Xingda Huang, Xi Gong, Aofei Xu, Wen Zhang, Yi Li, Yunfei Jia, Weizhou Yang, Na Yuan, Y Yang, Dezhi Wang, Weiguo Bian, Jiantao Liu
Large bone defects remain a major clinical challenge and often require load-bearing implants for reconstruction. Titanium alloys are widely used for bone defect repair because of their favorable mechanical properties and biocompatibility; however, their high elastic modulus and limited bioactivity can cause stress shielding and insufficient osseointegration. Porous architectures have therefore been introduced to tailor the elastic modulus and promote bone ingrowth. This review summarizes current clinical applications and unresolved challenges of porous titanium implants, and integrates recent preclinical evidence on manufacturing routes and key design parameters. We analyze how pore topology (periodic versus stochastic architectures), pore size, porosity, strut diameter, and multiscale designs affect osseointegration. Overall, the review provides design-oriented insights and highlights prospects and challenges for future preclinical and clinical research to improve the osseointegration of porous titanium implants.