Biological integration is a key determinant of long-term clinical success in cementless joint arthroplasty and is directly related to the process of osseointegration at the bone-implant interface. Implant stability relies on primary mechanical fixation achieved during implantation, followed by secondary biological stability resulting from bone attachment and ingrowth onto the implant surface. Osseointegration is a dynamic and tightly regulated biological process involving hematoma formation, inflammatory cell recruitment, osteogenic differentiation, and subsequent bone remodeling. Implant surface topography, chemical composition, and porous architecture play critical roles in modulating cellular responses and determining the quality of biological fixation. Contemporary arthroplasty implants incorporate a wide range of surface technologies, including grit-blasted and acid-etched surfaces, titanium plasma-sprayed coatings, sintered bead and fiber mesh structures, bioceramic coatings, porous metals, and additively manufactured three-dimensional porous surfaces. Among these, porous architectures are particularly effective in promoting bone ingrowth and mechanical interlocking, thereby enhancing osseointegration. However, optimal biological fixation requires a careful balance between pore size, porosity, and mechanical strength, which is highly dependent on the implant material and manufacturing technique. This narrative review summarizes the current surface technologies used in modern joint prostheses, focusing on their osseointegration mechanisms and clinical implications. In addition, emerging strategies such as bioactive coatings, nanotechnology-based surface modifications, and advanced manufacturing techniques are discussed as promising approaches to further improve biological fixation and long-term implant performance.