Abstract: This study investigated enhancing the wear resistance of Ti6Al4V alloys for medical applications by incorporating TiC nano-reinforcements using advanced spark plasma sintering (SPS). The addition of up to 2.5wt% TiC significantly improved the mechanical properties, including a notable 18.2% increase in hardness (HV 332). Fretting wear tests against 316L stainless steel (SS316L) balls demonstrated a 20wt%–22wt% reduction in wear volume in the Ti6Al4V/TiC composites compared with the monolithic alloy. Microstructural analysis revealed that TiC reinforcement controlled the grain orientation and reduced the β-phase content, which contributed to enhanced mechanical properties. The monolithic alloy exhibited a Widmanstätten lamellar microstructure, while increasing the TiC content modified the wear mechanisms from ploughing and adhesion (0–0.5wt%) to pitting and abrasion (1wt%–2.5wt%). At higher reinforcement levels, the formation of a robust oxide layer through tribo-oxide treatment effectively reduced the wear volume by minimizing the abrasive effects and plastic deformation. This study highlights the potential of SPS-mediated TiC reinforcement as a transformative approach for improving the performance of Ti6Al4V alloys, paving the way for advanced medical applications.