Titanium and titanium alloys are widely used as biomedical materials due to good biocompatibility and mechanical properties. After surface treatment, titanium dioxide nanotubes array can be obtained on the surface of titanium and titanium alloys. The diameter and length of the titanium oxide nanotubes array are controllable and nanotubes usually have a large surface area, strong adsorption and super hydrophilicity, which can improve biocompatibility and corrosion resistance of titanium and titanium alloys and lay the foundation for conversion of more biological functions. After one more time of surface modification, the titanium and titanium alloy nanotubes can have better osseointegration, antibacterial and anti-inflammatory functions, drug-stimulated responsive release, biofluorescence imaging, etc., showing great potential in biomedical applications. The preparation method of nanotubes on the surface of titanium and titanium alloy was introduced, the biological characteristics of titanium oxide nanotubes on the surface of titanium and titanium alloys were analyzed, the effects of the physical characteristics of nanotubes on the cell behavior were discussed, the research progress of secondary surface modification technologies (including base treatment, hydrothermal treatment, electrochemical deposition, and sol-gel method) affecting the biological functions of titanium oxide nanotubes was reviewed, the research onbiological functions of titanium oxide nanotubes as drug carriers in drug sustained release, responsive release, and disease detection was summarized, some questions about the biological functionalization of titanium oxide nanotubes were proposed, and the future development direction was prospected.