1. The Development of Metallic Biomaterials Roger J Narayan MD PhD Associate Professor, North Carolina State University and the University of North Carolina

2. Abstract Man’s intrinsic desire to be active propelled the development of biomaterials. Hip joint replacement surgery is of the most revolutionary advances in modern orthopaedic surgery, which both relieves pain and improves function. The development of metallic biomaterials has emerged as the result of a process of evolution in a Darwinian manner. By the middle of the nineteenth century, physicians began performing systematic studies in order to better understand tissue-metal interaction. Unfortunately, the development of metallic biomaterials was limited by a lack of knowledge about durable and biocompatible materials. This historical review illustrates how surgeon- scientists who used off-the-shelf metallic biomaterials to treat their patients. The modern field of biomaterials science owes a great deal to these pioneering surgeons.

3. Hip Joint http://www2.ma.psu.edu/~pt/384hipj2.gif

4. Common Reasons for Hip Replacement Condition Incidence osteoarthritis 60 percent fracture-dislocations11 percent rheumatoid arthritis7 percent aseptic bone necrosis7 percent revision of previous hip operations6 percent

5. Bone replacement criteria include the following: 1. Appropriate tissue-material interface 2. Non-toxic 3. Non-corrosive 4. Adequate fatigue life 5. Proper design 6. Proper density 7. Relatively inexpensive 8. Elastic and mechanical properties comparable to those of bone

6. Early history http://www.ibiblio.org/wm/paint/auth/bruegel/beggars.jpg

7. John Rhea Barton from page 2, Raymond G. Tronzo, Surgery of the Hip Joint, Lea and Febiger, Philadelphia, 1973.

8. John Rhea Barton’s patient from page 2, Raymond G. Tronzo, Surgery of the Hip Joint, Lea and Febiger, Philadelphia, 1973.

9. Joseph Lister http://history.amedd.army.mil/booksdocs /misc/evprev/fig23.jpg

10. Hey-Groves examined use of metals to immobilize fractures in a cat model from page 4, Charles O. Bechtol, A. B. Ferguson, and Patrick G. Laing, Metals and Engineering in Bone and Joint Surgery, Williams and Wilkins Company, Baltimore, 1959.

11. Sherman observed failure of metal plates from page 5, Charles O. Bechtol, A. B. Ferguson, and Patrick G. Laing, Metals and Engineering in Bone and Joint Surgery, Williams and Wilkins Company, Baltimore, 1959.

12. Zierold showed cobalt-chromium alloy superior to high carbon steel from page 8, Charles O. Bechtol, A. B. Ferguson, and Patrick G. Laing, Metals and Engineering in Bone and Joint Surgery, Williams and Wilkins Company, Baltimore, 1959.

13. Mold arthroplasty using glass, Viscaloid, Pyrex, Bakelite, and Vitallium from page 201, P. G. Laing, Clinical Experience with Prosthetic Materials: Historical Perspectives, Current Problems, and Future Directions, in Corrosion and Degradation of Implant Materials ASTM STP 684, ASTM, West Conshohocken, 1979.

14. Early Moore Prostheses from page 14, Raymond G. Tronzo, Surgery of the Hip Joint, Lea and Febiger, Philadelphia, 1973.

15. Judet Prosthesis news.bbc.co.uk/2/low/in_pictures/4949528.stm

16. John Charnley from page 15, Raymond G. Tronzo, Surgery of the Hip Joint, Lea and Febiger, Philadelphia, 1973.

17. John Charnley news.bbc.co.uk/2/low/in_pictures/4949528.stm

18. Charnley Prosthesis news.bbc.co.uk/2/low/in_pictures/4949528.stm

19. Today, there are many new frontiers in biomaterials engineering, including: 1. Porous Coatings 2. Bioactive Ceramics 3. Bulk Metallic Glasses 4. Tissue Engineering

20. Conclusions The development of metallic biomaterials has emerged as the result of a process of evolution. By the middle of the nineteenth century, physicians began performing systematic studies in order to better understand tissue-metal interaction. Surgeon-scientists originally used off-the-shelf metallic biomaterials to treat their patients. The modern field of biomaterials science owes a great deal to these pioneering surgeons.