[The conquest of the surface]

The treatment of traumatic, degenerative, oncologic and septic diseases of the musculoskeletal system has relied on reconstruction and substitution strategies. The advances in the development of biomaterials have led to the design of very efficient implant designs for joint replacement, fracture fixation and correction of deformities. A sucessful implant requires an appropriate interaction between the biomaterials and the surrounding tissues. A tight direct funtional connection between living bone and the biomaterial surface is needed to archieve osteointegration for their long term stability and durability. Many multidisciplinary studies have increased our knowledge of this process and of the molecular, cellular and tissue factors involved. They have led to improved surface designs in implants adequate to solve most of the surgical problems in orthopaedic surgery and traumatology. However, "structural bioengineering" cannot regenerate tissues, the new paradigm of modern medicine. Tissue engineering opens new perspectives for infrequent but critical situations such as large tissue loss or injury in areas or patients of poor biological potential. Tissue engineering requires osteogenic cells, osteinductive factors and osteoconductive scaffolds for cellular and vascular penetration. The biomaterial surface needs a specific and friendly design to facilitate the biological "conquest" of the surface.