The New Biomaterials in Orthopaedics

Modern joint reconstruction surgery is founded not only on the concept of repairing pre-existing tissues with other, analogous tissues (often with both quantitative and qualitative differences), and on that of prosthetic replacement, but also on the concept of tissue healing, which involves the creation of tissue proper, the same as the pre-existing tissue. Whereas this is always possible in the case of bone tissue, for decades it did not prove possible for the other types of tissue (cartilage, ligaments, tendons). Nowadays, thanks to tissue engineering, which is based on study of the interaction between cells, growth factors and substrates, it has proved possible to recreate new tissues in vitro and subsequently to apply them in vivo . And it is the substrates, or scaffolds, that constitute the basis for joint reconstruction surgery, as regards both bone and other aspects. The authors outline the rationale and main characteristics of the most important and most widely used scaffolds (of homologous and of synthesised materials, resorbable and non-resorbable), and also take a look at the new developments now emerging in the field of bioengineering. They then look at the peculiarities of bioactive surfaces in prosthetics, which have the capacity to bring about more rapid and effective integration of the components with the recipient bone. Finally, they illustrate cases of clinical application of these biomaterials in various situations frequently encountered by the specialist in orthopaedics.