| Polymers have gained traction in the medical industry  due to their versatile properties. Since the medical  polymer market is expected to  witness sustained growth, key polymer manufacturers are showing interest to  invest to establish themselves as medical  polymer manufacturers. As per Nanomarkets, medical  polymers are widely used in three  major domains: implants  and devices; diagnostic systems; and hospital accessories such as pathological,  microbiological, and surgical, clinical labware. All of these  applications are predicted to see huge growth in terms of size and volume as  people across the world are willing to get better medical treatments.  Developments in polymer technology are triumphing over certain performance  limitations and facilitating these materials to fulfill the rigorous  prerequisites of this sector, especially for the implants and devices domain,  where the polymers need to be used inside the body. Pertaining to the physical  nature of the polymers, the medical polymer market is classified into two categories: plastic resins and fibers and  elastomers. They are also segmented into biostable/non-biodegradable or biodegradable.  Resins are liquid-soluble  polymers, while fibers appear in long elongated shapes.  Non-biodegradable medical fibers and resins are rigid plastics such as thermosets, thermally  remoldable, and thermoplastics. Thermoplastics are  largely used in the healthcare sector as they satisfy the challenging  property prerequisites of the medical industry. Additive like rheology modifiers, stabilizers, coloring  agent are added to further improve the mechanical properties of  plastics. While polymer processing is easier, the risk of additive or unreacted  monomer leaching during use needs to be addressed, especially for in-vivo  implantable devices. Better processability is required to minimize such side  effects, while utmost care must be taken for characterizing any biomaterial to  avoid the harmful tissue reaction. Elastomers are materials capable of withstanding large  deformations and regaining their original shape when the stress is removed,  thus showing a rubber-like elasticity. These materials exhibit a combination of  properties such as toughness, resilience, stretchability, and stiffness. Non-biodegradable elastomers  include natural rubber, silicon rubber, butyl rubber, polyurethanes, and  machined thermoplastic elastomers. In these materials, silicon rubber,  polyurethanes, and thermoplastic elastomers have found use in many medical  applications. Besides commodity polymers, new-age elastomers are increasingly used in the present  medical market. Commercial elastomers produced without physical or chemical  cross-links or vulcanization consist of more flexible molecular networks and  show both thermoplastic and elastomeric properties, thereby yielding a ‘soft  touch.’ The device industry coats accessories with these materials to impart a  soft touch feel. Their adoption is expected to increase in blood collection  devices, cardio systems¸ intravenous drug delivery systems owing to the fact  that engineered thermoplastic elastomers have high barrier properties in  addition to other benefits. Engineered polymers or copolymeric products  optimize the working efficiency of some of the aforementioned polymers by  imparting unique qualities advantageous for medical applications. This approach  facilitates imparting significant properties of individual polymer chains into  the final product. Sterlizability is another critical quality required for  polymers to be used in medical applications because of the necessity of  sterilizing all instruments and devices prior to their implantation into the  body. Engineered plastics and  thermoplastic elastomers are autoclavable and can be  sterilized by steam or radiation. However, the challenge is to make them stable  where repeatable sterilization cycles are used for different purposes, such as for labware products and  diagnostics. Biodegradable polymers are  significant to the paradigm shift from biostable polymers, especially for  enabling drug delivery in a controlled manner while leaving trace material  inside the body. It is predicted that entire prostheses will be produced from biodegradable polymers in the near future. Biodegradable polymers will be widely used in implants and  some clinical labware, but not in the production of diagnostic products. In  fact, biodegradable polymers coatings can be found in some commercially  available drug eluting stents. Leaching of small molecules during use is the  major drawback for biodegradable  polymers. Currently, natural polymers and degradable polymers earned the approval of regulatory bodies  like the FDA are predominant. Although there is more interest in  determining new biodegradable polymers for medical purpose, investment in this  field is limited because of the need to complete comprehensive long-term  studies for validating new materials.
