In this study, Ag is electron-beam evaporated to modify the topography of anodic TiO2 nanotubes of different diameters to obtain an implant with enhanced antibacterial activity and biocompatibility. We found that highly hydrophilic as-grown TiO2 nanotubes became poorly hydrophilic with Ag incorporation; however they could effectively recover their wettability to some extent under ultraviolet light irradiation. The results obtained from antibacterial tests suggested that the Ag-decorated TiO2 nanotubes could greatly inhibit the growth of Staphylococcus aureus. In vitro biocompatibility evaluation indicated that fibroblast cells exhibited an obvious diameter-dependent behavior on both as-grown and Ag-decorated TiO2 nanotubes. Most importantly, of all samples, the smallest diameter (25-nm-diameter) Ag-decorated nanotubes exhibited the most obvious biological activity in promoting adhesion and proliferation of human fibroblasts, and this activity could be attributed to the highly irregular topography on a nanometric scale of the Ag-decorated nanotube surface. These experimental results demonstrate that by properly controlling the structural parameters of Ag-decorated TiO2 nanotubes, an implant surface can be produced that enhances biocompatibility and simultaneously boosts antibacterial activity.