Nanotheranostics in orthopedic diseases: a critical review of molecular diagnostic-driven targeted therapeutics for personalized patient care

INTRODUCTION: Orthopedics could greatly benefit from nanotechnology, especially in drug delivery, bone tissue engineering, and implant design. Nanotheranostics represents a major step toward individualized treatment by combining diagnosis and treatment into a single nanoplatform. For orthopedic applications, nanocarriers such as carbon nanotubes, dendrimers, liposomes, and metallic or polymeric nanoparticles offer distinct advantages. Significant clinical challenges still exist, such as unresolved long-term toxicity, lack of knowledge about nanoparticle-bone interactions, manufacturing scale-up challenges, and regulatory barriers. AREAS COVERED: This review covers: (1) theranostic nanoparticles (iron oxide, gold, quantum dots, lipid-based systems); (2) therapeutic applications in osteoarthritis, rheumatoid arthritis, osteoporosis, and bone infections; (3) imaging and biomarker detection; (4) safety considerations including cytotoxicity, immunogenicity, and biocompatibility; and (5) personalized medicine advancements. Preclinical data suggest real-time therapy monitoring, tailored administration, and integrated diagnostics. EXPERT OPINION: Despite encouraging evidence, clinical translation faces constraints including chronic toxicity concerns, inaccurate animal models, high costs, and lacking regulatory frameworks. Future progress requires biocompatible materials with predictable pharmacokinetics, standardized safety procedures, and large animal model validation. Rather than complex multipurpose systems, straightforward platforms targeting specific high-value needs will yield the greatest advances. Nanotheranostics offers a revolutionary path toward customized, minimally invasive orthopedic therapy, improving patient outcomes through interdisciplinary cooperation.