Characteristics of metals used in implants.

The performance of any material in the human body is controlled by two sets of characteristics: biofunctionality and biocompatibility. With the wide range of materials available in the mid-1990s, it is relatively easy to satisfy the requirements for mechanical and physical functionality of implantable devices. Therefore, the selection of materials for medical applications is usually based on considerations of biocompatibility. When metals and alloys are considered, the susceptibility of the material to corrosion and the effect the corrosion has on the tissue are the central aspects of biocompatibility. Corrosion resistance of the currently used 316L stainless steel, cobalt-chromium, and titanium-based implant alloys relies on their passivation by a thin surface layer of oxide. Stainless steel is the least corrosion resistant, and it is used for temporary implants only. The titanium and Co-Cr alloys do not corrode in the body; however, metal ions slowly diffuse through the oxide layer and accumulate in the tissue. When a metal implant is placed in the human body, it becomes surrounded by a layer of fibrous tissue of a thickness that is proportional to the amount and toxicity of the dissolution products and to the amount of motion between the implant and the adjacent tissues. Pure titanium may elicit a minimal fibrous encapsulation under some conditions, whereas the proliferation of a fibrous layer as much as 2 mm thick is encountered with the use of stainless steel implants. Superior fracture and fatigue resistance have made metals the materials of choice for traditional load-bearing applications. In this review, the functionality of currently used metals and alloys is discussed with respect to stenting applications. In addition, the "shape memory" and "pseudo-elasticity" properties of Nitinol-an alloy that is being considered for the manufacturing of urologic stents-are described.