High-performance hydrogels in orthopedics: Structural design, performance tuning, and clinical potential

Orthopedic diseases (e.g., bone defects, degenerative spinal conditions, fracture non-unions, and bone infections) pose significant challenges to traditional clinical treatment strategies. Since hydrogels are polymeric materials characterized by three-dimensional hydrophilic network structures, they have broad application prospects for orthopedic treatment due to their excellent biocompatibility, tunable mechanical properties, efficient drug loading and controlled release capabilities, and structural characteristics closely resembling bone tissue microenvironments. A systematic review of the design principles for hydrogels in orthopedics is presented in this paper, covering material selection, structural regulation strategies, cross-linking mechanisms and functional modifications. Hydrogel applications in the orthopedic field include bone defect repair, spinal fusion, fracture healing promotion, infection control, and cartilage regeneration. In addition, the paper examines key challenges in hydrogel clinical translation for orthopedic applications. These challenges include insufficient mechanical strength and mismatched degradation rates in bone regeneration. Finally, this paper explores future development directions for integrating hydrogels with cutting-edge technologies such as 3D printing, smart responsive systems, and gene therapy, providing a theoretical basis for translating fundamental research on orthopedic hydrogels into clinical applications.