Bioabsorbable materials in orthopaedics.

The applications of bioabsorbable implants in orthopaedic surgery have mainly been mandated from the need to eliminate implant removal operations. Although they have not gained widespread popularity among orthopaedic surgeons, they still represent an area of evolution. Considerable effort has been put into developing new bioabsorbable materials with fewer adverse effects. In this article an extensive review of the literature is presented emphasising on basic science and clinical applications of these materials. A review of the types of implants, the materials used, their biochemical properties, their adverse effects and some of the potential future applications is presented.

[1]  P. Rokkanen,et al.  Long-term results of wrist arthrodeses fixed with self-reinforced polylevolactic acid implants in patients with rheumatoid arthritis. , 2001, Scandinavian journal of rheumatology.

[2]  P. Rokkanen,et al.  Causes of the clinical tissue response to polyglycolide and polylactide implants with an emphasis on the knee , 2001, Archives of Orthopaedic and Trauma Surgery.

[3]  F. Savoie,et al.  Arthroscopic Bankart reconstruction with a bioabsorbable anchor. , 2003, Journal of shoulder and elbow surgery.

[4]  F Leonard,et al.  Biodegradable poly(lactic acid) polymers. , 1971, Journal of biomedical materials research.

[5]  W C de Bruijn,et al.  Late degradation tissue response to poly(L-lactide) bone plates and screws. , 1995, Biomaterials.

[6]  P. Törmälä,et al.  Biodegradable semirigid plate and miniscrew fixation compared with rigid titanium fixation in experimental calvarial osteotomy. , 1999, Journal of neurosurgery.

[7]  M. Kellomäki,et al.  In vitro and in vivo behavior of self-reinforced bioabsorbable polymer and self-reinforced bioabsorbable polymer/bioactive glass composites. , 2004, Journal of biomedical materials research. Part A.

[8]  E. Mäkelä,et al.  Bioresorbable implants: applications in orthopaedic surgery. , 1997, Instructional Course Lectures.

[9]  Herman H. M. Tse,et al.  The combined use of hydroxyapatite and bioresorbable plates to repair cranial defects in children. , 2005, Journal of neurosurgery.

[10]  R. Ewers,et al.  Self-reinforced biodegradable plates and screws for fixation of zygomatic fractures. , 2005, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[11]  G. Duda,et al.  Poly(D,L-lactide) coating is capable of enhancing osseous integration of Schanz screws in the absence of infection. , 2005, Journal of biomedical materials research. Part B, Applied biomaterials.

[12]  R. Friedman,et al.  Pre-clinical in vivo evaluation of orthopaedic bioabsorbable devices. , 2000, Biomaterials.

[13]  N. Ashammakhi,et al.  Successful treatment of scaphoid fractures and nonunions using bioabsorbable screws: report of six cases. , 2004, The Journal of hand surgery.

[14]  Takashi Nakamura,et al.  The complete process of bioresorption and bone replacement using devices made of forged composites of raw hydroxyapatite particles/poly l-lactide (F-u-HA/PLLA). , 2005, Biomaterials.

[15]  Hideki Yoshikawa,et al.  A new biotechnology for articular cartilage repair: subchondral implantation of a composite of interconnected porous hydroxyapatite, synthetic polymer (PLA-PEG), and bone morphogenetic protein-2 (rhBMP-2). , 2005, Osteoarthritis and cartilage.

[16]  I. Jackson,et al.  Transphyseal Bioabsorbable Screws Cause Temporary Growth Retardation in Rabbit Femur , 2005, Journal of pediatric orthopedics.

[17]  O. Böstman,et al.  Tissue restoration after resorption of polyglycolide and poly-laevo-lactic acid screws. , 2005, The Journal of bone and joint surgery. British volume.

[18]  S. Sood,et al.  Complications of bioresorbable fixation systems in pediatric neurosurgery , 2005, Child's Nervous System.

[19]  F. Barber Poly-D,L-lactide interference screws for anterior cruciate ligament reconstruction. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[20]  P. Giannoudis,et al.  Use of bio-resorbable implants for stabilisation of distal radius fractures: the United Kingdom patients' perspective. , 2005, Injury.

[21]  P. Rokkanen,et al.  Absorbable fixation of femoral head fractures. A prospective study of six cases. , 1998, Annales chirurgiae et gynaecologiae.

[22]  D. Williams,et al.  Enzyme-accelerated hydrolysis of polyglycolic acid. , 1977, Journal of bioengineering.

[23]  D. Couture,et al.  Posterior lumbar interbody fusion with bioabsorbable spacers and local autograft in a series of 27 patients. , 2004, Neurosurgical focus.

[24]  Z. Gugala,et al.  Healing of critical-size segmental bone defects in the sheep tibiae using bioresorbable polylactide membranes. , 2002, Injury.

