Computer-Aided Tissue Engineering in Whole Bone Replacement Treatment

Abstract

Tissue engineering is developing into a less speculative field involving the careful interplay of numerous design parameters and multi-disciplinary professionals. Problem solving abilities and state of the art research tools are required to develop solutions for a wide variety of clinical issues. One area of particular interest is orthopaedic biomechanics, a field that is responsible for the treatment of over 700,000 vertebral fractures in the U.S alone last year. Engineers are currently lacking the technology and knowledge required to govern the subsistence of cells in vivo, let alone the knowledge to create a functional tissue replacement for a whole organ. Despite this, advances in Computer Aided Tissue Engineering (CATE) are continually growing. Using a combinatory approach to scaffold design, patient-specific implants may be constructed. Computer aided design (CAD), optimization of geometry using voxel finite element models or other optimization routines, creation of a library of architectures with specific material properties, rapid prototyping, and determination of a defect site using imaging modalities highlight the current availability of design resources. Our study represents a patient specific approach for constructing a complete vertebral body via building blocks. Though some of the methods described cannot be realized with current technology, namely complete construction of the vertebral body via FDM, the necessary advances are not far off. Computing power and CAD programs need to improve slightly to allow the rapid generation of complex models that would ease the fabrication of an appropriate number of building blocks. The main bottleneck of the process described in this study is the general lack of knowledge of human mechanobiology and the role of cellular interactions on artificial substrates including immune responses, and foreign body reactions. Assuming these biological parameters can be identified, a scaffold may be designed with a proper pore size and interconnectivity, microstructure, degradation rate, and surface chemistry. The advantage of the outlined process lies in adjustment of the vertebral compliance first, to ensure adequate load transfer, an important property for vertebral replacement. Subsequently, net biological properties can be fine tuned by simply scaling the final construct. Mixing and matching of geometries may be utilized to design asymmetric scaffolds, or scaffolds that exhibit a discontinuous microstructural stiffness with the goal of accentuating fluid flow. Finally, while these techniques lend themselves to the formulation of bone constructs, they can be used for other parts of the body as well that do not require load-bearing support.