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