Fatigue behaviour of load-bearing polymeric bone scaffolds: A review

Clinical challenges in bone tissue engineering - A narrative review

Bone tissue engineering (BTE) has emerged as a promising approach to address large bone defects caused by trauma, infections, congenital malformations, and tumors. This review focuses on scaffold design, cell sources, growth factors, and vascularization strategies, highlighting their roles in developing effective treatments. We explore the complexities of balancing mechanical properties, porosity, and biocompatibility in scaffold materials, alongside optimizing mesenchymal stem cell delivery methods. The critical role of growth factors in bone regeneration and the need for controlled release systems are discussed. Vascularization remains a significant hurdle, with strategies such as angiogenic factors, co-culture systems, and bioprinting under investigation. Mechanical challenges, tissue responses, and inflammation management are examined, alongside gene therapy's potential for enhancing osteogenesis and angiogenesis via both viral and non-viral delivery methods. The review emphasizes the impact of patient-specific factors on bone healing outcomes and the importance of personalized approaches. Future directions are described, emphasizing the necessity of interdisciplinary cooperation to advance the field of BTE and convert laboratory results into clinically feasible solutions.

Innovative 3D printing technologies and advanced materials revolutionizing orthopedic surgery: current applications and future directions

Three-dimensional (3D) printing has rapidly become a transformative force in orthopedic surgery, enabling the creation of highly customized and precise medical implants and surgical tools. This review aims to provide a more systematic and comprehensive perspective on emerging 3D printing technologies-ranging from extrusion-based methods and bioink printing to powder bed fusion-and the broadening array of materials, including bioactive agents and cell-laden inks. We highlight how these technologies and materials are employed to fabricate patient-specific implants, surgical guides, prosthetics, and advanced tissue engineering scaffolds, significantly enhancing surgical outcomes and patient recovery. Despite notable progress, the field faces challenges such as optimizing mechanical properties, ensuring structural integrity, addressing regulatory complexities across different regions, and considering environmental impacts and cost barriers, especially in low-resource settings. Looking ahead, innovations in smart materials and functionally graded materials (FGMs), along with advancements in bioprinting, hold promise for overcoming these obstacles and expanding the capabilities of 3D printing in orthopedics. This review underscores the pivotal role of interdisciplinary collaboration and ongoing research in harnessing the full potential of additive manufacturing, ultimately paving the way for more effective, personalized, and durable orthopedic solutions that improve patient quality of life.

Silk Nanofibers/Carbon Nanotube Conductive Aerogel

Natural silk nanofibers (SNF) are attractive conductive substrates due to their high aspect ratio, outstanding mechanical strength, excellent biocompatibility, and controllable degradability. However, the inherently non-conductivity severely restricts the potential sensor application of SNF-based aerogels. In this work, the conductive nanofibrous aerogels with low-density achieved through freeze-drying by dispersing carbon nanotubes (CNT) into SNF suspension. The addition of CNT significantly increases the conductivity with improved mechanical properties of composite aerogels. SEM results reveal that the distinct hierarchical structure comprising micropores and nanofibrous networks within the pores is formed when CNT content reached 30%. Furthermore, increased cell viability suggested the excellent biocompatibility of SNF-CNT-based conductive aerogel for tissue-engineering applications. Subsequently, the elastic water-borne polyurethane (WPU) is incorporated to SNF-CNT system to construct aerogel with good sensing properties. The introduction of WPU demonstrates enhanced compressive performances and an exceptionally high elastic recovery ratio of 99.8%, thereby exhibiting a stable and lossless strain-sensing signal output at 5% strain. This study provides a feasible choice and strategy for exploring the potential application of SNF in functional aerogels.

Multifunctional Biological Performance of Electrospun PCL Scaffolds Formulated with Silver Sulfide Nanoparticles

