Toward next-generation hip implants: From failure mechanisms to translational design

Area of Science:

• Biomaterials Engineering
• Orthopedic Surgery
• Computational Mechanics

Background:

• Total hip replacement (THR) complications like loosening and wear limit implant longevity due to monolithic designs failing to meet proximal femur's needs.
• Current implants struggle with physiological load transfer, osseointegration, and bone loss, necessitating advanced solutions.

Purpose of the Study:

• To review clinical, biomechanical, mechanobiological, and computational aspects of developing functionally graded hip scaffold-implant hybrids (FG-HSIHs).
• To identify challenges and opportunities for translating FG-HSIHs into clinically viable next-generation hip implants.

Main Methods:

• Synthesis of current research on THR failure mechanisms and their relation to implant design.
• Evaluation of mechanical modeling, mechanobiology, multiphysics analysis, and optimization strategies for FG-HSIH design.
• Analysis of existing frameworks for FG-HSIH development and identification of translational gaps.

Main Results:

• FG-HSIHs offer spatially controlled properties (stiffness, porosity, bioactivity) to better match bone structure and function.
• Simulation-guided design strategies can mitigate specific THR failure risks by tailoring implant properties.
• Current frameworks lack integration of mechanical, biological, transport, and degradation processes, and patient-specific biological factors.

Conclusions:

• A structured pathway exists for FG-HSIH development, linking failure mechanisms to design strategies.
• Addressing identified translational gaps (e.g., integrated models, patient-specific data, validation pipelines) is crucial for innovation.
• Next-generation hip implants derived from FG-HSIHs hold potential to improve patient outcomes and reduce revision surgery rates.