Advancements in design, surface modification, and spinal applications of biomedical metallic materials for bone repair

doi:10.1016/j.metadv.2026.02.006

Abstract

Abstract:

Bone defect repair imposes stringent requirements on biomaterials, including mechanical compatibility, biocompatibility, osteoinduction/osteoconduction, and biodegradability. Biomedical metallic materials serve as core solutions for bone reconstruction due to their exceptional mechanical strength, particularly in high-load-bearing regions such as the spine. To address metallic surface bioinertness, various surface modification technologies are widely employed to significantly enhance osseointegration, antibacterial efficacy, and corrosion resistance through micro/nano-structuring and bioactive coatings. 3D printing enables customized fabrication of porous metallic implants, optimizing mechanical compatibility and imaging compatibility. In spinal applications, metallic materials are extensively utilized in internal fixation systems, interbody cages, artificial discs/vertebrae, correction systems, and tumor prostheses. Their design and modification directly impact fusion success rates, anti-subsidence capability, and long-term stability. Despite significant progress, challenges remain in degradation rate matching, long-term biosafety, multifunctional synergy, and stability in complex physiological environments. Future efforts should focus on smart materials, precision surface engineering, AI-assisted personalized design, and long-term clinical evaluation to advance metallic bone-repair materials toward superior performance.

Key words: Biomedical metallic materials, Bone repair, Surface modification, Spinal implants, 3D printing, Osseointegration

Shiqiang Song, Lizhu Tang, Longjian Huang, Yuanli Luo, Huiqing Yang, Chengliang Yang. Advancements in design, surface modification, and spinal applications of biomedical metallic materials for bone repair[J]. Metals Advances, 2026, 42: 49-65.

Figures/Tables 14

Table 1. Comparison of key properties of various metallic materials.

Material type	Mechanical properties	Biocompatibility	Corrosion resistance	Degradability	Primary applications	Ref.
Stainless steel	High strength and toughness; elastic modulus close to bone	Good, but surface modification is needed to reduce Ni²⁺ ion release	Moderate	Non-degradable	Orthopedic fixation plates, dental instruments	[22], [24], [25]
CoCr alloy	High wear resistance, excellent mechanical strength	Co²⁺/Cr³⁺ ions may inhibit osteogenic differentiation	Excellent	Non-degradable	Artificial joints, dental restorations, orthopedic implants	[29], [30], [32]
Pure Ti & Ti alloys	Low elastic modulus, high fatigue strength	Excellent, highly bioinert	Excellent	Non-degradable	Dental implants, small orthopedic instruments, spinal fixation, artificial joints, load-bearing implants	[9], [33], [35], [45], [54]
NiTi alloy	Superelasticity, shape memory effect	Ni²⁺ ion release may cause sensitization, surface modification is often needed	Good	Non-degradable	Vascular stents, orthopedic memory alloy devices, spinal correction systems	[15], [56], [57], [61]
Degradable Fe alloys	High strength	Good	Poor	Degradable	Temporary bone fixation plates	[63], [65], [66]
Mg & Mg alloys	Elastic modulus and strength need improvement	Excellent, Mg²⁺ promotes bone formation	Poor	Degradable	Bone screws, bone plates, degradable stents, degradable bone plates, spinal fusion cages	[67], [72], [77]
Zn & Zn alloys	Relatively low strength	Excellent, Zn²⁺ promotes osteogenic differentiation	Moderate	Degradable	Vascular stents, bone repair scaffolds, degradable fixation devices	[79], [80], [85], [86]
Ta	High ductility, elastic modulus close to bone	Outstanding, highly bioinert, promotes osseointegration	Excellent	Non-degradable	High-load-bearing areas (e.g., acetabular reconstruction), spinal fusion cages, tumor prostheses	[89], [90], [91]

Table 1. Comparison of key properties of various metallic materials.

