinyl monomers, including but not limited to acrylic
acid and/or sulfopropyl methacrylate. The bottom region of the
bearing layer (bone anchoring layer) may be a stiff, non-resorbable
thermoplastic that can be caused to flow with ultrasonic welding
vibration, ultrasonic energy, laser energy, heat, RF energy and
electrical energy. The bone anchoring layer is used to anchor the
bearing layer to bone or a bone-like porous structure. If porous
bone is used, it can be cancellous bone from a human or animal. If
a synthetic bone-like material is used, it can consist of porous
calcium-phosphate (and/or other materials, including but not
limited to porous carbonated apatite, beta-tricalcium phosphate, or
hydroxyapatite), or a porous resorbable or non-resorbable
thermoplastic as described above, including but not limited to
polycarbonate urethane, polyether urethane, PLA, PLLA, PLAGA,
and/or PEEK. The bearing layer is anchored to the porous bone or
bone-like structure via application of pressure combined with
energy that cause the bone anchoring material to melt and flow into
the pores or spaces of the bone or bone-like structure, after which
the energy source is removed and the material resolidifies. The
energy source can include but is not limited to vibration,
ultrasonic energy, laser energy, heat, RF energy, and electrical
energy.
[0156] The following figures illustrate various embodiments of the
present invention as a device to partially or completely resurface
damaged joints in the body of mammals (animals or human). These
devices can be fixated to hone through any number of means, such as
a press-fit, screws (metal or plastic, either resorbable or
nonresorbable), sutures (resorbable or nonresorbable), glue;
adhesives, light-curable adhesives (e.g. polyurethane or
resin-based), or cement (such as polymethylmethacrylate, or calcium
phosphate, or dental cements).
[0157] FIGS. 9A-9D illustrate how an osteochondral graft implant
formed from an IPN or Semi-IPN of this invention can be used to
replace, or augment cartilage within a joint, such as a hip or
shoulder joint. As shown in FIG. 9A, the prosthetic cartilage 90 is
formed as a sock having a cap portion 91 and an optional collar 92.
The prosthesis 90 may be inverted, as shown in FIG. 9B, and slipped
over the head 94 of the humerus or femur. In an alternative
embodiment shown in FIGS. 10A and 10B, the prosthesis 90 may
include an opening 95 to accommodate a ligament 96 or other
anatomical structure.
[0158] Implants and other articles may be made iota variety of
complex shapes, according to the invention. FIGS. 11A-11E show
osteochondral grafts, formed from an IPN or semi-IPN of this
invention that may be used singly or in any combination needed to
replace or augment cartilage within a knee joint. FIG. 11A shows a
osteochondral graft 110 adapted to engage the femoral condyles (or
alternatively, just one condyle). FIG. 11B shows osteochondral
grafts 111 and 112 adapted to engage one or both sides of the
tibial plateau 113. FIG. 11C shows an osteochondral graft 118
adapted to engage the patella 114 and to articulate with an
osteochondral graft 119 adapted to engage the patellofemoral groove
115. FIG. 11D show osteochondral grafts 116 and 117 adapted to
engage the lateral and medial menisci. FIG. 11E Shows how some of
these prostheses may be assembled in place within the knee
joint.
[0159] Osteochondral grafts may also be used in other joints, such
as in the finger, hand, ankle, elbow, feet or vertebra. For
example, FIGS. 12A and 12B show osteochondral grafts 121 and 122
formed from the IPN's or semi-IPN's of this invention and shaped
for use in a finger joint. FIGS. 13A and 13B show a labrum
prosthesis 131 formed from an IPN or semi-IPN of this invention for
use in replacing or resurfacing the labrum of the shoulder or hip.
FIG. 14 shows the use of an IPN or semi-IPN of this invention as a
bursa osteochondral graft 141, labrum osteochondral graft 142,
glenoid osteochondral graft 143 and humeral head osteochondral
graft 144. FIG. 15 shows the use of an IPN or semi-IPN of this
invention as prostheses 151 and 152 for resurfacing intervertebral
facets.
[0160] The IPN's and semi-IPN's compositions of this invention may
be formed as prosthetic cartilage plugs for partial resurfacing of
joint surfaces. FIG. 16A shows a prosthetic cartilage plug 160
formed from a gradient IPN composition of this invention. Plug 160
has a stem portion 161 formed on a thermoplastic side of the
article and adapted to be inserted into a hole or opening in a
bone. The head 162 of the plug is formed to be a lubricious IPN or
semi-IPN, as described above. FIG. 16B shows a variation in which
porous surfaces are formed on the underside 163 of head 162 and on
the base 164 of stem 161. In the embodiment of FIGS. 16C and 16D,
the porous surface is formed only in the center portion 165 of base
164. In all embodiments, stem 161 may be press fit into a hole or
opening in the bone, leaving the lubricious IPN surface to be
exposed to act as prosthetic cartilage.
[0161] FIG. 17 shows an embodiment of a prosthetic cartilage plug
170 in which the stem 171 is provided with helical ridges 173 to
form a screw for fixation of the plug to bone. The top surface of
the head 172 is a lubricious IPN or semi-IPN, as above.
[0162] FIGS. 18A and 18B shows an embodiment of a prosthetic
Cartilage plug 180 having-three stems 181 for press fit insertion
into holes in the bone for fixation. The top surface of plug head
182 is a lubricious IPN or semi-IPN, as above.
[0163] FIG. 19 shows an embodiment of a prosthetic cartilage plug
190 in which the exposed head portion 192 is substantially the same
diameter as the stem 191. Stem 191 may be press fit into a hole in
the bone for fixation. The top surface of plug head 192 is a
lubricious IPN or semi-IPN, as above.
[0164] FIG. 20 shows an embodiment of a prosthetic cartilage plug
200 in which the exposed head portion 202 is narrower than stem
201, and stern 201 widens toward base 203. Stem 201 may be press
fit into a hole in the bone for fixation. The top surface of plug
head 202 is a lubricious IPN or semi-IPN, as above.
[0165] FIG. 21 shows an embodiment of a prosthetic cartilage plug
210 in which the stem 211 has circumferential ridges to aid
fixation. Stem 211 may be press fit into a hole in the bone for
fixation. The top surface of plug head 212 is a lubricious IPN or
semi-IPN, as above.
[0166] FIG. 22 shows an embodiment similar to that of FIG. 19 that
adds a rough porous surface to stem 221. The top surface of plug
head 222 is a lubricious IPN or semi-IPN, as above.
[0167] FIG. 23 shows an embodiment of an osteochondral graft 230
formed to physically grip the bone without additional fixation,
such as screws or stems. In this embodiment, the lubricious IPN or
semi-IPN portion of the prosthesis is on a concave surface 231 of
the device. The opposite convex surface 232 of the device is shaped
to match the shape of the bone to which prosthesis 230 will be
attached. Surface 232 is porous to facilitate bony ingrowth. The
porous material in this case can be fabricated from a porogen
method as described in the present invention, with the porogen
being sodium chloride, tricalcium phosphate, hydroxyapatite, sugar,
and derivatives or combinations thereof. Alternatively, the
porosity can he derived from sintering polymer beads (e.g.
polyether urethane or polycarbonate urethane) together using heat
or solvent.
[0168] Screw holes may be provided to the osteochondral graft for
fixation to the bone. In FIG. 24, prosthesis 240 is provided with
two holes 241 for screws 242. The bone-contacting concave side 244
of prosthesis 240 is porous (as above) to promote bony ingrowth and
has a shape adapted for physically gripping the bone. The outer
convex surface 243 of the prosthesis is a lubricious IPN or
semi-IPN, as above.
[0169] In FIG. 25, the osteochondral graft 250 is provided with a
screw hole 251 as well as a depression 252 for accommodating the
head of a screw 253. The bone-contacting concave side 254 of
prosthesis 250 is porous (as above) to promote bony ingrowth and
has a shape adapted for physically gripping the bone. The outer
convex surface 255 of the prosthesis is a lubricious IPN or
semi-IPN, as above.
[0170] FIG. 26 shows an embodiment of an osteochondral graft 260
having a stem 261 for insertion into a hole in the bone. The
bone-contacting concave side 262 of prosthesis 260 is porous (as
above) to promote bony ingrowth and has a shape adapted for
physically gripping the bone. The outer convex surface 263 of the
prosthesisis a lubricious IPN or semi-IPN, as above.
[0171] FIGS. 27A and 27B show embodiments of the composition of
this invention used to make two-side lubricious implants. in FIG.
27A, implant 270 is sized and configured to replace an
intervertebral disc. Implant 270 has lubricious IPN or semi-IPN
surfaces 271 and 272 (formed, e.g., as described above) on its
upper and lower sides. FIG. 27B shows a knee spacer 273 having a
wedge-shaped cross-section. As with disc prosthesis 270, spacer 273
also has lubricious. IPN or semi-IPN surfaces 274 and 275 on its
upper and lower sides.
[0172] Many of the osteochondral grafts and other implants
described above are affixed to a single bone surface. FIGS. 28 and
29 show orthopedic implants that are attached to surfaces of two
bones or other anatomic elements that move with respect to each
other, such as in a joint. In FIG. 28, implant 280 has upper and
lower bone contacting regions 281 and 282 formed to be porous (as
described above) to promote bony ingrowth. The interior of implant
280 is a fluid-filled capsule 283. Inwardly facing bearing surfaces
284 and 285 are lubricious IPN or semi-IPN surfaces (as above).
Implant 280 can be used, e.g., as an interpositional spacer and as
a replacement for the synovial capsule and cartilage of a joint.
The implant 290 of FIG. 29 is similar to that of FIG. 28, but adds
upper and lower sterns 291 and 292 for insertion and fixation in
corresponding holes in the bones defining the joint.
[0173] FIGS. 30A and 30B illustrate the integration of
osteochondral grafts and other implants of this invention into bone
over time. In FIG. 30A, an osteochondral graft implant 300 formed
as described above is placed over bone 301. Implant 300, has a
lubricious IPN or semi-IPN surface 302 and a bone interface-surface
303 formed from a thermoset or thermoplastic hydrophobic polymer
alone, which is optionally porous as described above. Between
surface 302 and surface 303 is a gradient or transition zone 304
between the IPN or semi-IPN and the hydrophobic polymer. Over time,
bone tissue will grow from bone 301 into and through the bone
contacting surface 303, as illustrated in FIG. 30B.
[0174] FIGS. 31A-31C illustrate three possible configurations of
osteochondral implants to repair cartilaginous joint surface
according to this invention. In FIG. 31A, implant 310 is formed as
a cap having a lubricious IPN or semi-IPN surface 311 transitioning
to a bone-contacting surface 312 formed from a thermoset or
thermoplastic hydrophobic polymer, as described above. When
implanted, implant 310 covers the outer surface of bone 313.
[0175] FIGS. 31B and 31C show configurations in which implant 314
is formed as a patch or plug (respectively) having a lubricious IPN
or semi-IPN surface 315 transitioning to a bone-contacting surface
316 formed from a thermoset or thermoplastic hydrophobic polymer,
as described above. When implanted, implant 314 fits within a
prepared opening 317 of bone 313.
