Lifestyle changes, accidents, and poor diets have led to a rise in bone issues like fractures and osteoporosis, impacting quality of life for many. Tissue engineering (TE) offers a promising solution by enabling the regeneration of damaged tissues through biomaterial-based scaffolds that mimic the body's extracellular matrix. These scaffolds, with their porous structures and interconnected pores, support tissue growth and bone ingrowth. Polylactic acid (PLA) is frequently used in scaffold fabrication due to its easy printability, customizable strength, biocompatibility, and controlled degradation, especially with fused deposition modeling (FDM) 3D printing. This technique allows for precise control over micro-and macroporosity, essential for cell attachment, nutrient delivery, and vascularization. Although achieving an ideal balance between porosity and strength is challenging, coating PLA scaffolds with bioactive materials that simulate natural bone surfaces has significantly improved scaffold properties. These enhancements address the diverse strengths and limitations of materials used in bone scaffolds. This review aims to provide valuable insights for researchers, clinicians, and policymakers on the application of 3D-printed PLA porous scaffolds with surface modifications for bone regeneration and localized drug delivery.