Material type	Mechanical properties	Biocompatibility	Corrosion resistance	Degradability	Primary applications	Ref.
Stainless steel	High strength and toughness; elastic modulus close to bone	Good, but surface modification is needed to reduce Ni²⁺ ion release	Moderate	Non-degradable	Orthopedic fixation plates, dental instruments	[22], [24], [25]
CoCr alloy	High wear resistance, excellent mechanical strength	Co²⁺/Cr³⁺ ions may inhibit osteogenic differentiation	Excellent	Non-degradable	Artificial joints, dental restorations, orthopedic implants	[29], [30], [32]
Pure Ti & Ti alloys	Low elastic modulus, high fatigue strength	Excellent, highly bioinert	Excellent	Non-degradable	Dental implants, small orthopedic instruments, spinal fixation, artificial joints, load-bearing implants	[9], [33], [35], [45], [54]
NiTi alloy	Superelasticity, shape memory effect	Ni²⁺ ion release may cause sensitization, surface modification is often needed	Good	Non-degradable	Vascular stents, orthopedic memory alloy devices, spinal correction systems	[15], [56], [57], [61]
Degradable Fe alloys	High strength	Good	Poor	Degradable	Temporary bone fixation plates	[63], [65], [66]
Mg & Mg alloys	Elastic modulus and strength need improvement	Excellent, Mg²⁺ promotes bone formation	Poor	Degradable	Bone screws, bone plates, degradable stents, degradable bone plates, spinal fusion cages	[67], [72], [77]
Zn & Zn alloys	Relatively low strength	Excellent, Zn²⁺ promotes osteogenic differentiation	Moderate	Degradable	Vascular stents, bone repair scaffolds, degradable fixation devices	[79], [80], [85], [86]
Ta	High ductility, elastic modulus close to bone	Outstanding, highly bioinert, promotes osseointegration	Excellent	Non-degradable	High-load-bearing areas (e.g., acetabular reconstruction), spinal fusion cages, tumor prostheses	[89], [90], [91]

Fig. 1. SLM-prepared high porosity, low elastic modulus 316L stainless steel scaffold. (A) Macroscopic photo of stainless steel scaffold. (B) Scanning electron microscope (SEM) images of the scaffold: (a) perpendicular to the surface, (b) tilted to the surface. (C) Tensile (a), compression (b), and bending tests (c).Reproduced with permission [47]. Copyright 2016, Elsevier.

Fig. 2. CoCrMo alloy scaffolds. (A) Scaffolds with different strut orientations, pore sizes, and porosities. (B) Scanning electron microscope images: (a) scaffold as manufactured before shot blasting, (b) after shot blasting, and (c) surface quality and powder adherence at joints post shot blasting.Reproduced with permission [55]. Copyright 2022, Elsevier.

Fig. 3. Nanosilver/poly(lactic-co-glycolic acid) (NSPTICU) coated Ti-Cu alloy. (A) In vitro antibacterial tests against S. aureus and E. coli for different Ti materials: (a) Co-culture with S. aureus, (b) bacterial colony count curve for groups co-cultured with S. aureus, (c) Co-culture with E. coli, (d) bacterial colony count curve for groups co-cultured with E. coli. (B) NSPTICU promotes osteogenesis in vivo: (a) micro-CT 3D images of peri-implant area 4 weeks post-implantation for each group, (b) bone morphometric analysis of peri-implant region, (c) H&E staining of peri-implant bone tissue, (d) quantitative analysis of new bone tissue area by H&E staining for each group, (e) Masson staining of peri-implant bone regeneration post-implantation week 4, (f) quantitative analysis of new bone tissue area by Masson staining for each group.Reproduced under terms of the CC-BY license [77]. Copyright 2024, Dovepress.

Fig. 4. Nickel-titanium shape memory alloy scaphoid arc nail. (A) Physical view of NT-SAN. (B) Schematic diagram of scaphoid fracture fixation with NT-SAN. (C), (D) Intraoperative photos of NT-SAN fixation. (E) Preoperative, postoperative, and post-hardware removal X-ray images.Reproduced under terms of the CC-BY license [90]. Copyright 2020, Wiley.

Fig. 5. Biodegradable iron scaffolds. (A) Scaffold design and manufacturing: (a) diamond unit cell, (b) scaffold design diagram. (B) Microstructure of iron materials: (a) AM porous iron, (b) CR iron. (C) In vitro degradation of iron scaffolds: (a) macroscopic view after degradation, (b) scaffold weight loss, (c) pH variation with immersion time, (d) ion concentration variation with immersion time.Reproduced with permission [92]. Copyright 2018, Elsevier.

