Reconstruction after bone tumour resection is entering a new era in which implants are expected not only to restore anatomy and stability but also to actively suppress tumour recurrence and foster regeneration.
Abstract
Abstract Background Critical-sized bone defects following malignant tumour resection remain among the most difficult challenges in orthopaedic oncology. Conventional substitutes such as autografts or polymethyl methacrylate (PMMA) provide initial stability but often fail to ensure durable integration or prevent recurrence. This review aims to summarize recent progress in bone defect reconstruction materials, with particular attention to strategies that unite structural reliability with biological functionality. Discussion Over the past decade, repair materials have evolved from inert fillers to multifunctional scaffolds capable of combining load-bearing support with local therapeutic action. Current designs integrate chemotherapy, photothermal hyperthermia or magnetic hyperthermia, immunomodulation, antibacterial function, and angiogenic–osteogenic cues. Intelligent drug delivery systems and additive manufacturing enable patient-specific, stimuli-responsive implants, while early clinical use of antibiotic-loaded cements and custom-printed prostheses demonstrates translational potential. Nevertheless, most evidence remains preclinical and heterogeneous, with inconsistent tumour, infection, regeneration, and safety endpoints; long-term safety, manufacturing reproducibility, cost-effectiveness, and regulatory acceptance remain unresolved. Conclusions Reconstruction after bone tumour resection is entering a new era in which implants are expected not only to restore anatomy and stability but also to actively suppress tumour recurrence and foster regeneration. Multifunctional and patient-tailored scaffolds hold promise to redefine limb-salvage surgery, provided that future work delivers robust clinical validation and scalable manufacturing pathways.
ABSTRACT Introduction Postoperative fracture infection can cause serious limb deformity and dysfunction. Polymethylmethacrylate (PMMA) bone cement is widely used for treating open bone defect infections, yet its limitations necessitate a review of current strategies and future directions. Areas covered This review summarizes PMMA’s history, biological properties, and drug-loaded applications in orthopedics, focusing on antibiotic combination therapy for fracture defects. Literature was sourced from PubMed and Web of Science, covering studies from the clinical introduction of PMMA to recent advances published up to 2025. Expert opinion PMMA bone cement remains a critical antibiotic delivery system. While modified composites and combination strategies show promise in improving release profiles and osteogenic activity, challenges such as non-degradability, optimal pore formation, and clinical translation of bioactive additives persist. Future research should prioritize developing fully biodegradable, highly osteogenic PMMA alternatives and establishing standardized protocols for antibiotic combination therapies. The ideal solution would balance mechanical strength, drug release kinetics, and complete resorption, potentially transforming infected bone defect management within five years.
Haitao Liu, Yu Bo, Peng-Cheng Gao et al.· Expert Review of Medical Dev...· 0 citations
Bone defect repair remains a major clinical challenge in orthopedics. Over 2 million cases caused by trauma, tumors, and other factors occur annually, with large‐scale defects posing a particular bottleneck due to limited self‐healing capacity. The inherent limitations of traditional bone grafting techniques, such as donor site scarcity and immune rejection, have driven the rapid advancement of bone tissue engineering and the development of novel bone repair materials. This review summarizes the pathological mechanisms of bone repair, encompassing three stages: inflammation, regeneration, and remodeling. It elaborates on the regulatory roles of immune cells, stem cells, and cytokines within each stage. Key material categories and advantages are highlighted: bioceramics offer excellent osteoconductivity; polymers provide adaptability; metallic materials meet load‐bearing demands, with degradable metals avoiding second surgery; composites achieve synergistic performance. This review outlines evaluation systems, analyzes clinical challenges including complex microenvironments, material matching, multicell regeneration, and translation barriers. Finally, it highlights frontier directions such as bionic design, intelligent regulation, and immune modulation, offering theoretical references for developing novel bone repair materials.
Yuanbin Zhang, Junlei Chai, Quanwei Ding et al.· Visual Information Expert Wo...· 0 citations
Bone augmentation procedures are widely used in implant dentistry to reconstruct deficient alveolar bone and support implant placement. However, outcomes are often evaluated mainly by defect filling, volumetric stability, or implant survival, which do not necessarily reflect the biological quality of regenerated tissue. This narrative review synthesizes human and supporting mechanistic evidence across autogenous, allogeneic, xenogeneic, and alloplastic grafts, including biologically functionalized constructs, with emphasis on bone remodeling dynamics and functional regeneration. Available evidence indicates that volumetric preservation alone should not be considered equivalent to complete bone regeneration and that remodeling is material-, product-, processing-, and indication-dependent. Augmented sites may contain newly formed vital bone together with persistent residual graft particles, forming a hybrid tissue whose significance depends on graft integration, vascularization, remodeling capacity, and the intended therapeutic objective. Persistent particles may influence the local immune microenvironment and, under unfavorable conditions, contribute to foreign body reactions or other complications, although such events appear uncommon and causal relationships remain uncertain. Biomaterial assessment should integrate quantitative, structural, and biological parameters, while residual graft persistence should be interpreted in an indication-specific manner rather than as evidence of treatment failure or inferior long-term performance in isolation.