[0176] The invention has non-medical applications. For example,
FIG. 32 shows the use of a lubricious IPN or semi-IPN composition
of this invention to resurface the hull of a marine vessel. Panels
320 of a thermoplastic gradient IPN (as described above) have been
attached to the surface of hull 322 to reduce drag and biofilm
formation. Alternatively, the IPN material can be in some
embodiments painted on the hulls as a liquid and allowed to cure or
harden. The gradient IPN can be negatively charged on its surface
or uncharged and can be made from one or more types of monomer
species. Various UV protection and anti-oxidizing agents or other
additives can also be incorporated into these materials to improve
their performance.
[0177] FIG. 33 shows the use of a lubricious thermoplastic or
thermoset IPN (as described above) to modify interfacing surfaces
of machine parts that move with respect to each other, such as
surface 331 of rotating and translating part 330 and surface 333 of
stationary part 332. FIG. 34 shows the use of a lubricious
thermoplastic or thermoset IPN (as described above) to reduce fluid
drag on the inner surface 340 of a pipe 342.
[0178] The materials of the present invention have utility in
applications requiring electrochemical conductivity. The
conductivity of the IPNs and semi-IPNs is based on the flow of ions
through the hydrated matrix of the material. Thin films of
polyetherurethane were swelled with four different compositions of
an acrylic acid and water mixture (15, 30, 50, and 70% acrylic acid
in water). Each swelled film was then cured in UV light to form the
semi-IPN. The films were then neutralized in PBS. The electrical
resistance of the materials was measured using an ohm meter. To
measure resistance, the IPN film was lightly patted with a paper
towel to remove excess PBS and the ohm meter probes were clipped to
the film across a film width of 60-70 mm. The initial and
steady-state resistance values were recorded. In addition, the
resistances of an unmodified polyetherurethane film and liquid PBS
were measured. The resistance of PBS was measured by placing the
ohm meter probes directly into a PBS bath at an approximate
distance of 60 mm between the probes. Resistance measurements are
in the following Table.
TABLE-US-00001 TABLE 1 Lowest resistance Steady-state resistance
Material reading (k.OMEGA.) reading (k.OMEGA.) PEU alone (0% AA)
out of range out of range (dielectric) (dielectric) PEU/PAA (15%
AA) 175 200 PEU/PAA (30% AA) 132 177 PEU/PAA (50% AA) 150 161
PEU/PAA (70% AA) 110 141 PBS bath 300 600
[0179] The results show that the resistances of the semi-IPNs are,
lower than (but within the same order of magnitude as) pure PBS
fluid alone. The limit of the ohm meter was 40,000 ohms. Typical
values for insulators (including polyurethanes) are
10.sup.14-10.sup.16 ohms; therefore, the resistance values of the
PEU alone were outside the range of the meter used. Permeability of
the PEU/PAA semi-IPN was measured using a device similar to the one
described by Maroudas et al. in Permeability of articular
cartilage. Nature, 1968. 219(5160): p. 1260-1. The permeability was
calculated according to Darcy's Law (Q=KAAp/L), where Q is the flow
rate [mm.sup.3/sec]. A the cross-sectional area of the plug
[min.sup.2], zip the pressure gradient applied [MPa] (pressurized
fluid), L is the thickness of the hydrogel. The permeability of the
PEU/PAA semi-IPN prepared from 70% acrylic acid was found to be
K=1.45.times.10.sup.-17 m.sup.4/N*sec. For natural cartilage,
literature values range from 1.5.times.10.sup.16 to
2.times.10.sup.-15 m.sup.4/N*sec. Therefore, the PEU/PAA is 10-100
times less permeable than cartilage, which may make it legs prone
to dehydration under prolonged compressive loads compared to
natural cartilage. The permeability of the IPN can be tuned by
varying the concentration of AA in the swelling solution; the
higher the AA content, the higher the. permeability. In contrast,
the unmodified PEU material alone is effectively impermeable to
solutes; although it retains some moisture (.about.1%), in practice
it does not act as a solute-permeable matrix.
[0180] Other variations and modifications to the above
compositions, articles and methods include:
[0181] The first polymer can be one that is available commercially
or custom-made and made by a number of ways (e.g., extruded,
injection molded,; compression molded, reaction injection molded
(RIM) or solution-casted.) The first polymer can be uncrosslinked
or crosslinked by various means. Either polymer can be crosslinked
by, e.g., gamma radiation or electron beam radiation.
[0182] Any number or combinations of ethylenically unsaturated
monomers or macromonomers (e.g., containing reactive double bonds)
can be used as the basis of the second or subsequent network so
long as the total contains at least 2% by weight ionizable chemical
groups. These include but are not limited those containing vinyl,
acrylate, methacrylate, allyl ether, or acrylamide groups. And
number of pendant functional groups can be conjugated to these
ethylenicaly unsaturated groups including but not limited to
carboxylic acid, sulfonic acid, acetates, alcohols, ethers,
phenols, aromatic groups, or carbon chains.
[0183] The polyurethane-based polymer can be (but is not limited
to) the following: polyether urethane, polycarbonate urethane,
polyurethane urea, silicone polyether urethane, or silicone
polycarbonate urethane. Other polyurethanes with other hard
segments, soft segments, and chain extenders are possible.
[0184] Other polymers can be used in the first network, such as
homopolymers or copolymers of silicone, (polydimethylsiloxane) or
polyethylene.
[0185] When a polyurethane-based polymer is used as the first
polymer, the extent of physical and chemical crosslinking of the
polyurethane-based polymer can be varied between physical
crosslinking-only (thermoplastic) to extensive chemical
crosslinking. In the case of chemical crosslinking, the
crosslinkable polyurethane can be used alone or as a mixture with
thermoplastic (uncrosslinked) polyurethane.
[0186] The conditions of polymerization (i.e., ambient oxygen, UV
intensity, UV wavelength, exposure time, temperature) may be
varied.
[0187] The orientation and steepness of the composition gradients
can be varied by various means such as time and/or method of
immersion in the monomer, and the application of external
hydrostatic positive or negative pressure.
[0188] The thermoplastic can be made porous by various techniques
such as foaming or salt-leaching. After swelling of the porous
polymer (such as PU) with a monomer (such as AA) followed by
polymerization or AA, a porous IPN is formed.
[0189] Additional layers of thermoplastics can be added to material
on either the IPN side or the thermoplastic side-only by curing or
drying the new thermoplastic to the surface. The layers can all be
the same material or be different materials (e.g. ABS+polyurethane,
polyether urethane+polycarbonate urethane, etc.
[0190] A number of different solvents can be used during the
synthesis of the, polyurethane, the second network, or both,
including but not limited to dimethylacetamide, tetrahydrofuran,
dimethylformamide, ethanol, methanol, acetone, water,
dichloromethane, propanol, methanol, or combinations thereof.
[0191] Any number of initiators can be used such as photoinitiators
(e.g., phenone containing compounds and Irgacure.RTM. products),
thermal initiators, or chemical initiators. Examples of thermal
initiators include but are not limited to azo-compounds, peroxides
(e.g., benzoyl peroxide), persulfates (e.g., potassium persulfate
or ammonium persulfate), derivatives, or combinations thereof.
[0192] Variations of the crosslinking identity and density (e.g.
0.0001%-25% by mole crosslinking agent with respect to the
monomer), initiator concentration (e.g. 00001%-10% by mole with
respect to the monomer) molecular weight of precursor polymers,
relative weight percent of polymers, light wavelength (UV to
visible range), light intensity (0.01 mW/cm.sup.21 W/cm.sup.2),
temperature, pH and ionic strength of swelling liquid, and the
level of hydration.
[0193] The second network material can be synthesized in the
absence of a crosslinking agent.
[0194] The water content of these materials can range between 2% to
99%.
[0195] Different components of the IPN can be incorporated in
combination with ionizable monomers, such as poly(vinyl alcohol),
poly(ethylene glycol)-acrylate, poly(2-hydroxyethylactylate),
poly(2-hydroxyethylmethacrylate), poly(methacrylic acid),
poly(2-acrylamido-2-methyl propane sulfonic acid), other
vinyl-group containing sulfonic acids, poly(acrylamide),
poly(N-isopropylacrylamide) poly(dimethacrylamide), and
combinations or derivatives thereof. For instance, a copolymer of
acrylic acid and vinyl sulfonic acid or 2-acrylamido-2-methyl,
propane'sulfonic acid can be created for the second network to form
a polyurethane first network and a poly(acrylic
acid-co-acrylamido-methyl-propane sulfonic acid) copolymeric second
network. Any monomer or combination of monomers can, be used in
conjunction with a suitable solvent as long as they contain at
least 2% by weight ionizable monomer and are able to enter (swell)
the first polymer.
[0196] The IPN can have incorporated either chemically or
physically within its, bulk or its surface certain additives such
as antioxidants (e.g., Vitamin C, Vitamin E, Irganox.RTM., or
santowhite powder) and/or anti-microbial agents (e.g.,
antibiotics). These can be chemically linked to the material by,
for example, esterification of the anti-oxidant with any
vinyl-group, containing monomer such as methacrylate, acrylate,
acrylamide, vinyl, or allyl ether.
[0197] More than two networks (e.g., three or more) can also be
formed, each of which are either crosslinked or uncrosslinked.
[0198] The polyurethane itself can be modified in a number of ways,
such as by sulfonation at the urethane group by reaction of 1,3
propane sulfone in the presence of sodium hydride, or the formation
of allophanate linkages at the urethane group by reaction with
excess isocyanate groups. For instance, excess isocyanatoethyl
methacrylate can be reacted with polyurethane in toluene in the
presence of dibutyltin dilaurate for 2.5 hours to yield a
methacryloxy-conjugated polyurethane surface. The methacryloxy
groups can then be used subsequently tether other methacryloxy (or
other vinyl group) containing monomers or macromonomers via free
radical polymerization. Such modifications can be carried out
before or after the formation of the second network of the IPN.
EXAMPLES
[0199] Example 1 In one example, a polycarbonate urethano,(Bionate
551)) was immersed in 70% acrylic acid in water containing 0.1% v/v
2-hydroxy-2-methyl propiophenone and 0.1% v/v triethylene glycol
dimethacrylate with respect to the monomer overnight. The
polycarbonate-urethane was removed from the solution, placed
between two glass slides, and exposed to UV light (2 mW/Cm.sup.2)
for 15 minutes. The resulting semi-IPN was removed, and washed and
swollen in phosphate buffered saline. The material swelled and
became lubricious within hours. In other examples, segmented
polyurethane urea, as well as silicone polyether urethane and
silicone polycarbonate urethanes were placed in acrylic acid
solutions and polymerized and washed in the same fashion to yield a
lubricious IPN.
[0200] Example 2 In another example, a polyether urethane
(Elasthane.TM. 55D) was immersed 70% acrylic acid in water
containing 0.1% v/v 2-hydroxy;2-methyl propiophenone and 0.1% v/v
triethylene glycol dimethacrylate with respect to the monomer
overnight. The polyether urethane was removed from the solution,
placed between two glass slides, and then exposed to UV light (2
mW/cm.sup.2) for 15 minutes. The resulting semi-IPN was removed and
then washed and swollen in phosphate buffered saline. The material
swelled and became lubricious within hours. In other examples,
polycarbonate urethane, segmented polyurethane urea, as well as
silicone polyether urethane and silicone polycarbonate urethanes
were placed in acrylic acid solutions and polymerized and washed in
the same fashion to yield lubricious IPN.
