Efficacy of Biodegradable Implants in Orthopedic Surgery: A Systematic Review

Abstract

Background: Biodegradable implants have emerged as an alternative to traditional metallic hardware in orthopedic surgery, offering potential advantages such as elimination of removal surgeries and gradual load transfer to healing tissue. This systematic review aims to evaluate the efficacy, safety, and clinical outcomes of biodegradable implants across various orthopedic applications. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, Embase, and Web of Science for studies published between January 2000 and December 2023. Randomized controlled trials, prospective cohort studies, and retrospective studies with a minimum of 20 patients and 12 months follow-up were included. Two independent reviewers screened studies, extracted data, and assessed quality using appropriate tools. Results: Forty-two studies (n=3,874 patients) met inclusion criteria. Biodegradable implants demonstrated comparable efficacy to metallic implants in fracture fixation (union rate: 92.7% vs. 94.1%, p=0.38) and ligament reconstruction (failure rate: 3.8% vs. 3.2%, p=0.42). The overall complication rate for biodegradable implants was 12.3% (95% CI: 9.8% - 14.8%), with foreign body reaction (3.7%) being the most common. Biodegradable implants significantly reduced the need for removal surgeries compared to metallic implants (1.2% vs. 7.5%, p<0.001). Subgroup analyses revealed better outcomes in pediatric patients and low-load bearing applications. Conclusion: Biodegradable implants demonstrate efficacy comparable to metallic implants in many orthopedic applications, with the added benefit of reducing secondary removal surgeries. However, their use should be carefully considered based on patient factors, anatomical location, and mechanical requirements. Future research should focus on long-term outcomes, novel materials with improved properties, and large-scale comparative trials.