An Osteoconductive, Osteoinductive, and Osteogenic Tissue-Engineered Product for Trauma and Orthopaedic Surgery: How Far Are We?

Abstract

The management of large bone defects due to trauma, degenerative disease, congenital deformities, and tumor resection remains a complex issue for the orthopaedic reconstructive surgeons. The requirement is for an ideal bone replacement which is osteoconductive, osteoinductive, and osteogenic. Autologous bone grafts are still considered the gold standard for reconstruction of bone defects, but donor site morbidity and size limitations are major concern. The use of bioartificial bone tissues may help to overcome these problems. The reconstruction of large volume defects remains a challenge despite the success of reconstruction of small-to-moderate-sized bone defects using engineered bone tissues. The aim of this paper is to understand the principles of tissue engineering of bone and its clinical applications in reconstructive surgery.

Mechanical Properties and In Vitro Behavior of Additively Manufactured and Functionally Graded Ti6Al4V Porous Scaffolds

“…In summary, an ideal scaffold for bone regeneration should facilitate cell attachment, infiltration and matrix deposition to guide bone formation [69] as well as providing initial mechanical support to the surrounding bone [70]. Porous titanium scaffolds can meet the mechanical strength and bone formation requirements without osseoinductive biomolecules [68]; however, the pore size of the scaffolds needs to be high for bone-ingrowth whereas, as the porosity increases, the mechanical strength and integrity of the structure decreases [71].…”

Autologous Bone Marrow Stem Cells combined with Allograft Cancellous Bone in Treatment of Nonunion

“…A triangular-shaped complex of interactions between the potent osteogenic cell populations, the osteoinductive stimulus and the osteoconductive matrix scaffolds are extensively studied and applied in search for the optimal grafting material (Giannoudis et al, 2007;Khan et al, 2011;Virk and Lieberman, 2012). Mechanical stability is added to the diamond model as a crucial factor for bone healing, and essential for the formation of a callus that bridges the fracture site allowing loads to be transmitted across the fracture line (Fayaz et al, 2011;Hernigou et al, 2005b).…”

Advanced bioactive and biodegradable ceramic biomaterials

“…In addition to growth factor delivery, an in vitro bioreactor system approach can be applied to speed up in vivo healing. In this scenario, the mesenchymal stem cells (with the potential to transform into osteoblasts and/or pre-osteoblasts) are isolated from the host, expanded ex vivo and seeded onto the biomaterial matrix to produce an extracellular matrix (Khan et al , 2012). Once the extracellular matrix is attained, the scaffold is implanted into the host to treat the bone defect or trauma site.…”

“…Once the extracellular matrix is attained, the scaffold is implanted into the host to treat the bone defect or trauma site. The pace of ex vivo cellular production can be further enhanced through use of gene therapy, whereby genetically transduced adult stem cells capable of expressing osteo-inductive factors, such as bone morphogenetic proteins (BMP2, BMP4 and BMP7), core binding factor α 1 (Cbfa1), vascular endothelial growth factor and noggin (NOG), are employed (Fleming et al , 2000;Khan et al , 2012;Zanetti et al , 2013).…”