Abrasive waterjet (AWJ) peening is a new mechanical surface treatment process envisioned for use on metal orthopedic implants. The process utilizes an abrasive waterjet to simultaneously texture and work harden the surface of a metal substrate through controlled hydrodynamic erosion. In this study, a titanium alloy (Ti6Al4V) was subjected to AWJ peening over a range of parametric conditions. The textured surfaces were quantified in terms of the apparent interdigitation volume (V i ), the effective stress concentration factor (K t ) posed by the surface topography, and the magnitude of residual stress ( r ). Topographical features of the prepared surfaces were determined using contact profilometry, and X-ray diffraction was used in evaluating the in-plane residual stress. It was found that a large range in V i (9.4 -43.8 m 3 /m 2 ) and K t (1.3-2.7) are available through selection of the AWJ peening process parameters. Furthermore, a compressive residual stress (ุ409 ุ r ุ ุ33) was found to result within the surface of the Ti6Al4V substrates regardless of treatment conditions. When compared to a titanium plasma spray coating used for cementless fixation, the AWJ peened Ti6Al4V exhibited a surface topography with significantly lower effective stress concentration and higher compressive residual stress. Based on results from this study, AWJ peening may serve as a new method of surface treatment for metal orthopedic implants, which supports the development of stable primary fixation and simultaneously enhances the component fatigue strength.