Addressing bone defects is a complex medical challenge that involves dealing with various skeletal conditions, including fractures, osteoporosis (OP), bone tumours, and bone infection defects. Despite the availability of multiple conventional treatments for these skeletal conditions, numerous limitations and unresolved issues persist. As a solution, advancements in biomedical materials have recently resulted in novel therapeutic concepts. As an emerging biomaterial for bone defect treatment, graphene oxide (GO) in particular has gained substantial attention from researchers due to its potential applications and prospects. In other words, GO scaffolds have demonstrated remarkable potential for bone defect treatment. Furthermore, GO-loaded biomaterials can promote osteoblast adhesion, proliferation, and differentiation while stimulating bone matrix deposition and formation. Given their favourable biocompatibility and osteoinductive capabilities, these materials offer a novel therapeutic avenue for bone tissue regeneration and repair. This comprehensive review systematically outlines GO scaffolds’ diverse roles and potential applications in bone defect treatment.

Cite this article: Bone Joint Res 2024;13(12):725–740.

Osteoarthritis (OA) is a degenerative joint disease affecting millions worldwide. Early detection of OA and monitoring its progression is essential for effective treatment and for preventing irreversible damage. Although sensors have emerged as a promising tool for monitoring analytes in patients, their application for monitoring the state of pathology is currently restricted to specific fields (such as diabetes). In this study, we present the development of an optical sensor system for real-time monitoring of inflammation based on the measurement of nitric oxide (NO), a molecule highly produced in tissues during inflammation. Single-walled carbon nanotubes (SWCNT) were functionalized with a single-stranded DNA (ssDNA) wrapping designed using an artificial intelligence approach and tested using S-nitroso-N-acetyl penicillamine (SNAP) as a standard released-NO marker. An optical SWIR reader with LED excitation at 650 nm, 730 nm and detecting emission above 1000 nm was developed to read the fluorescence signal from the SWCNTs. Finally, the SWCNT was embedded in GelMa to prove the feasibility of monitoring the release of NO in bovine chondrocyte and osteochondral inflamed cultures (1–10 ng/ml IL1β) monitored over 48 hours. The stability of the inflammation model and NO release was indirectly validated using the Griess and DAF-FM methods. A microfabricated sensor tag was developed to explore the possibility of using ssDNA-SWCNT in an ex vivo anatomic set-up for surgical feasibility, the limit of detection, and the stability under dynamic flexion. The SWCNT sensor was sensitive to NO in both in silico and in vitro conditions during the inflammatory response from chondrocyte and osteochondral plug cultures. The fluorescence signal decreased in the inflamed group compared to control, indicating increased NO concentration. The micro-tag was suitable and stable in joints showing a readable signal at a depth of up to 6 mm under the skin. The ssDNA-SWCNT technology showed the possibility of monitoring inflammation continuously in an in vitro set-up and good stability inside the joint. However, further studies in vivo are needed to prove the possibility of monitoring disease progression and treatment efficacy in vivo. Acknowledgments: The project was co-financed by Innosuisse (grant nr. 56034.1 IP-LS)

The inability to replace human muscle in surgical practice is a significant challenge. An artificial muscle controlled by the nervous system is considered a potential solution for this. We defined it as neuromuscular prosthesis. Muscle loss and dysfunction related to musculoskeletal oncological impairments, neuromuscular diseases, trauma or spinal cord injuries can be treated through artificial muscle implantation. At present, the use of dielectric elastomer actuators working as capacitors appears a promising option. Acrylic or silicone elastomers with carbon nanotubes functioning as the electrode achieve mechanical performances similar to human muscle in vitro. However, mechanical, electrical, and biological issues have prevented clinical application to date. In this study, materials and mechatronic solutions are presented which can tackle current clinical problems associated with implanting an artificial muscle controlled by the nervous system. Progress depends on the improvement of the actuation properties of the elastomer, seamless or wireless integration between the nervous system and the artificial muscle, and on reducing the foreign body response. It is believed that by combining the mechanical, electrical, and biological solutions proposed here, an artificial neuromuscular prosthesis may be a reality in surgical practice in the near future