 As per Strategic Business Insights, one of  the main reasons behind the increasing use of Engineering Polymers (EPs) in  medical devices is the quest by engineers to replace traditional materials such  as metals, ceramics, and glass with better materials. Some EPs have several  advantages over traditional materials, which can include weight,  biocompatibility and cost. Concerns in 2012 surrounding the wear and corrosion  of metal-on-metal (MoM)  hip implants have also led to a surge in the medical community's uptake  of implants containing EPs.
 EPs such as polyetheretherketone  (PEEK), polyetherimide, polyphenylsulfone and polysulfone saw first use  in experimental medical implants in the 1980s. Researchers then went on to  conduct in-depth clinical studies in the 1990s that helped characterize the  biocompatibility and in vivo stability of EPs. However, further progress was  impeded by the reluctance of polymer manufacturers to supply the health-care  market following a series of lawsuits against Dow Corning in the 1990s. These  lawsuits claimed that Dow Corning's silicone breast implants caused systematic  health problems and eventually resulted in Dow Corning's agreeing to a  multi-billion-dollar settlement for victims. To protect the chemical and  plastics industry from future lawsuits, the US government established the US  Biomaterials Assurance Act (BAAA) in 1998 and placed the burden of  responsibility for any device failure on the manufacturer, not the material  supplier. The BAAA's reassurances to suppliers meant that the number of EP  manufacturers seeking entry into the health-care market slowly grew in the next  decade. In 2007, Solvay provided a notable entry by a leading EP manufacturer  into the health-care market. Since then, the number of EP suppliers to follow  suit has risen significantly, partly because of the relative stability of the  health-care market, which has been sheltered from much of the impact of the  global economic crisis that began in 2008.
 Although the strategic maneuvering of suppliers is indicative of an increase in  demand for EPs, medical-device makers are the real driving force behind the  growth in this sector. One indicator of medical-device manufacturers' growing  interest in EPs is the rising number of US Food and Drug Administration (FDA)  510(k) clearances. FDA 510(k) clearances are necessary for companies  introducing new medical devices into the US market. In 2001, only one FDA  510(k) clearance with a PEEK polymer featured in the registered name of an  implantable device. Since 2001, the FDA has granted 97 such clearances, with  the past two years (2011–12) accounting for 33% of these clearances. One reason  why device manufacturers are looking for a shift from traditional materials to  EPs is that high-performance engineering polymers—such as PEEK—are less  expensive than medical-grade metals such as titanium. Many EPs also have  excellent chemical, thermal, and mechanical stability and are radiolucent,  making implants compatible with a range of medical-imaging tools. Devices made  from PEEK show the lowest wear rate of any counter metallic material. An FDA  enquiry in June 2012 called into question the safety and durability of MoM  implants and concluded that it sees little use for MoM implants, favoring a  greater use of ceramic and plastic alternatives in the future. Regulatory  warnings from the FDA surrounding MoM implants may also become a significant  contributory factor in future decision making about the type of material that  goes into medical implants.
 As per Strategic Business Insights, application of EPs in medical implants typically falls into three  categories:
 Spinal Implants : Device manufacturers use  high-performance engineering polymers in a variety of spinal implants,  including lumbar and cervical spacers. Surgeons typically use spacer units in  spinal-fusion operations, a process in which surgeons fuse two or more  vertebrae so that they can become a single strengthened unit - a procedure that  helps protect the sensitive nerves running alongside the spinal column. Lumbar  and cervical spacers typically contain a bone-graft material that, once  implanted, promotes bone healing and facilitates the fusion. Many of the screws  and rods that surgeons use to stabilize the spine further are also made of  high-performance polymers. The use of EPs in spinal implants offer numerous  advantages over the use of metals - such as titanium - including a similar  elasticity to that of bone, helping to reduce jarring during situations of  impact. Because of these advantages, the use of PEEK in spinal implants is  becoming commonplace, with the number of FDA 510(k) clearances accelerating  during 2012. Many of these clearances come from small start-up companies, such  as Nexxt Spine and SpineNet, that specialize in the manufacture of unique  cervical and lumbar spacers using Solvay's Zeniva PEEK.
