Computational analyses of small endosseous implants in osteoporotic bone.

For many years orthopedic implants were developed for patients with good bone stock. Recently it has become clear that these implants have a decreased performance when implanted in bone with low density, such as in osteoporosis. Reduced performance in osteoporotic bone is not unexpected because of the reduced quality of the peri-implant bone and the reduced bone-implant contact area. Nevertheless, the precise failure mechanisms are not well understood. Although experimental testing is considered the gold standard to determine implant fixation, it is hampered by many limitations. Computational models could potentially aid in obtaining a better understanding of implant fixation as they allow analyzing the mechanical interaction between implants and peri-implant tissues. This article provides a review of the existing finite element models of small endosseous implants in bone. The aim is to analyze the potential of such models to aid the understanding of implant failure mechanisms with the goal of improving implant performance in low quality bone.