For orthopedic implants, biocompatibility is essential to ensure that they integrate with biological systems without causing negative reactions or impairing tissue function. Orthopedic implants must be cellularly acceptable to interact with neighboring tissues, including muscle, cartilage, and bone. Implant materials should not cause cytotoxic reactions or inflammatory responses that might hinder healing or result in long-term inflammation. Progress in surface engineering and biomaterials science is discovering implants that work well with the body, benefiting patients in the long run. The biocompatibility of orthopedic implants, their interaction with surrounding tissues, and the potential for biological problems are all important aspects of their design and operation. Orthopedic implants must be successful and long-lasting to ensure biocompatibility, promote osseointegration (osteointegration), avoid biofilm development, and consider the patient's biological environment. This paper discusses biocompatibility in orthopedic implants, its advancements, and challenges.