Bioabsorbable implants in forefoot surgery: a review of materials, possibilities and disadvantages

Abstract

Bioabsorbable and biodegradable implants offer new possibilities in orthopaedic and trauma surgery. As soon as the initial stability of the degradable implants has reached the qualities of conventional materials, new devices may find usage in younger and more demanding patients. Residual conventional osteosynthetic material or the necessity to remove metal increasingly seems to be more of an adverse event than daily practice in forefoot surgery. Nevertheless, some drawbacks need to be discussed. Recent literature screened for the use of bioabsorbable and biodegradable materials in forefoot surgery, available implants and indications in forefoot surgery were analysed and summarized. Apart from common indications in forefoot surgery, points of interest were the type of biomaterial, the process of biodegradation and biointegration, and possible adverse events. Materials were comprehensively discussed for each indication based on the available literature. Polylactide, polyglycoside and polydioxanone are considered safe and sufficiently stable for use in forefoot surgery. Low complication rates (e.g. 0.7% for pin fixation in hallux deformities) are given. Magnesium implants suffered from an extensive corrosive process in the first generation but now seem to be safe in forefoot surgery and offer good options compared with conventional titanium screws, especially in procedures of the first ray. Allograft bone has proven feasibility in small case series, but still lacks larger or randomized clinical trials. The first results are promising. Bioresorbable and osseointegrating devices offer attractive new possibilities for surgeons and patients. Despite all the known advantages, the difficulties and possible complications must not be forgotten, such as soft tissue reactions, unwanted osteolysis and a lower primary mechanical load capacity. Cite this article: EFORT Open Rev 2021;6:1132-1139. DOI: 10.1302/2058-5241.6.200157

Characterization of PLA/PCL/Nano-Hydroxyapatite (nHA) Biocomposites Prepared via Cold Isostatic Pressing

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Biodegradable Materials for Tissue Engineering: Development, Classification and Current Applications

“…There are several typical clinical indications for the use of biodegradable implants in orthopedics, which are mostly used for fractures stabilization, osteotomy procedures, bone grafts and fusions [ 6 , 7 ]. Furthermore, they can be used in re-attachment of tendons, ligaments, meniscal cracks, and other tissue structures [ 8 ].…”

Biomaterials for Interbody Fusion in Bone Tissue Engineering

“…Polylactide (PLA), alkyl polyglycoside, and polydioxane are considered safe and sufficiently stable absorbable materials, while iron, Mg, and zinc are the main absorbable metal elements. Although the inconvenience of a second surgery can be avoided by harvesting biomaterials, the possible complications, such as soft-tissue reactions, unwanted osteolysis, and low primary mechanical loading capacity, also limit the use of absorbable interbody fusion cages ( Ulum et al, 2019 ; Pisecky et al, 2021 ). The hardness of the bioabsorbable fusion cage is similar to that of bone, which may accelerate interbody fusion.…”