[0201] Example 3 In another example, silicone polyether urethane
and silicone polycarbonate urethanes were separately placed
overnight in 100% acrylic acid solutions, to which were added 0.1%
v/v 2-hydroxy-2-methyl propiophenone and 0.1% v/v triethylene
glycol dimethacrylate with respect to the monomer. After
polymerization and crosslinking, the semi-IPNs swelled and became
lubricious. The addition of silicone (polydimethylsiloxane) in the
polyurethane adds an extra level of biostability to the material as
well as potentially useful surface chemistry and properties.
[0202] Example 4 In another example, a methacryloxy-functionalized
polycarbonate urethane was exposed to UV light to crosslink the
polycarbonate urethane, and then swollen in 70% acrylic acid with
0.1% v/v 2-hydroxy-2-methyl propiophenone and 0.1% v/v triethylene
glycol dimethacrylate with respect to the monomer overnight. The
material was removed from the solution, placed between two glass
slides, and then exposed to UV light (2 mW/cm) for 15 minutes to
yield a fully interpenetrating polymer network of the polycarbonate
urethane and poly(acrylic acid.) The IPN was then washed in an
aqueous salt solution to neutralize the poly(acrylic acid), achieve
equilibrium swelling, and remove any unreacted monomers.
[0203] Example 5 In another example, a methacryloxy-functionalized
polyether urethane was exposed to UV light (in the presence of 0.1%
2-hydroxy-2-methyl propiophenone and 0.1% triethylene glycol
dimethacrylate) to crosslink the polyetherurethane, and then was
swollen in 70% acrylic acid with the aforementioned photoinitiator
and crosslinker followed by UV-initiated crosslinking to yield a
fully interpenetrating polymer network of the polyetherurethane and
poly(acrylic acid.) The-IPN was then washed in an aqueous salt
solution to neutralize the poly(acrylic acid), achieve equilibrium
swelling, and remove any unreacted monomers.
[0204] Example 6 In another example, a 25% solution of
methacryloxy-functionalized polycarbonate urethane in DMAC along
with 0.1% of the aforementioned photoinitiator was exposed to UV
light to crosslink the polycarbonate urethane. After removing the
solvent in a heated (60.degree. C.) convection oven, an additional
layer of polycarbonate urethane was then cast on one side of the
crosslinked polycarbonate urethane to yield a laminate structure
and then only the crosslinked side was swollen in 70% acrylic acid
with the 0.1% 2-hydroxy-2-methyl propiophenone and 0.1% triethylene
glycol dimethacrylate followed by UV-initiated crosslinking to
yield a fully interpenetrating polymer network of the polycarbonate
urethane and poly(acrylic acid.) The IPN was then washed in an
aqueous salt solution to neutralize the poly(acrylic acid), achieve
equilibrium swelling, and remove any unreacted monomers.
[0205] Example 7 In another example, a 25% solution of
methacryloxy-functionalized. polycarbonate urethane in DMAC along
with 0.1% of the aforementioned photoinitiator was exposed to UV
light to crosslink the polyether urethane. After removing the
solvent in a heated (60.degree. C.) convection oven, an additional
layer of polyether urethane was then cast on one side of the
crosslinked polycarbonate urethane to yield a laminate-structure
and then only the crosslinked side was swollen in 70% acrylic acid
with 0.1% 2-hydroxy-2-methyl propiophenone and 0.1% triethylene
glycol dimethacrylate followed by UV-initiated crosslinking to
yield a fully interpenetrating polymer network of the polyether
urethane and poly(acrylic acid.) The IPN was then washed in an
aqueous salt solution to neutralize the poly(acrylic acid), achieve
equilibrium swelling, and remove any unreacted monomers.
[0206] Example 8 In another set of examples, a layer of
methacroxy-functionalized polyether urethane was cast onto a layer
of injection molded polyether urethane, and separately, another
layer was cast onto a layer of injection molded polycarbonate
urethane. Each was exposed to UV light, to yield laminate
structures. Only the crosslinked sides were swollen in 70% acrylic
acid with 0.1% 2-hydroxy-2-methyl propiophenone and 0.1%
triethylene glycol dimethacrylate followed by UV-initiated
crosslinking to yield a fully interpenetrating polymer networks.
The IPNs were then washed in an aqueous salt solution to neutralize
the poly(acrylic acid), achieve equilibrium swelling, and remove
any unreacted monomers.
[0207] Example 9 In one example, acrylonitrile butadiene styrene
(ABS) was exposed to 100% acrylic acid in water containing 0.1% v/v
2-hydroxy-2-methyl propiophenone and 0.1% v/v triethylene glycol
dimethacrylate with respect to the monomer for 15 minutes. The
surface-exposure was accomplished by drop-casting the monomer
solution on the surface of the ABS for 30 minutes. The ABS was then
placed between two glass slides, and then exposed to UV light (2
mW/cm.sup.2) for 15 minutes. The resulting ABS/PAA gradient IPN was
removed and then washed and swollen in phosphate buffered saline.
The IPN was washed in an aqueous salt solution to neutralize the
poly(acrylic acid), achieve equilibrium swelling, and remove any
unreacted monomers. The material swelled and became lubricious
within hours.
[0208] Example 10 To reshape the thermoplastic gradient IPNs, heat
was applied. An ABS/PAA gradient IPN was heated using a heat gun
and then laid on a cylindrical polypropylene tube. After letting
the material cool to room temperature, acetone was injected between
the ABS/PAA and the polypropylene. After applying manual pressure
and allowing the sample to dry, the result was a thermoplastic
gradient IPN wrapped around and bonded to a polypropylene tube.
[0209] Example 11 In another example, a thermoplastic gradient
ABS/PAA IPN was attached to polycarbonate urethane by injecting
acetone between the ABS and polycarbonateurethane and applying
manual pressure to yield a thermoplastic gradient IPN bonded to a
polycarbourethane.
[0210] Example 12 In another example, a curved polycarbonate
urethane IPN was made straight again by applying heat on the
polyurethane side using a heat gun, manually reversing the
curvature of the material, and cooling the IPN in water.
[0211] Example 13 In another example, a polyether urethane solution
(e.g. 20% in dimethylacetamide ("DMAC")) was cast on top of a
polycarbonate urethane in a laminate structure, allowed to dry in a
heated (60.degree. C.) convection oven, and then only the polyether
urethane surface. was exposed to 70% acrylic acid in water
containing 0.1% v/v 2-hydroxy-2-methyl propiophenone and 0.1% v/v
triethylene glycol dirnethacrylate with respect to the Monomer for
15 minutes. The surface-exposure was accomplished by laying the
laminate material polyether urethane-side down on a bed of fabric
that was soaked in the aforementioned monomer solution. The
material was removed from the fabric that placed between two glass
slides, and then exposed to UV light (2 mW/cm.sup.2) for 15
minutes. The resulting gradient semi-IPN was removed, washed and
swollen in phosphate buffered saline. The material swelled and
became lubricious within hours. In other examples, polyether
urethane, segmented polyurethane urea, silicone polyether urethane,
and silicone, polycarbonate urethane were handled the same way to
yield a lubricious semi-IPNs.
[0212] Example 14 In another example, a layer of polycarbonate
urethane (20% in DMAC) containing 50% by weight sodium chloride was
solution cast on a premade polyether urethane-polycarbonate
urethane and dried at 80.degree. C. under convection. The salt was
washed away in water to yield a porous side on the laminated
polyurethane. Other materials have been made with sodium chloride
concentrations varying between 10% and 80%
[0213] Example 15 In another example, a layer of polycarbonate
urethane (20% in DMAC) containing 20% tricalcium phosphate was
solution cast on a premade polyether urethane-polycarbonate
urethane and dried at 80.degree. C. under convection. The
tricalcium phosphate was left embedded within the polyurethane as
an osteoconductive agent. Other materials have been made with
tricalcium phosphate concentrations varying from 0.001%-20%
[0214] Example 16 In another example, a polyurethane urea (e.g. 20%
in dimethylacetamide) was cast on top of a polycarbonate urethane
in a laminate structure, and then only the polyurethane urea
surface was exposed to 70% acrylic acid in water containing 0.1%
v/v 2-hydroxy-2-methyl propiophenone and 0.1% v/v triethylene
glycol dimethacrylate with respect to the monomer for 15 minutes.
The surface exposure was accomplished by laying the laminate
material polyurethane urea-side down on a bed of fabric that was
soaked in the aforementioned monomer solution. The polycarbonate
urethane was removed from the fabric mat, placed between two glass
slides, and then exposed to UV light (2 mW/cm.sup.2) for 15
minutes. The resulting gradient semi-IPN was removed and then
washed and swollen in phosphate buffered saline. The material
swelled and became lubricious within hours. The material was washed
in PBS to neutralize the poly(acrylic acid), achieve equilibrium
swelling, and remove any unreacted monomers.
[0215] Example 17 In another example, a methacryloxy-functionalized
polyether urethane mixed with a thermoplastic polyether urethane in
solution (25% in dimethylacetamide) was exposed to UV light to
crosslink the polycarbonate urethane. An additional layer of
polyether urethane was then cast on one side of the crosslinked
polyether urethane to yield a laminate structure and then only the
crosslinked side was swollen in 70% acrylic acid with the
aforementioned photoinitiator and crosslinker, followed by
UV-initiated crosslinking to yield a fully interpenetrating polymer
network of the polyether urethane and poly(acrylic acid.) The IPN
was then washed in an aqueous salt solution to neutralize the
poly(acrylic acid), achieve equilibrium swelling, and remove any
unreacted monomers.
[0216] Example 18 In one example, flat sheets were created by
solution casting of thermoplastic polyurethanes in
(dimethylacetamide (DMAC). Polyurethane solutions of polyether
urethane (Elasthane.TM.), polycarbonate urethane (Bionate),
polyether urethane urea (Biospan), silicone polycarbonate urethane
(Carbcisil), and silicone polyether urethane (Pursil) were
synthesized in dimethylacetamide (DMAC) at solids concentrations Of
about 25% by the manufacturer.
[0217] Example 19 Spherical shapes were cast by dip-coating glass
as well as silicone spheres in polyurethane solutions (in DMAC).
Polycarbonate urethane (20% in DMAC) was dip coated onto a
spherical glass mold (49.5 mm outer diameter), and separately, onto
a silicone sphere. The solvent was removed by drying at 80.degree.
C. in a convection oven. This process was repeated two more times
to create three total coatings. Then, the sphere was dip coated in
polyether urethane (20% in DMAC) and then dried at 80.degree. C.
under convection. This process was also repeated two more times.
The resulting capped-shaped, laminate polyurethane was removed from
the mold; and its outer side immersed in a 70% acrylic acid
solution in water, with 0.1% 2-hydroxy-2-methyl-propiophenone and
0.1% triethylene glycol dimethacrylate for 1.5 hours. The cap was
inverted; placed back over a spherical glass mold, and exposed to
UV light (2 mW/cm.sup.2) for 15 minutes. Next the cap was removed
from the mold and placed in phosphate buffered saline. The result
was a spherical, gradient IPN with one lubricious surface and one
pure thermoplastic surface. Other temperatures and other solvents
can also be used to carry out this process, as well as other mold
materials and polymer components.
[0218] Example 20 In another example, a polyether urethane was
swollen in 70% acrylic acid with 0.1% 2-hydroxy-2-methyl
propiophenone and 0.1% methylene bisacrylamide. One side of the
material was dabbed dry, and then exposed to air and treated with
UV light. The resulting gradient semi-IPN was then washed in
an-aqueous salt solution to neutralize the poly(acrylic acid),
achieve equilibrium swelling, and remove any unreacted monomers. In
other experiments, the material was exposed to nitrogen or argon
during curing.
