Biocompatibility is a key characteristic in the design of biomaterial such as implants. The key aspects of surface quality that affect biocompatibility are surface roughness, surface feature, surface chemistry, crystallinity and porosity. The biocompatibility can be assessed in vitro by observing cell behaviour such as cell differentiation, proliferation and viability. Furthermore, surface aspect such as surface roughness induced selective protein adsorption onto the biomaterial surface. The effect of surface quality on protein adsorption is also important to be understood because cells will attach to the protein adsorbed, instead of the material directly. This review paper critically analyses the role of surface quality on biocompatibility of biomaterials based on the information available in literature. For quantitative analyses, in vivo assessment such as osseointegration phenomenon was discussed in detail. Towards that, a systematic review was conducted with chronological development in this field.