Nitinol based shape memory alloys were introduced to Medicine in the late seventies. They possess a unique combination of properties including shape memory, superelasticity, great workability in the martensitic state, resistance to fatigue and corrosion. Despite these exceptional physical, chemical and mechanical properties the worldwide medical application has been hindered for a long time because of the lack of knowledge on the nature of the biocompatibility of these enriched by nickel alloys. A review of biocompatibility with an emphasis on the most recent studies, combined with the results of X-ray surface investigations, allows us to draw conclusions on the origin of the good biological response observed in vivo. The tendency of Nitinol surfaces to be covered with TiO2 oxides with only a minor amount of nickel under normal conditions is considered to be responsible for these positive results. A certain toxicity, usually observed in in vitro studies, may result from the much higher in vitro Ni concentrations which are probably not possible to achieve in vivo. The essentiality of Ni as a trace element may also contribute to the Nitinol biocompatibility with the human body tissues. Examples of successful medical applications of Nitinol utilizing shape memory and superelasticity are presented.