To improve the wear resistance of biomedical titanium alloys, ultrasound cold forging technology (UCFT) was used as a pretreatment before microarc oxidation (MAO) coatings were prepared. The grain size and surface roughness of the sample treated by UCFT was measured by transmission electron microscope (TEM) and atomic force microscope (AFM). Morphologies and phase composition were conducted by scan electron microscope (SEM) and Xray diffraction (XRD). Microhardness tester was used to measure the sample hardness. The highspeed reciprocating friction and wear tester was used to test the wear performance of the samples. The results show that the surface of titanium alloys is refined with small grain by UCFT. The average surface roughness is only 36.98 nm. The hardness increases from 330 HV0.05 of the untreated samples to 518 HV0.05 of the UCFTMAO samples. The friction coefficient decreases and the weight loss of impreved by UCFTMAO samples is only one third of the untreated samples. The wear resistance of the MAO coated titanium alloys is improved by UCFT processing.