As a biomedical material, porous titanium alloy has gained widespread recognition and application within the field of orthopedics. Its remarkable biocompatibility, bioactivity, and mechanical properties establish it as a promising material for facilitating bone regeneration. A well-designed porous structure can lower the material’s modulus while retaining ample strength, rendering it more akin to natural bone tissue. The progression of additive manufacturing (AM) technology has significantly propelled the advancement of porous implants, simplifying the production of such structures. AM allows for the customization of porous implants with various shapes and sizes tailored to individual patients. Additionally, it enables the design of microscopic-scale porous structures to closely mimic natural bone, thus opening up avenues for the development of porous titanium alloy bone implants that can better stimulate bone regeneration. This article reviews the research progress on the structural design and preparation methods of porous titanium alloy bone implants, analyzes the porous structure design parameters that affect the performance of the implant, and discusses the application of porous medical titanium alloys. By comparing the effects of the parameters of different porosity, pore shape, and pore size on implant performance, it was concluded that pore diameters in the range of 500~800 μm and porosity in the range of 70%–90% have better bone-regeneration effects. At the same time, when the pore structure is a diamond, rhombohedral, or cube structure, it has better mechanical properties and bone-regeneration effects, providing a reference range for the application of clinical porous implants.