[0219] Example 21 In another example, a polyether urethane
(Elasthane.TM. 55D) was injection molded and then swollen in 70%
acrylic acid with 0.1% v/v 2-hydroxy-2-methyl propiophenone and
0.1% w/w methylene bisacrylamide followed by UV-initiated
crosslinking to yield a fully interpenetrating polymer network of
the polyether urethane and poly(acrylic acid). The IPN was then
washed in an aqueous salt solution to neutralize the poly(acrylic
acid), achieve equilibrium swelling, and remove any unreacted
monomers.
[0220] Example 22 In another example, a polyether urethane
(Elasthane.TM. 75D) was injection molded, dip-casted (solution
casted) on one side in a polyether urethane solution (Elasthane.TM.
55D in 25% DMAC) and dried in a convection oven to remove the DMAC
solvent. The dried material was Swollen in 70% acrylic acid with
the 70% acrylic acid with 0.1% v/v 2-hydroxy-2-methyl propiophenone
and 0.1% w/w methylene bisacrylamide followed by UV-initiated
crosslinking to yield a fully interpenetrating polymer network of
the polyether urethane and poly(acrylic acid). The IPN was then
washed in an aqueous salt solution to neutralize the poly(acrylic
acid), achieve equilibrium swelling, and remove any unreacted
monomers.
[0221] Example 23 in another example, a polycarbonate urethane
(Bionate 75D) was injection molded, dip-casted (solution casted) on
one side in a polyether urethane solution (Elasthane.TM. 55D in 25%
DMAC) and dried in a convection oven to remove the DMAC solvent.
The dried material was swollen in 70% acrylic acid with 0.1% v/v
2-hydroxy-2-methyl propiophenone and 0.1% w/w methylene
bisacrylamide followed by UV-initiated crosslinking to yield a
fully interpenetrating polymer network of the polyether urethane
and poly(acrylic acid). The IPN was then washed in an aqueous salt
solution to neutralize the poly(acrylic acid), achieve equilibrium
swelling, and remove any unreacted monomers.
[0222] Example 24 In another example, a polyether urethane
(Elasthane.TM. 75D) was injection molded and then dip-casted
(solution casted) in a methacryloxy-functionalized polyether
urethane solution (Elasthane.TM. 55D in 25% DMAC) along with the
aforementioned photoinitiator and then was exposed to UV light to
crosslink the methacryloxy-functionalized polyether urethane. The
material was then dried in a convection oven to remove the DMAC
solvent. The dried material was then swollen in 70% acrylic acid
with the 0.1% v/v 2-hydroxy-2-methyl propiophenone and 0.1% w/w
methylene bisacrylamide followed by UV-initiated crosslinking to
yield a fully interpenetrating polymer network of the polyether
urethane and poly(acrylic acid). The IPN was then washed in an
aqueous salt solution to neutralize the poly(acrylic acid),
achieve, equilibrium swelling, and remove any unreacted
monomers.
[0223] Example 25 In another example, a polycarbonate urethane
(Bionate 75D) was injection molded and then dip-casted (solution
casted) in a methacryloxy-functionalized polyether urethane
solution (Elasthane.TM. 55D in 25% DMAC) and then was exposed to UV
light to crosslink the methacryloxy-functionalized polyether
urethane. The material was then dried in a convection oven to
remove the DMAC solvent. The dried material was then swollen in 70%
acrylic acid with the 0.1% v/v 2-hydroxy-2-methyl propiophenone and
0.1% v/v triethylene glycol dimethacrylate followed by UV-initiated
crosslinking to yield a fully interpenetrating polymer network of
the polyether urethane and poly(acrylic acid). The IPN was then
washed in an aqueous salt solution to neutralize the poly(acrylic
acid), achieve equilibrium swelling, and remove any unreacted
monomers.
[0224] Example 26 In another example, a polyether urethane
(Elasthane.TM. 55D) solution casted and then swollen in 35%
sulfopropyl methacrylate in acetic acid with 0.1% v/v
2-hydroxy-2-methyl propiophenone and 0.1% w/w methylene
bisacrylamide followed by UV-initiated crosslinking to yield a
fully interpenetrating polymer network of the polyether urethane
and poly(acrylic acid). The semi-IPN was then washed with water to
remove the acetic acid, and then in an aqueous salt solution to
neutralize, the poly(acrylic acid), achieve equilibrium swelling,
and remove any unreacted monomers.
[0225] Example 27 In another example, a polyether urethane
(Elasthane.TM. 55D) solution casted and then swollen in 35%
sulfopropyl methacrylate and 35% acrylic acid in water with the
0.1% v/v 2-hydroxy-2-methyl propiophenone and 0.1% w/w methylene
bisacrylamide followed by UV-initiated crosslinking to yield a
fully interpenetrating polymer network of the polyether urethane
and poly(acrylic acid). The semi-IPN was then washed in an aqueous
salt solution to neutralize the poly(acrylic acid)/poly(sulfopropyl
methacrylate) copolymer, achieve equilibrium swelling, and remove
any unreacted monomers.
[0226] Example 28 In another example, a rectangular sample of PMMA
(plexiglass) was swollen briefly in 100% acrylic acid in water with
the 0.1% v/v 2-hydroxy-2-methyl propiophenone and 0.1% w/w
methylene bisacrylamide followed by UV-initiated crosslinking to
yield a fully interpenetrating polymer network of the PMMA and
poly(acrylic acid). The IPN was then washed in an aqueous salt
solution to neutralize the poly(acrylic acid), achieve equilibrium
swelling, and remove any unreacted monomers.
[0227] Example 29 In another example, a rectangular specimen of
polydimethyl sulfoxide (PDMS, Sylgard.RTM. 184) was prepared
according to the manufacturer's specifications and then was swollen
briefly in a 35% acrylic acid solution in tetrahydrofuran along
with 0.1% v/v 2-hydroxy-2-methyl propiophenone and 0.1% v/v
triethylene glycol dimethaerylate, followed by UV-initiated
crosslinking to yield a fully interpenetrating polymer network of
the PDMS and poly(acrylic acid). The IPN was washed in an aqueous
salt solution to neutralize the poly(acrylic acid), achieve
equilibrium swelling, and remove any unreacted monomers.
[0228] Example 30 FIG. 35 is a cross-section of a hydrated
arthroplasty device and shows that the arthroplasty device is, in
effect, a synthetic version of an osteochondral graft that emulates
the structure, elastic modulus, fracture strength, and lubricious
surface of natural cartilage on one side and the stiffness,
strength, and porosity of trabecular hone on the other side. The
device is comprised of a composite gradient material featuring a
lubricious, cartilage-like polymer that smoothly transitions into a
stiff, porous, bone-like anchoring surface. The gradient was
designed to mimic the compositional gradient inherent to natural
joints, in which compliant, slippery cartilage becomes
progressively more hard and bone-like from superficial to deep
along the thickness direction. In practice, this "biomimetic"
gradient should yield a physiologic stress distribution over the
underlying bone while also minimizing micromotion at the bone
interface by effectively matching the stiffnesses of the device and
bone at their point of contact. Suitable materials are described,
e.g., in the following, the disclosures of which are incorporated
herein by reference: U.S. Provisional Patent Application No.
61/079,060 (filed Jul. 8, 2008); U.S. Provisional Patent
Application No. 61/095,273 (filed Sep. 8, 2008); and U.S. Patent
application Ser. No. 12/148,534 (filed Apr. 17, 2008).
[0229] Example 31 FIG. 36 shows contact angle analysis indicating
that the material of this invention is very hydrophilic. When a
drop of water is placed on a surface, the shape the drop takes is
dependent on the composition of the surface. A hydrophilic surface
attracts the water and creates a flatter drop, while a hydrophobic
surface repels the water and creates a rounder drop. The degree of
hydrophilicity of the surface is inferred by measuring the angle
created between the surface and the drop of water, referred to as
the contact angle. Typically, a more hydrophilic surface will have
a contact angle of about 0-45.degree. with water, while a more
hydrophobic surface will have a contact angle greater than
45.degree. with water.
[0230] The contact angle between the charged hydrogel IPN made by
this invention and water was determined. Briefly, a sheet of
Elasthane.TM. 55D (polyetherurethane) was soaked in acrylic acid
with initiator and cross-linker, and cured to form a semi-IPN
(PEU/PAA semi IPN). After curing, the charged PEU/PAA semi IPN was
hydrated in phosphate buffered saline. The material was removed
from the solution and its surface briefly dabbed to remove any
residual liquid. A drop of water was placed on the surface of the
material, and the contact angle read using a Goniometer. The
results showed a contact angle of approximately 8.degree.. For
comparison, readings taken on starting materials of solution-casted
polyurethanes and injection-molded polyurethane had contact angles
of approximately 72.degree. and 69.degree., respectively. This
result demonstrates that the incorporation of a poly(acrylic acid)
network into polyurethane according to the current invention
dramatically increases surface hydrophilicity.
[0231] Example 32 The differences in the structures of the charged
hydrogel IPN and polyurethane are shown by Transmission Electron
Microscopy (TEM). TEM creates a highly magnified image of a
material. TEM was performed on samples of
polyetherurethane/poly(acrylic) acid semi IPN (PEU/PAA semi IPN) of
the current invention and of unmodified polyetherurethane. Briefly,
a sheet of Elasthane.TM. 55D (polyetherurethane) was soaked in
acrylic acid with initiator and cross-linker, and cured. It was
stained with osmium tetroxide per standard procedures to perform
TEM analysis, FIG. 37A shows a 34 kX magnification image of PEU
while FIG. 37 B shows the PEU/PAA semi-IPN. The sizes of light and
dark regions, corresponding to the amorphous (soft) and ordered
(hard) domains, are increased in the TEM images of the PEU/PAA
semi-IPN relative to the unmodified PEU. The PAA appears
sequestered within the PEU soft segments. On the basis of the
larger domain sizes in the PEU/PAA sample compared to the PEU
sample, the degree of phase separation is greater in the PEU/PAA
sample compared to the unmodified PEU.
[0232] Example 33 FIG. 38 shows a TEM of the same PEU/PAA semi-IPN
material as FIGS. 37A and 37B at 12.4 kX magnification. The
schematic illustrates how the hard segments are phase separated
from the soft segments of the interpenetrated polymer network.
[0233] Example 34 FIG. 39 shows the static mechanical properties of
the PEU/PAA IPN which comprises an exemplary joint interface
surface of an orthopaedic implant. Uniaxial tensile tests were
conducted to determine the initial Young's modulus in tension, the
strain-at-break, and stress-at-break of the materials. Dog bone
specimens were tested according to ASTM D638, at a strain rate of
0.3%/sec. The average true stress--true strain curve for the
material of the joint interface material is presented in FIG. 40.
In the linear portion of the curve, the elastic modulus (as
provided from the true stress, true strain curve) is E=15.3 MPa
which is very close to the tensile properties reported for natural
cartilage. The ultimate true stress was found to be at
approximately .sigma..sub.ult=52 MPa at .sub.ult=143% true strain
(of note, cartilage is found to fail at around 65% strain). Strain
hardening under tension was observed for true strains of 80% and
higher. The Poisson's ratio (equilibrium) was estimated by
measuring the lateral contraction of the dog bone neck region and
was found to be consistent along the strain range at v=0.32. The
bulk modulus was therefore calculated from the equation K=E/3(1-2v)
and was found to be 18.3 MPa. Unconfined compression plug tests
according to ASTM D695 reveal that PEU/PAA semi-IPN has excellent
compressive properties, with a compressive stiffness modulus of
15.6 MPa (same as the tensile modulus, based on true stress-strain)
and a failure strength that is higher than 50 MPa.
