Insufficient glenoid fixation is one of the main reasons for failure in total shoulder arthroplasty. This is predominantly caused by the inert nature of the ultra-high molecular weight polyethylene (UHMWPE) used in the glenoid component of the implant, which makes it difficult to adhesively bind to bone cement or bone. Previous studies have shown that this adhesion can be ameliorated by changing the surface chemistry using plasma technology. An atmospheric pressure plasma jet is used to treat UHMWPE substrates and to modify their surface chemistry. The modifications are investigated using several surface analysis techniques. The adhesion with bone cement is assessed using pull-out tests while osteoblast adhesion and proliferation is also tested making use of several cell viability assays. Additionally, the treated samples are put in simulated body fluid and the resulting calcium phosphate (CaP) deposition is evaluated as a measure of the in vitro bioactivity of the samples. The results show that the plasma modifications result in incorporation of oxygen in the surface, which leads to a significant improved adhesion to bone cement, an enhanced osteoblast proliferation and a more pronounced CaP deposition. The plasma-treated surfaces are therefore promising to act as a shoulder implant.

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Non-thermal plasma technology is one of those techniques that suffer relatively little from diffusion limits, slow kinetics, and complex geometries compared to more traditional liquid-based chemical surface modification techniques. Combined with a lack of solvents , preservation of the bulk properties, and fast treatment times; it is a well-liked technique for the treatment of materials for biomedical applications. In this book chapter, a review will be given on what the scientific community determined to be essential to obtain appropriate scaffolds for tissue engineering and how plasma scientists have used non-thermal plasma technology to accomplish this. A distinction will be made depending on the scaffold fabrication technique, as each technique has its own set of specific problems that need to be tackled. Fabrication techniques will include traditional fabrication methods, rapid prototyping, and electrospinning. As for the different plasma techniques, both plasma activation and grafting/polymerization will be included in the review and linked to the in-vitro/in-vivo response to these treatments. The literature review itself is preceded by a more general overview on cell communication, giving useful insights on how surface modification strategies should be developed.