ReviewJournal of experimental orthopaedics2025
The relationship between stress shielding, bone density changes and implant migration, failure and fracture after total knee arthroplasty: A systematic review.
Review in Journal of experimental orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- Osteoporosis and osteoporosis therapies as determinants of implant fixation failure in arthroplasty and spinal fusion constructs: a position statement from the Fracture Working Group of the Council of Scientific Advisors of the International Osteoporosis Foundation.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Early migration following revision total knee arthroplasty with tibial metaphyseal cones: a 2-year prospective RSA cohort study of 25 patients.Acta orthopaedica · 2026Article
- Article
- Toward next-generation hip implants: From failure mechanisms to translational design.Journal of orthopaedic translation · 2026Review
- Perioperative denosumab exposure and risk of revision after total hip and knee arthroplasty in osteoarthritis: a registry-based data linkage study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Femoral finite element analysis of a novel cementless revision total knee arthroplasty system.Scientific reports · 2026Article
- The relationship between stress shielding, bone density changes and implant migration, failure and fracture after total knee arthroplasty: A systematic review.Journal of experimental orthopaedics · 2025Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Purpose: Total knee arthroplasty (TKA) represent a well-established treatment for advanced osteoarthritis. Despite advancements in implant design and materials, the impact of stress shielding on bone mineral density (BMD) and its relationship with implant migration, loosening, and fracture remains insufficiently explored. This study aims to evaluate the association between stress shielding, BMD changes, and implant outcomes after TKA. Methods: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four major databases (MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WOS), EMBASE) were thoroughly reviewed. Results: A total of 491 studies were initially identified, of which nine met the inclusion criteria and were included in the final review. Eight were randomised controlled trials, and one was a prospective observational study. All studies were conducted in clinical settings, comprising a total of 467 patients. BMD variations due to stress shielding were most pronounced during the first 6-12 months postoperatively. However, except for one isolated case, no direct correlation was identified between BMD changes caused by stress shielding and implant migration, loosening or fracture. Conclusions: This systematic review highlights that variations in bone mineral density due to stress shielding are not directly correlated with implant failure, migration or loosening in TKA. Stress shielding remains a critical phenomenon, particularly in the early postoperative phases, emphasising the importance of optimised materials, fixation methods and implant designs to reduce bone loss and improve long-term stability. Due to its recognised occurrence in clinical practice, further in vivo studies would contribute to a better understanding of the stress shielding. Level of Evidence: Level II, systematic review of studies.
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