[0234] Example 35 FIG. 40 shows the thermal curves of PEU and
PEU/PAA semi-IPN samples evaluated by Differential. Scanning
calorimetry (DSC) at a heating rate of 40.degree. C. per minute.
FIG. 41 compares the thermal transitions of PEU and PEU/PAA
Semi-IPN samples evaluated by DSC at two different heating rates.
The thermal transition temperatures including the-glass transition
temperature T.sub.g, the crystallization temperature, and the
melting temperature Tm were determined. Below its T.sub.g, the heat
capacity of the polymer is lower and the polymer is harder or
glassier. Above the T.sub.s, the heat capacity of the polymer
increases and the polymer becomes more flexible. Above this
temperature, for some polymers is the crystallization, temperature
and at least some of the domains of the molecule become more
organized, and essentially crystalline. At a higher temperature is
the, melting temperature when the crystalline portions completely
melt. The procedure was done following ASTM D3418-03 test method
using a TA Instruments Q200 DSC system with a Modulated
Differential Scanning calorimeter and Refrigerated Cooling System
(RCS90). Briefly, a sheet of Elasthane.TM. 55D (polyetherurethane)
was soaked in acrylic acid with an initiator and cross-linker and
then cured. A small amount (2-6 mg) of PEU/PAA semi-IPN sample was
placed into a first aluminum pan. A cover was placed on the top of
the pan and crimped with a Universal Crimping press to sandwich the
sample between pan and cover. Heat was applied to the first pan
and, separately, to a reference pan, and the current flow to each
was changed to keep the temperatures of the two materials the same.
The heat flew of the material being tested was graphed against the
temperature and the slopes of the curves indicate, the thermal
transition temperatures (FIG. 40). Several tests were performed,
using different rates of heating (10.degree. C. and 40.degree.C.
per minute). By performing the tests at different rates of heating,
different resolution is obtained for the thermal transitions, as
seen in FIG. 41. Because the T.sub.s can depend-on the previous
thermal history of the material, the material is subjected to two
heat cycles. The first heat cycle is used to standardize the
conditions under which the polymer arrives at its test state, and
the second test cycle is used to generate transition temperatures.
The glass transition temperatures, T.sub.g, for both the, PEU/PAA
semi IPN and the PEU were around 21.degree. C. when the rate of
heating was kept at 10.degree. C. per minute. The crystallization
and melting temperatures were lower in the PEU/PAA compared with
the PEU. At a heating rate of 40.degree. C. per minute, the
crystallization temperatures were 90.degree. C. for the PEU/PAA
compared with 93.degree. C. for the PEU. When the heating rate was
slowed to 10.degree. C. per minute, the crystallization
temperatures observed were 79.degree. C. for the PEU/PAA compared
with 92.degree. C. for the PEU. Finally, at a heating rate of
40.degree. C. per minute, the Tm temperatures were 164.degree. C.
for the PEU/PAA compared with 178.degree. C. for the PEU. When the
heating rate was slowed to 10.degree. C. per minute, the T.sub.m
temperatures observed were 154.degree. C. for the PEU/PAA with 176
and 186.degree. C. for the PEU. In some analyses of the PEU, two
T.sub.m's were observed (176.degree. C. and 186.degree. C.), which
may be due to different segments in the polymer. The change of the
T.sub.m is due at least in part to an increase in polymer volume
caused by the addition of the PAA, leading to fewer hard segments
per volume of polymer.
[0235] Example 36 The coefficient of friction .mu. of a PEU/PAA
semi-IPN of this invention against itself was measured. real-time
during a wear test using a built-in torque cell, and was found to
range between 0.015 to 0.06, and as shown in FIG. 42, is similar to
cartilage-on-cartilage .mu. values, Because of its lower (compared
to cartilage) permeability, the PEU/PAA semi-IPN of this invention
can preserve a lower coefficient of friction for longer and at
higher contact pressures. FIG. 42 shows the effective coefficient
of friction during a wear test of the joint interface material
(labeled "PEU/PAA-on-PEU/PAA" in the graph) under 2.4 MPa of
continuous (static) contact pressure. Literature reports on natural
cartilage values and experimental data/literature reports on UHMWPE
on CoCr arc also, presented in the plot (Mow, 2005; Wright 1982).
As expected, the coefficient of friction was found to remain
unchanged over the course of time when the load was applied in
cycles of 1 Hz; similar results are repotted, for cartilage. The
low coefficient of friction in the material can be explained in
terms of (a), hydroplaning action, (b) load sharing between the
solid and the fluid phases of the material (c) thin film
lubrication as water persists on the surface of the material. The
small increase of .mu. under static load can be explained by a
small partial dehydration of the material under the pressure. In
comparison, natural cartilage will lose most of its water under
static load and therefore its coefficient of friction increases
rapidly and to higher levels. Removal of the load and subsequent
rehydration restores the initial coefficient of friction for
natural cartilage.
[0236] Example 37 The coefficient of friction is a number that
indicates the force resisting lateral motion of an object. It is
expressed as a unitless ratio of the frictional force to the normal
force. The dynamic coefficient of friction for the polyether
urethane/polyacrylic acid (PEU/PAA) semi-IPN on was tested on
metal, and the dynamic coefficient of friction is shown as a
function of time. Briefly, a piece of Elasthane.TM. 55D
(polyetherurethane) was soaked in acrylic acid with an initiator
and cross-linker, and cured to forma water swellable semi-IPN of
the present invention. Plugs 8.8 mm in diameter and 1 mm thick were
cut, swollen in PBS, and then rotated at a frequency of 1 Hz
against a 3/16'' stainless. steel disc at a contact stress of 2.0
MPa while being submerged in PBS. Using a custom-made wear tester
made according to ASTM F732 standards equipped with both a force
load cell and a torque load cell, the dynamic coefficient of
friction was measured real-time during the wear test experiment.
The dynamic coefficient of friction of the material varied between
0.005 and 0.015 over a period of 36 hours.
[0237] Example 38 Wear experiments of the PEU/PAA semi-IPN of this
invention were conducted according to ASTM F732 using a pin-on-disc
configuration. Results are shown in FIGS. 44A-44C, 45A-45C, and 46.
Discs and pits formed from the joint interface material were tested
to 2,500,000 cycles. As a basis for comparison to industry standard
materials; a CoCr pin-on-UHMWPE (Cobalt chrome on ultra-high
molecular weight polyethylene) disc configuration was also tested
for 1,000,000 cycles.
[0238] In the test of the PEU/PAA semi IPN of this invention, the
pins were 8:8 mm in diameter, 2.5 mm in thickness. The disc was 88
mm in diameter and 2.5 mm in thickness. The pins were rotated over
the disc at a radius of 24 mm and at a rate of 1.33 Hz under a
pneumatically applied cyclic load. A pressure regulator was used to
adjust the air pressure so that the desired force was applied. The
load was measured using a load cell (Sensotec Honeywell, Calif.)
directly under the disc. The disc and the pins were mechanically
isolated so that the torque caused by the friction generated
between them can be measured by a torque cell (Transducer
Techniques, Calif.) connected to a computer equipped with a data
acquisition card Instruments, Tex.). The pin and discs were
contained in a chamber filled with POS. The temperature was
controlled and kept constant at 37.degree. C. using a
thermocouple-resistor-fan system. Using the equation .mu.=T/r*F,
where T is the measured torque, r is the radius of rotation (=24
mm) and F being the total force applied on the pins, the
coefficient of friction was constantly monitored. The coefficient
of friction was found to be 0.016 and independent of the contact
pressure (range tested 0.1-3.5 MPa) and slightly increased to 0.021
under heavy static contact load, but returned to the original value
after fluid recovery. The wear was measured using the gravimetric
method every million cycles: the disc and the pins were weighed
separately after vacuum drying for 3 days. The wear test solution
(PBS) was collected and visually examined; no signs of visible wear
particles were noted at all steps of the tests. The wear test PBS
solution was vacuum filtered using a 2.5 .mu.m pore filter to
capture any wear particles, flushed with deionized water to remove
remaining PBS salts and then dried overnight under vacuum and
desiccant. AS a control, a similar test was performed using CoCr
pins (Fort Wayne Metals, Ind.) on UHMWPE (Orthoplastics, UK). Three
polished (Ra<1.6 .mu.m) CoCr flat pins of OD=7 mm were tested in
the same instrument against a polished UHMWPE disc of 2.5 mm
thickness and OD=88 mm (rotation radius=24 mm), rotating at 1.2 HZ
under 3.4 MPa static contact load and at 37.degree. C. isolated
environment.
[0239] Observation of the disc formed from the PEU/PAA semi-IPN of
this invention after the test (FIG. 44A) revealed
no-macroscopically perceptible wear track along the pin-on-disc
articulation surface. (FIG. 44B is a close-up view of the location
of the wear track. Dashed lines have been added to indicate the
path; the radial arrows start from the center of the disc.) In
comparison, as shown in FIG. 44C, the UHMWPE disc after 2.0 M
cycles of wear against CoCr pins has a visible track 126 .mu.m
deep.
[0240] Weighing of the wear test solution filtrate using a scale
with a 0.01 mg resolution (Mettler Toledo, Ohio.) showed that the
volumetric wear rate of the PEU/PAA semi-IPN was approximately 0.6
mg/10.sup.6 cycles or 0.63 mm.sup.3/10.sup.6 cycles or 0.63
mm.sup.3/150.times.10.sup.3 m. This value, however is close to the
resolution of the methods. A schematic of the wear test solution
from the wear test of the inventive joint interface material
comprised of PEU/PAA semi-IPN is shown in FIG. 45A, demonstrating
an absence of particles in the PBS solution. Compare FIG. 45A to
schematics of the wear test solution of the UHMWPE disc shown in
FIGS. 45B and 45C, which show substantial wear debris particles
generated during the CoCr-on-UHMWPE wear test.
[0241] Although attention was paid to eliminate external factors
such as dust, moisture and static in order to increase the accuracy
of the results, the wear values are well near the statistical and
practical detection limits of the methods available. These results
are consistent with the hypothesis that since the PEU/PAA semi IPN
according to the present invention like natural cartilage is
comprised of mostly water, and the surface is persistently
lubricated with a film of water, there is little, if any, contact
between solid matrices.
[0242] Wear particle measurements were also taken for the
CoCr-on-UHMWPE experiments, which not only created a visible wear
track (FIG. 44B) on the UHMWPE disc, but generated substantial
macroscopic wear debris (FIGS. 45B and 45C). The UHMWPE disc was
weighed and the difference in weight yielded an average wear rate
of 64 mg/10.sup.6 cycles or 69 mm.sup.3/150.times.10.sup.3m (FIG.
46). This study points that the joint interface material of this
invention (labeled "PEU/PAA-on-PEU/PAA") is at least more than 100
more resistant to wear than the traditional combination of CoCr
UHMWPE, widely used in total joint replacements.
[0243] Example 39 FIG. 47 shows the swelling behavior of PEU/PAA
and PEU in various aqueous and organic solvents. Briefly, a sheet
of Elasthane.TM. 55D (polyether urethane) was soaked in acrylic
acid with initiator and cross-linker, and cured to form a semi IPN.
