Presently, special metallic materials (titanium and a number of its alloys, stainless steels, magnesium alloys, etc.) are extensively used for the manufacturing of many medical tools and devices and choosing the appropriate material is of vital importance as it determines the success and safety of the medical devices for their application. Recent years witnessed active research and development to improve the mechanical and functional properties of these biomaterials using their nanostructuring by means of severe plastic deformation (SPD) techniques. The specific nanostructural features induced by SPD processing in metallic biomaterials significantly contribute to their performance, which has been evidenced in a series of investigative activities conducted lately to improve existing metallic biomaterials and explore potential for their production capability. This paper presents a review of these works and considers the scientific principles of achieving a higher level of properties in the metallic biomaterials as well as related challenges and uncertainties, which forms the basis for the production of a new generation of medical implants with improved design and increased biofunctionality. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.