Our work describes the green synthesis of silver sulfide nanoparticles (Ag2S NPs) and their formulation into polycaprolactone fibers (PCL), aiming to improve the multifunctional biological performance of PCL membranes as scaffolds. For this purpose, an extract of rosemary (Salvia rosmarinus) was employed as a reducing agent for the Ag2S NPs, obtaining irregular NPs and clusters of 5-60 nm, with a characteristic SPR absorption at 369 nm. Ag2S was successfully incorporated into PCL fibers by electrospinning using heparin (HEP) as a stabilizer/biocompatibility agent, obtaining nanostructured fibers with a ca. 500-800 nm diameter. Different amounts of Ag2S NPs (0.05, 0.5, and 1 wt.%) enhanced the nanostructured membranes' surface polarity and mechanical performance, with a controlled ion release after 6 days submerged in PBS solution, determined by cyclic voltammetry. As a result, PCL/HEP/Ag2S scaffolds exhibit high antibacterial performance (80-90%) at early stages of contact (3 h) against E. coli and S. aureus. Also, cytotoxicity analysis demonstrated that the nanostructured membranes are biocompatible and exhibit high fibroblast cell regeneration, which is optimal for their application as scaffolds. To validate the regenerative response of PCL/HEP/Ag2S scaffolds, controlled wounds were induced in Wistar rats, presenting a favorable healing response by contact with PCL/HEP/Ag2S 1%, compared with the untreated wound. Our results indicated that nanostructured scaffolds enable the development of novel nanomaterials with multifunctional biological performance.

Therapeutic functions of medical implants from various material categories with integrated biomacromolecular systems

Medical implants are designed to replace missing parts or improve body functions and must be capable of providing structural support or therapeutic intervention for a medical condition. Advances in materials science have enabled the development of devices made from metals, polymers, bioceramics, and composites, each with its specific advantages and limitations. This review analyzes the incorporation of biopolymers, proteins, and other biomacromolecules into implants, focusing on their role in biological integration and therapeutic functions. It synthesizes advancements in surface modification, discusses biomacromolecules as carriers for controlled drug release, and explores the application of nanoceramics and composites to improve osseointegration and tissue regeneration. Biomacromolecule systems are capable of interacting with device components and therapeutic agents - such as growth factors (GFs), antibiotics, and nanoceramics - allowing control over substance release. Incorporating therapeutic agents into these systems enables localized treatments for tissue regeneration, osseointegration, post-surgery infection control, and disease and pre-existing conditions. The review highlights these materials' therapeutic advantages and customization opportunities, by covering mechanical and biological perspectives. Developing composites and hybrid drug delivery systems align with recent efforts in interdisciplinary personalized medicine and implant innovations. For instance, a trend was observed for integrating inorganic (especially nanoceramics, e.g., hydroxyapatite) and organic phases in composites for better implant interaction with biological tissues and faster recovery. This article supports understanding how integrating these materials can create more personalized, functional, durable, and biocompatible implant devices.

A review of computational optimization of bone scaffold architecture: methods, challenges, and perspectives

The design and optimization of bone scaffolds are critical for the success of bone tissue engineering (BTE) applications. This review paper provides a comprehensive analysis of computational optimization methods for bone scaffold architecture, focusing on the balance between mechanical stability, biological compatibility, and manufacturability. Finite element method (FEM), computational fluid dynamics (CFD), and various optimization algorithms are discussed for their roles in simulating and refining scaffold designs. The integration of multiobjective optimization and topology optimization has been highlighted for developing scaffolds that meet the multifaceted requirements of BTE. Challenges such as the need for consideration of manufacturing constraints and the incorporation of degradation and bone regeneration models into the optimization process have been identified. The review underscores the potential of advanced computational tools and additive manufacturing techniques in evolving the field of BTE, aiming to improve patient outcomes in bone tissue regeneration. The reliability of current optimization methods is examined, with suggestions for incorporating non-deterministic approaches andin vivovalidations to enhance the practical application of optimized scaffolds. The review concludes with a call for further research into artificial intelligence-based methods to advance scaffold design and optimization.

Advances of naturally derived biomedical polymers in tissue engineering

The extensive utilization of natural polymers in tissue engineering is attributed to their excellent biocompatibility, degradability, and resemblance to the natural extracellular matrix. These polymers have a wide range of applications such as delivering therapeutic medicine, detecting diseases, sensing biological substances, promoting tissue regeneration, and treating diseases. This is a brief review of current developments in the properties and uses of widely used biomedical polymers derived from nature. Additionally, it explores the correlation between the characteristics and functions of these materials in different biomedical applications and highlights the prospective direction for the advancement of natural polymer materials in tissue engineering.

