Hydroxyl groups on titanium surfaces have been believed to play an important role in absorbing Ca in solution, which is crucial in the formation of bioactive calcium phosphates both in vitro and in vivo. CASTEP, a first-principles density functional theory (DFT) code, was employed to investigate Ca adsorption on various rutile (110) surfaces in order to clarify how hydroxyl groups effect Ca adsorption. The surfaces modeled in the present study include a bare rutile (110) surface, a hydroxylated rutile (110) surface, an oxidized rutile (110) surface, and a rutile (110) surface bonded with mixed OH groups and water. The results reveal that not all OH groups favors to attract Ca adsorption and loosely bonded OH and water on a rutile surface actually combine with Ca during adsorption. An oxidized rutile surface has the highest ability to attract Ca atoms, which partially explains that alkali-treated Ti surfaces could induce hydroxyapatite formation in alkaline environments.