Audit: patient reported outcomes of extracorporeal septorhinoplasty.

BACKGROUND: Extracorporeal septorhinoplasty (ECS) presents an important option in the surgical correction of the markedly deformed and twisted nose. However, there is a paucity of literature on the qualitative outcomes of ECS. METHODOLOGY: Retrospective telephone and postal questionnaire study of operations performed over 2 years (2008-2009) under the care of a senior rhinologist at two linked hospitals in the United Kingdom. Questionnaires were designed (i) relating to the procedure and (ii) patient perceptions of surgical success, improvements in physical health, psychosocial functioning and social interactions. For succinctness a shortened version of the Glasgow Benefit Inventory was used. RESULTS: Forty-six cases were analysed eight of which were revision cases. Two cases required revision surgery and two minor complications occurred, managed conservatively. The patients had a minimum of two to three follow-ups from seven days to one year. Questionnaire scores suggested high satisfaction in response to surgical success, with notable improvements in physical health (sleep disturbance) and in general health and well-being. Regarding psychosocial functions patients reported feeling either moderately less self-conscious or not self-conscious at all post-surgery. Improvements in social interactions were less well-defined. CONCLUSION: In this audit of cases with significant deformities, ECS appears to confer high levels of satisfaction.

Learning about leadership - A personal account.

PURPOSE: A personal account of learning about leadership. This article introduces the theory of power and influence, and aimed to report especially the personal reflection, emotional intelligence and learning about oneself that occurred on the way. APPROACH: Reading, group discussion and active reflection. Thoughts, reflections and learning were recorded regularly. PRACTICAL IMPLICATIONS: The concept of leadership, influence tactics and emotional intelligence all have implications in workplace relationship management and ultimately leadership qualities. The issues discussed serves as food for thought for others. ORIGINALITY: This is a genuine and very personal learning experience.

What is in a name--patients' view of the involvement of 'care practitioners' in their operations.

BACKGROUND: There has been a plethora of new job titles emerging in the NHS. While the term 'nurse practitioner' was fairly well received, and offers a pretty clear indication of the background of the person working, other new titles can be misleading. Since 2003, when the NHS Modernisation Agency proposed its 'Changing Workforce Programme', nurses and other allied health professionals were recruited and trained to perform 'simple operations'. The surgical care practitioner is being developed along with other practitioners. OBJECTIVE: To find out whether patients are able to identify healthcare professionals by their title and what do patients think about a non-medically qualified person carrying out their operations. METHODS: A cross-sectional survey of ENT patients using a questionnaire. MAIN FINDINGS: Titles similar to those of medically qualified professionals--anaesthetic practitioner, consultant nurse and surgical care practitioners--can lead patients to think that they are doctors. Fifty-three per cent of the respondents agreed that not all hospital visits need to be attended by a doctor, but if an operation is needed, 92% of respondents thought it should be carried out by someone who is medically trained. Ninety-four per cent stated that they should be informed if this is not the case. Seventy-nine per cent of the respondents stated that they would rather wait longer to be operated on by a doctor than being operated on earlier by someone who is not medically qualified but trained to perform the operation only. This result is significant, p<0.001). CONCLUSION: Patients do find the different titles confusing, with many preferring a more transparent approach in knowing who their surgeon is. The majority would prefer to wait longer for their operation if this means it is carried out by a doctor.

Chitosan-mediated crystallization and assembly of hydroxyapatite nanoparticles into hybrid nanostructured films.

The synthesis and subsequent assembly of nearly spherical nano-hydroxyapatite (nHA) particles in the presence of trace amounts of the polysaccharide chitosan was carried out employing a wet chemical approach. Chitosan addition during synthesis not only modulated HA crystallization but also aided in the assembly of nHA particles onto itself. Solvent extraction from these suspensions formed iridescent films, of which the bottom few layers were rich in self-assembled nHA particle arrays. The cross-section of these hybrid films revealed compositional and hence structural grading of the two phases and exhibited a unique morphology in which assembled nHA particles gradually gave way to chitosan-rich top layers. Transmission electron microscope and selected area electron diffraction studies suggested that the basal plane of HA had interacted with chitosan, and scanning electron microscope studies of the hybrid films revealed multi-length scale hierarchical architecture composed of HA and chitosan. Phase identification was carried out by X-ray diffraction (XRD) and Rietveld analysis of digitized XRD data showed that the basic apatite structure was preserved, but chitosan inclusion induced subtle changes to the HA unit cell. The refinement of crystallite shape using the Popa method clearly indicated a distinct change in the growth direction of HA crystallites from [001] to [100] with increasing chitosan concentration. The paper also discusses the likelihood of chitosan phosphorylation during synthesis, which we believe to be a pathway, by which chitosan molecules chemically interact with calcium phosphate precursor compounds and orchestrate the crystallization of nHA particles. Additionally, the paper suggests several interesting biomedical applications for graded nHA-chitosan nanostructured films.

