A Review of Polyvinyl Alcohol (PVA) Hydrogels for Orthopedic Applications

Polyvinyl alcohol (PVA) is a synthetic polymer that is increasingly being used in biomedical applications due to its biocompatibility, aqueous solubility, low toxicity, and tissue-mimicking properties. The physiochemical properties of PVA hydrogels are widely tunable and allow for a diverse range of tissue-specific applications and delivery methods. In this review, we evaluate the published information on the history of PVA with respect to its safety and efficacy as a biomedical device for orthopedic applications in articular cartilage, fibrocartilage, and intervertebral disc prosthesis. The review includes a classification of the mechanical properties, swelling mechanics, and lubricity and wear properties of the use of PVA in clinical applications, and in vitro and in vivo biocompatibility studies. STATEMENT OF SIGNIFICANCE: This review synthesizes the engineering design principles that underpin the development of poly(vinyl alcohol) (PVA) hydrogels for orthopedic applications, including articular cartilage, fibrocartilaginous tissues, and intervertebral disc repair and replacement. By critically examining how molecular characteristics, crosslinking strategies, processing methods, composite architectures, and biomimetic designs influence mechanical performance, tribological behavior, swelling regulation, fatigue resistance, and biocompatibility, the review establishes a framework linking material design decisions to functional outcomes. Unlike prior reviews focused primarily on individual tissues or material formulations, this work emphasizes the translational pathway through which these design principles have been leveraged to progress from benchtop materials development to preclinical validation, clinical evaluation, and commercial orthopedic products. By identifying both successful strategies and persistent translational challenges, this review provides practical guidance for biomaterials scientists and orthopedic researchers developing the next generation of load-bearing hydrogel implants.