Hydroxyapatite (HA) has been an excellent replacement for the natural bone in orthopedic applications owing to its close resemblance to the bone properties; however, it is brittle and has low strength. Surface modification techniques have been able to allay such mineral issues by depositing on substrate. These methods, being economical, impart mechanical strength without compromising biocompatibility. In this review article, the discussion is confined to plasma spray (high temperature) and other low temperature surface modification techniques: high-velocity oxy-fuel (HVOF) and cold spray. The processing temperature seems to significantly affect the performance of implants deposited with HA. Monolithic HA may not add enough strength to the bioimplants. Hence, this review discusses selective reinforcements to HA and their roles in enhancing the properties. Herein, a variety of selective reinforcements are discussed, such as carbon allotropes: graphene, carbon nanotubes, and nano diamond; metallic materials: Ag, Sr, Mg, and Ti; ceramic materials: Al2O3, SiO2, ZrO2, and TiO2; multi-materials: Al2O3-CNT/HA, Al2O3-TiO2/HA and others; and functionally graded composites: HA, 20 and 50 wt% Ti-6Al-4V/HA layered coating. Most of these reinforcements could not trade-off between biocompatibility and strength. The detailed in vitro and in vivo studies are still lacking. The literature on the relative effectiveness of these reinforcements is scanty, while the interface between HA coating and reinforcements is seldom explored. This review presents the suitability of thermal spray techniques based on the microstructure, mechanical, and biological properties. Therefore, it is envisaged that the present review can intrigue future researchers to understand the scope of surface coatings in achieving the better performance of implants at clinical trials. © 2022 The Royal Society of Chemistry.

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