Here today, gone tomorrow: Should we stop researching biodegradable implants?

Abstract

Abstract Purpose: This systematic review examines the role of biodegradable implants in orthopedic traumatology, focusing on their advantages, limitations, and clinical applications compared to traditional non-biodegradable implants. Key factors such as biocompatibility, mechanical performance, and degradation were evaluated to understand their impact on fracture healing and patient outcomes. Methods: A systematic search of current literature and clinical studies between 2010 and 2023 was conducted. Comparative data between biodegradable (polymeric and metallic) and non-biodegradable metallic implants were assessed, particularly concerning clinical outcomes, and patient satisfaction. The review process was conducted according to the PRISMA guidelines. Results: Forty studies were selected for analysis out of 1366 studies. Biodegradable implants demonstrated effective mechanical support during bone healing, with gradual load transfer to the regenerating bone. They reduced the need for secondary surgeries, particularly in pediatric cases, where they mitigated growth disturbances associated with metallic implants. However, challenges such as implant-related inflammation and premature degradation were noted. Comparative studies revealed similar or superior clinical outcomes with biodegradable implants, though mechanical strength remained a concern in specific applications. Conclusions: Biodegradable implants can represent a transformative shift in orthopedic traumatology, offering significant advantages over traditional metallic implants alongside other positive externalities, which influence the patient's potential outcomes. Future research and development of advanced materials are essential to address current limitations. Emerging technologies, such as complex alloys, the addition of reinforcements, new manufacturing techniques, and a focus on biocompatibility, bone regeneration and functionalization of the implant, may offer controlled biodegradation, superior biocompatibility, antimicrobial properties, and tailored mechanical performance.