Fig. 6. Bioactive coating-modified Mg scaffolds. (A) Scaffold characterization: (a) representative image of a scaffold, (b) stress-strain curve, (c) Young's modulus, (d) compressive strength. (B) Biocompatibility evaluation of scaffolds: (a) live/dead cell staining of Human bone marrow mesenchymal stem cells (HBMSCs), (b) live/dead cell staining of HUVECs, (c, d) determination of cell proliferation values for HBMSCs and HUVECs in each scaffold group, (e) SEM observation of HBMSC attachment to JDBM/SrOCP scaffold. (C) In vivo micro-CT analysis of osteogenesis and angiogenesis: (a, b) micro-CT images at 4, 8, and 12 weeks post-implantation in vivo, including new bone (yellow) and implant (green) images, (d-g) quantitative analysis of osteogenic ability, (c) 3D reconstructed images of internal vasculature in scaffolds at 4, 8, and 12 weeks detected by micro-CT. 8 weeks post-implantation, (h) quantitative analysis of vascular volume.Reproduced under terms of the CC-BY license [102]. Copyright 2025BMC, part of Springer Nature.

Fig. 7. Zinc-based scaffolds. (A) Scaffold appearance and characterization: (a) scaffold macroscopic morphology, (b) SEM/EDS images of scaffold and energy spectrum, (c) porosity of scaffold groups, (d) elastic modulus of scaffold, (e) release curves of Zn2+ and Sr2+ from scaffold. (B) Micro-CT reconstruction images of rat cranial defect repair at weeks 6 and 12 for each experimental group.Reproduced with permission [16]. Copyright 2023, Royal Society of Chemistry.

Fig. 8. Porous tantalum scaffolds. (A) Three-dimensional modeling, macroscopic appearance, and scanning electron microscope images of scaffolds with different porosities. (B) Micro-CT images of scaffolds implanted into rats 6 and 12 weeks post-surgery.Reproduced under terms of the CC-BY license [114]. Copyright 2023, Frontiers.

Table 2. Summary of surface modification techniques for biomedical metallic materials.

Technique	Principle	Materials used	Key advantages	Limitations	Application examples	Refs.
Thermal spraying	High-temperature molten/semi-molten materials sprayed at high velocity onto substrate to form functional coatings.	Hydroxyapatite (HAp), bioactive glass	Enhanced osteoconductivity; improved wear resistance & bioactivity.	Coating prone to delamination; requires precise temperature control.	HAp coating on spinal fusion cages accelerates bone ingrowth.	[113], [116]
Grit-blasting & mechanical grinding	Mechanical abrasion to roughen surface or control morphology.	Alumina particles, acid etchants	Creates microporous structure; enhances coating adhesion & cell attachment.	May cause microcracks; requires controlled abrasive particle size.	Micro-roughened titanium cages significantly improve fusion success rate vs. PEEK.	[117], [149]
Laser surface treatment	High-energy laser to restructure surface microstructure.	Titanium alloys, magnesium alloys	Precise control of pores/geometry; improves corrosion resistance.	High cost; heat-affected zone may weaken substrate.	Custom lattice titanium rods reduce magnetic resonance imaging (MRI) artifacts.	[10], [122]
Plasma treatment	Ionized gas produces reactive species to alter surface chemistry.	Ag⁺/Co²⁺ ions, oxygen plasma	Strong antibacterial effect; improves coating adhesion.	Limited penetration depth; complex equipment.	Non-thermal plasma treatment on Ti/Zr implant surfaces reduces peri-implantitis risk.	[107], [124]
Ion implantation	High-energy ion bombardment achieves sub-surface element doping.	Zr/N/Cu/Ca ions	"Coating-free" modification; enhances corrosion resistance & biocompatibility.	Shallow modified layer; expensive equipment.	Cu-ion implanted 3D-printed Ti alloy spinal implants synergistically promote osteogenesis & angiogenesis.	[128], [129]
Chemical etching	Selective dissolution of metal using acids/bases to form micro/nano porous structures.	HCl/H₂SO₄, HF/HNO₃ mixtures	Increased surface area; optimized degradation control & osteoblast adhesion.	Use of hazardous chemicals; risk of over-etching.	Acid-etched porous zinc scaffolds promote bone defect repair.	[131], [132]
Anodization	Electrochemical formation of oxide layer.	Fluoride-containing electrolytes	Enables drug loading; reduces bacterial adhesion.	Limited to conductive metals; oxide layer is brittle.	TiO₂ nanotube layers on Ti implants increase bone-implant contact rate in spinal fusion zones.	[133], [134]
Micro-arc oxidation (MAO)	High-voltage discharge grows ceramic coating in situ.	Zn/Ce-doped electrolytes, dicalcium phosphate	Combines corrosion resistance & bioactivity; self-sealing capability.	High energy consumption; porous coating may reduce durability.	Zn-doped MAO coated Mg alloy fusion cages used in caprine cervical fusion.	[136], [138]

Table 2. Summary of surface modification techniques for biomedical metallic materials.

