Strain-adaptive bone remodeling post-orthopaedic implantation: current insights and future directions

The long-term performance of orthopaedic implants is governed by coupled interactions between mechanical loading, bone biology, and implant design. Cellular interactions at the bone–implant interface regulate bone regeneration and osseointegration, thereby influencing the load transferred to the surrounding bone tissue and consequently determining peri-implant bone response. Bone remodeling is a dynamic, strain-adaptive process in which resorption and formation are continuously adjusted in response to mechanical stimuli, making it central to bone loss associated with implant-induced stress shielding. This review synthesizes current understanding of strain-adaptive bone remodeling, with emphasis on mechano-biological principles and remodeling algorithms used to quantitatively describe bone adaptation in response to changes in mechanical environment. Applications of these algorithms are discussed, including studies integrating remodeling predictions with topology optimization to enhance bone response and implant performance. Moreover, the effects of loading-related factors such as loading frequency, number of loading cycles, and rest periods on bone mechano-adaptation are analyzed. By integrating biological, mechanical and computational perspectives, this study provides a broader understanding of bone biomechanical behavior and outlines key considerations for advancing predictive approaches to peri-implant bone adaptation.