Bone‐Adhesive Materials: Clinical Requirements, Mechanisms of Action, and Future Perspective

Abstract

Each year, millions of people suffer from complex bone fractures which require proper external or internal fixation. This fixation is usually achieved by means of devices such as plates, pins, and screws. These traditional fixation strategies are associated with severe drawbacks, which have prompted research and development of a variety of bone‐adhesive biomaterials as alternative. However, a clinically applicable bone‐adhesive biomaterial—in the form of a bone‐glue or bone‐adhesive membrane—that meets all requirements has not yet been identified. This perspective article discusses the current state of the art of bone‐adhesive materials with a particular focus on their clinical requirements, mechanisms of action, and future perspective. To develop adhesive biomaterials with specific affinity to bone tissue, a more rational design should be implemented. This perspective article is intended as a starting point and inspiration for future research and development of suitable bone‐adhesive materials.

Adhesive Cements That Bond Soft Tissue Ex Vivo

“…Tissue adhesives are easy to apply, cause minimal trauma, they allow tissues to heal without needing to remove the adhesive at a later point, produce lower rates of infection [6,7] and less morbidity compared to staples and sutures, reduce operating time, and can improve cosmetic outcomes (i.e., less scaring) [1,8,9]. Many different adhesives have been explored for closing [10,11,12], or reattaching, injured soft tissues, including adhesives based on acrylate “superglue” [13], fibrin [14], polysaccharide [15,16], protein [1,17,18], or organic acid [19,20]. The chemistry underlying these adhesives utilize direct crosslinking with the tissue surface, via L-dopa bonding, aldehyde condensation, or enzymatic crosslinking (fibrin) [13,21,22].…”

The Few Who Made It: Commercially and Clinically Successful Innovative Bone Grafts

“…However, limitations exist and there is still room for improvement ( Van der Stok et al, 2011 ; DeKeyser et al, 2019 ; McCoy et al, 2019 ). Specifically, there is a major clinical need in bone surgery to attach the implant to bone and/or bone to bone, whilst improving biomechanical properties and promoting de novo osteoinduction ( Sánchez-Fernández et al, 2019 ). However, there is a gap in the clinical translation of an adhesive biomaterial to meet this specific need.…”

“…Surgical adhesives, such as cyanoacrylates, have been investigated and shown good mechanical properties in vitro ( Kandalam et al, 2013 ), but they lack the osteoinductive potential and their degradation products induce local and systemic toxicity ( Hochuli-Vieira et al, 2017 ; Sánchez-Fernández et al, 2019 ). Other adhesives, such as fibrin-based glues, present poor mechanical properties ( Noori et al, 2017 ; Sánchez-Fernández et al, 2019 ). To fill this unmet need, functionalized bone cements have been developed, such as the OsStic TM (GPBio), which is a bioceramic glue composed of tricalcium phosphate combined with phosphoserine, an amino acid.…”

Current State of Bone Adhesives—Necessities and Hurdles

“…Although different approaches in terms of biomimetic synthetic and hybrid concepts have been pursued to prepare bone adhesives [24,46,47,48], to this date, there has been no commercially available bone adhesive that meets all the above-mentioned requirements [49], but we are getting closer to wide clinical applications and are curious for mid- and long term results.…”

“…Since then, intensive research has been carried out to improve this approach. Detailed information regarding the chemistry of different types of bone-adhesive materials and ensuing mechanisms of adhesion can be found elsewhere [49]. The main lines of research can be classified into synthetic, biomimetic, and biobased approaches:…”