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

The development of safe and efficient absorbable bone wax is urgently required by orthopedic surgeons. Bone wax lacks absorbability and multifunctional properties in clinical practice. The most critical factors determining the successful clinical outcome of absorbable bone wax are absorbability and functionalization, which largely depend on component design. This comprehensive review demonstrates the development of the component design and functionalization of absorbable bone wax from bench to bedside. First, absorbable bone wax is classified into alkylene oxide copolymer-based, polyester-based, and bioceramic cement-based categories, and the component-correlated absorbability is analyzed. Second, the relationship between components and functional outcomes (hemostasis, osteogenesis, and antibacterial activity) is also elucidated. Finally, this review 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.