Background context. Fusion is a fundamental procedure in spine surgery. Although autogenous grafts have ideal bone graft characteristics, their use may remain limited due to various morbidities. Even though ceramic based synthetic bone grafts are used commonly at present, in order to enhance their efficacy, their combined use with other materials has been investigated. The use of carbon nanotubes (CNTs) together with synthetic bone grafts such as hydroxyapatite (HA) has contributed to positive developments in bone tissue engineering. Purpose. The aim of the present study was to investigate the effect of CNTs/ HA- tricalcium phosphate (TCP) composite prepared in posterolateral spinal fusion model. Study Design/Setting. Experimental animal study. Methods. At first, CNTs and CNTs/HA-TCP composites were prepared. Twenty adult male Spraque Dawley rats were randomized into four groups with five rats in each group. Decortication was carried out in standard manner in all animals. Group 1 (only decortication), group 2 (CNTs), group 3 (HA-TCP) and group 4 (CNTs/HA-TCP) were formed. Eight weeks later all animals were sacrificed and obtained fusion segments were evaluated by manual palpation, histomorphometry and micro computed tomography (mCT). Results. In all evaluations, highest fusion values were obtained in Group 4. In mCT investigations, bone volume/ tissue volume (BV/TV) ratio was found to be significantly higher in composite group (group 4) only compared to ceramic group (group 3). Although in Group 2, in which only CNTs were used, the ratio was found to be significantly higher than group 1, the difference was not considered significant in terms of fusion and in addition in group 2, CNTs were completely surrounded by fibrous tissue, i.e. no bone formation was observed. Conclusions. The combined use of carbon nanotubes with ceramic based bone grafts enhances spinal fusion markedly. Although CNTs are inadequate in producing spinal fusion when they are used by themselves, due to especially their high biocompatibillity and unique bicomechanic characteristics compatible with bone tissue, they increase fusion rates significantly, particularly together with ceramic based synthetic grafts. Keywords. Spinal fusion; Rat; Carbon nanotube(s); Ceramic(s); Bone graft subsitutes; Hydroxyapatite

Objectives. The purpose of this study was to evaluate in vivo biocompatibility of novel single-walled carbon nanotubes (SWCNT)/poly(lactic-co-glycolic acid) (PLAGA) composites for applications in bone and tissue regeneration. Methods. A total of 60 Sprague-Dawley rats (125 g to 149 g) were implanted subcutaneously with SWCNT/PLAGA composites (10 mg SWCNT and 1gm PLAGA 12 mm diameter two-dimensional disks), and at two, four, eight and 12 weeks post-implantation were compared with control (Sham) and PLAGA (five rats per group/point in time). Rats were observed for signs of morbidity, overt toxicity, weight gain and food consumption, while haematology, urinalysis and histopathology were completed when the animals were killed. Results. No mortality and clinical signs were observed. All groups showed consistent weight gain, and the rate of gain for each group was similar. All groups exhibited a similar pattern for food consumption. No difference in urinalysis, haematology, and absolute and relative organ weight was observed. A mild to moderate increase in the summary toxicity (sumtox) score was observed for PLAGA and SWCNT/PLAGA implanted animals, whereas the control animals did not show any response. Both PLAGA and SWCNT/PLAGA showed a significantly higher sumtox score compared with the control group at all time intervals. However, there was no significant difference between PLAGA and SWCNT/PLAGA groups. Conclusions. Our results demonstrate that SWCNT/PLAGA composites exhibited in vivo biocompatibility similar to the Food and Drug Administration approved biocompatible polymer, PLAGA, over a period of 12 weeks. These results showed potential of SWCNT/PLAGA composites for bone regeneration as the low percentage of SWCNT did not elicit a localised or general overt toxicity. Following the 12-week exposure, the material was considered to have an acceptable biocompatibility to warrant further long-term and more invasive in vivo studies. Cite this article: Bone Joint Res 2015;4:70–7

