Biosensor-Integrated Tibial Components in Total Knee Arthroplasty: A Narrative Review of Innovations, Challenges, and Translational Frontiers.

BACKGROUND: The incorporation of biosensors into orthopedic implants, particularly tibial components in total knee arthroplasty (TKA), marks a new era in personalized joint replacement. These smart systems aim to provide real-time physiological and mechanical data, enabling dynamic postoperative monitoring and enhanced surgical precision. OBJECTIVE: This narrative review synthesizes the current landscape of electrochemical biosensor-embedded tibial implants in TKA, exploring technical mechanisms, clinical applications, challenges, and future directions for translation into clinical practice. METHODS: A comprehensive literature review was conducted across PubMed and Google Scholar. Articles were thematically categorized into technology design, integration strategies, preclinical and clinical evidence, regulatory frameworks, ethical considerations, and strategic recommendations. Findings were synthesized narratively and organized to support forward-looking system design. RESULTS: Smart tibial implants have demonstrated feasibility in both bench and early clinical settings. Key advances include pressure-sensing intraoperative tools, inertial measurement units for remote gait tracking, and chemical biosensors for infection surveillance. However, the field remains limited by biological encapsulation, signal degradation, regulatory uncertainty, and data privacy challenges. Interdisciplinary design, standardized testing, translational funding, and ethical oversight are essential to scaling these innovations. CONCLUSIONS: Biosensor-enabled tibial components represent a promising convergence of orthopedics, electronics, and data science. By addressing the technological, biological, regulatory, and ethical gaps outlined herein, this field can transition from prototype to widespread clinical reality-offering new precision in arthroplasty care.