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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5361_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Aim and Scope
- •Preface
- •Acknowledgments
- •Contents
- •Contributors
- •About the Editors
- •1.1 Introduction
- •1.2.1 Friction
- •1.2.1.3 Friction Under Lubricated Conditions
- •1.7.1 Joint Tribology
- •1.7.2 Skin Tribology
- •1.7.3 Oral Tribology
- •1.8 Summary
- •References
- •2.1 Introduction
- •2.3.1 Fluid Pressurization/Fluid-Film Lubrication
- •2.3.2 Boundary Lubrication
- •2.3.3 Hydrodynamic Lubrication
- •2.3.4 Squeeze-Film Lubrication
- •2.3.5 Synovial Fluid
- •2.3.6 Hydration Lubrication
- •2.5.2 Scaffolds
- •2.5.3 Synthetic Polymer
- •2.5.4 Polyacrylamide
- •2.5.5 PEG Hydrogel
- •2.5.6 PVA Hydrogel
- •2.5.7 Double Network Hydrogel
- •2.5.8 Triple Network Hydrogel
- •2.6.1 Polyacrylamide
- •2.6.2 PEG Hydrogel
- •2.6.3 PVA Hydrogel
- •2.6.4 Double Network Hydrogel
- •2.6.5 Triple Network Hydrogel
- •2.7.1 Mechanical Properties
- •2.7.2 Structural Properties
- •2.8 Conclusion
- •References
- •3.1 Introduction
- •3.3.1 Label-Based Biosensors
- •3.3.2 Label-Free Biosensors
- •3.4 Different Nanobiosensing Techniques
- •3.4.1 Optical Sensing
- •3.4.2 Electrochemical/Electrical Sensing
- •3.4.3 Magnetic Sensing
- •3.4.4 Mass-Based Sensing
- •3.6.2 Neurodegenerative Diseases
- •3.6.3 Infectious Diseases
- •3.6.4 Metabolic Diseases
- •References
- •4.1 Introduction
- •4.2.1 Surface Functionalization
- •4.2.2 Bioconjugation
- •4.3 Synthesis Approach
- •4.3.1 Hydrothermal Method
- •4.3.2 Chemical Vapor Deposition (CVD)
- •4.3.3 Wet Chemical Method
- •4.4 Plasmonic Black Bodies (PBBs)
- •4.4.1 Gold NP (AuNPs)-Based PBB
- •4.4.2 Silver NPs (Ag NPs)-Based PBB
- •4.4.3 Platinum NPs (Pt NPs)-Based PBB
- •4.5 Biomimetic NP
- •4.6 Upconverting NP (UCNP)
- •4.6.1 Synthesis
- •4.7 Inorganic NP
- •4.7.1 Synthesis
- •4.8 Photothermal Therapy (PTT)
- •4.9 Conclusion
- •References
- •5.1 Introduction
- •5.2 Human Skin
- •5.10 Future Scope
- •5.11 Conclusion
- •References
- •6.1 Introduction
- •6.1.1 Class 1
- •6.1.2 Class 2
- •6.1.3 Class 3
- •6.4.1.1 Surface Patterning
- •6.4.1.2 Direct-Write Patterning
- •6.4.1.5 Dip-Pen Nanotechnology
- •6.4.1.7 Composing Using Beams
- •6.4.1.8 Direct Write Photolithography (DWP)
- •6.4.1.9 Light-Beam Lithography Electron
- •6.4.1.10 Focused Ion Beam Lithography
- •6.4.2 Fabrication Techniques
- •6.4.2.4 Non-invasive Glucose Monitoring Devices Technique
- •6.4.2.6 Cost-Effective Electrochemical Voltametric Sensors Techniques
- •6.4.2.7 Three-Dimensional (3D) Printing Techniques
- •6.4.2.8 UV-LED Stereolithography Printer Technique
- •6.4.2.9 4D Printing Techniques
- •6.4.2.10 Advanced Biomedical Techniques Involving Biorobots
- •References
- •7.1 Introduction
- •7.6 Mechanical Biocompatibility Challenges
- •7.7 Poor Bio-Printing Resolution
- •7.9 Limited Biomaterial Selection
- •7.11 Conclusion
- •8.2 Animal Tribology
- •8.2.1 Joint
- •8.2.3 Integumentary Change
- •References
- •8.1 Introduction
- •8.3.1 Nanotribology
- •8.4 Green Tribology
- •8.5 Conclusion
- •References
- •9.1 Introduction
- •9.2 Bio-Tribological Issues
- •9.3.2 Bone Fracture Fixation
- •9.3.4 Cardiovascular Devices
- •9.3.5 Minimal Invasive Surgical Devices
- •References
- •10.1 Introduction
- •10.2.2.1 Structural Integrity
- •10.2.2.2 Controlled Release Properties
- •10.2.2.3 Enhanced Drug Loading Capacity
- •10.2.2.4 Tailored Material Properties
- •10.2.3.1 Biocompatibility
- •10.2.3.3 Mechanical Properties
