Orthopedic implant science is undergoing a paradigm shift driven by sophisticated biomechanical approaches that bridge traditional engineering design with clinical efficacy. The historical evolution from inert fixation to biologically and mechanically integrated solutions underscores the critical need for optimizing load transfer, enhancing osseointegration, and mitigating long-term failure modes such as aseptic loosening and stress-shielding. This review aims to synthesize contemporary conceptual frameworks, methodological innovations, and translational applications that define modern implantology. Key biomechanical frameworks include patient-specific computational modeling, evidence-based design optimization, and advanced interface mechanics. Methodological advancements are explored through finite element analysis (FEA), in vitro fatigue simulation, and imaging-based kinematic assessment, which collectively enhance predictive accuracy for implant performance. Major clinical applications span joint arthroplasty, spinal instrumentation, trauma fixation, and personalized additive-manufactured implants, directly impacting implant stability, revision surgery reduction, and functional patient outcomes. The integration of biomechanical data into preoperative planning and the fostering of multidisciplinary collaboration are highlighted as essential for clinical translation. Concluding remarks emphasize the imperative to standardize evaluation protocols, harness emerging digital twin and AI-assisted technologies, and prioritize long-term survivorship data. These strategic directions promise to further personalize orthopedic care and solidify the evidence base for next-generation implant systems, ultimately improving patient quality of life and healthcare system sustainability.