Abstract Introduction Various works have shown that diamond-like carbon (DLC) coatings are able to improve the cells adhesion on prosthesis material and also cause protection against the physical wear. On the other hand there are reports about the effect of substrate polishing, in evidence of that roughness can enhance cell adhesion. In order to compare and quantify the joint effects of both factors, i.e, polishing and DLC coating, a commonly prosthesis material, the Ti-6Al-4V alloy, was used as raw material for substrates in our studies of macrophage cell adhesion rate on rough and polished samples, coated and uncoated with DLC. Methods The films were produced by PECVD technique on Ti-6Al-4V substrates and characterized by optical profilometry, scanning electron microscopy and Raman spectroscopy. The amount of cells was measured by particle analysis in IMAGE J software. Cytotoxicity tests were also carried out to infer the biocompatibility of the samples. Results The results showed that higher the surface roughness of the alloy, higher are the cells fixing on the samples surface, moreover group of samples with DLC favored the cell adhesion more than their respective uncoated groups. The cytotoxity tests confirmed that all samples were biocompatible independently of being polished or coated with DLC. Conclusion From the observed results, it was found that the rougher substrate coated with DLC showed a higher cell adhesion than the polished samples, either coated or uncoated with the film. It is concluded that the roughness of the Ti-6Al-4V alloy and the DLC coating act complementary to enhance cell adhesion.