Abstract
Large bone defects and nonunion fractures remain serious clinical challenges due to the limited regenerative capacity of adult bone and the drawbacks of autografts/allografts. Conventional hydrogels offer a three-dimensional scaffold for cells but often lack intrinsic osteogenic cues and sufficient mechanical strength. Piezoelectric hydrogels – polymer networks embedded with piezoelectric materials – can convert physiological mechanical loads into local electrical signals, thereby mimicking bone’s native electromechanical environment. Recent studies have shown that such electroactive scaffolds can strongly promote osteogenesis, angiogenesis, and immune modulation in vitro and in vivo. For example, a silk–zinc oxide (ZnO) composite hydrogel generated electrical stimulation under body motion, significantly enhancing mesenchymal stem cell (MSC) osteogenic differentiation and vascular network formation in a rat defect model. Here we review the fundamentals, mechanisms, design principles, and applications of piezoelectric hydrogels for bone repair. We discuss how embedded piezoelectric components (e.g. ZnO, barium titanate, electrospun PVDF fibers) endow hydrogels with electromechanical responsiveness, and how the resulting bioelectric cues regulate cell adhesion, proliferation, differentiation, angiogenesis, and macrophage polarization Design strategies (choice of polymers, fillers, and crosslinking) and key parameters (mechanical modulus, piezoelectric output, biodegradability, injectability, etc.) are highlighted. Representative application scenarios – from implantable scaffolds to injectable or 3D-printed constructs, often combined with cells/exosomes or growth factors – are surveyed. Finally, we address challenges (e.g. long-term signal stability, biosafety, and translation barriers) and future directions toward “smart” piezoelectric biomaterials. Altogether, piezoelectric hydrogels represent a promising direction at the interface of materials science and bone bioengineering for enhanced bone regeneration.