A small piece of the IPN or Elasthane.TM. 55D was obtained and
weighed. The sample was soaked for 20 hours in a solution
containing the solvent indicated in the Figure. (The samples were
swollen, but did not dissolve). The sample was removed from the
solvent, briefly dabbed dry, and then weighed again. The change in
weight due to swelling is expressed as the % difference. While
Elasthane.TM. 55D on its own does not take up water, the IPN of the
present invention readily swells with water to form a lubricious,
hydrated IPN. In addition, other solvents can be used to swell the
starting polymer to create the IPN of the current invention. In the
case of polyurethanes, the ability of various solvents to swell the
material depends on the properties of the solvent, (such as its
polarity, acidity, and-molecular weight) as well as the relative
solubility of the polymer components (e.g. hard and soft segments)
in the solvent.
[0244] Example 40 The swelling of polyetherurethane by acrylic acid
in water and acetic acid was tested. Swelling solutions were
prepared containing 10, 30, 50, and 70% acrylic acid monomer in
deionized water (FIG. 48A) and in acetic acid (FIG. 48B). Small
pieces of Elasthane.TM. .RTM. 55D (polyetherurethane) were obtained
and measured. A sample of Elasthane.TM. was placed in each
solution. The samples were removed from the solvent, the surface
briefly dabbed dry, and then measured again. The change due to
swelling is expressed as the final length of the specimen after
equilibrium swelling (L.sub.f) divided by the original length
(L.sub.o) minus 1; in this way, the fractional increase in length
relative to the initial state (y=0) is plotted versus time.
Swelling of the Elasthane.TM. 55D was observed using either water
or acetic acid as a solvent. More swelling was observed when a
higher amount of acrylic acid was used in the swelling solution. Of
note, the concentration dependence of acrylic acid on the swelling
of the Elastbane.TM. samples was different depending on whether
water or acetic acid was used as the solvent.
[0245] Example 41 FIG. 49 shows the amount of poly(acrylic acid)
present in the PEU/PAA semi-IPN after curing is plotted as a
function of the starting concentration of acrylic acid monomer in
different swelling solutions.
[0246] Swelling solutions were prepared containing 10, 30, 50, and
70% acrylic acid monomer in deionized water and in acetic acid.
Small pieces of Elasthane.TM. 55D (polyetherurethane) were obtained
and weighed. Samples were placed in each of the water/acrylic acid
or acetic acid/acrylic acid solutions along with cross-linker and
initiator. The samples were cured, swollen in acrylic acid in
either water or acetic acid, removed from the solution, dried, and
then weighed again. Incorporation of acrylic acid into the
Elasthane.TM. 55D to form a semi-IPN was observed using either
water or acetic acid as solvent. More incorporation of acrylic acid
was observed when a higher concentration of acrylic acid was
present in the swelling solution.
[0247] Example 42 Semi IPNs were prepared essentially as described
in FIG. 49, and the polyacrylic acid content of the IPNs was
determined. The dried materials were weighed, swollen in saline
until equilibrium was reached, and weighed again. The change in
weight of the semi IPN is expressed as a ratio of the weight of the
swollen material/weight of the dry material (Ws/Wd) for each
concentration of polyacrylic acid. An increased amount of
polyacrylic acid in the polymer correlates with an increased uptake
of saline into the water-swellable semi-IPN. Since the semi IPNs in
these experiments were neutralized to pH 7.4, in these experiments,
the dry weight of the semi-IPN included the salts present in the
saline swelling solution, since the monovalent cations
(predominantly sodium, which has a MW of 23 g/mol) are counterions
to the carboxylate groups in the material.
[0248] Example 43 FIGS. 51A-54 show the results of creep, and
stress relaxation/compression testing. Tests were performed on
PEU/PAA semi IPNs formed from Elasthane.TM. 55 D
(polyetherurethane) soaked in acrylic acid with initiator and
cross-linker, and cured.
[0249] FIGS. 51A and 51B shows the results of cyclic compression
testing. The behavior of the PEU/PAA semi IPN was tested under
dynamic compression conditions to determine permanent creep and
creep recovery. Permanent creep is the time-dependent deformation
of a material under a constant load. Creep recovery measures the
rate of decrease in the applied deformation after a load is
removed. Experimental setup of the compression test followed the
ASTM standard D695, Standard Test Method for Compressive Properties
of Rigid Plastics, with the samples being subjected to a sinusoidal
loading scheme designed to mimic the physiologic, cyclic
compressive loads seen in a gait cycle.
[0250] A sample of the PEU/PAA semi IPN was removed and measured in
the direction of its thickness, subject to cycles of compressive
stress from 0-3 MPa at a frequency of 1 Hz for over 60,000 cycles,
measured again in the direction of its thickness, re-equilibrated
(relaxed) in PBS to allow for recovery from creep, and measured
again in the direction of its thickness. FIG. 51A shows the
results, of thickness measurements on representative samples
subject to one-second long cycles of tests (at the last, 1000th,
10,000th, 20,000.sup.th, 40,000.sup.th, and 60,000.sup.th cycles)
superimposed in one figure. FIG. 51B shows how the thickness of the
material changes over all cycles of testing. The thickness of the
material, as measured after load was removed during the cycle,
dropped from an initial value of 2.160 mm at the first cycle to
about 2.000 mm by the 60,000.sup.th cycle. However, after
re-equilibration (relaxation) in PBS and creep recovery at the last
cycle, the material returned to a thickness of 2.135 mm, a total
loss of thickness of only 1.1% due to permanent creep.
[0251] FIG. 52 presents the equilibrium compressive behavior of the
PEU/PAA semi IPN as determined through a multiple-step stress
relaxation test, in which a given displacement is applied and then
the material is allowed to relax (equilibrate). Notably, under
these test conditions, the material fully recovered to its
equilibrium value after removal of the load, as shown by the last
data point in the FIG. 52, indicating full creep recovery. The
stress of 2.20 MPa (4th data point) is 15% higher than the maximum
functional stress in a hip device (total load through the hip of 3
times body weight) that is predicted by finite element models.
[0252] A static creep test was also performed (data not shown).
Creep is the time-dependent deformation of a material under a
constant load. The behavior of the PEU/PAA semi IPN tested under
static compression was tested following ASTM D2290-01 "Standard
Test Methods for Tensile, Compressive, and Flexural Creep and
Creep-Rupture of Plastics". A plug of the PEU/PAA semi IPN with an
initial diameter of 9.525 mm and a thickness of 1.115 mm was put
under an initial stress 4 MPa in a fluid PBS bath. After applying
the stress for approximately 20,000 seconds (to a total strain of
14.29%), the load was released and the material allowed to relax
(re-equilibrate) in PBS. The final thickness of the plug was 1.109
mm. The final unrecovered creep after more than 40,000 cycles was
2.7%.
[0253] FIG. 53 shows the results of a compression set test
according to ASTM D395. In this test, a plug of PEU/PAA with an
initial diameter of 9.525 mm and a thickness of 2.13 mm was
subjected to a constant compressive strain of 15% for 23 hours at
room temperature in a fluid bath filled with PBS. After allowing
the material to relax and re-equilibrate in PBS, the final
thickness of the plug was 2.08 mm. This yields a compression set
value of 9.5%. As a basis of comparison, PEU (Elasthane.TM. 55D)
alone exhibits a compression set value of about 45% under the same
conditions (22 hrs, room temperature). Therefore, the presence of
the polyelectrolyte in the PEU/PAA semi-IPN provides a way for the
PEU material to resist permanent creep through rehydration of the
matrix with water due to the hydrophilicity and high swellability
of the negatively charged polyelectrolyte.
[0254] Example 44 FIG. 54 shows a list of some of the materials
made in accordance with the present invention. The first column
shows the hydrophobic polymer used. If a modification was made to
the hydrophobic polymer as indicated in the second column, the
material for the modification was cast with the material, or, if
the modification was crosslinking functionality, the modification
was added and the material prepared and crosslinked and used
thereafter with the crosslinks reacted. The monomer, comonomer (if
any), crosslinker and initiator were added in the indicated solvent
as indicated in the figure in order to swell the prepared
hydrophobic polymer. Each hydrophobic polymer sample was allowed to
swell for up to 2 days, removed from the solution, and cured using
the indicated method following standard procedures. The material
was washed and swollen in PBS. The abbreviations used are as
follows: MBAA=methylene bisacrylamide, HMPP=2-hydroxy-2-methyl
propiophenone, TEGDMA=triethylene glycol dimethacrylate, and
H.sub.2=water.
[0255] Another aspect of the invention provides an orthopedic
implant with a bone interfacing member that may be conducive to
bone in-growth and a water swellable IPN or semi-IPN. The addition
of a water-meltable IPN or semi-IPN to a bone interfacing member
(e.g. a rigid or mostly rigid, ceramic, metal, or polymeric member
placed in contact with the bone) may provide certain advantages,
such as by taking advantage of current knowledge and surgical
expertise related to accepted orthopedic implants while overcoming
some of the disadvantages of such implants.
[0256] Another aspect of the invention provides a synthetic joint
capsule that may surround or partially surround or connect with
other components of the device. The joint capsule may function as a
self-contained fluid reservoir for the implant. In particular, in a
hip implant (e.g. a femoral or acetabular component), a synthetic
"joint capsule" may surround the femoral, acetabular, and/or labral
components and provide lubricant in-between the femoral and
acetabular components.
[0257] Another aspect of the invention provides other components
for providing support, lubrication, and/or spacing to a joint of a
body. For example, the addition of a "labral" or ring-like
component that contours the acetabular rim or the shoulder joint,
or a meniscal component that contours an outer aspect of a tibial
plateau could act as a buffer between acetabular/femoral
components, humeral head/glenoid, or femoral/tibial components of
an implant similar to way the natural labrum and meniscus
function.
[0258] One aspect of the invention is an orthopaedic implant
comprising a hydration, stiffness, and/or compositional gradient
polymer alloy (an IPN or semi-IPN) that is fused (e.g. along an
attachment zone) to a bone interfacing member. FIGS. 55A and 55B
and FIG. 56 show a gradient polymer alloy and a porous metal before
(FIGS. 55A and 55B) and after (FIG. 56) they are joined. FIGS. 55A
and 55B shows the gradient polymer and porous metal in an exploded
view with three phases of gradient polymer alloy, including
hydrated phase 401 (with a bearing surface 412), transitional phase
402, non-hydrated phase 403 (with attachment zone 414), and porous
metal bone interfacing member 409. Any gradient polymer may be
used, including any polymer described herein or in Copending U.S.
patent application Ser. No. 13/219,348, filed Aug. 26, 2011, now
U.S. Pat. No. 8,883,915.
[0259] In one embodiment, a semi-IPN or IPN may include a
compositional gradient polymer alloy (an IPN or semi-IPN) with a
second gradient made of PMMA (polymethyl methacrylate). The PMMA
may form a second gradient from a portion of a gradient IPN or
semi-IPN to an attachment zone. In a particular example, the
gradient polymer alloy may include polyurethane and poly(acrylic
acid) and the second gradient may be PMMA. In this embodiment,
methyl methacrylate (MMA) monomers may be diffused into a
polyurethane side or zone of a gradient IPN or semi IPN comprising
polyurethane, and poly(acrylic acid), then polymerized to form an
IPN or Semi-IPN of PMMA and polyurethane within the attachment
zone. This yields an attachment zone with affinity and adhesiveness
for PMMA bone cement according to co-pending application U.S.
patent application Ser. No. 13/219,348, filed Aug. 26. 2011, now
U.S. Pat. No. 8,883,915. This gradient IPN with a PMMA-containing
attachment zone can therefore be adhered to a bone interface member
comprising a metal; a polymer (such as PMMA bone cement), or
ceramic.
