Overview
ABSTRACT
Repair of large bone defects is a major challenge for orthopedic, reconstructive and maxillo-facial surgery. The autologous bone graft is the gold standard for the repair of these defects, but its use is limited by supply and donor site morbidity. These disadvantages have prompted an ongoing search for alternative methods that could supersede the need for autologous bone harvest. This article reviews the state of the art and future directions for engineering bone. With this aim, it describes the current methods (autologous and allogenic bone grafts, bone substitutes and bone morphogenic proteins) and future alternatives (stem cell therapies) for repairing bone. It also discusses the technological and regulatory challenges for its transfer to clinical use.
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Read the articleAUTHORS
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Mickael DESCHEPPER: PhD, post-doctoral fellow, Laboratoire de bioingénierie et bioimagerie ostéoarticulaire UMR CNRS 7052, UFR de médecine, Université Paris Diderot, France
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Joseph PAQUET: PhD, post-doctoral fellow, Laboratoire de bioingénierie et bioimagerie ostéoarticulaire UMR CNRS 7052, UFR de médecine, Université Paris Diderot, France
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Adrien MOYA: Doctoral student, Laboratoire de bioingénierie et bioimagerie ostéoarticulaire UMR CNRS 7052, UFR de médecine, Université Paris Diderot, France
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Mathieu MANASSERO: PhD, MCU, Laboratoire de bioingénierie et bioimagerie ostéoarticulaire UMR CNRS 7052, UFR de médecine, Université Paris Diderot, École vétérinaire de Maisons-Alfort, France
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Morad BENSIDHOUM: PhD, Research Fellow, Laboratoire de bioingénierie et bioimagerie ostéoarticulaire UMR CNRS 7052, UFR de médecine, Université Paris Diderot, France
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Hervé PETITE: PhD, Laboratory Director, Laboratoire de bioingénierie et bioimagerie ostéoarticulaire UMR CNRS 7052, UFR de médecine, Université Paris Diderot, France
INTRODUCTION
Every year, over 2.2 million bone grafts are performed worldwide. These grafts are used to: (i) fill and repair large bone defects, such as those observed after tumour resection; (ii) treat fracture complications such as pseudarthrosis (lack of bone consolidation between bone fragments); (iii) fuse vertebral bodies in cases of chronic disc degeneration; (iv) improve bone integration of joint prostheses such as hip replacements.
Bone grafts are usually obtained from the patient (autograft), since they are histocompatible and non-immunogenic. Bone graft harvesting, however, is an additional source of morbidity, increasing operating times and costs. Moreover, the quantity, and sometimes the quality, of autograft is limited. Surgeons therefore resort to allografts or bone substitutes. Unfortunately, these materials can only be used to fill small defects. Biologically "dumb", they only serve as passive supports for bone formation. These limitations have prompted researchers to develop bone-tissue substitutes with high osteogenic capacity, conferred via growth factors or stem cells. In this article, we describe these different methods of bone repair, their limitations and the new scientific and medical challenges facing this multidisciplinary field.
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KEYWORDS
innovatives bone substitutes | growth factors | stern cells | imaging | tissue engineering | materials chemistry | rapid prototyping | cell culture
From biomaterials to tissue engineering: perspectives in bone repair
Consolidation of simple bone fractures
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