Bioresorbable implants--practical considerations

Traditional metal implants, primarily used for internal fixation, have been used by the orthopedic surgeon for years. Decades of development have produced such devices for almost every conceivable need. Despite their widespread use, a relatively consistent set of problems or issues have been identified. These include the potential for long term migration, breakage, stress shielding, reaction to the material, interference with standard imaging techniques, and growth restriction in young patients. A number of bioresorbable polymer devices have recently become available to create a viable alternative for some indications. As expected with an evolving technology, solving one set of problems has engendered another. One of the most limiting aspects of bioresorbable polymers is their inherently lower strength compared to metals. Although more of an issue with some materials and applications than others, significant tissue reactions have been observed in some cases as well. This paper discusses the field of synthetic bioresorbable polymers in general, but with specific reference to those materials and devices that can be used in place of metal implants for internal fixation.