Remodelling-informed evaluation of electrical discharge machining-textured and diamond-like carbon-coated titanium implants

The growing number of arthroplasties is linked to a rise in implant failures, with aseptic loosening being a significant factor in the need for revision surgeries. The long-term success of titanium implants regarding robust osseointegration depends not only on osteoblast-driven bone formation, but also on a balanced osteoimmune process, linking implant surface cues to coordinated bone remodelling. Using electrical discharge machining (EDM) and diamond-like carbon (DLC) as exemplars of topographical and physicochemical surface-engineering strategies, this review summarizes their generated surface cues and discusses how these cues may influence protein adsorption, osteoblast behaviour, macrophage activation, osteoclastogenesis, and bone-remodelling outcomes. Current evidence remains largely focused on osteogenic endpoints, whereas macrophage and osteoclast-specific data are still scarce. We therefore re-evaluate EDM and DLC surface modifications through an osteoimmunology framework and propose that future studies incorporate immune cell and remodelling-linked endpoints, as well as combined EDM/DLC interfaces, to support rational surface design for durable osseointegration.