Stress shielding

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Stress shielding is the reduction in bone density (osteopenia) as a result of removal of typical stress from the bone by an implant (for instance, the femoral component of a hip prosthesis). [1] This is because by Wolff's law, [2] bone in a healthy person or animal remodels in response to the loads it is placed under.

When a distal implant is used, forces are transferred to the implant from the proximal parts of the bone, thus shielding the latter close to the joint, resulting in bone atrophy. A proximal implant reduces this effect by applying more stress to the proximal portion of the bone. However, this leads to high proximal peak loads. Ideally, stress is applied evenly over the whole implant. [3] The elastic modulus of human bone (3–20 GPa) varies, [4] but is closer to that of magnesium (41–45 GPa) than to those of titanium (110–127 GPa), stainless steel (189–205 GPa), iron (211.4 GPa), or zinc (78–121 GPa), so that magnesium implants can curtail stress-shielding phenomena; [5] [6] such implants are also bioresorbable. [7] Porous implantation can also alleviate stress shielding. [8] [9]

References

  1. ↑ Ibrahim, H.; Esfahani, S. N.; Poorganji, B.; Dean, D.; Elahinia, M. (January 2017). "Resorbable bone fixation alloys, forming, and post-fabrication treatments". Materials Science and Engineering: C. 70 (1): 870–888. doi: 10.1016/j.msec.2016.09.069 . PMID   27770965.
  2. ↑ Frost, HM (1994). "Wolff's Law and bone's structural adaptations to mechanical usage: an overview for clinicians". The Angle Orthodontist. 64 (3): 175–188. doi:10.1043/0003-3219(1994)064<0175:WLABSA>2.0.CO;2. PMID   8060014.
  3. ↑ Ruchholtz, Steffen; Wirtz, Dieter Christian, eds. (2013). Orthopädie und Unfallchirurgie essentials (in German) (2 ed.). Stuttgart: Georg Thieme Verlag. doi:10.1055/b-0034-35163. ISBN   978-3-13-148442-0.
  4. ↑ "Mechanical properties of bone". University of Cambridge. Retrieved 21 March 2026.
  5. ↑ Kong, Lingyun; Heydari, Zahra; Lami, Ghadeer Hazim; Saberi, Abbas; Baltatu, Madalina Simona; Vizureanu, Petrica (3 July 2023). "A Comprehensive Review of the Current Research Status of Biodegradable Zinc Alloys and Composites for Biomedical Applications". Materials. 16 (13): 4797. Bibcode:2023Mate...16.4797K. doi: 10.3390/ma16134797 . PMC   10343804 . PMID   37445111.
  6. ↑ Saberi, A.; Bakhsheshi-Rad, H.R.; Karamian, E.; Kasiri-Asgarani, M.; Ghomi, H. (April 2020). "Magnesium-graphene nano-platelet composites: Corrosion behavior, mechanical and biological properties". Journal of Alloys and Compounds. 821 153379. doi:10.1016/j.jallcom.2019.153379. S2CID   214172320.
  7. ↑ Hung, Chun Ho; Kwok, Yui Chit (2025). "Bioabsorbable Magnesium-Based Materials Potential and Safety in Bone Surgery: A Systematic Review". Craniomaxillofacial Trauma & Reconstruction. 18 (2). AO Foundation: 24. doi:10.3390/cmtr18020024 . Retrieved 21 March 2026.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  8. ↑ Dhandapani, Ramya; Krishnan, Priya Dharshini; Zennifer, Allen; Kannan, Vishal; Manigandan, Amrutha; Arul, Michael R.; Jaiswal, Devina; Subramanian, Anuradha; Kumbar, Sangamesh Gurappa; Sethuraman, Swaminathan (March 2020). "Additive manufacturing of biodegradable porous orthopaedic screw". Bioactive Materials. 5 (3): 458–467. doi:10.1016/j.bioactmat.2020.03.009. PMC   7139166 . PMID   32280835.
  9. ↑ USpatent 5702449,William F. McKay,"Reinforced porous spinal implants",published 1997-12-30,issued 1997-12-30, assigned to Danek Medical, Inc., Memphis, Tenn.and SDGI Holdings Inc.
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