Background: Controversy exists regarding the use of titanium and stainless steel implants in fracture surgery. To our knowledge, no recent, comprehensive review on this topic has been reported.Purpose: To perform a systematic review of the evidence in the current literature comparing differences between titanium and stainless steel implants for fracture fixation.Methods: A systematic review of original research articles was performed through the PubMed database using PRISMA guidelines. Inclusion criteria were English-language studies comparing titanium and stainless steel implants in orthopaedic surgery, and outcome data were extracted.Results: The search returned 938 studies, with 37 studies meeting our criteria. There were 12 clinical research articles performed using human subjects, 11 animal studies, and 14 biomechanical studies. Clinical studies of the distal femur showed the stainless steel cohorts had significantly decreased callus formation and an increased odds radio (OR 6.3, 2.7-15.1; P < .001) of nonunion when compared with the titanium plate cohorts. In the distal radius, 3 clinical trials showed no implant failures in either group, and no difference in incidence of plate removal, or functional outcome. Three clinical studies showed a slightly increased odds ratio of locking screw breakage with stainless steel intramedullary nails compared with titanium intramedullary nails (OR 1.52, CI 1.1-2.13).
Conclusion:Stainless steel implants have equal or superior biomechanical properties when compared with titanium implants. However, there is clinical evidence that titanium plates have a lower rate of failure and fewer complications than similar stainless steel implants in some situations. Although our review supports the use of titanium implants in these clinical scenarios, we emphasize that further prospective, comparative clinical studies are required before the conclusions can be made.
The objective of this study was to determine if implementation of a simplified care pathway for total knee arthroplasty (TKA) would affect outcomes of total hip arthroplasty (THA) patients in the same health care system. Data were collected from a total of 5,095 consecutive THA patients in the year before and 2 years after implementation of the care pathway for TKA patients. Postimplementation increases were observed in both early activity ( < 0.0001) and continuous urinary catheter avoidance ( < 0.0001) among THA patients. These improvements in protocol adherence were associated with decreased complications ( < 0.0001), fewer 30-day readmissions ( < 0.0019), and decreased hospital length of stay ( < 0.0001). Based on these results, the implementation of a simplified care pathway for TKA patients can also improve outcomes for THA patients in the same health care system.
Results: 86 of the 91 patients randomized into the FAITH-2 pilot study were deemed eligible. There were no significant differences in patient-reported function or HRQL between the treatment groups at 12 months post-fracture. At the 6-and 9-month assessments, a potential benefit in hip function was seen in the cancellous screw group. In all treatment groups, participants reported lower function and HRQL at 12 months post-fracture as compared to their pre-injury assessment.Conclusions: Few differences were found in function and HRQL among the treatment groups in the FAITH-2 pilot study. Despite modern implants and vitamin D supplementation, neither function nor HRQL returns to baseline in this population. Additional effort s to improve the outcomes of these challenging injuries are still needed.
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