Building better bone: The weaving of biologic and engineering strategies for managing bone loss

Abstract

Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost-sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice-changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell-based strategies. Despite an ever-evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled "Building better bone: The weaving of biologic and engineering strategies for managing bone loss," was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering-clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855-1864, 2017.

Biodegradable Scaffolds for Bone Regeneration Combined with Drug-Delivery Systems in Osteomyelitis Therapy

“…In addition, autograft and allograft implants are made of avascular and non-viable tissue; they do not carry cellular components of bones, resulting in a lack of bone remodelling. The percentage of failure of these procedures is up to 25–35% when the immune system induces graft rejection [ 24 , 25 ].…”

Prospectives for using artificial scaffolds in oral and craniofacial surgery: literature review

“…Critical issues related to allograft and autograft implants are identified as high risk of infections, painful procedures needed to harvest bone graft from the iliac crests, and long post-operative recovery [21]. In addition, autograft and allograft implants are made of avascular and non-viable tissue; they do not carry cellular components of bones, resulting in a lack of bone remodeling.…”

Recent Advances in Mechanically Loaded Human Mesenchymal Stem Cells for Bone Tissue Engineering

“…To date, there are no reliable long-term healing approaches for the repair of large bone defects. The conventional clinical approaches used to augment bone regeneration include distraction osteogenesis-and-bone transport, bone grafting and Masquelet techniques [6,7]. Among these, bone grafting is the current gold-standard approach for the repair of non-healing or large bone defects.…”