- •10.2.3.4 Drug Compatibility
- •10.2.3.5 Fabrication Compatibility
- •10.3.1 Matrix Material Properties
- •10.3.4 Biocompatibility Assessment
- •10.3.4.1 In Vitro Cell Culture Studies
- •10.3.4.2 Hemocompatibility Studies
- •10.3.4.3 In Vivo Animal Studies
- •10.3.4.4 Histological Analysis
- •10.3.4.5 Immune Response Evaluation
- •10.3.4.6 Biodegradation Assessment
- •10.4 Surface Engineering Considerations
- •10.4.2.1 Surface Coatings
- •10.4.2.2 Plasma Treatment
- •10.4.2.3 Surface Grafting
- •10.4.2.4 Dip Coating
- •10.4.2.5 Spray Coating System
- •10.4.2.6 Electrotreated Coating
- •10.4.2.9 Microfabrication Techniques
- •10.4.2.10 Surface Roughness Control
- •10.5.1.2 Mechanical Properties
- •10.5.1.3 Surface Characteristics
- •10.5.1.4 Release Kinetics Analysis
- •10.5.1.5 Biological Compatibility
- •10.5.1.7 Other Analyses
- •10.6 Advanced Fabrication Techniques
- •10.8 Conclusion
- •References
- •11.1 Introduction
- •11.2 Shape Memory Alloys (SMA)
- •11.3 Shape Memory Polymers
- •11.3.1 Heat
- •11.3.2 Light
- •11.3.3 Magnetic Field
- •11.4 Shape-Changing Hydrogels
- •11.5 Biomedical Applications
- •11.6 Conclusion
- •References
- •12.1 Introduction
- •12.3 Bioresorbable Orthopedic Implants
- •12.4.1 Polylactides
- •12.4.2 Poly (Ortho Esters)
- •12.4.3 Polyphosphoesters
- •12.4.4 Polyphosphazenes
- •12.4.5 Polycaprolactone
- •12.4.6 Polyurethanes
- •12.4.7 Polycarbonates
- •12.5.1 Compression Molding
- •12.5.2 Transfer Molding
- •12.5.3 Injection Molding
- •12.5.4 Extrusion
- •12.5.5 Blow Molding
- •12.5.6 Calendering Process
- •12.5.7 Fiber Spinning
- •12.5.8 Thermoforming
- •12.5.9 Polymer Foaming
- •12.7 Challenges
- •12.8 Conclusion
- •References
- •13.1 Introduction
- •13.3.1.1 Total Hip Replacement (THR)
- •13.3.2 Resurfacing Hip Replacement (RHR)
- •13.5.1 Adhesive Wear
- •13.5.2 Abrasive Wear
- •13.5.3 Fatigue Wear
- •13.5.4 Corrosion/Oxidative Wear
- •13.5.5 Surface Cracking
- •13.6.1 Metallic Implants
- •13.6.1.1 Stainless Steel
- •13.6.1.2 Co-Cr Alloys
- •13.6.1.3 Ti-Alloy
- •13.6.2 Ceramic Implants
- •13.6.3 Polymer Implants
- •13.6.4 Composite Implants
- •13.6.5.2 Surface Coatings
- •13.7.2.1 Hydrodynamic Lubrication
- •13.7.2.2 Boundary Lubrication
- •13.7.2.3 Elastohydrodynamic Lubrication
- •13.7.3 Biomimetic Lubrication Approaches
- •13.7.3.1 Replicating Natural Lubrication Mechanisms
- •13.7.4.1 Implant Wear
- •13.7.4.3 Synovial Fluid Degradation
- •13.8.1 Hydroxyapatite Coatings
- •13.8.1.1 Bone Integration
- •13.8.1.2 Implant Stability
- •13.8.1.4 Biocompatibility
- •13.8.2 Diamond-Like Carbon Coatings
- •13.8.3 Metal Nitride Coatings
- •13.8.4 Polymeric Coatings
- •13.8.5 Nanocomposite Coatings
- •13.9.1 Pin-on-Disk Testing
- •13.9.2 Hip Joint Simulators
- •13.9.3 Knee Joint Simulators
- •13.9.4 Tribo-Corrosion Testing
- •13.9.5 Wear Debris Analysis Techniques
- •13.9.5.1 Scanning Electron Microscopy (SEM)
- •13.9.5.2 Energy-Dispersive X-Ray Spectroscopy (EDS)
- •13.10.1.1 Tailored Geometries
- •13.10.1.2 Improved Wear Characteristics
- •13.10.1.3 Accelerated Innovation
- •13.10.2.1 Real-Time Wear Monitoring
- •13.10.2.2 Functionality Assessment
- •13.10.2.3 Implant Status Monitoring
- •13.10.2.4 Patient-Centric Healthcare
- •13.10.3.1 Advanced Biomaterials
- •13.10.3.4 Multidisciplinary Approaches
- •13.10.4.1 Wear Data Analysis
- •13.10.4.2 Predictive Wear Patterns
- •13.10.4.3 Early Intervention Strategies
- •13.10.4.4 Personalized Treatment Plans
- •13.11 Conclusion
- •References
- •14.1 Introduction
- •14.2.1 Powder Bed Fusion (PBF)
