Bone repair remains a major clinical challenge. Although traditional metal implants, such as titanium and its alloys, provide mechanical strength, they are often limited by stress shielding, insufficient osseointegration, and a lack of biological activity. Recent advances in metallic topological structures offer a promising solution by integrating mechanical adaptability with biological functionality. This review systematically summarizes the design, properties, and biological interactions of metallic topological implants for bone repair. We first compare conventional metallic materials and their limitations, followed by an overview of manufacturing strategies, including structural and surface modification techniques, unit cell-based architectures, topology optimization, and reverse-engineered biological designs. The potential integration of machine learning and 4D printing is also highlighted as a future direction for personalized implant design. At the biological level, we discuss how topological cues regulate cellular responses through mechanotransduction pathways, osteogenic differentiation signaling, angiogenesis regulation, and immune modulation. Finally, we analyze the practical applications of metallic topological structures in orthopedic implants, as well as the remaining technical and translational challenges. Overall, this review emphasizes the potential of metal topologies to create a new generation of implants with greater mechanical adaptability and better biological performance. The Translational Potential of this Article: This work offers insights into the development of orthopedic metallic topological implants with enhanced mechanical and biological performance. The integration of metallic topologies with emerging technologies like 4D printing and machine learning could lead to highly personalized solutions for bone repair, addressing current limitations in clinical applications and improving patient outcomes.
Wang et al. (Tue,) studied this question.