Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2017; 8(2): 87-98
Published online Feb 18, 2017. doi: 10.5312/wjo.v8.i2.87
Challenges of bone tissue engineering in orthopaedic patients
Enrique Guerado, Enrique Caso
Enrique Guerado, Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, 29603 Marbella (Malaga), Spain
Enrique Caso, Research Unit, Hospital Costa del Sol, University of Malaga, 29603 Marbella (Malaga), Spain
Author contributions: Guerado E was the main author of the Introduction and the sections on RIA, the Masquelet technique and bone transportation; Caso E wrote the sections on combined stem cells therapy, tissue engineering and future directions; both authors jointly reviewed, corrected and edited the paper.
Conflict-of-interest statement: There is no conflict of interest to declare that could provoke any potential bias in the study design, the interpretation of the results obtained or the presentation of the scientific/medical content, including but not limited to commercial, personal, political, intellectual or religious interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Enrique Guerado, Professor and Chairman, Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Autovia A-7, Km 187, 29603 Marbella (Malaga), Spain. eguerado@hcs.es
Telephone: +34-951-976224
Received: September 14, 2016
Peer-review started: September 19, 2016
First decision: October 21, 2016
Revised: October 31, 2016
Accepted: November 21, 2016
Article in press: November 23, 2016
Published online: February 18, 2017
Abstract

Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting techniques and other procedures in which healing is slow, there is a high risk of infection and considerable pain is provoked - with no guarantee of complete correction of the defect. Therefore, the search for surgical alternatives continues to present a major challenge in orthopaedic traumatology. The reamer-irrigator-aspirator (RIA) system, which was devised to avoid the problems that can arise with autograft harvesting from the iliac crest, consists of collecting the product of the femoral canal after reaming. The RIA technique improves osteogenic differentiation of mesenchymal stem cells, compared to bone marrow aspiration or cancellous bone harvesting from the iliac crest using a spoon. Another approach, the Masquelet technique, consists of reconstructing a long bone defect by means of an induced membrane grown onto an acrylic cement rod inserted to fill the defect; in a second surgical step, once the membrane is constituted, the cement rod is removed and cancellous autograft is used to fill the defect. Both in RIA and in the Masquelet technique, osteosynthesis is usually needed. Bone transportation by compression-distraction lengthening principles is commonly implemented for the treatment of large bone loss. However, complications are frequently encountered with these techniques. Among new techniques that have been proposed to address the problem of large bone loss, the application of stem cells in conjunction with tissue engineering techniques is very promising, as is the creation of personalised medicine (or precision medicine), in which molecular profiling technologies are used to tailor the therapeutic strategy, to ensure the right method is applied for the right person at the right time, after determining the predisposition to disease among the general population. All of the above techniques for addressing bone defects are discussed in this paper.

Keywords: Bone loss, Mesenchymal stem cells, Reamer-irrigator-aspirator, Autograft, Personalised medicine, Bone transportation, Precision medicine, Masquelet technique

Core tip: This paper discusses the problems created by large bone loss, especially after major trauma, and considers current alternatives to autograft or allograft, such as the reamer-irrigator-aspirator system, the Masquelet technique, bone transportation, or the combination of stem cell therapy and tissue engineering. Future Directions addressed mainly concern the new concepts of personalised medicine and precise medicine.