- •14.2.2 Directed Energy Deposition
- •14.3.1 Extrusion-Based AM
- •14.5 Biomanufacturing
- •14.5.1 Tissue Engineering
- •14.5.2 Organ-on-a-Chip Models
- •14.6 Conclusion
- •References
- •Index

Chapter 9
Medical Devices Tribology
NipunJain , YusufOlatunjiWaidi , SaswatChowdhury ,
RanjitBarua , SamirDas , ArbindPrasad , andSudiptoDatta
Abstract In this book chapter, we will discuss the signicance of tribology in vari-
ous surgical and medical devices and instruments like dental implants, contact
lenses, cardiovascular devices, surgical instruments, orthodontic and dental
implants, articial joints, and teeth. Also, we have briey discussed the present
condition and the future progress of these medical devices from the tribological
viewpoint, along with the fundamental mechanism.
Keywords Medical devices · Orthopedic · Dental implants · Surgical instrument ·
Contact lenses
9.1 Introduction
Medical appliances are used in everyday life for various reasons, including medical
care, injury healing, anatomical guidance, and biological functions. The worldwide
market has grown steadily, reaching $456.9 billion in 2019 [1]. Medical devices
N. Jain · Y. O. Waidi · S. Datta (*)
Department of Materials Engineering, Indian Institute of Science,
Bangalore, Karnataka, India
e-mail: nipunjain@iisc.ac.in; yusufwaidi@iisc.ac.in
S. Chowdhury
Department of Bioengineering, Indian Institute of Science, Bangalore, Karnataka, India
e-mail: saswatc@iisc.ac.in
R. Barua
Centre for Healthcare Science and Technology, Indian Institute of Engineering Science and
Technology, Howrah, West Bengal, India
S. Das
Biomaterials and Tissue Engineering Lab, School of Medical Science and Technology Indian
Institute of Technology, Kharagpur, West Bengal, India
A. Prasad
Mechanical Engineering Department, Katihar Engineering College (Under Department of
Science, Technology and Technical Education, Government of Bihar), Katihar, Bihar, India
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024
A. Kumar et al. (eds.), Applications of Biotribology in Biomedical Systems,
https://doi.org/10.1007/978-3-031-58327-8_9
235

236
N. Jain et al.
offer certain benets and help improve the quality of life. Nevertheless, they also
carry a substantial built-in risk; thus, safety and efcacy become priorities in design
consideration. Different interfaces are also created when these devices are utilized
in the body to carry out specic tasks.
Device failure occurs at these formed interfaces, such as excessive wear, loosening, or fretting. For this reason, the effectiveness of these depends on the way these
interfaces interact with one another. Tribology is the science that studies interacting
surfaces. Dowson and Wright rst coined the word “bio-tribology,” which has been
used to study the behavior and mechanism of interfaces in biological systems [2].
Many studies have been carried out to look at the bio-tribological behavior and
workings of medical devices.
In this article, we review current knowledge regarding the bio-tribology of medical devices from various perspectives and offer insightful data regarding the comprehension of bio-tribological conduct and function. Medical devices have a variety
of applications, and their underlying principles and working mechanisms differ
greatly. The tribological problems associated with widely used medical equipment
are outlined, and the latest developments in the eld are scrutinized. The difculties
and potential advancements for tribological effectiveness are emphasized.
