This review investigates the available metallic powder bed additive manufacturing technologies with respect to their basic principles and capabilities in terms of developing orthopedic implants. Detailed descriptions of commonly used metallic alloys employed for orthopedic applications are also presented. The relationship between implant surface properties and cellular attachment and the formation of bacterial colonies are also discussed. Accordingly, we show how different surface modification techniques have been applied to improve both the biointerface of metallic implants for enhanced osseointegration and to control the formation of biofilm to protect against implant infection. In addition, the future direction of metallic additive manufacturing in the case of improving bone interface has been discussed. This review aids in the design of bone-interfacing metallic implants fabricated by additive manufacturing processes, specifically accommodating enhanced biointerfaces for the next generation patient-specific orthopedic implants.