Technique	Principle	Materials used	Key advantages	Limitations	Application examples	Refs.
Thermal spraying	High-temperature molten/semi-molten materials sprayed at high velocity onto substrate to form functional coatings.	Hydroxyapatite (HAp), bioactive glass	Enhanced osteoconductivity; improved wear resistance & bioactivity.	Coating prone to delamination; requires precise temperature control.	HAp coating on spinal fusion cages accelerates bone ingrowth.	[113], [116]
Grit-blasting & mechanical grinding	Mechanical abrasion to roughen surface or control morphology.	Alumina particles, acid etchants	Creates microporous structure; enhances coating adhesion & cell attachment.	May cause microcracks; requires controlled abrasive particle size.	Micro-roughened titanium cages significantly improve fusion success rate vs. PEEK.	[117], [149]
Laser surface treatment	High-energy laser to restructure surface microstructure.	Titanium alloys, magnesium alloys	Precise control of pores/geometry; improves corrosion resistance.	High cost; heat-affected zone may weaken substrate.	Custom lattice titanium rods reduce magnetic resonance imaging (MRI) artifacts.	[10], [122]
Plasma treatment	Ionized gas produces reactive species to alter surface chemistry.	Ag⁺/Co²⁺ ions, oxygen plasma	Strong antibacterial effect; improves coating adhesion.	Limited penetration depth; complex equipment.	Non-thermal plasma treatment on Ti/Zr implant surfaces reduces peri-implantitis risk.	[107], [124]
Ion implantation	High-energy ion bombardment achieves sub-surface element doping.	Zr/N/Cu/Ca ions	"Coating-free" modification; enhances corrosion resistance & biocompatibility.	Shallow modified layer; expensive equipment.	Cu-ion implanted 3D-printed Ti alloy spinal implants synergistically promote osteogenesis & angiogenesis.	[128], [129]
Chemical etching	Selective dissolution of metal using acids/bases to form micro/nano porous structures.	HCl/H₂SO₄, HF/HNO₃ mixtures	Increased surface area; optimized degradation control & osteoblast adhesion.	Use of hazardous chemicals; risk of over-etching.	Acid-etched porous zinc scaffolds promote bone defect repair.	[131], [132]
Anodization	Electrochemical formation of oxide layer.	Fluoride-containing electrolytes	Enables drug loading; reduces bacterial adhesion.	Limited to conductive metals; oxide layer is brittle.	TiO₂ nanotube layers on Ti implants increase bone-implant contact rate in spinal fusion zones.	[133], [134]
Micro-arc oxidation (MAO)	High-voltage discharge grows ceramic coating in situ.	Zn/Ce-doped electrolytes, dicalcium phosphate	Combines corrosion resistance & bioactivity; self-sealing capability.	High energy consumption; porous coating may reduce durability.	Zn-doped MAO coated Mg alloy fusion cages used in caprine cervical fusion.	[136], [138]

Fig. 9. (A) Untreated pedicle screw and bioactive pedicle screw. (B) Surface analysis (FE-SEM/EDX) of retrieved pedicle screws.Reproduced under terms of the CC-BY license [152]. Copyright 2018, PLOS.

Fig. 10. (A) Macroscopic and SEM images of novel porous tantalum implants. (B) Postoperative images of different experimental groups. (C) Micro-CT images of lumbar intervertebral space 12 months post-surgery: (a) control group, (b) autograft group, (c) porous tantalum implant group, (d) radiographic fusion index scores at different time points.Reproduced under terms of the CC-BY license [154]. Copyright 2019, Chinese Medical Journal.

Fig. 12. (A) CAD design and finished product of unilateral arm prosthesis. (B) Intraoperative images of tumor resection/prosthesis placement and postoperative radiographs.Reproduced with permission [170]. Copyright 2023, Wolters Kluwer Health.

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