9.2 Bio-Tribological Issues
Joint replacement is becoming more popular as the population ages and demands an
active lifestyle. A variety of devices have surfaced as a result of technological
advancements and an increase in clinical expertise [3]. Patients benet greatly from
joint replacement, but some hazards, such as tribological dysfunction, are also
involved. An articial joint normally has three different kinds of interfaces: articulating, modular, and xation (refer to Fig.9.1). In daily operations, articulating
interfaces offer simultaneous movement and bearing loads. Wear particles mostly
cause articial hip and knee joint revisions from sliding friction. One crucial reason
for a revision is aseptic loosening brought on by xation failure, which is
Fig. 9.1 Schematic of an
articial joint with three
different interfaces.
(Adapted from Zhang
etal. [1])

9 Medical Devices Tribology
237
particularly dangerous in younger patients [4]. A prosthetic hip joint with various
modular head and neck combinations has been studied to enhance biomechanical
functions and restore anatomical features. Nonetheless, physical accelerations frequently result in fretting corrosion, which leads to the breakdown of modular interfaces [5].
An orthopedic surgeon performing a “reduction” procedure is called upon to
rebuild the fractured bone. Several structures are employed in fracture xation.
Fracture-xing devices are commonly made of titanium alloys, cobalt-chromium
alloys, stainless steel, and NiTi shape-memory alloys [6]. Micro-action is created at
the interface between the screw and the bone plate, which encourages fretting wear.
Fatigue fracture frequently happens under cyclic loading. Micro-motion damages
the bone by hastening the formation of cracks. It may cause the synthetic effects of
corrosion and cause them to become unstable. Additionally, the wear debris and ion
release from bone plates can cause inammation and perhaps cancer-causing consequences [7]. The eld of dentistry is experiencing a surge in tribological investigations, driven by its rapid growth and advancements. This research delves into dental
materials’ frictional and wear behavior, which is crucial for ensuring their long-term
functionality. Dental restoration tribology itself encompasses two main areas: dental implant and tooth restoration tribology [8]. Tooth restoration materials face a
unique challenge; hence, they must exhibit optimal wear resistance. Ideally, they
should neither wear themselves excessively nor cause undue wear to their opposing
surfaces, whether natural teeth or other restorations (dental implants), presenting
distinct tribological concerns. The primary considerations are preventing modular
interface fretting corrosion and maintaining the bone-implant interface’s long-term
stability [8].
Cardiovascular diseases, the world’s leading non-communicable killer, have
seen tremendous therapeutic progress thanks to innovative devices like stents, heart
valves, and assist devices. However, these advancements are not without challenges
[9]. Tribological issues, particularly in mechanical heart valves and VADs, can trigger complications like hemolysis and thrombus formation, leading to device failure.
Moving parts cause wear and friction, while additional contact with blood introduces further friction at the interface. This interface requires careful design to minimize potential blood cell damage and ensure adequate clearance of blood products
[10]. Similarly, due to their inherent interaction with blood vessels, stents and catheters also fall under the purview of tribology. Catheters, for example, can damage
the vessel’s endothelium through unavoidable contact [11]. Addressing these tribological challenges is crucial for ensuring cardiovascular devices’ long-term success
and safety, ultimately improving patients’ lives suffering from these debilitating
diseases. While stenting can lead to tissue damage and unpredictable migration due
to imbalanced friction and hemodynamic forces, minimally invasive surgery (MIS)
procedures like endoscopic surgery have become increasingly prevalent, introducing a new set of tribological challenges. These include friction between needles and
endoscope-tissue interactions, device-tissue interactions, and soft tissue. These
friction-related challenges complicate precise positioning and force control during
MIS, impacting key factors like grasp, needle insertion, transmission hysteresis, and

238
haptic feedback [12]. While transmission hysteresis due to cam pulley or tendonsheath mechanisms falls outside bio-tribology, it’s important to acknowledge its
potential impact on surgical accuracy.
N. Jain et al.
9.3 Research Advances intheBio-Tribology
9.3.1 Articial Joints
Although wear resistance and friction coefcient are crucial for the long-term survival of articial joints, improper tribological design leading to excessive wear and
aseptic loosening poses the greatest threat to their performance and effectiveness
[13]. Optimizing the articulating surfaces’ tribological properties has become a key
focus in bio-tribology research. Two main material combinations are employed:
hard-on-hard and soft-on-hard. The exceptional combination of impact resistance
and tensile strength exhibited by Ultra-high molecular weight polyethylene
(UHMWPE) and its modied forms renders them the material of choice for “soft”
components with demanding mechanical requirements. At the same time, the “hard”
counterpart often comprises titanium alloys, stainless steel, cobalt-chromium alloys,
zirconia-toughened alumina composite ceramics (ZTA) or zirconia, and alumina.
