The increasing need for joint replacement surgeries, musculoskeletal repairs, and orthodontics worldwide prompts emerging technologies to evolve with healthcare's changing landscape. Metallic orthopaedic materials have a shared application history with the aerospace industry, making them partly efficient in the biomedical domain. However, metallic materials' suitability in hard tissue replacements and regenerative therapies remains unchallenged due to their superior mechanical properties, although not perfect biocompatibility. Therefore, exploring ways to improve biocompatibility is the most critical step toward designing the next generation of metallic biomaterials. This review discusses methods of improving the biocompatibility of metals used in biomedical devices under surface modification, bulk modification, and incorporation of biologics. Our investigation spans multiple length scales, from bulk metals to the effect of microporosities, surface nanoarchitecture, and biomolecules such as DNA incorporation toward the enhanced biological response in metallic materials. We examine recent technologies such as 3D printing in alloy design and storing surface charge on nanoarchitecture surfaces, metal-on-metal, and ceramic-on-metal coatings to present a coherent and comprehensive understanding of the subject. Finally, we consider the advantages and challenges of metallic biomaterials and identify future directions.

全球范围内对关节置换手术、肌肉骨骼修复和正畸的需求不断增长，促使新兴技术随着医疗保健环境的变化而发展。金属矫形材料与航空航天工业有着共同的应用历史，这使得它们在生物医学领域部分有效。然而，金属材料由于其优越的机械性能，尽管不具有完美的生物相容性，但在硬组织替代和再生治疗中的适用性仍然没有受到挑战。因此，探索提高生物相容性的方法是设计下一代金属生物材料最关键的一步。本综述讨论了通过表面改性、本体改性和生物制剂掺入来提高生物医学设备中使用的金属的生物相容性的方法。我们的研究跨越多个长度尺度，从大块金属到微孔、表面纳米结构和生物分子（例如 DNA 掺入）对金属材料中增强生物反应的影响。我们研究了合金设计中的 3D 打印以及在纳米结构表面、金属对金属和陶瓷对金属涂层上存储表面电荷等最新技术，以呈现对该主题的连贯且全面的理解。最后，我们考虑了金属生物材料的优势和挑战，并确定了未来的方向。