Crack propagation in TPMS scaffolds under monotonic axial load: Effect of morphology

In this paper, the mechanical behaviour and failure of porous additively manufactured (AM) polylactide (PLA) scaffolds based on the triply periodic minimal surfaces (TPMS) is investigated using numerical calculations of their unit cells and representative volumes. The strain-amplification factor is chosen as the main parameter, and the most critical locations for failure of different types of scaffold structures are evaluated. The results obtained are presented in comparison with a multiple-crack-growth algorithm using the extended finite element method (XFEM), underpinned by the experimentally obtained fracture properties of PLA. The effect of morphology of TPMS structures on the pre-critical, critical and post-critical behaviours of scaffolds under monotonic loading regimes is assessed. The results provide an understanding of the fracture behaviour and main risk points for crack initiation in structures of AM-PLA scaffolds based on typical commonly used types of TPMS, as well as the influence of structure type and external load on this behaviour.

Injectable mineralized Sr-hydroxyapatite nanoparticles-loaded ɛ-polylysine-hyaluronic acid composite hydrogels for bone regeneration

In this study, multifunctional injectable mineralized antibacterial nanocomposite hydrogels were prepared by a homogenous distribution of high content of (up to 60 wt%) Sr-substituted hydroxyapatite (Sr-HAp) nanoparticles into covalently cross-linked ɛ-polylysine (ɛ-PL) and hyaluronic acid (HA) hydrogel network. The developed bone-targeted nanocomposite hydrogels were to synergistically combine the functional properties of bioactive Sr-HAp nanoparticles and antibacterial ɛ-PL-HA hydrogels for bone tissue regeneration. Viscoelasticity, injectability, structural parameters, degradation, antibacterial activity, and in vitro biocompatibility of the fabricated nanocomposite hydrogels were characterized. Physical performances of the ɛ-PL-HA hydrogels can be tailored by altering the mass ratio of Sr-HAp. The nanocomposite hydrogels revealed good stability against enzymatic degradation, which increased from 5 to 19 weeks with increasing the mass ratio of Sr-HAp from 40 % to 60 %. The loading of the Sr-HAp at relatively high mass ratios did not suppress the fast-acting and long-term antibacterial activity of the ɛ-PL-HA hydrogels against S. aureus and E. coli. The cell studies confirmed the cytocompatibility and pre-collagen I synthesis-promoting activity of the fabricated nanocomposite hydrogels.

Finite element analysis and in vitro tests on endurance life and durability of composite bone substitutes

Bone structures facilitate the regeneration and repair of bone tissue in regions where it has been damaged or destroyed, either temporarily or permanently. Therefore, the bone's fatigue strength and durability are crucial to its efficacy and longevity. Several variables, such as the construct's material qualities, design, and production procedure, loading and unloading cycles, and physiological conditions influence the endurance life of bone constructs. Metals, ceramics, and polymers are all routinely utilized to create bone substitutes, and each of these materials has unique features that might affect the fatigue strength and endurance life of the final product. The mechanical performance and capacity to promote bone tissue regeneration may be affected by the scaffold's design, porosity, and pore size. Researchers employ mechanical testing under cyclic loading circumstances as one example of an experimental approach used to assess bone construction endurance. These analyses can give us important information about the stress-strain behavior, resistance to multiple loading cycles, and fatigue strength of the new structure. Predicting the endurance life of the developed construct may also be possible with the use of simulations and numerical analyses. Hence, in order to create reliable and efficient constructs for bone tissue engineering, it is crucial to understand their fatigue strength and durability. The purpose of this study is to analyze the effective parameters for fatigue strength of bone structures and to gather the models and evaluations utilized in endurance life assessments.

Recent Advances in 3D Printing of Smart Scaffolds for Bone Tissue Engineering and Regeneration

The repair and functional reconstruction of bone defects resulting from severe trauma, surgical resection, degenerative disease, and congenital malformation pose significant clinical challenges. Bone tissue engineering (BTE) holds immense potential in treating these severe bone defects, without incurring prevalent complications associated with conventional autologous or allogeneic bone grafts. 3D printing technology enables control over architectural structures at multiple length scales and has been extensively employed to process biomimetic scaffolds for BTE. In contrast to inert and functional bone grafts, next-generation smart scaffolds possess a remarkable ability to mimic the dynamic nature of native extracellular matrix (ECM), thereby facilitating bone repair and regeneration. Additionally, they can generate tailored and controllable therapeutic effects, such as antibacterial or antitumor properties, in response to exogenous and/or endogenous stimuli. This review provides a comprehensive assessment of the progress of 3D-printed smart scaffolds for BTE applications. It begins with an introduction to bone physiology, followed by an overview of 3D printing technologies utilized for smart scaffolds. Notable advances in various stimuli-responsive strategies, therapeutic efficacy, and applications of 3D-printed smart scaffolds are discussed. Finally, the review highlights the existing challenges in the development and clinical implementation of smart scaffolds, as well as emerging technologies in this field.

