Titanium alloys exhibit exceptional strength-to-density ratios, high hardness, and outstanding resistance to elevated temperatures, making them indispensable structural materials in aerospace engineering, marine construction, and biomedical applications. In aerospace systems specifically, fatigue failure represents the predominant failure mode for titanium alloy components. This review systematically examines prevalent surface treatment techniques for titanium alloys—including shot peening, ultrasonic rolling treatment, hot isostatic pressing (HIP), physical vapor deposition (PVD), micro-arc oxidation (MAO), and thermal spray processes—and critically evaluates their respective effects on fatigue performance. The underlying mechanisms of each technique are concisely outlined, with emphasis on stress state evolution, near-surface microstructural refinement, and interfacial integrity. Building upon the characteristic surface-dominated fatigue fracture behavior of titanium alloys, this work focuses on how coating composition, architecture (e.g., graded, multilayer, or nanocomposite designs), and interfacial bonding strength govern fatigue resistance. A unified analysis is presented on the distinct yet complementary roles of substrate deformation strengthening (e.g., residual compression, grain refinement) and coating-mediated protection (e.g., barrier function, crack deflection, stress redistribution) during fatigue crack initiation and propagation. Key determinants of fatigue performance, including residual stress distribution, coating/substrate adhesion, thermal mismatch, and environmental degradation susceptibility, are rigorously assessed. Finally, emerging research frontiers are identified, including intelligent process–structure–property mapping, in situ monitoring of fatigue damage at coated interfaces, and design of multifunctional gradient coatings that synergistically enhance strength, wear resistance, and fatigue endurance of titanium alloy components.