Titanium (Ti) and its alloys are widely recognized as preferred materials for bone implants due to their superior mechanical properties. However, their natural surface bio-inertness can hinder effective tissue integration. To address this challenge, micro-arc oxidation (MAO) has emerged as an innovative electrochemical surface modification technique. Its benefits range from operational simplicity and cost-effectiveness to environmental compatibility and scalability. Furthermore, the distinctive MAO process yields a porous topography that bestows versatile functionalities for biological applications, encompassing osteogenesis, antibacterial, and anti-inflammatory properties. In this review, we undertake an examination of the underlying mechanism governing the MAO process, scrutinize the multifaceted influence of various factors on coating performance, conduct an extensive analysis of the development of diverse biological functionalities conferred by MAO coatings, and discuss the practical application of MAO in implants. Finally, we provide insights into the limitations and potential pathways for further development of this technology in the field of bone implantation.