The Role of Osseointegration in Orthopedics: The Physiologic Basis, New Trends, and Clinical Implications

Abstract

Osseointegration Orthopaedic Surgery: Mechanisms, Advances, and Future Perspectives
Osseointegration is the well-established phenomenon in orthopaedic surgery that describes the direct structural and functional connection between living bone and implant materials without the presence of fibrous tissue. This biologic process plays a fundamental role in the long-term success of orthopaedic implants, including joint replacements, limb prostheses, and trauma fixation devices.
This review outlines the current understanding of Osseointegration with particular emphasis on the cellular and molecular levels of interactions at the bone-implant interface. We further discuss developments in implant design-surface modifications, bioactive coatings, and 3D-printed implants-that are being investigated to improve Osseointegration and increase the longevity of implants. Furthermore, we explore biomaterials used in research, including titanium alloys, ceramics, and biodegradable polymers, for their implications on implant stability and host response.
Besides traditional applications, we further discuss the latest advancements in osseointegrated limb prostheses that have redefined the rehabilitation approach for amputees by enhancing mechanical stability and offering improved sensory feedback. We also discuss challenges related to implant longevity, including aseptic loosening, strategies to prevent infection, and the use of patient-specific implants.
Looking ahead, the integration of many different aspects of regenerative medicine, including cell therapies, tissue engineering, and growth factor delivery, holds some of the most promising avenues for improving Osseointegration and increasing the longevity of the implant. Ethical concerns regarding customized implants, biological materials, and the economic impacts of advanced orthopaedic solutions are discussed as well.
This review synthesizes current evidence and recent innovations to present the clinician, biomedical engineer, and researcher with a more thorough understanding of the factors affecting implant success in improving patient outcomes from orthopaedic surgery.