Porosity-engineered titanium alloysTitanium alloys have become an important focus of recent research for biomedical applications owing to their superior mechanical compatibility, corrosionCorrosion resistance, and favorable tribological behaviorTribological behavior under physiological conditions. Nevertheless, their tribological performance remains a major challenge, primarily due to the risk of wear debris generation and metallic ion release, which can provoke adverse biological responses. This paper presents a comprehensive review of the tribological behaviorTribological behavior of advanced porous titanium alloysTitanium alloys, with particular emphasis on β-phase titanium systems such as Ti-Nb-Mo alloys. The influence of processing parameters (e.g., milling timeMilling time, porosity level, and applied loadApplied load) on microstructural evolution, wear mechanismsWear mechanisms, and surface chemistry is systematically examined. Special attention is given to the critical relationship between microstructureMicrostructure and tribological propertiesProperties, providing insights that are essential for the design of next-generation titanium-based biomaterialsBiomaterials. In addition, recent experimental findings, including our latest work on Ti-25Nb-25Mo alloys, are analyzed to highlight the key factors governing wear resistance, coefficient of friction, and long-term tribological stability in biomedical environments.