Contemporary advances in bioengineering and materials science have substantially improved the viability of medical implants. The demand for optimized implant technologies has led to the development of advanced coatings that enhance biocompatibility, antimicrobial activity, and durability. Implant manufacturers and surgeons must anticipate both biological and mechanical challenges when implementing devices for patient use. Key areas of concern include infection, corrosion, wear, immune response, and implant rejection; regulatory and economic considerations must also be addressed. Materials science developments are optimizing the integration of established materials such as biometrics, composites, and nanomaterials, while also advancing fabrication-based innovations including plasma functionalization, anodization, and self-assembled monolayers. Emerging smart and stimuli-responsive surface technologies enable controlled drug delivery and real-time implant status communication. These innovations enhance osseointegration, antimicrobial performance, and overall device functionality across orthopedic, dental, and cardiovascular applications. As implant design continues to shift toward personalized, responsive systems, advanced coating technologies are poised to deliver significantly improved long-term clinical outcomes for patients.

Surface engineering and architectural design represent key frontiers in total ankle arthroplasty (TAA) implant development. This narrative review examines biointegration strategies, focusing on porous structures, surface modification techniques, and emerging smart technologies. Optimal porous architectures with 300–600 µm pore sizes facilitate bone ingrowth and osseointegration, while functionally graded structures address regional biomechanical demands. Surface modification encompasses bioactive treatments (such as calcium phosphate coatings), topographical modifications (including micro/nanotexturing), antimicrobial approaches (utilizing metallic ions or antibiotic incorporation), and wear-resistant technologies (such as diamond-like carbon coatings). Multifunctional approaches combine strategies to simultaneously address infection prevention, enhance osseointegration, and improve wear resistance. Emerging technologies include biodegradable scaffolds, biomimetic surface nanotechnology, and intelligent sensor-based monitoring systems. While many innovations remain in the research stage, they demonstrate the potential to establish TAA as a comprehensive alternative to arthrodesis. Successful implant design requires integrated surface engineering tailored to the ankle joint’s demanding biomechanical and biological environment

Total ankle arthroplasty (TAA) has evolved significantly through advances in alloy selection and manufacturing technologies. This narrative review examines the metallurgical foundations of contemporary TAA implants, analyzing primary alloy systems and their mechanical properties. Cobalt-chromium alloys provide superior mechanical strength and durability but present metal ion release concerns, while titanium alloys (Ti6Al4V) optimize biocompatibility with elastic modulus values (101–113 GPa) closer to bone, despite tribological limitations. Novel β-titanium formulations (Ti-35Nb-7Zr-5Ta, Ti10Mo6Zr4Sn3Nb) eliminate toxic aluminum and vanadium components while achieving lower elastic modulus values (50–85 GPa) that better match cortical bone properties. Manufacturing has transitioned from traditional methods (investment casting, forging, CNC machining) toward additive manufacturing technologies. Selective laser melting and electron beam melting enable patient-specific geometries, controlled porosity, and optimized microstructures, though challenges remain with residual stresses, surface finish requirements, and post-processing needs. Emerging biodegradable materials, composite structures, and hybrid implant designs represent promising future directions for addressing current material limitations. This review provides evidence-based insights for alloy selection and manufacturing approaches, emphasizing the critical role of materials engineering in TAA implant performance and clinical outcomes.

