Three-phase fluidized bed bioreactors have advantages over conventional chemical reaction systems. There is a lack of agreement over most major operational conditions, and a wide range of design variables are open to question. A large body of recent work in the field has been reviewed, with a degree of historical comparison and discussion. It has been found that aspects of fluidized bed biofilm reactors of vital importance include: choice of solid media, gas and liquid loadings, bacterial type and reactor mechanical design. A large proportion of the work in the field of three-phase fluidization is non-biologically specific, or not tested on a bacterially inoculated system. The majority of three-phase fluidized bed bioreactor work is in the field of water treatment. Although this work has highlighted the potential for use of bio-fluidized beds for this application, there are still specific problems hindering the large scale industrial acceptance of three-phase fluidized bed bioreactors.