Auxetic metamaterials are characterized by a negative Poisson ratio (NPR) and display an unexpected property of lateral expansion when stretched and densification when compressed. Auxetic properties can be achieved by designing special microstructures, hence their classification as metamaterials, and can be manufactured with varied raw materials and methods. Since work in this field began, auxetics have been considered for different biomedical applications, as some biological tissues have auxetic-like behaviour due to their lightweight structure and morphing properties, which makes auxetics ideal for interacting with the human body. This research study is developed with the aim of presenting an updated overview of auxetic metamaterials for biomedical devices. It stands out for providing a comprehensive view of medical applications for auxetics, including a focus on prosthetics, orthotics, ergonomic appliances, performance enhancement devices, in vitro medical devices for interacting with cells, and advanced medicinal clinical products, especially tissue engineering scaffolds with living cells. Innovative design and simulation approaches for the engineering of auxetic-based products are covered, and the relevant manufacturing technologies for prototyping and producing auxetics are analysed, taking into consideration those capable of processing biomaterials and enabling multi-scale and multi-material auxetics. An engineering design rational for auxetics-based medical devices is presented with integrative purposes. Finally, key research, development and expected technological breakthroughs are discussed.

The major problem in bone tissue engineering is the development of scaffolds which can simultaneously meet the requirements of porous structure, as well as have the ability to guide the regeneration of damaged tissue by biological fixation. Composites containing biodegradable matrix and bioactive filler are the new hope in this research field. Herein we employed a simple and facile solvent casting particulate-leaching method for producing polylactide acid/hydroxyapatite (PLA/HA) composites at room temperature. FT-IR analysis confirmed the existence of necessary functional groups associated with the PLA/HA composite, whereas energy-dispersive X-ray (EDX) spectra indicated the uniform distribution of hydroxyapatite particles in the polymer matrix. The beehive-like surface morphology of the composites revealed the presence of macropores, ranged from 300 to 400 μm, whereas the thickness of the pores was noticed to be 1–2 μm. The total porosity of the scaffolds, calculated by hydrostatic weighing, was found to be 79%. The water contact angle of pure PLA was decreased from 83.6 ± 1.91° to 62.4 ± 4.17° due to the addition of hydroxyapatite in the polymer matrix. Thus, the wettability of the polymeric biomaterial could be increased by preparing their composites with hydroxyapatite. The adhesion of multipotent mesenchymal stromal cells over the surface of PLA/HA scaffolds was 3.2 times (p = 0.03) higher than the pure PLA sample. Subcutaneous implantation in mice demonstrated a good tolerance of all tested porous scaffolds and widespread ingrowth of tissue into the implant pores. HA-containing scaffolds showed a less pronounced inflammatory response after two weeks of implantation compared to pure PLA. These observations suggest that PLA/HA composites have enormous potential for hard tissue engineering and restoring maxillofacial defects.