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One of the biggest challenges in the biocompatibility of implantable metals is the prevention of the stress shielding effect, which is related to the coupling of the bone-metal mechanical properties. This stress shielding phenomenon provokes bone resorption and the consequent adverse effects on prosthesis fixation. However, it can be inhibited by adapting the stiffness of the implant material. Since the use of titanium (Ti) porous structures is a great alternative not only to inhibit this effect but also to improve the osteointegration of orthopedic and dental implants, a brief description of the techniques used for their manufacturing and a review of the current commercialized implants produced from porous Ti assemblies are compiled in this work. As powder metallurgy (PM) with space holder (SH) is a powerful technology used to produce porous Ti structures, it is here discussed its potential for the fabrication of medical devices from the perspectives of both design and manufacture. The most important parameters of the technique such as the size and shape of the initial metallic particles, the SH and binder type of materials, the compaction pressure of the green form, and in the sintering stage, the temperature, atmosphere, and time are reviewed according to the bibliography reported. Furthermore, the importance of the porosity and its types together with the influence of the mentioned parameters in the final porosity and, consequently, in the ultimate mechanical properties of the structure are discussed. Finally, a few examples of the PM-SH application for the manufacturing of orthopedic implants are presented.

Surface modification stands out as a versatile technique to create instructive biomaterials that are able to actively direct stem cell fate. Chemical functionalization of titanium has been used in this work to stimulate the differentiation of human mesenchymal stem cells (hMSCs) into the osteoblastic lineage, by covalently anchoring a synthetic double-branched molecule (PTF) to the metal that allows a finely controlled presentation of peptidic motifs. In detail, the effect of the RGD adhesive peptide and its synergy motif PHSRN is studied, comparing a random distribution of the two peptides with the chemically-tailored disposition within the custom made synthetic platform, which mimics the interspacing between the motifs observed in fibronectin. Contact angle measurement and XPS analysis are used to prove the efficiency of functionalization. We demonstrate that, by rationally designing ligands, stem cell response can be efficiently guided towards the osteogenic phenotype: In vitro, PTF-functionalized surfaces support hMSCs adhesion, with higher cell area and formation of focal contacts, expression of the integrin receptor α5β1 and the osteogenic marker Runx2, and deposition a highly mineralized matrix, reaching values of mineralization comparable to fibronectin. Our strategy is also demonstrated to be efficient in promoting new bone growth in vivo in a rat calvarial defect. These results highlight the efficacy of chemical control over the presentation of bioactive peptides; such systems may be used to engineer bioactive surfaces with improved osseointegrative properties, or can be easily tuned to generate multi-functional coatings requiring a tailored disposition of the peptidic motifs. Statement of significance Organic coatings have been proposed as a solution to foster osseointegration of orthopedic implants. Among them, extracellular matrix-derived peptide motifs are an interesting biomimetic strategy to harness cell-surface interactions. Nonetheless, the combination of multiple peptide motifs in a controlled manner is essential to achieve receptor specificity and fully exploit the potentiality of synthetic peptides. Herein, we covalently graft to titanium a double branched molecule to guide stem cell fate in vitro and generate an osseoinductive titanium surface in vivo. Such synthetic ligand allows for the simultaneous presentation of two bioactive motifs, thus is ideal to test the effect of synergic sequences, such as RGD and PHSRN, and is a clear example of the versatility and feasibility of rationally designed biomolecules.

According to a study of the European Commission, approximately one million hips are replaced by prostheses worldwide every year. The interaction of the human body with foreign materials that are subjected to alternating mechanical load in a highly corrosive environment still provides challenges. The main factors affecting prosthesis failure are stress shielding effect and poor osseointegration. In this thesis the problem of prosthesis failure has been approached from the material and from the osseointegration point of view trying to give a global solution to the problem. Niobium and hafnium, which are demonstrated to be totally biocompatible, were used to design a Ti-based alloy. The effect of the alloying elements regarding microstructure and elastic modulus was studied and the best composition was deeply characterized in terms of microstructure, elastic modulus, corrosion resistance and superficial energy. Recombinant fragments of fibronectin were synthesised spanning the cell attachment site and the heparin binding domain which are important for cell viability. These motifs were used to functionalise the surface of the TiNbHf alloy. Two tethering methods were studied: physisorption and silanisation. Silanisation was not used before to immobilise fibronectin recombinant fragments onto metallic substrates and in this thesis, its good performance was demonstrated. In vitro studies were made with each fragment and with different combinations of the fragments, which showed the importance of the heparin binding domain to obtain a cell response equivalent to that of fibronectin in terms of cell adhesion, proliferation and differentiation., De acuerdo con un estudio de la Comisión Europea, aproximadamente un millón de caderas son remplazadas por prótesis en el mundo anualmente. La interacción del cuerpo humano con materiales externos sujetos a una carga mecánica alternante en un medio altamente corrosivo todavía presenta ciertos desafíos. Los factores que contribuyen principalmente al fallo de una prótesis son el apantallamiento de cargas y la pobre osteointegracion. En la presente tesis el problema de la fallida de prótesis ha sido abordado desde el punto de vista del material y de la osteointegracion en un intento de dar una solución global al problema. El niobio y el hafnio, cuya total biocompatibilidad ha sido demostrada, se han utilizado para diseñar una aleación de titanio. El efecto de dichos aleantes respecto a la microestructura y el módulo elástico ha sido estudiado y la mejor composición ha sido profundamente caracterizada en términos de microestructura, módulo elástico, resistencia a la corrosión y energía superficial. Fragmentos recombinados de fibronectina han sido sintetizados abarcando la zona de adhesión celular y la unión de heparina, las cuales son esenciales para la viabilidad celular. Dichos motivos han sido utilizados para funcionalizar la superficie de la aleación TiNbHf. Dos métodos de unión diferentes han sido estudiados: fisisorción y silanización. La silanización es un método que no se ha utilizado hasta el momento para inmovilizar fragmentos de fibronectina sobre superficies metálicas y en la presente tesis su idoneidad ha sido demostrada. Finalmente, estudios celulares in vitro se han llevado a cabo con cada fragmento y con diferentes combinaciones de ambos, lo cual ha mostrado la importancia de la zona de unión de heparina para obtener una respuesta celular equivalente a la obtenida con la molécula de fibronectina en cuanto a adhesión celular, proliferación y diferenciación.