Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review
Abstract 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...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-01-01
|
| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-022-03492-9 |
| _version_ | 1828056686222376960 |
|---|---|
| author | Sarah Safavi Yihang Yu Dale L. Robinson Hans A. Gray David C. Ackland Peter V. S. Lee |
| author_facet | Sarah Safavi Yihang Yu Dale L. Robinson Hans A. Gray David C. Ackland Peter V. S. Lee |
| author_sort | Sarah Safavi |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-10T21:00:34Z |
| format | Article |
| id | doaj.art-0089692d8c14454c9ec1f53cd0d578b4 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-10T21:00:34Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-0089692d8c14454c9ec1f53cd0d578b42023-01-22T12:20:04ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-01-0118112310.1186/s13018-022-03492-9Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic reviewSarah Safavi0Yihang Yu1Dale L. Robinson2Hans A. Gray3David C. Ackland4Peter V. S. Lee5Department of Biomedical Engineering, University of MelbourneDepartment of Biomedical Engineering, University of MelbourneDepartment of Biomedical Engineering, University of MelbourneDepartment of Biomedical Engineering, University of MelbourneDepartment of Biomedical Engineering, University of MelbourneDepartment of Biomedical Engineering, University of MelbourneAbstract 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.https://doi.org/10.1186/s13018-022-03492-93D printingLattice structureAseptic looseningJoint prosthesisOrthopedic implantOsseointegration |
| spellingShingle | Sarah Safavi Yihang Yu Dale L. Robinson Hans A. Gray David C. Ackland Peter V. S. Lee Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review Journal of Orthopaedic Surgery and Research 3D printing Lattice structure Aseptic loosening Joint prosthesis Orthopedic implant Osseointegration |
| title | Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review |
| title_full | Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review |
| title_fullStr | Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review |
| title_full_unstemmed | Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review |
| title_short | Additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding: a systematic review |
| title_sort | additively manufactured controlled porous orthopedic joint replacement designs to reduce bone stress shielding a systematic review |
| topic | 3D printing Lattice structure Aseptic loosening Joint prosthesis Orthopedic implant Osseointegration |
| url | https://doi.org/10.1186/s13018-022-03492-9 |
| work_keys_str_mv | AT sarahsafavi additivelymanufacturedcontrolledporousorthopedicjointreplacementdesignstoreducebonestressshieldingasystematicreview AT yihangyu additivelymanufacturedcontrolledporousorthopedicjointreplacementdesignstoreducebonestressshieldingasystematicreview AT dalelrobinson additivelymanufacturedcontrolledporousorthopedicjointreplacementdesignstoreducebonestressshieldingasystematicreview AT hansagray additivelymanufacturedcontrolledporousorthopedicjointreplacementdesignstoreducebonestressshieldingasystematicreview AT davidcackland additivelymanufacturedcontrolledporousorthopedicjointreplacementdesignstoreducebonestressshieldingasystematicreview AT petervslee additivelymanufacturedcontrolledporousorthopedicjointreplacementdesignstoreducebonestressshieldingasystematicreview |