ABSTRACT
Purpose: Bone grafting is still requested to fill bone defects in traumatology, or after tumor removal, but also in orthopedic surgery for spine, arthroplasty revisions, and osteotomies. Due to the limitations of autografts and allografts, and the progress of biomaterial research, a large number of nonhuman bony scaffolds have been developed including synthetic calcium phosphates and highly processed xenografts. The most important parameters for bone ingrowth are the macroporosity of the scaffold with the suitable biological autologous cells and factors, optimal osteoinductive, osteointegrative and osteoconductive properties can be achieved. Methods and Results: The important factors regulating these properties are discussed in this paper, which also reports preclinical and clinical results obtained with such bone graft substitutes. Conclusions: Among different bone graft substitutes available, the porosity, the accessibility of pores, the internal surface exposed to the biological components of bone repair, are present in highly processed bovine hydroxyapatites. Compared to autografts, allografts and synthetic substitutes, they associate an initial conductivity, and a long term stability suitable for some orthopedic indications.