The elastic modulus of traditional solid titanium alloy tibial implants is much higher than that of human bones, which can cause stress shielding. Designing them as a porous structure to form a bone-like trabecular structure effectively reduces stress shielding. However, the actual loading conditions of bones in different parts of the human body have not been considered for some trabecular structures, and their mechanical properties have not been considered concerning the personalized differences of other patients. Therefore, based on the elastic modulus of the tibial stem obtained from Quantitative Computed Tomography (QCT) imaging between 3.031 and10.528 GPa, and the load-bearing state of the tibia at the knee joint, a porous structure was designed under compressive and shear loading modes using topology optimization. Through comprehensive analysis of the mechanical and permeability properties of the porous structure, the results show that the Topology Optimization–Shear-2 (TO-S2) structure has the best compressive, shear mechanical properties and permeability and is suitable as a trabecular structure for tibial implants. The Gibson–Ashby model was established to control the mechanical properties of porous titanium alloy. A gradient filling of porous titanium alloy with a strut diameter of 0.106–0.202 mm was performed on the tibial stem based on the elastic modulus range, achieving precise matching of the mechanical properties of tibial implants and closer to the natural structure than uniformly distributed porous structures in human bones. Finally, the new tibial implant was printed by selective laser melting (SLM), and the molding effect was excellent.