However, UHMWPE’s softness is the primary cause of wear and debris, as evidenced by normal wear characteristics in retrieved acetabular cups [14].
Consequently, extensive research has been dedicated to enhancing UHMWPE’s
wear resistance, with recent advancements like highly cross-linked UHMWPE
showing signicant promise. Notably, irradiated UHMWPE exhibits a substantial
decrease in wear rate with increasing cross-linking gamma irradiation [15]. While
hard-on-hard pairings (metal-on-metal and ceramic-on-ceramic) hold promise for
articial joints, their durability presents distinct challenges. Thanks to effective
lubrication, metal-on-metal boasts impressive initial wear rates under ideal conditions. However, its vulnerability to lm breakdown under stress drastically increases
wear, raising concerns about its long-term viability and contributing to its clinical
decline. Ceramic-on-ceramic’s superior hardness and scratch resistance, leading to
sustained low wear, have driven its wider clinical adoption, particularly in knee
replacements [16]. However, further research is needed to ensure the long-term
durability of surface coatings used on metallic counter-faces, as their potential
impact on soft surfaces remains unclear. Polyether-ether-ketone (PEEK) boasts
impressive biocompatibility, radiation permeability, and enhanced wear resistance
via carbon or glass ber reinforcement (CFR-PEEK, GFR-PEEK) [17]. However,
the clinical benets of traditional total hip designs remain elusive compared to
established alternatives like HXLPE or ceramic liners. The emergence of Ultra-lowwear polyethylene (ULWPE), with its superior wear properties due to its highly
linear structure and narrow molecular weight distribution, further challenges
PEEK’s dominance in the eld. Fixation methods for articial joints primarily rely

9 Medical Devices Tribology
239
on bone cement or biological approaches. Additionally, Joint replacement surgery
relies on two main methods to secure the prosthesis: cementless and cemented xation. In cemented xation, the prosthesis is “glued” directly to the bone using quickdrying bone cement. In contrast, cementless xation relies on press-tting, specially
textured or porous prostheses that encourage bone ingrowth over time. The optimal
approach has been debated for decades. While cementless xation offers the theoretical advantage of long-term biological integration, where host bone grows into
the prosthesis, it requires precise t. It can be impacted by excessive micro- motion,
which hinders bone growth and weakens the bond [18]. Ultimately, the success of
both methods hinges on a balance between micro-motion that allows bone formation and excessive motion that leads to instability and failure.
9.3.2 Bone Fracture Fixation
On the surface where screws and bone plates connect, corrosion and abrasion commonly appear. The mechanical and tribological properties of Ti6Al4V were examined in research by Bartolomeu etal. using various processing techniques, including
standard casting, SLM, and hot pressing [19]. Due to a very diverse microstructure,
their research showed that SLM produced the best toughness and wear resistance
levels. Proteins and reactive oxygen species are among the many living elements in
the invivo milieu of bone complex dish surfaces. Zhang etal.’s study examined
Ti6Al4V’s corrosion behavior in physiological saline, emphasizing the effects of
albumin and H2O2 [20]. According to their ndings, albumin greatly speeds up corrosion over a longer time (120h) but rst prevents dissolving over brief periods
(less than 24h). This phenomenon is associated with a thinner oxide coating that
results from the erosion-producing coating dissolving under the action of albumin.
The slipping frictional behaviors of bovine cortical bone and Ti–6Al–4 V plates
were studied in a range of bio-lubricants, such as physical saline, simulated bodily
uids, and fetal bovine serum [21]. It was observed that the friction pair with the
highest wear rate and friction coefcient was lubricated with fetal bovine serum.
Bio-lubricants caused corrosion wear, which increased the rate at which bones wore
out at greater sliding velocities and normal loads. Attabi etal. examined the tribological behavior of Ti6Al4V alloy treated with ion nitriding in different research
[22]. They found notable improvements in microhardness and a decreased coefcient of friction. The wear behavior of TiO2 nanotube-coated Ti6Al4V bone plates
was studied by Wang etal. Their ndings showed a reduction in wear volume and
friction coefcient, which they attributed to better lubrication by increased hydrophilicity and decreased elasticity [23]. More recently, topology optimization was
used by Al-Tamimi etal. to enhance the xation plate’s mechanical, biological, and
tribological performance. Their results demonstrated a respectable level of wear
resistance and a signicant improvement in biological function [7].

