Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review
Background
Total joint replacements are an established treatment for patients suffering from reduced mobility and pain due to severe joint damage. Aseptic loosening due to stress shielding is currently one of the main reasons for revision surgery. As this phenomenon is related to a mismatch in mechanical properties between implant and bone, stiffness reduction of implants has been of major interest in new implant designs. Facilitated by modern additive manufacturing technologies, the introduction of porosity into implant materials has been shown to enable significant stiffness reduction; however, whether these devices mitigate stress-shielding associated complications or device failure remains poorly understood.
Methods
In this systematic review, a broad literature search was conducted in six databases (Scopus, Web of Science, Medline, Embase, Compendex, and Inspec) aiming to identify current design approaches to target stress shielding through controlled porous structures. The search keywords included ‘lattice,’ ‘implant,’ ‘additive manufacturing,’ and ‘stress shielding.’
Results
After the screening of 2530 articles, a total of 46 studies were included in this review. Studies focusing on hip, knee, and shoulder replacements were found. Three porous design strategies were identified, specifically uniform, graded, and optimized designs. The latter included personalized design approaches targeting stress shielding based on patient-specific data. All studies reported a reduction of stress shielding achieved by the presented design.
Conclusion
Not all studies used quantitative measures to describe the improvements, and the main stress shielding measures chosen varied between studies. However, due to the nature of the optimization approaches, optimized designs were found to be the most promising. Besides the stiffness reduction, other factors such as mechanical strength can be considered in the design on a patient-specific level. While it was found that controlled porous designs are overall promising to reduce stress shielding, further research and clinical evidence are needed to determine the most superior design approach for total joint replacement implants.
Top-30
Journals
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Journal of the Mechanical Behavior of Biomedical Materials
2 publications, 4.08%
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Materials
2 publications, 4.08%
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Frontiers in Bioengineering and Biotechnology
2 publications, 4.08%
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Journal of Functional Biomaterials
2 publications, 4.08%
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Computers in Biology and Medicine
1 publication, 2.04%
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Journal of Medical and Biological Engineering
1 publication, 2.04%
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Cureus
1 publication, 2.04%
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Biosensors and Bioelectronics
1 publication, 2.04%
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Materials Today Communications
1 publication, 2.04%
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Journal of Orthopaedics
1 publication, 2.04%
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Journal of the American Ceramic Society
1 publication, 2.04%
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MethodsX
1 publication, 2.04%
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Progress in Biomedical Engineering
1 publication, 2.04%
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Bioprinting
1 publication, 2.04%
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Journal of Clinical Orthopaedics and Trauma
1 publication, 2.04%
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Progress in Additive Manufacturing
1 publication, 2.04%
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Scientific Reports
1 publication, 2.04%
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Nature Reviews Bioengineering
1 publication, 2.04%
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Biosurface and Biotribology
1 publication, 2.04%
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Computer Methods in Biomechanics and Biomedical Engineering
1 publication, 2.04%
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Journal of Clinical Medicine
1 publication, 2.04%
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Advanced healthcare materials
1 publication, 2.04%
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Small
1 publication, 2.04%
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Journal of Medical Engineering and Technology
1 publication, 2.04%
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Progress in Materials Science
1 publication, 2.04%
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International Journal of Mechanical Sciences
1 publication, 2.04%
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ACS Biomaterials Science and Engineering
1 publication, 2.04%
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Journal of Biomedical Materials Research - Part B Applied Biomaterials
1 publication, 2.04%
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3D Printing in Medicine
1 publication, 2.04%
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Biomedical Materials & Devices
1 publication, 2.04%
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Publishers
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Elsevier
14 publications, 28.57%
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Springer Nature
11 publications, 22.45%
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MDPI
8 publications, 16.33%
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Wiley
5 publications, 10.2%
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Frontiers Media S.A.
2 publications, 4.08%
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IOP Publishing
2 publications, 4.08%
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Taylor & Francis
2 publications, 4.08%
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American Chemical Society (ACS)
2 publications, 4.08%
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Institution of Engineering and Technology (IET)
1 publication, 2.04%
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AIP Publishing
1 publication, 2.04%
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SAGE
1 publication, 2.04%
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- We do not take into account publications without a DOI.
- Statistics recalculated weekly.