Fatigue Performance of 3D-Printed Poly-Lactic-Acid Bone Scaffolds with Triply Periodic Minimal Surface and Voronoi Pore Structures

Bone scaffolds serve a crucial role in tissue engineering, particularly in facilitating bone regeneration where natural repair is insufficient. Despite advancements in the fabrication of polymeric bone scaffolds, the challenge remains to optimize their mechanical resilience. Specifically, research on the fatigue behaviour of polymeric bone scaffolds is scarce. This study investigates the influence of pore architecture on the mechanical performance of poly-lactic-acid (PLA) scaffolds under quasi-static and cyclic compression. PLA scaffolds with a 60% porosity were fabricated using extrusion-based 3D printing in various designs: Gyroid, Lidinoid, Fischer-Koch, IWP, and Voronoi. Results demonstrated that Gyroid scaffolds had the highest compressive strength (6.6 MPa), followed by Lidinoid, Fischer-Koch, IWP, and Voronoi designs. Increased strut thickness was linked to higher compressive strength. However, normalized fatigue resistance showed a different pattern. While scaffolds resisted fatigue cycles at low strain amplitudes, fatigue damage was observed at higher strains. Voronoi structures exhibited the highest normalized fatigue performance, enduring around 58,000 cycles at 85% strain amplitude, followed by Gyroid, Fischer-Koch, Lidinoid, and IWP structures. Enhanced fatigue performance in different topologies correlated with the minimum cross-sectional area of scaffolds. Given the importance of both static and fatigue strength, the Gyroid topology emerges as the superior choice overall.

Chestnut-Inspired Hollow Hydroxyapatite 3D Printing Scaffolds Accelerate Bone Regeneration by Recruiting Calcium Ions and Regulating Inflammation

This study aims to overcome the drawbacks associated with hydroxyapatite (HAP) dense structures after sintering, which often result in undesirable features such as large grain size, reduced porosity, high crystallinity, and low specific surface area. These characteristics hinder osseointegration and limit the clinical applicability of the material. To address these issues, a new method involving the preparation of hollow hydroxyapatite (hHAP) microspheres has been proposed. These microspheres exhibit distinctive traits including weak crystallization, high specific surface area, and increased porosity. The weak crystallization aligns more closely with early mineralization products found in the human body and animals. Moreover, the microspheres' high specific surface area and porosity offer advantages for protein loading and facilitating osteoblast attachment. This innovative approach not only mitigates the limitations of conventional HAP structures but also holds the potential for improving the effectiveness of hydroxyapatite in biomedical applications, particularly in enhancing osseointegration. Three-dimensional printed hHAP/chitosan (CS) scaffolds with different hHAP concentration gradients were manufactured, and the physical and biological properties of each group were systematically evaluated. In vitro and in vivo experiments show that the hHAP/CS scaffold has excellent performance in bone remodeling. Furthermore, in-scaffold components, hHAP and CS were cocultured with bone marrow mesenchymal stem cells to explore the regulatory role of hHAP and CS in the process of bone healing and to reveal the cell-level specific regulatory network activated by hHAP. Enrichment analysis showed that hHAP can promote bone regeneration and reconstruction by recruiting calcium ions and regulating inflammatory reactions.

Raising the Bar: Progress in 3D-Printed Hybrid Bone Scaffolds for Clinical Applications: A Review

Damage to bones resulting from trauma and tumors poses a significant challenge to human health. Consequently, current research in bone damage healing centers on developing three-dimensional (3D) scaffolding materials that facilitate and enhance the regeneration of fractured bone tissues. In this context, the careful selection of materials and preparation processes is essential for creating demanding scaffolds for bone tissue engineering. This is done to optimize the regeneration of fractured bones. This study comprehensively analyses the latest scientific advancements and difficulties in developing scaffolds for bone tissue creation. Initially, we clarified the composition and process by which bone tissue repairs itself. The review summarizes the primary uses of materials, both inorganic and organic, in scaffolds for bone tissue engineering. In addition, we present a comprehensive study of the most recent advancements in the mainstream techniques used to prepare scaffolds for bone tissue engineering. We also examine the distinct advantages of each method in great detail. This article thoroughly examines potential paths and obstacles in bone tissue engineering scaffolds for clinical applications.