Atypical joint spaces, such as those encountered in complex segmental bone loss and large structural defects, remain challenging to manage with conventional implants within divisions across orthopedics, including arthroplasty, tumor reconstruction, trauma, and spine. Additive manufacturing advances have made patient-specific implants a possibility, and this promising solution has enabled the creation of implants with customized geometry and controlled surface porosity to enhance osseointegration, reduce rejection rates, optimize biomechanics, and promote longevity. Despite its potential, patient-specific implants are still eclipsed in use by conventional, “off-the-shelf” implants due to their lower cost, documented long-term durability, insurance coverage, and the strength of available clinical evidence supporting their use. This narrative review summarizes current materials and manufacturing approaches for additively manufactured metal porous implants, including imaging and design workflows, lattice and pore architecture, and how the printing process influences implant stiffness, fatigue strength, surface roughness, and porosity. We also discuss the experimental and preclinical data on mechanical performance, fatigue resistance, and osseointegration for new developments in the field. Emerging trends such as material innovation, streamlined digital planning-to-implant workflows, 4D printing and other advanced additive manufacturing concepts, and cost-reduction efforts are examined in the context of clinical practicality. In this review, the integration of engineering principles with early clinical outcomes will provide orthopedic surgeons with a realistic understanding of the benefits and limitations of the future utilization of additive manufacturing in clinical practice.

Diabetes mellitus (DM) is highly prevalent among patients undergoing foot and ankle surgery and is associated with substantially increased perioperative and postoperative risk. This narrative review synthesizes the current literature on optimization of DM patients undergoing foot and ankle surgery. Complications of chronic hyperglycemia, including neuropathy and peripheral vascular disease, make the foot and ankle particularly vulnerable to ulceration, infection, and deformity, contributing to high rates of both operations and postoperative complications such as surgical site infection and readmission. Glycemic control and obesity are modifiable predictors of surgical outcomes and represent key targets for preoperative optimization. Lifestyle modification and pharmacologic therapy play central roles in DM optimization. Traditional agents such as metformin, sulfonylureas, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors remain foundational therapies, while newer therapies such as sodium–glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 (GLP-1) agonists offer meaningful improvements to glycemic control and weight loss. Pharmacologic regimens must be individualized, and many agents require careful perioperative management. Despite advances in medical therapy, high-quality evidence specific to foot and ankle surgery remains limited. Future research should focus on developing procedure- and agent-specific guidelines to reduce the substantial clinical and economic burden of DM in foot and ankle surgical patients.

Purpose: Meniscal repair failure is a significant clinical concern, but existing literature treats it as a single outcome without differentiating timing. Early and late failures may represent mechanistically distinct phenomena; identifying their differential predictors could improve risk stratification and postoperative monitoring. Methods: A retrospective cohort study used a national database to identify patients undergoing arthroscopic meniscal repair, including both isolated repairs and repairs performed with concomitant anterior cruciate ligament reconstruction, classified into early failure (reoperation <365 days, approximating the conventional period of meniscal healing), late failure (≥365 days) or no failure. Cause‐specific Cox proportional hazards regression identified independent predictors of each failure type separately. Results: Of 38,003 patients, 3399 (8.9%) experienced failure (1996 early; 1403 late). A bimodal hazard pattern supported phenotypic distinction between groups. Early failure was independently predicted by female sex (hazard ratio [HR] 1.15), bucket‐handle tear (HR 1.30), traumatic mechanism (HR 1.14), concomitant microfracture (HR 1.54), hamstring autograft (HR 1.21) and single‐anchor repair (HR 1.28); three or more anchors were protective (HR 0.83). Late failure was uniquely predicted by knee osteoarthritis (HR 1.33), whereas increasing age was independently protective (HR 0.98/year) as well as three or more anchors (HR 0.86). Among isolated meniscal repairs, partial meniscectomy was the most common reoperation in both groups, but more frequent in late failures (60.1% vs. 53.7%). Re‐repair was more common after early failure (22.5% vs. 16.1%), while TKA was more prevalent after late failure (9.8% vs. 5.4%). All reported associations and between‐group differences were statistically significant ( p < 0.05). Conclusion: Early and late meniscal repair failures are distinct clinical phenotypes with differing risk factors and reoperation patterns. Early failure appears driven by mechanical and technical factors; late failure is more strongly associated with degenerative joint disease and host biology. These findings may inform individualised monitoring and risk stratification strategies. Level of Evidence: Level III, retrospective cohort study.