Ti and Ti alloys are corrosion resistant, light, yet sufficiently strong for utilization as loadbearing and machinable orthopaedic implant materials. They are one of the few biocompatible metals which osseo-integrate, provides direct chemical or physical bonding with the adjacent bone surface without forming a fibrous tissue interface layer. For these reasons, they have been used successfully as orthopaedic and dental implants (Ratner 2004). To impart even greater bioactivity to the Ti surface and enhance integration properties, surface treatments such as surface roughening by sand blasting, formation of anatase phase TiO2 (Uchida et al. 2003), hydroxyapatite (HAp) coating, or chemical treatments (Ducheyne et al. 1986; Cooley et al. 1992) have been employed. However, these treatments are generally on the micron scale. Webster et al. (Webster et al. 2001; Webster, Siegel, and Bizios 1999) reported that it is even more advantageous to create nanostructured, in particular in the less than 100nm regime, surface designs for significantly improved bioactivity at the Ti implant interface and for enhanced cell adhesion. Since then, advances in biomaterial surface structure and design, specifically on the nanoscale, have improved tissue engineering in general. This chapter is a report on titanium dioxide (TiO2, or Titania) nanotube surface structuring for optimization of titanium (Ti) implants utilizing nanotechnology. The main focus will be on the unique 3-D tube-shaped nanostructure of TiO2 and its effects on creating profound impacts on cell behavior. We will also shed light on the effects of changing the nanotube diameter size and optimizing the geometry for enhanced cell behavior. This work focuses on the tissue specific areas of cartilage and bone. Specifically, we will discuss how the desired cell behavior and functionality are enhanced on surfaces with TiO2 nanotube surface structuring. Here we reveal how the TiO2 surface nanoconfigurations are advantageous in various tissue engineering and regenerative medicine applications, for osteo-chondral, orthopedic, and osteo-progenitor implant applications discussed here and beyond. This chapter will also shed light on future applications and the direction of nanotube surface structuring.