Exosome-mediated Piezo1 activation in 3D-printed titanium scaffolds promotes repair of femoral head osteonecrosis

levels, upregulated YAP1/β-catenin expression, and nuclear localization, underpinning the scaffold's osteo-angiogenic synergy. In a rat ONFH model, P-Exos@HAMA/Ti restored trabecular architecture and bone volume, improved micro-CT indices (increased BV/TV, Tb.N, Tb.Th; decreased Tb.Sp), and enhanced osteogenic/angiogenic marker expression, alongside superior locomotor recovery. This multifunctional platform couples mechanical stabilization with Piezo1-mediated mechanotransduction, establishing a pro-regenerative niche integrating biomechanical support with sustained exosomal signaling for effective repair of ischemic bone defects.