MSCs (mesenchymal stem cells) are bone marrow-derived cells capable of replication and differentiation in-vitro into several tissues including bone, cartilage, stroma, fat, muscle and tendon. MSCs can be isolated by relatively simple procedures and then expanded without losing the ability to differentiate into multiple lineages. As such, these cells have immense clinical potential in regenerative medicine and in orthopaedics for repair or replacement of damaged tissues. In this work we investigated the interaction between magnetic carbon nanotubes (CNTs) and MSCs and their ability to guide these cells injected intravenously in living mice by using an external magnetic field. CNTs did not affect cell viability and their ability to differentiate. Both the CNTs and the magnetic field did not alter cell growth rate, phenotype and cytoskeletal conformation. CNTs, when exposed to magnetic fields, are able to shepherd MSCs towards the magnetic source in vitro. Moreover, the application of a magnetic field alters the biodistribution of CNT-labelled MSCs after intravenous injection into rats. We demonstrated that CNTs hold the potential for use as nano-devices to improve therapeutic protocols for transplantation and homing of stem cells in vivo. This could pave the way for the development of new strategies for manipulation/guidance of MSCs in regenerative medicine and cell transplantation for the treatment of many orthopaedic diseases

This paper outlines the recent development of an exchange Travelling Fellowship scheme between the British and American Orthopaedic Research Societies.

Articular cartilage repair remains a challenge to surgeons and basic scientists. The field of tissue engineering allows the simultaneous use of material scaffolds, cells and signalling molecules to attempt to modulate the regenerative tissue. This review summarises the research that has been undertaken to date using this approach, with a particular emphasis on those techniques that have been introduced into clinical practice, via in vitro and preclinical studies.

Carbon nanotubes are an exciting new type of material and have extraordinary properties (. 1. ). A special category of carbon nanotubes (multiwalled or MWNT) is flexible yet have tensile strengths 200 times stronger than traditional carbon fibers (. 2. ). Because of their extremely large surface area-to-volume ratio, theory suggests that MWNTs can bond more strongly to polymethylmethacrylate (PMMA) than any other material tested (. 2. ). The combination of large tensile strength and strong interfacial (PMMA matrix) bonding suggests that when added to bone cement, MWNTs could bridge and arrest fatigue or impact cracks and thereby favorably improve the clinical performance of bone cement. The objective of this study was to determine the validity of this hypothesis and whether MWNTs can significantly improve the tensile properties of PMMA. Methods MWNTs (20–30 nanometers in diameter, 20–100 microns long) were grown on a fused quartz substrate by the thermal decomposition of xylene in the presence of a metal catalyst. They are formed in well-aligned mats and grow perpendicular to the walls of a tubular reactor. As a first approach MWNTs were separated and dispersed through the liquid monomer component of PMMA by using an ultrasonic probe. The remaining polymer component was then mixed with this dispersion and the product was used to prepare specimens by casting in molds. Since prior work in other polymer systems (. 3. ) indicated that small concentrations of MWNTs could significantly affect a polymer’s physical properties, only fractions (1/16, ¼ and ½) of 1% of MWNTs (by weight) were used to prepare tensile test specimens. Control (0% MWNTs) and experimental (MWNT containing) groups of PMMA specimens were cured in air at room temperature for 7 days and then pulled to failure at 6 mm/min in a protocol conforming to ASTM D638. Maximum load, strength, results a total of 41 specimens have been prepared and tested: 13 controls, 9 with 0.063%, 10 with 0.25%, and 9 with 0.5% (by weight) of MWNTs. Carbon nanotubes improved the tensile load bearing properties of all experimental groups from 17% to 24%, and these values were significant (p=0.01 and p=0.02) for the 0.25% and 0.5% concentrations. The lowest concentration of MWNTs made the smallest improvement (17%) and this was not significant (p=0.07). Scanning electron microscopic examination of the fractured surface revealed nanotubes that were well distributed throughout the matrix. Discussion: These preliminary results clearly demonstrate that carbon nanotubes can significantly improve the mechanical performance of bone cement. This result is especially encouraging because the MWNTs were added only to the monomer component. Additional performance enhancement may be expected from ongoing work using higher concentrations of MWNTs and their dispersion into the polymer component of bone cement in addition to the monomer component. Since MWNTs are also electrically conducting and have magnetic properties, MWNTs may also help dissipate the heat generated by polymerization or permit bone cement with an “engineered” mechanical anisotropy. Although static tensile tests are an incomplete measure of bone cement, these preliminary results are very encouraging and motivate continuing study of the more clinically relevant (impact resistance, fatigue properties, etc.) measures of the mechanical performance of MWNT augmented bone cement