Is There a Role for Absorbable Metals in Surgery? A Systematic Review and Meta-Analysis of Mg/Mg Alloy Based Implants

Abstract

Magnesium (Mg) alloys have received attention in the literature as potential biomaterials for use as absorbable implants in oral and maxillofacial and orthopedic surgery applications. This study aimed to evaluate the available clinical studies related to patients who underwent bone fixation (patients), and received conventional fixation (intervention), in comparison to absorbable metals (comparison), in terms of follow-up and complications (outcomes). A systematic review and meta-analysis were performed in accordance with the PRISMA statement and PROSPERO (CRD42020188654), PICO question, ROBINS-I, and ROB scales. The relative risk (RR) of complications and failures were calculated considering a confidence interval (CI) of 95%. Eight studies (three randomized clinical trial (RCT), one retrospective studies, two case-control studies, and two prospective studies) involving 468 patients, including 230 Mg screws and 213 Titanium (Ti) screws, were analyzed. The meta-analysis did not show any significant differences when comparing the use of Mg and Ti screws for complications (p = 0.868). The estimated complication rate was 13.3% (95% CI: 8.3% to 20.6%) for the comparison group who received an absorbable Mg screw. The use of absorbable metals is feasible for clinical applications in bone surgery with equivalent outcomes to standard metal fixation devices.

Bioresorbable Magnesium-Based Alloys as Novel Biomaterials in Oral Bone Regeneration: General Review and Clinical Perspectives

“…According to a recent systematic review and meta-analysis including eight studies (three randomized clinical trials [ 85 , 89 , 94 ], one retrospective study [ 109 ], two case-control studies [ 98 , 103 ], and two prospective studies [ 88 , 111 ]) and involving a total number of 230 patients, the estimated complication rate was 13.3% for the group treated with Mg screw [ 112 ]. The meta-analysis did not show any significant difference for complications between the use of Mg and Ti screws [ 112 ]. Additionally, one case series revealed an extensive cystic lesion after Mg implantation in an unstable scaphoid fracture [ 93 ].…”

“…Physicians and surgeons have to be aware of this radiographical aspect of product accumulation around the implanted Mg-based material as well as the rare possibility of subcutaneous gas accumulation. This last complication is infrequent and no case of subcutaneous gas accumulation was reported in a systematic review including 230 Mg-based screws [ 112 ].…”

Can Hardware Removal be Avoided Using Bioresorbable Mg-Zn-Ca Screws After Medial Malleolar Fracture Fixation? Mid-Term Results of a First-In-Human Study

“…Mid-term results, 6 and 12 months after MM fracture reduction with bioresorbable ZX00 screws exhibit excellent clinical and functional outcomes without complications. According to a recent systematic review and meta-analysis including eight clinical trials and reviewing a total number of 230 patients, the estimated complication rate for Mg-based implants was 13.3% [29] . In the current literature a total of five clinical studies including prospective and retrospective clinical trials investigating Mg-based alloys implanted in foot ankles are registered and exhibit similar clinical and functional outcomes [30][31][32][33][34] .…”

Change in Pull-Out Force during Resorption of Magnesium Compression Screws for Osteosynthesis of Mandibular Condylar Fractures

“…There are no differences between magnesium and titanium fixation materials with regard to biocompatibility and frequency of complications. Therefore, magnesium materials should be considered for clinical applications in maxillofacial surgery and orthopedics [ 65 ], and they are much more suitable than polylactoglycolic materials [ 66 ]. More randomized controlled trials or prospective studies are needed to demonstrate that different resorbable materials are better or comparable to titanium screws [ 67 , 68 ].…”