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N. Jain et al.
9.3.3 Dental Restoration andImplants
Chewing exposes the teeth to a great deal of wear and tear. Therefore, a dental
replacement material’s wear resistance is crucial. Various materials have been
employed for tooth restoration, including polymers, ceramics, metals, and alloys
[24]. Because dental restorations must consider aesthetics, the value of the metal
and its alloys has declined over time due to its unappealing hue. Amalgam llings
are utilized as dental repair materials in very small quantities. Dental implants and
orthodontic equipment are the primary uses for the bulk of metal and alloy dental
materials. While polymeric materials are also utilized for dental restorations, they
frequently exhibit poor gloss retention and a high wear rate [25]. The crystalline and
glassy phases that make up dental ceramics are closely connected regarding their
mechanical and tribological characteristics. Dental ceramics offer superior wear
resistance in addition to a look that is similar to that of natural teeth. This makes
them a popular choice for repair ingredients [26]. One of the drawbacks of ceramics
is that they might break easily, which could lead to the restoration failing. Dental
ceramics have a stronger wear resistance than natural teeth, which can lead to signicant wear on the opposite natural tooth’s occlusal surface.
Organic ller materials (like alumina, zirconia, quartz, borosilicate glass, etc.)
are mixed with organic monomers (like Bisphenol Bis-GMA, 2-hydroxyethyl methacrylate, A-glycidyl methacrylate, TEGDMA, HEMA, Urethane dimethacrylate,
and Bis-EMA, ethoxylated bisphenol A-dimethacrylate) in resin-based dental composites [27]. As such, materials are often used to repair decaying tooth tissues and
x cavities because they closely resemble the properties of genuine teeth. Instead of
dental ceramics, composite-based materials may be applied directly, signicantly
increasing clinical competence [28]. Initial resin composites show a high wear rate
because of the big ller particles they contain. The introduction of micro/nanohybrid composites has greatly increased the wear resistance [29]. The wear behavior of a composite based on Bis-GMA/TEGDMA with varying weight fractions of
silane-treated micro zirconia particles was examined by Kumar etal. Their dental
composite, lled with 3-weight percent nano zirconia ller, demonstrated exceptional wear resistance, minimal wear rate, and maximum hardness compared to conventional dental composites [30]. Chadda etal. examined the wear behavior and
fracture toughness of hydroxyapatite and silica/hydroxyapatite-lled Bis-GMA/
TEGDMA composite. The composites with the lowest ller content (20wt%) show
the best wear resistance and increased fracture toughness, whereas those with a
ller level ranging from 30 to 40wt% show the best wear resistance [31]. Materials
with polymer-inltrated ceramic networks (PICNs) offer superior wear resistance
and improved mechanical qualities. The wear behavior and mechanism of a PICN
material (commercial ENAMIC) were examined by Xu etal. They discovered that
whereas the ENAMIC and tooth enamel have comparable Vickers hardness, they
differ in Young’s moduli [32]. Moreover, the ENAMIC has less wear resistance than
tooth enamel yet displays a comparable wear damage mode. The impact of acidic
substances on the wear behavior of a PICN material (Vita Enamic, Vita Zahnfabrik,

9 Medical Devices Tribology
Fig. 9.2 Dental restoration implants. (a) A diagrammatic illustration of human teeth. (b) An
actual image of dental restoration implant assembly. (Adapted from Armentia etal. [34])
241
Bad Sackingen, Germany) was investigated by Yu etal. While acid erosion had a
notable impact on the PICN’s early wear behavior, it did not appear to have any
discernible inuence on the wear property over the long run [33].
A strong base for permanent or removable replacement teeth that mimic natural
teeth is provided by implants [34]. Dental implants have several benets, including
improved aesthetics, increased durability, and ease of use (Fig.9.2). Even with these
advantages, there are also cases of clinical failure. Potential reasons include interface fretting and corrosion [35], which can directly affect bone ingrowth during the
rst phase of implant placement and the long-term survival of dental implants.
