Nano-multi-structured antibacterial coatings on the surface of bone implants possess multiple advantages. They can effectively enhance the antibacterial rate of materials and prevent the bacterial resistance associated with antibiotic use. Compared with single-layer coatings, nano-multi-structured antibacterial coatings simultaneously provide various properties required for bone implants, promoting the proliferation and differentiation of bone cells while effectively reducing adverse reactions caused by cytotoxicity. Therefore, they are currently the focal point in research on surface coatings for bone implants. This article reviews the research progress of nano-multi-structured antibacterial coatings, including their performance, fabrication methods, and antibacterial mechanisms, and discusses the future directions of nano-multi-structured antibacterial coatings, which holds promise in addressing bacterial infections and bone integration.