Patient-specific and physiological load sustaining synthetic graft substitutes for fusion of critically sized segmental bone defects

TL;DR

This study developed a customizable, load-bearing, bioresorbable synthetic bone graft substitute using 3D printing, demonstrating its mechanical stability, biocompatibility, and potential for supporting bone regeneration in critically sized defects.

Contribution

It introduces a patient-specific, physiologically load sustaining synthetic graft fabricated from polylactic acid with optimized architecture and demonstrated biological and mechanical viability.

Findings

Comparable compressive properties to adult human femurs

Achieved stability after 200,000 fatigue cycles under load

Enhanced mineralization at 2Hz loading frequency

Abstract

Critically sized defects are currently treated via autologous or allograft bone grafting, distraction osteogenesis, and membrane induction. However, these methods have major weaknesses which encourage the development of synthetic bone graft substitutes. A bioresorbable and physiologically load sustaining graft substitute was fabricated from polylactic acid using 3D printing, a versatile method which enables parameters to be customizable in a patient-specific manner. The internal architecture consists of vertical and horizontal conduits that are organized to achieve gradients in porosity and pore size in the radial direction to emulate cortical bone encapsulating cancellous bone. A diameter of 30mm and height of 10mm was designed to target the repair of critically sized long bone defects. The compressive properties of these graft substitutes were determined to be comparable to adult human femurs. Furthermore, dynamic fatigue testing at twice the human torso weight (800N) indicated that the bone graft substitute achieved stability as quickly as 200,000 cycles, suggesting its ability to support weight bearing loads while it gradually degrades as bone cells proliferate and mineralize. Additionally, the graft substitutes were seeded with human fetal osteoblasts to validate homogenous cellular attachment and cytocompatibility. Graft substitutes were also dynamically cultured for 28 days under various loading regimens using human mesenchymal stem cell differentiated osteoblasts, and these resulting tissue constructs were subjected to fatigue testing. The frequency of loading during dynamic culturing had a profound effect on the rate of mineralization which was particularly high at 2Hz, confirmed by Alizarin Red staining of the calcium deposits. Taken together, these bone graft substitutes have potential for use as orthopaedic implants to facilitate the repair of critically sized bone defects.