[25]  C Lindqvist,et al.  A 5-year in vitro and in vivo study of the biodegradation of polylactide plates. , 1998, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[26]  C. Kaeding,et al.  A prospective randomized comparison of bioabsorbable and titanium anterior cruciate ligament interference screws. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[27]  P. Törmälä,et al.  Treatment of subcapital femoral neck fractures with bioabsorbable or metallic screw fixation. A preliminary report. , 2000, Annales chirurgiae et gynaecologiae.

[28]  Y. Konttinen,et al.  Biodegradable polydioxanone and poly(l/d)lactide implants: an experimental study on peri-implant tissue response. , 2005, International journal of oral and maxillofacial surgery.

[29]  H. Terai,et al.  Optimized use of a biodegradable polymer as a carrier material for the local delivery of recombinant human bone morphogenetic protein-2 (rhBMP-2). , 2006, Biomaterials.

[30]  C. Lindqvist,et al.  Bioresorbable poly-L/DL-lactide (P[L/DL]LA 70/30) plates are reliable for repairing large inferior orbital wall bony defects: a pilot study. , 2006, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[31]  N. Ashammakhi,et al.  Spotlight on naturally absorbable osteofixation devices. , 2003, The Journal of craniofacial surgery.

[32]  P. Törmälä,et al.  Fixation of distal femoral osteotomies with self-reinforced polymer/bioactive glass rods: an experimental study on rabbits. , 2004, Biomaterials.

[33]  O. Böstman,et al.  Adverse Tissue Reactions to Bioabsorbable Fixation Devices , 2000, Clinical orthopaedics and related research.

[34]  J. Arata,et al.  ARTHRODESIS OF THE DISTAL INTERPHALANGEAL JOINT USING A BIOABSORBABLE ROD AS AN INTRAMEDULLARY NAIL , 2003, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[35]  Fred Leonard,et al.  Polylactic Acid for Surgical Implants , 1966 .

[36]  O. Böstman,et al.  Osteoarthritis of the ankle after foreign-body reaction to absorbable pins and screws: a three- to nine-year follow-up study. , 1998, The Journal of bone and joint surgery. British volume.

[37]  D. Buss,et al.  Poly-L-lactic Acid Tack Synovitis after Arthroscopic Stabilization of the Shoulder * , 2003, The American journal of sports medicine.

[38]  Catherine G. Ambrose,et al.  Bioabsorbable Implants: Review of Clinical Experience in Orthopedic Surgery , 2004, Annals of Biomedical Engineering.

[39]  L. de Leij,et al.  Inhibition of the tissue reaction to a biodegradable biomaterial by monoclonal antibodies to IFN-gamma. , 1998, Journal of biomedical materials research.

[40]  N. Ashammakhi,et al.  Successful Use of Biosorb Osteofixation Devices in 165 Cranial and Maxillofacial Cases: A Multicenter Report , 2004, The Journal of craniofacial surgery.

[41]  N. Ashammakhi,et al.  Use of self-reinforced polylactide osteosynthesis devices in craniofacial surgery: a long-term follow-up study. , 2001, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[42]  G. Lajtai,et al.  Bone tunnel remodeling at the site of biodegradable interference screws used for anterior cruciate ligament reconstruction: 5-year follow-up. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[43]  L. Cheung,et al.  A randomized controlled trial of resorbable versus titanium fixation for orthognathic surgery. , 2004, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[44]  J. Pajarinen,et al.  Fixation of Syndesmotic Ruptures in 38 Patients With a Malleolar Fracture: A Randomized Study Comparing a Metallic and a Bioabsorbable Screw , 2005, Journal of orthopaedic trauma.

[45]  Albert Losken,et al.  Resorbable PLLA-PGA Plate and Screw Fixation in Pediatric Craniofacial Surgery: Clinical Experience in 1883 Patients , 2004, Plastic and reconstructive surgery.

[46]  W. D. de Jong,et al.  Tissue response to partially in vitro predegraded poly-L-lactide implants. , 2005, Biomaterials.

[47]  O. Böstman Absorbable implants for the fixation of fractures. , 1991, The Journal of bone and joint surgery. American volume.

[48]  Nureddin Ashammakhi,et al.  Self-reinforced bioresorbable poly-L/DL-lactide [SR-P(L/DL)LA] 70/30 miniplates and miniscrews are reliable for fixation of anterior mandibular fractures: a pilot study. , 2004, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[49]  A. Prokop,et al.  Biodegradable Implants for Pipkin Fractures , 2005, Clinical orthopaedics and related research.

[50]  J. Arata,et al.  Osteosynthesis in Digital Replantation Using Bioabsorbable Rods , 2003, Annals of plastic surgery.

[51]  J. Delee,et al.  Fixation of Osteochondritis Dissecans Lesions Using Poly(l-lactic Acid)/ Poly(glycolic Acid) Copolymer Bioabsorbable Screws , 2005, The American journal of sports medicine.

