This 2001 narrative review by Albrektsson and Johansson defines and distinguishes three foundational concepts in bone biology and implant science. It clarifies what osteoinduction, osteoconduction, and osseointegration actually mean — terms widely misused in orthopedic literature — and explains the biological and material prerequisites for each.
The terms osteoinduction, osteoconduction, and osseointegration are frequently conflated in clinical discussions — and that imprecision leads to poor implant selection decisions and unrealistic patient counseling.
When you see a porous-coated arthroplasty on imaging, you cannot call it osseointegrated based on radiographs alone. Resolution is insufficient to confirm direct bone contact. True osseointegration requires histologic sections under 20 μm or biomechanical assessment with RSA.
When you are choosing implant material or counseling a patient about why their construct failed, the 150 μm micromotion threshold is the key number. Any technique that sacrifices primary stability. Too-rapid loading, oversized reaming without cooling, cement heat injury. Sets the implant on the path to fibrous encapsulation rather than bone ingrowth.
The BMP framework from this paper is why recombinant BMP-2 and BMP-7 became targets for clinical use in spinal fusion and fracture nonunion. They are the only agents that can directly recruit undifferentiated cells into the osteoblast lineage.
This 2001 narrative review by Albrektsson and Johansson defines and distinguishes three foundational concepts in bone biology and implant science. It clarifies what osteoinduction, osteoconduction, and osseointegration actually mean — terms widely misused in orthopedic literature — and explains the biological and material prerequisites for each.
The terms osteoinduction, osteoconduction, and osseointegration are frequently conflated in clinical discussions — and that imprecision leads to poor implant selection decisions and unrealistic patient counseling.
When you see a porous-coated arthroplasty on imaging, you cannot call it osseointegrated based on radiographs alone. Resolution is insufficient to confirm direct bone contact. True osseointegration requires histologic sections under 20 μm or biomechanical assessment with RSA.
When you are choosing implant material or counseling a patient about why their construct failed, the 150 μm micromotion threshold is the key number. Any technique that sacrifices primary stability. Too-rapid loading, oversized reaming without cooling, cement heat injury. Sets the implant on the path to fibrous encapsulation rather than bone ingrowth.
The BMP framework from this paper is why recombinant BMP-2 and BMP-7 became targets for clinical use in spinal fusion and fracture nonunion. They are the only agents that can directly recruit undifferentiated cells into the osteoblast lineage.