Mastication pressures cause fretting at the dental implant/bone contact, and for
osseointegration to be effective, the implant’s micro-motion amplitude must be kept
below a certain threshold. Micro-motions between 50 and 150μm for stability are
the ideal range [36]. As implantation technology develops, customized thresholds
impacted by surface treatment, implant materials, and superstructure design will be
expected to replace the traditional upper limit for micromotion amplitude. Various
alloying elements have been investigated to advance the tribological characteristics
of CP-Ti; titanium alloys with β and near-β showing promise are among them. Other
surface alterations have also been used, including anodic oxidation, sandblasting,
plasma-spraying, and etching [37]. Following sandblasting and acid etching (SLA),
ultrane-grain pure titanium (UFG-Ti) has a surface with a hierarchical porous
structure that offers good wettability. Ti-6Al-4V with PEEK covering has improved
wear resistance and biocompatibility [38]. Porous materials, such as porous titanium and porous tantalum, have been introduced for dental implants. For long-term
stability, porosity increases the coefcient of friction between implants and the surrounding tissues, which promotes osseointegration and bone ingrowth [39]. The
pores’ size, shape, and porosity strongly impact the tight integration of the implant
and growing bone tissue. Earlier bone ingrowth and added constant bone addition

242
N. Jain et al.
are encouraged by porous tantalum, which has been modied on the surface to
increase biocompatibility [40].
Various investigations are also available where bioresorbable composites were
used for orthopedic implants such as cancellous screws, cortical screws, staples and
pins [41–50]. Bioresorbable implants have a lot of advantages over metallic implants
[46, 51–54]. The patient does not need to visit the doctor for the removal of the
metallic implants after bone healing. Resorbable-based polymeric implants are
nowadays used in various biomedical applications [55–57].
9.3.4 Cardiovascular Devices
Concerns about wear and friction, especially at the hinge area of titling-disc and
bileaet valves and between the ball and cage in cage-ball valves, have led to much
research on mechanical heart valves. Valve failure may result from strut fracture or
leaet escape due to excessive wear. As documented by Zhang etal., a low-prole
bileaet prosthesis experienced leaet escape due to severe wear at the leaet outow edge [58].
Ventricular assist devices (VADs) support heart function and come in pulsatile
and rotary pump designs, utilizing different bearing systems like rolling elements,
pivot, and journal bearings [59]. While rolling element bearings don’t directly contact blood, friction heat can induce hemolysis in sealed ball-bearing systems.
Additionally, shaft seals are necessary to prevent blood from entering bearing voids,
preventing bearing seizure.
Although uid shear stress can cause hemolysis, pivot bearings immersed in
blood depend on boundary lubrication and need a signicant blood uid layer for
washout [60]. Journal bearings are less prone to wear, but they frequently require
extra thrust bearings, which increases complexity. Using a blood saline solution in
journal bearings is a typical x that calls for a reservoir and a ow cycling line.
Nevertheless, using blood as the bearing uid carries a risk of coagulation-related
pump seizure. Sundareswaran etal. determined the ball bearing wear rate to be less
than 1.46μm/yr using a surface prolometer [59].
In their investigation on apical aortic blood pumps, Da Silva etal. discovered that
bearing component wear reduction is essential for durability [61]. Their testing
demonstrated a direct correlation between load and wear at this pivot point, with
wear at the lower bearing pivot being the primary cause of device failure. The friction that occurs during stent installation is important between blood arteries and
stents [62]. Because re-endothelized tissue frequently malfunctions and raises the
likelihood of in-stent thrombosis and restenosis, endothelial damage during this
process leads to restenosis-related failures [63]. Blood uid friction has been connected to stent migration and corrosion after placement. Friction between porcine
aorta and aortic stent-grafts was investigated by Chen etal., along with the use of
polyvinyl alcohol (PVA) and polydimethylsiloxane (PDMS) cryogels [64].

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9.3.5 Minimal Invasive Surgical Devices
Traditional surgeries generally depend on accessing the open wound created through
a planned incision, which often leads to certain postoperative complications, such as
granular tissue formation and longer healing periods [65]. Minimally invasive surgery (MIS) minimizes some of these complications, increasing patient compliance
and quality of life. This involves inserting the endoscopy lens and surgery accessories at the target site. This set of systems helps perform critical tasks through exterior surroundings without directly accessing the interior system. In contrast to
conventional “open” surgeries, minimally invasive surgical techniques offer certain
clinical advantages, such as limited tissue disruption, lower pain, and improved
healing and recovery [66]. Moreover, it offers reduced hospitalization times and
remains economically viable. However, some shortcomings are associated with it,
such as minimal dexterity, absence of 3D imaging modalities, and minimal design
parameters, subsequently leading to improper feedback from the operated tissue
site [67].