 Cranial Injuries : The cranial-implant market is  dominated by a number of medical-device manufacturers, including Synthes, which  has been providing custom-fit cranial implants since 2004. The cranial implants  themselves have traditionally been made from metals - such as titanium - and  customized using patients' computed tomography data and computer-aided  design/computer-aided manufacturing. Manufacturers such as Synthes are now  starting to move away from the use of metal in preference for high-performance  EPs because of their lower cost and improved biocompatibility. Choice of  material is not the only aspect of implants that medical-device manufacturers  are changing. The means of manufacture is also changing, with 3D printing  seeing increasing use. In December 2011, the Custom IMD group, an EU–backed  initiative, designed and manufactured the first laser-sintered PEEK cranial implant.  Working in conjunction with EOS, the Custom IMD group used a unique sintering  system that operated at temperatures up to 385°C, necessary for processing  PEEK. One of the advantages of using 3D printing to manufacture these implants  is that surgeons can design implants to include highly complex structures. The  prototype designed by the Custom IMD group comprised a structured PEEK mesh  that was subsequently filled with a bioabsorbable polymer/ceramic hybrid material. The Custom IMD  group demonstrated that the combination of the mesh and the bioabsorbable  polymer allowed the gradual infiltration of a patient's own bone cells and  promoted natural bone growth. The demand for custom-made implants using  additive-manufacturing techniques is likely to increase as the capabilities of  3D printing continue to expand.
 Hip and Joint Replacements : Researchers  at the Fraunhofer Institute for Manufacturing and Automation in Stuttgart,  Germany, part of the EU-backed ENDURE (Enhanced Durability Resurfacing  Endoprosthesis) project, are currently working on the final design of a  prototype hip replacement.  The project's design comprises a hip socket made of carbon-fiber-reinforced  PEEK in combination with a ceramic femoral head. The prototype has several  distinct advantages over traditional hip replacements. Aside from being metal  free, the prototype hip replacement works with the natural shape of the joint  instead of removing large sections of the existing bone structure. In doing so,  the transmission of force through the PEEK hip socket to the pelvic bone is modeled on natural  conditions, thus avoiding any potential adverse bone adaptation. In a separate  study in September 2012, researchers at the University of Glasgow (Scotland)  published their findings about the use of PEEK in hip implants. In traditional  hip-replacement surgery, surgeons remove the head of the femoral bone and  replace it with an implant, which is held in place by a rod fixed inside the  marrow along the length of the bone. One of the problems associated with using  this technique with a metal rod is that stem cells in the bone marrow tend to  differentiate into soft tissue, leading to the loosening of the implant,  typically limiting the lifetime of the implant to about 20 years. The  researchers at Glasgow found that PEEK implants may potentially go some way to  solving this problem and creating an "implant for life."
 In collaboration with the University's James Watt Nanofabrication Centre, the  researchers at Glasgow produced a PEEK sample with nanopatterns of tiny holes—about  120 nanometers in diameter—along the surface. When they placed stem cells  on the surface of the PEEK sample, the stem cells diffused into the pores and,  unlike metal, preferentially differentiated into bone cells, creating a much  stronger bond between the PEEK and the surrounding tissue. The researchers  believe that this technique could apply to a wide range of joint replacements  and other orthopedic surgeries and are hoping to see a prototype ready for use  within a decade, as per Strategic Business Insights.  
The demand for EPs within the health-care market will be driven not only by  advances in manufacturing and new applications but also by the growing markets  of Asia: Japan, with its high-age population, will be a large target audience  for medical implants and devices, and China is set to become one of largest  marketplaces for medical devices and implants, driven by radical health-care  reform and a rapidly growing middle class able to afford implant surgeries.
 
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