A novel beta-type, Ti-29Nb-13Ta-4.6Zr, referred to as TNTZ has been developed for biomedical applications. Its fatigue strength is one of the most important mechanical biocompatibilities of TNTZ because, in surgical applications, it will be used under cyclic loading conditions. The effect of the microstructural refinement by high-pressure torsion (HPT) on the fatigue behaviour of TNTZ is systematically investigated in this study. TNTZ subjected to HPT processing where the rotation number (N) is 20 (TNTZ(AHPT)) after aging treatment (AT) shows a unique microstructure having ultrafine elongated grains (285 nm in length and 36 nm in width) with high-density dislocations, a large fraction of blurred and wavy boundaries consisting of non-uniform subgrains with high misorientation and nanostructured precipitated alpha phase. Remarkably, a good combination of high mechanical strength (1375 MPa) and low Young's modulus (87 GPa), compared to that of Ti-6Al-4V (Ti64) ELI, is achieved for TNTZ(AHPT) at N = 20. TNTZ(AHPT) a great fatigue strength, which is comparable to those of (Ti64) ELI.