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Titanium (Ti) and its alloys are widely used as load\u2010bearing implants; however, their inherent biological inertness hinders early osteogenesis and delays osseointegration. With advances in bone tissue engineering, biofunctionalized 3D\u2010printed porous Ti scaffolds have emerged as a promising strategy to overcome these limitations. Among the various biomaterials investigated, silk fibroin (SF) has attracted considerable interest owing to its excellent biocompatibility, controllable biodegradability, tunable mechanical properties, and intrinsic capacity for drug loading. The integration of SF onto Ti scaffolds through coatings, hydrogels, or composite structures mitigates the biological inertness of Ti and confers additional functionalities, such as controlled drug release, osteogenic stimulation, and immunomodulation. This review summarizes the structural characteristics, drug\u2010delivery behavior, and degradation mechanisms of SF, and highlights current evidence on its osteogenic and anti\u2010inflammatory effects both in vitro and in vivo when combined with porous Ti scaffolds. Furthermore, we discuss emerging multifunctional strategies, including composite coatings incorporating hydroxyapatite, metal\u2010ion doping, and SF\u2010based hydrogel systems. Overall, this review provides comprehensive insights into SF\u2010enhanced Ti scaffolds for next\u2010generation bone repair.<\/jats:p>","DOI":"10.1002\/mabi.70222","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T03:12:32Z","timestamp":1787281952000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Silk Fibroin\u2010Modified Titanium Implants for Bone Tissue Engineering: Structural Basis, Functionalization and Composite Strategies"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6696-4972","authenticated-orcid":false,"given":"Jiajun","family":"Liu","sequence":"first","affiliation":[{"name":"Tianjin Hospital Tianjin University  Tianjin China"},{"name":"Tianjin Orthopedic Institute  Tianjin China"},{"name":"Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering  Tianjin 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