Component design and functionalization of absorbable bone wax: From bench to bedside

Abstract

The development of safe and efficient absorbable bone wax is an urgent demand of orthopedic surgeons. Bone wax in clinical practice lacks absorbability and multifunctional properties. The most critical factors determining the successful clinical outcome of absorbable bone wax are the absorbability and functionalization, which largely depend on the component design. This comprehensive review demonstrates the development of component design and functionalization of absorbable bone wax from bench to bedside. Firstly, the absorbable bone wax is classified into alkylene oxide copolymer-based, polyester-based, and bioceramic cement-based three categories and the component correlated absorbability is analyzed. Secondly, the relationship between component and functional outcomes (hemostasis, osteogenesis, and antibacterial activity) is also elucidated. Finally, the review further summarizes the clinical advantages and limitations of commercial absorbable bone wax. We look forward to the trends of absorbable bone wax including controllable degradation, multifunctional integration and standardized evaluation frameworks to bridge translational gaps, which are beneficial to accelerate the transformation of absorbable bone wax from a passive hemostatic agent into an intelligent, tissue-regenerative platform for precision orthopedics.