Nikola Gapińska, Marek Śmielecki, K. Krasny· Journal of Functional Biomat...· 0 citations
The repair of bone defects represents a major clinical challenge in orthopedics, oral and maxillofacial surgery, and trauma surgery. The heterogeneity of their etiology, anatomical sites, local microenvironments, and patients’ systemic conditions imposes diverse and sometimes contradictory performance requirements on repair materials. As the primary inorganic component of human bone, hydroxyapatite (HA) is considered an ideal foundational material for bone repair due to its excellent biocompatibility, osteoconductivity, and osteoinductive potential. However, its inherent brittleness, insufficient mechanical strength, and single functionality limit its application in complex clinical scenarios. This article reviews the latest advances in the modification of HA-based materials through strategies such as ion doping, composite reinforcement, structural regulation, and surface functionalization, aiming to precisely modulate their mechanical properties, degradation behavior, osteogenic activity, antibacterial capacity, and pro-vascularization functions. Furthermore, this article provides an in-depth analysis of the heterogeneous characteristics of various clinical bone defect types—including infectious, load-bearing, ischemic (insufficient blood supply), osteoporotic, and post-tumor resection defects—and their differential requirements for material performance. On this basis, a new clinical problem-oriented material design paradigm is proposed, shifting from a “universal” approach to a “personalized” one. This involves a personalized research and development strategy that conducts precise functional integration and performance trade-offs for specific clinical scenarios (e.g., “antibacterial-dominant,” “mechanical-bioactive synergy,” “osteogenesis/anti-resorption dual regulation,” “pro-vascularization induction,” and “integrated tumor suppression and repair”), thereby achieving a precise match between material properties and specific clinical needs. Finally, this article discusses the current limitations regarding the standardization of performance evaluation, multi-functional synergistic mechanisms, and clinical translation. It also anticipates future development directions for personalized bone repair materials, including the construction of a multi-scale and multi-dimensional material performance evaluation system, the advancement of “personalized responsive” material development, and the strengthening of clinical translation research.
Leiyun Huang, Jinghan Hu, Qingjin Cai et al.· Frontiers in Bioengineering...· 0 citations
Objective Infection-induced bone defects are a challenging disease in orthopedic clinical practice. Traditional treatments face core problems such as limited bone sources, high risk of antibiotic systemic application-induced resistance, and difficulties in synchronizing infection control and bone regeneration. Method 3D printing technology, with its advantages of personalized customization, precise structural regulation, and compatibility and adaptability of multiple materials, has become the core preparation method for repair scaffolds for infection-induced bone defects. Constructing an integrated scaffold with three functions - antibacterial, osteogenic, and vascularization - that is temporally coupled and spatially stratified, and oriented towards clinical translation is a key direction to break through the treatment bottleneck of this disease. Results This review differs from existing reviews that only focus solely on antibacterial materials, 3D printing scaffold preparation, or bone regeneration mechanisms. It is the first to systematically construct a three-function collaborative framework of “infection control - angiogenesis - bone regeneration” with temporal coupling and spatial stratification. It deeply analyzes the adaptability of different material systems in the infection microenvironment, the logic of selecting anti-infection strategies, and the design rules of biomimetic structures. It comprehensively summarizes the key bottlenecks in clinical translation, real clinical case evidence, and industrialization paths, and clarifies the time-controlled regulatory mechanism and clinical translation targeting path of the three-function collaboration. Conclusion 3D printed anti-infection bone scaffolds can achieve synchronous repair of infection clearance, bone regeneration, and angiogenesis. The three-function temporal and spatial collaborative design and integrated research for clinical translation are the core development directions in this field, providing theoretical support and practical guidance for the precise treatment of infection-induced bone defects.
Peijie Zhao, Zewen Qiao· Frontiers in Bioengineering...· 0 citations
Clinical repair of bone defects has long faced challenges including the limited availability of autografts, immunological rejection of allografts, and mechanical mismatch of traditional implants. Injectable hydrogels have emerged as highly promising strategies in bone tissue engineering due to their unique advantages: minimally invasive implantation, the ability to conform to irregular defect cavities, excellent biocompatibility, and high functional tunability. This review systematically outlines recent advances in injectable hydrogels for bone regeneration. It comprehensively outlines material classifications and fundamental properties. Specifically, it analyzes key design strategies, including enhancing mechanical support through cross-linking optimization and the incorporation of reinforcing phases, reconstructing the regenerative microenvironment via bioactive factor loading, and enabling synchronized degradation and tissue regeneration. Furthermore, this review summarizes current applications for different bone defect types, identifies current technical bottlenecks such as balancing mechanical strength with minimally invasive delivery, and anticipates future directions, including stimuli-responsive design and multifunctional integration.
Xin-Yue Zhang, Zhen-Shun Zhuang, Bo Liu et al.· RSC Advances· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
