A systematic review of the use of titanium versus stainless steel implants for fracture fixation

Abstract

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.

Manual Instruments as an Alternative to Drilling for Bony Exposure in Skull Base Surgery: Concept and Technique

“…27 An example of it is disappearance of stainless steel (SS) spine implants from the market for more than a decade, replaced by titanium implants, which are approximately 50 to 100 times costlier than SS implants. 28,29 Its implications on patients affordability in LMICs, where most of the cost is born by the patients as out-of-pocket expenditure of health care services, is usually 65 to 85%. 30 Interestingly, significant numbers of patients never undergo magnetic resonance imaging (MRI) study in their lifetime, as MRI compatibility is one of the most important considerations in favor of titanium implants.…”

Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated with Lateral Locked Plating: A Risk-Stratified Analysis

“…4,5 Plate length and plate type were neither significantly associated nor did they improve models when they were included as variables. Stainless steel plates have been identified as independent risk factors for nonunion, 5,23 ostensibly because of the higher Young's modulus and the creation of a bridging construct that is potentially too stiff. 6 However, the stiffness of any plate is a combination of material and plate geometric factors, such as thickness, so material type alone is not the sole indicator of the mechanical performance of the plate.…”

The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates

“… 19 In this series, a careful selection of the length of the plate, screw–plate density, implant material (titanium plate was used) and appropriate reduction and compression at the site of non-union were made with the aim of avoiding failure. 20 , 21 The literature supports titanium as more of a biocompatible and flexible material with Young's modulus comparable to the bone as opposed to stainless steel. 11 , 21 …”

“… 20 , 21 The literature supports titanium as more of a biocompatible and flexible material with Young's modulus comparable to the bone as opposed to stainless steel. 11 , 21 …”