Clinicians routinely perform medical endoscopy due to the multiple associated
benets, such as minimal pain and faster recovery. In a typical endoscopic procedure, the instrument itself may lead to compression, tension, and other mechanical
damage, which causes great pain and triggers a cascade of anomalies. Therefore,
more focused research on the tool-tissue interface becomes particularly relevant.
During gastrointestinal endoscopy, the endoscope is inserted into the GI tract. As it
advances, it can result in many negative repercussions, such as throat congestion,
bleeding, sub-mucosal tearing, etc. [68]. All of these are caused by the tribological
effects of repeated insertion, rotation, pushing, and retrieval procedures. The rst
study reported on collapsed GI tract surgery was in the early 2000s. The friction
coefcient at the interface of the endoscope increases proportionally with the speed
and can be measured by a viscoelastic model [69]. The challenge of performing
experimental investigations is evident because of the inated cost and ethical considerations. The complex anatomy of the digestive tract in humans has aided in the
development of endoscopy. The digestive tract has altered diameters, wall thickness, and lengths at different locations, from the esophagus to the large intestine.
The microbiota of the digestive tract also exerts additional frictional forces that have
been proven experimentally, the data of which can help in considering the safetyrelated parameters during gastrointestinal endoscopic interventions.
Laparoscopy, i.e., MIS in the abdomen, involves relatively small cuts in the
abdominal region. The endoscopic advancements aid the clinician with visual input
and organ control. The design of the instruments provides a handle, tip, and a rigid
shaft, which allows the surgeon to perform axial sliding, rotation, and pivoting in
two perpendicular planes. This fulcrum inuence signicantly reduces exibility
and connes the surgeon mostly to the frontal or sideway tissue. The Laparoscopic
graspers are often used for tissue interactions, such as clamping, gripping, and dragging. Tissue damage is almost inevitable in these cases due to the associated friction
at the tool-tissue interface. Also, there is increased pressure build-up during the

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withdrawal of the laparoscopic graspers, which remains a primary reason for excessive injury in a typical laparoscopic procedure. Studies suggest that such trauma
caused by a pressure build-up has a 2–4% higher risk of injury to the bile duct,
bowel, and vascular structures than in traditional surgical procedures [70]. It was
also hinged that 66% of tissue-related damage during laparoscopic intervention was
attributed to grasping action.
Another class of MISDs is vascular stents, where tribology is crucial both during
the delivery and post-delivery stage. Predominantly, the stent should not drive an
extensive tissue injury due to friction and does not migrate and get washed downstream by the owing blood [71]. Stent migration can be reduced by studying different forces involved in the stent-tissue interaction, i.e., time-dependent blood ow,
normal force that the vessel exerts on the stent strut structure, and friction force.
One of them is to increase the normal force by oversizing the stent, which can exert
more strain on the vessel [62]. Alternative options for the same are by increasing the
contact area of the stent with the vessel wall, either by broadening the contact area
between struts or by introducing additional struts. (Fig.9.3). There is a chance to
raise the friction coefcients, and tribology becomes relevant as stents are intended
to remain static after being progressively inated [72]. The primary elements inuencing the interaction are the chemical and physical characteristics such as Van der
Waals forces, capillary forces, and electrostatic interactions.
The other related MISD is a catheter that enables the insertion of stents into constricted vessels and contributes to tribological contexts. A typical vascular surgery
also uses guidewires to push the catheter and guide it to the deployment site.
Lubrication becomes important as the catheters must adjust according to the vessel,
and a low-friction material is more helpful.
9.4 Current Challenges andFuture Work
Tribological problems with biomechanical, electrochemical, and tribological interactions are common in fracture xation components. Because of its intricacy, the
coupling mechanism in the invivo environment is yet unknown. Although material
mechanical and tribological performance has been effectively improved through
invitro research, more thought must be given to fracture structures invivo biomechanical settings. Porous materials encourage bone ingrowth and cell adhesion and
have a greater coefcient of friction. Nevertheless, further research is needed to
optimize bone ingrowth and osseointegration by surface modication and changes
to porous structure design (porosity, pore size, etc.). Further investigation is necessary to understand fully how oral microbial habitats affect porous implants. Although
research on dental materials invitro mostly focuses on their wear characteristics, it
is still unclear how long-term invivo wear occurs. The scarcity of knowledge on
material wear processes may hamper dental material development.
Studying the bio-tribology of cardiovascular devices is crucial for enhancing
performance and reliability. Future advancements should focus on creating
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