[0260] FIG. 56 shows the gradient polymer Metal alloy of FIGS. 55A
and 55B joined with a bone interface member (metal device including
hydrated phase 401 (with a bearing surface 412), transitional phase
402, non-hydrated phase 403, interfacial zone 407 comprising
non-hydrated polymer from the attachment zone 414 interdigitated
with porous metal, and porous metal from bone interfacing member
409. The gradient polymer alloy is mechanically interdigitated with
porous metal to create a strong, smooth interface region.
[0261] A bone interfacing member may be any material, but
preferably is one useful in orthopaedics and biocompatible, such as
a metal, ceramic, or polymer. A bone interfacing member may be any
metal, such as aluminum, cobalt, molybdenum, nickel, stainless
steel, titanium, or combinations or alloys thereof and/or any other
metals used in biomedical implants. A bone interfacing member may
be any polymer that is sufficiently strong and biocompatible, such
as PEEK, polyurethane, or UHMWPE. For simplicity, a bone
interfacing member will be referred to as a metal, but it should be
understood any material that connects a polymer gradient alloy to a
bone can be used. A metal may be substantially solid, porous,
etched, coated, or otherwise treated to aid in attaching the metal
to bone and/or attaching a gradient polymer alloy to the metal, or
may have a combination Of these characteristics or treatments. A
porous metal includes but is not limited to porous "trabecular"
metal, porous metal foam, sintered metal beads (e.g. that form a
porous structure), plasma sprayed porous metal, and/or chemically
etched porous metal. A portion of the metal may be solid, porous,
rough, etched, coated with osteoconductive material (e.g. calcium
phosphate or hydroxyapatite), or otherwise treated and another
portion not solid, porous, etched, coated, or otherwise not
treated. In one example, a metal is porous on the bone contacting
surface. In another example, a metal is porous on a polymer alloy
facing side. In another example, a metal is porous on both a bone
contacting surface and a polymer alloy facing side. A hydration
gradient polymer alloy may be a combination of a hydrophilic
polymer and a hydrophobic polymer, such that one side of the alloy
is hydrophilic and hydrated, and the other side non-hydrated and
hydrophobic. The latter side may be mechanically interdigitated or
chemically bound with a metal bone interfacing construct. If a
porous metal is used, the porosity may be any that allows or aids
in attaching to a gradient polymer alloy or in attaching to bone.
The porosity of the metal may be similar to the porosity of
cancellous bone.
[0262] The gradient polymer alloy can be attached, connected or
bound to the metal in any way.
[0263] In one example, the gradient polymer alloy was placed in
contact with a porous metal specimen that was heated past the
melting point of the polymer backing material. The two materials
were compressed together under a load of, for example, 1 metric
ton, and then allowed to cool. The result was. a gradient polymer
alloy fused to a porous metal. Examples of porous metals used were
aluminum and titanium.
[0264] The use of porous metal or polymer in combination with a
gradient polymer alloy allows for bone in-growth into the metal or
polymeric bone-facing side of a device to create a strong but
lubricious joint replacement having gradual transition from
hydrated surface to strong bone. Polymer/metal and
metal/bone-regions of overlap are shown in FIGS. 57A-57C and
58A-58C. FIGS. 57A-57C show a porous metal or polymer
counter-surface (bone interface member), though the surface may
also be non-porous. FIGS. 57A-57C and FIGS. 58A-58D show orthopedic
implants. in the shape of a cap 530 (FIG. 57A) and a cup 523 (FIG.
58A) being attached to and in-grown with bone. The implants have
hydrated polymer portions 501, 512 to provide hearing surfaces 526,
528 to interface with a joint surface. The hydrated polymer portion
of the gradient polymer alloy and porous metal have been
interdigitated 503 (518) in the region between 503' and 501' (512'
and 517') to create a polymer/metal overlap region 502, 518. The
implants also have porous metal portions 501, 517 with bone
attachment zones 522 (524) to attach the interdigitated polymer
metal implant 530, 523 to bone. When implant 530, 523 is placed
next to bone 504, 514, the implant forms anew artificial joint
surface on the bone. Post-operatively, bone grows into the porous
metal side to create metal-bone integrated region 506, 520 between
original bone surface interface 504' and new interface 504'' (at
the limit of the bone in-growth) that can strongly anchor the
implant too-a bone. The interdigitated metal-bone region
distributes stresses better than does a sharp interface between the
two materials, providing a strong anchor. An expanded view of the
interfacial zone 508 is shown in FIG. 58D with bone 514 connected
with metal implant 517 which is in turn connected with cartilage
replacement polymer 512. FIG. 58D shows a closer view of the region
shown in FIG. 58C overlap or interdigitation 520 between bone and
metal, overlap or interdigitation 518 between polymer 512 metal
518, and transition from strong metal to lubricious surface 532 to
create a strong, smooth joint replacement.
[0265] FIG. 59A shows two sides of a generic-articular joint with
both sides of the joint replaced with orthopedic implants according
to the current disclosure. Concave bony prominence 614 has bone
surface 617 accepting concave articular component 612. Convex bony
prominence 613 has hone surface 616 accepting convex articular
component 611. Concave articular component 612 mates with convex
articular component 611 at articular interface 615. Cross section
618 of concave articular component 612 is shown in FIG. 59B
immediately after being placed in the joint, i.e., before any bone
ingrowth has occurred. Next to the bone is a layer of porous metal
622 serving as a bone interface member, then a polymer-metal
interface region 621, non-hydrated side 620 of the polymer and,
facing the articular surface, hydrated side 619 of the polymer.
[0266] In one example, a gradient polymer alloy can be physically
snap-fitted into a metal mating component with a non-porous smooth
contact surface and a counter-surface (bone contact surface)
configured for attaching to bone that is porous, rough, and/or
coated with osteoconductive material such as calcium phosphate or
hydroxyapatite. In this case, a gradient polymer alloy component
may be used similarly to the way that existing ultrahigh molecular
weight polyethylene (UHMWPE) acetabular cups are fitted into metal
hacking components.
[0267] In another example, a gradient polymer alloy can be
physically snap-fitted into a mating, polymeric component with a
non-porous smooth contact surface (attachment surface) and a
counter-surface (bone contact surface) meant for anchoring to bone.
A counter-surface may be porous or non-porous. A counter surface
may be coated with an osteoconductive material such as calcium
phosphate or hydroxyapatite. Anchoring a gradient polymer alloy to
bone can be achieved through any suitable means including one or
more of: 1) bone ingrowth into a porous counter-surface (bone
contacting surface), 2) briefly melting an entire surface or
portions of a surface of a solid counter-surface and causing the
material to flow into the bone pores, and solidifying the material
to form, a grout-like anchoring, 3) using or applying adhesive,
cement (e.g. polymethylmethacrylate (PMMA)), epoxy, glue, or grout,
to bind (e.g. chemically) or mechanically hold a counter-surface to
bone.
[0268] In another example, a gradient polymer alloy may be
chemically bonded to a metal portion or implant. Either (or both)
sides of a metal maybe smooth, porous, or rough. Any number or type
of chemical bonds may be made. In one embodiment a urethane linkage
is formed between a polyurethane-based gradient polymer alloy and a
bibochemically modified metal surface through reaction of terminal
isocyanates in the polymer precursor and reactive OH groups on the
metal surface. A metal surface can be tribochemically modified with
oxides, which can subsequently be further modified to hydroxyl
groups, which can in turn be chemically reacted with free
isocyanate groups to form an isocyanate chemical bond (see Myung et
al., U.S. Patent Publ. No. 2008/0241214). The gradient polymer
alloy can also be joined to the bone interfacing member using or
applying adhesive, cement (e.g. polymethylmethacrylate (PMMA)),
epoxy, glue, or grout.
[0269] A gradient polymer bound to a metal surface may have any
thickness. A gradient polymer may form a thin coating or layer over
a metal surface. A coating or layer may be less than 30, less than
25, less than 20, less than 15, or less than 10 mm in a thickest
region. In one particular example, a coating on a metal is less
than 5 mm in a thickest region.
[0270] kgradient polymer alloy may be polyurethane based, and the
polyurethane side of the alloy may be physically fused with a
porous metal by melting a portion of the polyurethane and flowing
it into pores of the metal, and then cooling the metal and
polyurethane. Because a polyurethane side of a gradient polymer can
be tough and hydrophobic, it is able to robustly anchor to the
porous metal with an interface that is highly resistant to extreme
and repetitive mechanical stresses.
[0271] An implant or device may be made after separate fabrication
of a gradient material and a porous metal, and then the material
and metal are fused. They may be fused by heating the metal,
apposing the material and the metal, compressing, the material and
metal together, and then cooling the metal. In this way, the
hydrophobic side of a gradient polymer is "melted" into the pores
of a porous metal. Alternatively, a precursor of a gradient polymer
can be injected molded directly onto a (pre-fabricated) porous
metal, followed by post-processing of the polymer to yield a
gradient polymer that is fused to the metal.
[0272] In another aspect of the disclosure, a synthetic joint
capsule may be implanted. A synthetic joint capsule may surround
one or both (or may be near, but not surround) implant components.
A capsule component(s) may be closed or sealed to contain a fluid
such that fluid cannot move in and out of a volume or space
created, at least in part, by the capsule.
[0273] FIGS. 60 and 61 illustrate placement of cap-on-cup,
synthetic joint capsule and labral implants of a gradient polymer
in a hip joint according to one aspect of the disclosure. FIG. 60
is a simplified version showing total cartilage replacement with
convex articular component cap 632 over femoral head 631 and
concave articular component cup 634 facing acetabulum 633 without a
synthetic joint capsule or synthetic labral components in place.
The components (e.g. cap and cup) are made from a gradient polymer
alloy without a metal component.
[0274] FIG. 61 shows a total cartilage replacement device based on
gradient polymer alloy components with the components shown in FIG.
60 and encapsulation of the hip joint with a capsule component 635,
shown in superior cross-section 636a and inferior cross-section
636b, a labral component shown in superior cross-section 635a and
inferior cross-section 635b, and containing lubricant fluid 637. In
this embodiment, the capsule 635 encloses the entire joint,
including the cap 632 and cup 634 described above. Capsule 635 may
contact bone, joint implants or both to form its joint
enclosure.
[0275] A joint capsule may be part of a gradient polymer and porous
metal combination implant, or may be present in an implant having a
gradient polymer without a porous metal component. A synthetic
labral component may also be used in combination with the femoral
and acetabular components, with or without a synthetic joint
capsule component. The same holds true for the humeral head and
glenoid in a shoulder joint.
[0276] The capsule's geometry and shape may similar to all or part
of a natural joint capsule, which normally provides stability to
the joint. In one example, a synthetic joint capsule contains a
phosphate buffered saline or normal saline solution, which may
serve as a lubricant fluid for a gradient polymer bearing
surface(s). A synthetic capsule may be manufactured as an attached
part of one or more bearing components, or may be a separate part.
