AccScience Publishing / IJB / Volume 12 / Issue 3 / DOI: 10.36922/IJB026180160
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RESEARCH ARTICLE

Three-dimensional-printed porous titanium scaffolds outperform biphasic calcium phosphate ceramics for load-bearing critical-sized bone defect repair

Zijian Li1,2† ,  Chenliang Quan2,3† ,  Guanglin Wang1,2† ,  Xiao Liu1,2 ,  Hufei Wang1,2 ,  Jianpeng Gao1,2 ,  Zhengyang Chang1,2,4 ,  Jiazhi Yan1,2,4 ,  Hua Chen1,2* ,  Ming Li1,2* ,  Jianheng Liu1,2*
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1 Department of Orthopaedics, The Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
2 Department of Orthopaedics, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
3 Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
4 Department of Orthopaedics, Medical School of Chinese PLA, Beijing, China
†These authors contributed equally to this work.
IJB 2026, 12(3), 026180160 https://doi.org/10.36922/IJB026180160
Received: 29 April 2026 | Revised: 6 June 2026 | Accepted: 7 June 2026 | Published online: 8 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Repairing critical-sized, load-bearing bone defects remains a formidable clinical challenge, primarily due to the mechanical fragility of traditional bioceramics. This study systematically compared the bone regenerative efficacy of surface-microstructured three-dimensional (3D)-printed porous titanium (3D-SMPT) and reinforced biphasic calcium phosphate (RBCP) ceramics. In vitro evaluations demonstrated that a biomimetic coating effectively overcame titanium’s bioinertness, thereby endowing 3D-SMPT with excellent biocompatibility and osteoinductivity comparable to those of RBCP. In vivo cross-species assessments revealed significant biomechanical differences: in a low-load rabbit ulnar model, both scaffolds exhibited equivalent osteogenesis. However, in a true weight-bearing beagle femoral model, RBCP suffered severe structural collapse due to inherent brittleness. In stark contrast, leveraging its cortical bone-matched compressive strength (83.14 MPa, approximately 10-fold higher than that of RBCP at 7.68 MPa) and interconnected porosity, 3D-SMPT maintained long-term mechanical stability, effectively mitigating stress shielding to facilitate massive mature bone ingrowth and robust osseointegration. In conclusion, 3D-SMPT achieves a perfect integration of bioactivity and load-bearing stability, overcoming the inherent fragility of traditional ceramics and offering a highly promising clinical alternative for the repair of massive load-bearing bone defects.

Graphical abstract
Keywords
Three-dimensional printing
Porous titanium scaffold
Biphasic calcium phosphate
Microstructural modification
Bone regeneration
Funding
This research was funded by the National Natural Science Foundation of China (grant numbers 82372401 and 82272455) and the Beijing Natural Science Foundation (L256032).
Conflict of interest
The authors declare they have no competing interests.
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International Journal of Bioprinting, Electronic ISSN: 2424-8002 Print ISSN: 2424-7723, Published by AccScience Publishing
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