[52]  P. Törmälä,et al.  Complications in the first 1043 operations where self-reinforced poly-L-lactide implants were used solely for tissue fixation in orthopaedics and traumatology , 2002, International Orthopaedics.

[53]  P. Törmälä,et al.  Absorbable self-reinforced polylactide (SR-PLA) composite rods for fracture fixation: strength and strength retention in the bone and subcutaneous tissue of rabbits , 1992 .

[54]  P. Rokkanen,et al.  Arthrodesis of the first metatarsophalangeal joint in patients with rheumatoid arthritis with bioabsorbable self-reinforced poly(l/dl)lactide 70:30 screw fixation—a preliminary report , 2002 .

[55]  T. Lanman,et al.  Lumbar interbody fusion after treatment with recombinant human bone morphogenetic protein-2 added to poly(L-lactide-co-D,L-lactide) bioresorbable implants. , 2004, Neurosurgical focus.

[56]  A. Jubel,et al.  Soft tissue reactions of different biodegradable polylactide implants. , 2004, Biomaterials.

[57]  W. Hayes,et al.  Composite poly(lactide)/hydroxylapatite screws for fixation of osteochondral osteotomies. A morphometric, histologic and radiographic study in sheep , 2002, Journal of biomaterials science. Polymer edition.

[58]  R. Ewers,et al.  Biodegradable fixation of mandibular fractures in children: stability and early results. , 2005, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[59]  P. Törmälä,et al.  Comparison of in vitro hydrolysis, subcutaneous and intramedullary implantation to evaluate the strength retention of absorbable osteosynthesis implants. , 1990, Biomaterials.

[60]  Michel Vert,et al.  Structure-property relationships in the case of the degradation of massive poly(α-hydroxy acids) in aqueous media , 1990 .

[61]  Michel Vert,et al.  Structure-property relationships in the case of the degradation of massive aliphatic poly-(α-hydroxy acids) in aqueous media , 1990 .

[62]  R. Ewers,et al.  Fixation of mandibular fractures with biodegradable plates and screws. , 2002, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[63]  K. Garvin,et al.  Polylactide-polyglycolide antibiotic implants. , 2005, Clinical orthopaedics and related research.

[64]  O. Böstman,et al.  Intraosseous cellular response to biodegradable fracture fixation screws made of polyglycolide or polylactide , 2004, Archives of Orthopaedic and Trauma Surgery.

[65]  T. Turvey,et al.  Self-reinforced biodegradable screw fixation compared with titanium screw fixation in mandibular advancement. , 2006, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[66]  A. Vaccaro,et al.  The use of bioabsorbable implants in the spine. , 2003, The spine journal : official journal of the North American Spine Society.

[67]  G. Schmidmaier,et al.  [Biological coating of implants in trauma and orthopedic surgery]. , 2004, Der Unfallchirurg.

[68]  D. E. Cutright,et al.  Fracture reduction using a biodegradable material, polylactic acid. , 1971, Journal of oral surgery.

[69]  E. Duek,et al.  Pins composed of poly(L-lactic acid)/poly(3- hydroxybutyrate-co-hydroxyvalerate) PLLA/PHBV blends: Degradation in vitro. , 2005, Journal of applied biomaterials & biomechanics : JABB.

[70]  W. H. Warden,et al.  Magnetic Resonance Imaging of Bioabsorbable Polylactic Acid Interference Screws During the First 2 Years After Anterior Cruciate Ligament Reconstruction , 1999 .

[71]  R. Mazzonetto,et al.  A retrospective evaluation of rigid fixation in orthognathic surgery using a biodegradable self-reinforced (70L:30DL) polylactide. , 2004, International journal of oral and maxillofacial surgery.

[72]  Rokkanen Pu,et al.  BIOABSORBABLE FIXATION DEVICES IN ORTHOPAEDICS AND TRAUMATOLOGY , 1998 .

[73]  R. Suuronen,et al.  Assessment of material- and technique-related complications following sagittal split osteotomies stabilized by biodegradable polylactide screws. , 2005, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[74]  P. Törmälä,et al.  Biodegradable self-reinforced composite materials; manufacturing structure and mechanical properties. , 1992, Clinical materials.

[75]  M. Kellomäki,et al.  Developments in craniomaxillofacial surgery: use of self-reinforced bioabsorbable osteofixation devices. , 2001, Plastic and reconstructive surgery.

[76]  C Lindqvist,et al.  Are there any complications with bioabsorbable fixation devices? A 10 year review in orthognathic surgery. , 2003, International journal of oral and maxillofacial surgery.

[77]  N. Ashammakhi,et al.  Use of Bioabsorbable Osteofixation Devices in the Hand , 2004, Journal of hand surgery.

[78]  K C Pani,et al.  Polylactic acid for surgical implants , 1966, Archives of surgery.

[79]  R. Bell,et al.  The use of biodegradable plates and screws to stabilize facial fractures. , 2006, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.