It may be assembled either pre-operatively or intra-operatively
with another joint component(s). In another example, the capsule
may be filled with a lubricant, such as a lubricating polymer (e.g.
carboxymethyl cellulose, hyaluronic acid, or sodium
polyacrylate).
[0277] The addition of a synthetic capsule may provide advantages,
such as protection against dislocation, containment of wear debris,
protection of the articular interface against host cells, or bone
or cement particles, and/or creation of a one-piece device that may
be implanted in a single step, much like an interpositional spacer
device.
[0278] A total cartilage replacement metal device with a polymer
cap-on-cup surface may be placed in a joint. FIG. 62 shows a
cartilage replacement device placed in a hip joint. Femoral
component 650 is in place over femoral head 631. It includes has
porous metal backing 643. Acetabular component 645 abuts acetabulum
644. Component surfaces 642, 645 mate to provide a joint interface.
One or both component surfaces 645, 642 may be a polymer. FIG. 62
also shows porous metal backings 646, 643.
[0279] An implant according to the disclosure may be assembled
before insertion into a joint region or two or more parts may be
assembled intraoperatively while in the joint. FIG. 63 shows a
metal implant and a gradient polymer liner that can be separately
inserted into a joint. Metal cup 804 may be first placed in a
joint, then gradient polymer liner 802 may be placed. Polymer liner
802 may be attached or adhered to metal cup 804 in any fashion. It
may be held by chemical bonds or physical means. FIG. 63 shows
grooves 806 for holding or flowing a material to aid in attaching a
liner to a metal portion. The metal or the polymer liner may have
features that change shape to aid in attachment, such as tabs. The
metal cup and liner may be adhered using adhesive, cement (e.g.
polymethylmethacrylate (PMMA)), epoxy, glue, or grout. FIG. 63
shows an optional ring to secure the liner to the metal. The ring
may interlock or screw the liner to the metal. In one example, a
liner can be removed and replaced with a new liner without removing
the metal portion.
[0280] For a femoral device, a gradient IPN "cap" may be designed
to fit on top of a metal femoral cap. A modular arrangement may
allow a wider range of size interchangeability and tolerances in
terms of the fit between a convex and concave joint surface. In
addition, it may allow for various cup geometries for different
pathologies. For example, it would allow for metal cups/backings
with screw holes for additional fixation in the case of poor bone.
It may also allow for-a dysplasia cup and finned cups. A modular
arrangement gives flexibility to adapt to patient needs and surgeon
preference, which may be decided intra-operatively. The modularity
may be enabled by mechanism. Modularity may be enabled by a locking
mechanism, such as a taper, deforming tab, and a "screw-in"
mechanisms. Typically, with modular systems on the market today,
the liner (poly, ceramic, metal) is assembled to the metal cup as a
last step. This allows the surgeon to perform a final trialing
prior to final implantation. It also gives the surgeon the option
to use a lipped liner for additional stability should be deem it
necessary at time of surgery. Any of these mechanisms may also be
used with a non-modular (e.g. preassembled) device. Modularity also
provides the option of replacing just the bearing materials in the
artificial joint for various reasons without disturbing the bone
interfacing members.
[0281] Another aspect of the invention provides methods and
implants for changing a shape of an implant. A metal, especially a
porous metal, may have some ability to deform (e.g. bend, crimp,
expand, fold, stretch, twist) or otherwise change a shape under an
applied stress. A shape change may be transient. A metal may deform
by bending one or more struts or regions along a metal
meshwork.
[0282] In one example, an implant may cover an area greater than
180 degrees of a bone. For example, a hip implant for a femoral cap
may encompass greater than 180 degrees, as shown in FIG. 62. The
deformability of the porous metal and the polymer to which it is
attached allows the entire cap to deform (e.g., open, stretch or
otherwise change its spatial configuration or spatial conformation)
to enable it to be placed over a spherical femoral head. A tool can
be used to return the device to a different or preferred shape,
such as to contact more of the femoral head or femoral neck
surface. Metals with good shape memory properties would be useful
in this particular embodiment.
[0283] An implant having a porous metal surface and a flexible or
deformable polymer may change a shape. Any metal that can change a
shape may be used. Any polymer that provides a biocompatible
surface useful in a joint replacement may be used in an implant. A
polymer on a surface may create a slippery, a soft, and/or a smooth
surface. A polymer may be a lubricious polymer. In one example, an
implant polymer is a gradient polymer alloy as described
herein.
[0284] One aspect of the invention involves methods for inserting
an orthopedic implant into a joint.
[0285] A shape of an implant may be changed for any reason. A
change in shape may provide an implant with a smaller size to aid
in implant insertion (e.g. for arthroscopic or minimally invasive
surgery). A change in shape or size may allow an implant to fit
into a joint region. For example, a shape may be changed to allow
an implant to fit over a femoral head. A shape of an implant may be
changed so that the implant conforms to at least a portion of a
shape of a joint. For example, a portion of a joint may have an
irregular surface and an implant shape may be changed to abut or
fit a shape of the surface.
[0286] FIG. 64 shows another embodiment of an orthopedic implant
able, to change a shape, e.g. to aid in insertion into a joint.
FIG. 64 shows implant (cap) 810 with metal portion 812 attached to
polymer 818. Polymer 818 may be any flexible or deformable
biocompatible polymer useful for joint replacement. In one example,
it is a gradient polymer as described herein. Metal portion or back
812 has two or more discontinuous segments (or leaves) 814. There
may be lines of separation or gaps 816 between the segments to
allow the implant to change shape. The lines of separation may run
in a longitudinal direction anywhere from a few degrees from the
opening (collar) to well beyond the equator. The lines may allow
the device to "open" transiently in a radial direction (like a claw
or petal on a flower). Individual segments may be deposited on or
attached to the polymer. Metal may be laid down on the polymer, and
then portions removed (e.g. by laser etching) to leave segments. In
another embodiment, portions or segments may be hinged, connected,
or otherwise attached at the north pole (like a clamshell) and may
open as the implant stretches out while being lowered over the
femoral head. The portions or segments may close after being
lowered to surround the implant and femoral head. A metal may be
sufficiently flexible and resilient, yet rigid enough to snap back
into position after a transient deformation. In another embodiment,
the metal segments or portions are mostly discontinuous, but retain
some continuity through flexible connecting elements. The elements
may be, for example, curves, zig-zags, or springs.
[0287] FIG. 65 shows the metal portion of an orthopediocap implant,
like the one shown in FIG. 64, configured for placement on a
femoral head. For simplicity, the polymer portion is not shown.
Implant 822 has to fit over femoral head 824. In particular, the
region of the implant near collar 832 as well as collar 832 need to
pass over the large femoral head 824 and then rest on smaller edge
of femoral head 834 and femoral neck 826. Lines of separation 830
between segments, 828 in the implant along with a flexible metal
allow the implant to expand for insertion. The metal may be
sufficiently resilient to take a preferred shape after insertion,
or may take a preferred shape after a treatment (e.g. heat) or
application of a tool.
[0288] FIG. 65 shows another embodiment of an orthopedic implant
able to change a shape. Segments 836 of metal separated by gaps 840
are embedded or-otherwise attached or connected with flexible
polymer 846. The segments (or elements) may be substantially solid,
porous. The metallic elements may be arranged in a discontinuous
fashion. The gaps may be strategically placed, with specific sizes
and orientations, or they may be randomly placed. The entire device
may as a whole flex and in turn, minimize the stress placed on each
individual structure. The gradient polymer may be stretched or
deformed (e.g. to change its spatial conformation or spatial
configuration), while the individual metal components move relative
to one another. The exact movement may depend on how the polymer is
deformed and the orientation and structure of the metal segments.
Metal-free gaps (or spaces) may be strategically placed. The gaps
may be chosen to allow a predetermined location and direction fora
metal to expand or collapse. Gaps and metal composition may be
different for different purposes. In response to a stimulus, such
as being stretched (e.g. by hand, heat, placement on a joint
surface) the polymer stretches to accommodate to a new shape. After
placement in the joint, the polymer may return to its original or a
preferred shape and size. FIG. 65 shows that metal segments may
separate radially from one another as the implant is brought down
over a spherical femoral head, and stretched at the opening to
clear the equator of the head. The figure depicts rectangular
shaped segments, but the present invention can be comprised of
segments of other shapes, including but not limited to circular
(disc) shapes, squares, triangles, or any polyhedron with n-number
of sides. The size and spacing between such segments can vary.
[0289] FIG. 67 shows an acetabular component 870 with a segmented
metal backing having a plurality Of segments 872 attached to or
embedded with a polymer member. Segments are discontinuous with
slots or gaps 874 between segments to allow the implant to
collapse, expand, or otherwise change its shape. The gaps in the
figure are exaggerated to show how the polymer may stretch. The
implant is able to flex and bend due to the gaps between the metal
segments without putting undue stress or strain on the metal
components themselves. The metal segments may be continuous or may
have holes, pores, or slots. The implant or metal may transiently
bend during placement in a body or in a joint. The metal may
provide a bone'contact surface for attaching to a bone. The metal
may allow bone ingrowth.
[0290] In one aspect, a method of inserting an implant in a joint
of a body may include inserting a polymer-metal implant into a
joint space and changing a shape of the, implant from a first shape
to a second shape to conform to a shape of at least a portion of a
bone forming the joint. The method may include returning the
implant back to the first shape. The method may also include
deforming the implant prior to the changing step from an original
shape to a first shape. This may be useful, for example, to place
the implant in the joint (e.g. through arthroscopic or minimally
invasive surgery). For an implant configured to be placed on a
femoral head of a hip joint, deforming may include expanding at
least a portion of the implant to fit over the femoral head.
[0291] The various embodiments of the present invention arc
applicable to any joint in the body, including but not limited to
the hand, feet, digits (of the hands and feet), ankle,
intervertebral discs (cervical, thoracic, lumbar, or sacral),
intervertebral facets, hip, knee, shoulder, and temporomandibular
joint. The devices may be used with a, acromioclavicular joint,
ankle joint, condyle, elbow joint, finger joint, glenoid, hip
joint, intervertebral disc, intervertebral facet joint, labrum,
meniscus, metacarpal joint, metatarsal joint, patella, tibial
plateau, toe joint, temporomandibular joint, or wrist joint.
[0292] Any of the devices, features, materials, or methods
described herein may be combined with any other devices, feature,
material or method.
[0293] FIG. 68 shows a total hip cartilage and joint replacement
system with gradient polymer metal alloy cap-on-cup implants
according to one aspect of the disclosure. Both sides of the joint
as well as labral and capsule components arc replaced. The system
may include femoral implant 650 and acetabular component 652. The
bearing surfaces of the polymers on the two sides of the joint are
configured to mate to provide a smooth, lubricious artificial joint
interface. Lubricous IPN polymer 642 and lubricious IAN polymer 645
are respectively attached to metal bone interfacing members 646,
643 with porous metal backings which are in turn attached to femur
631 and acetabulum 644. The total replacement system may further
include an artificial labral component shown in superior cross
section 647a and inferior cross section 647b which may enclose
lubricant 649. The system may also include an artificial capsule as
shown in superior cross section 648a and inferior cross section
648b capsule components. A labral or capsule component may be made
of any strong material with a smooth surface to provide support,
stability, and/or lubriciousness to a joint. A labral or capsule
component may be made from any of the IPNs or semi-IPNs described
or referenced herein.
[0294] FIG. 69 shows another embodiment of a hip total cartilage
replacement system with an acetabular implant similar to the one
described in FIG. 68 and with an integrat