Titanium and its alloys have been widely applied in many biomedical fields because of its excellent mechanical properties, corrosion resistance and good biocompatibility. However, problems such as rejection, shedding and infection will occur after titanium alloy implantation due to the low biological activity of titanium alloy surface. The structures with specific functions, which can enhance osseointegration and antibacterial properties, are fabricated on the surface of titanium implants to improve the biological activity between the titanium implants and human tissues. This paper presents a comprehensive review of recent developments and applications of surface functional structure in titanium and titanium alloy implants. The applications of surface functional structure on different titanium and titanium alloy implants are introduced, and their manufacturing technologies are summarized and compared. Furthermore, the fabrication of various surface functional structures used for titanium and titanium alloy implants is reviewed and analyzed in detail. Finally, the challenges affecting the development of surface functional structures applied in titanium and titanium alloy implants are outlined, and recommendations for future research are presented.