Nanostructural characteristics, mechanical properties, and osteoblast response of spark plasma sintered hydroxyapatite.

This study aimed to fabricate bulk nanostructured hydroxyapatite (HA) pellets with improved properties using spark plasma sintering (SPS) for orthopedic applications. Spray-dried nanostructured HA (nSD-HA) powders were consolidated using the rapid SPS processing. The SPS processed nSD-HA was characterized using Raman spectroscopy and field emission scanning electron microscopy (FESEM). Mechanical properties of the consolidates were also evaluated through indentation approach. The nanostructures ( approximately 80 nm in grain size) of the starting powders were successfully retained after the SPS processing operated at 950 degrees C with <15 min holding time. The SPS consolidated nSD-HA showed promising mechanical properties, approximately 118 GPa for Young's modulus, and up to 2.22 MPa m(0.5) for fracture toughness. SPS holding time showed minor influence on the phases of the pellets. Furthermore, the spheroidized nanostructured HA retained the HA structure after the SPS consolidation. Preliminary cytotoxicity and cell attachment studies were also carried out using a human osteoblast cell line hFOB 1.19. Enhanced cell attachment and proliferation on the nanostructured pellets were revealed. The presence of the nanostructures accounts mainly for the enhanced mechanical properties and promoted proliferation of the osteoblast cells. This study suggests that the SPS technique is an appropriate process for fabrication of bulk nSD-HA from nanostructured powder.

Conductometric study of precursor compound formation during wet-chemical synthesis of nanocrystalline hydroxyapatite.

Conductometry was employed to study the phase evolution of calcium phosphate compounds during the wet-chemical synthesis of hydroxyapatite (HA). Calcium hydroxide and orthophosphoric acid were used to prepare HA at various temperatures ranging from 30 to 95 degrees C. The electrical conductivity and pH of the reaction mixture were measured at regular intervals of time during acid addition, and the rate of change of conductivity was used to decipher the end point of the reaction. Our previous studies have shown that the end product of this reaction route yields mildly carbonated crystalline HA. The trend of the change in conductivity with time was similar at all temperatures. The conductivity curves were divided into three regions based on the variation in slope of the curves. The slope of the curves decreased with increasing temperatures in the first two regions, and the slope is greater in the second region than in the first. From the conductivity and pH measurement results, the possible precursor phase was identified and it had the composition Ca(3)(PO(4))(2). The kinetics of phase transformation was also analyzed and compared to previous work. The similarities between this work and the traditionally adapted experimental work for phase formation and transformation kinetics are highlighted, and the novelty in the current work is discussed.

Effects of incorporation of HA/ZrO(2) into glass ionomer cement (GIC).

Glass ionomer cements (GICs) are a class of bioactive cements that bond directly to bone. In this paper, a new bioactive hydroxyapatite (HA)/zirconia (ZrO(2))-filled GIC composite was developed to improve the biocompatibility and bioactivity of the GICs with the surrounding bone and connective tissues. Nano-sized HA/30 wt% ZrO(2) powders were heat treated at 700 degrees Celsius and 800 degrees Celsius for 3 h to elucidate the influence of the crystallinity of composite powders on the performance of HA/ZrO(2)-GICs. The effects of different volume percentages of HA/ZrO(2) powders (4, 12, 28 and 40 vol%) substituted within GICs were investigated based on their microhardness, compressive strength and diametral tensile strength. The HA/ZrO(2)-GICs composite was soaked in distilled water for 1 day and 1 week before subjecting the samples to mechanical testing. Results showed that the glass and HA/ZrO(2) particles were distributed uniformly in the GIC matrix. The substitution of highly crystalline HA/ZrO(2) improved the mechanical properties of the HA/ZrO(2)-GICs due to the slow resorption rate for highly crystalline powders in distilled water. The mechanical properties of HA/ZrO(2)-GICs increased with increasing soak time due to the continuous formation of aluminium salt bridges, which improved the final strength of the cements. The compositions 4 and 12 vol% HA/ZrO(2)-GICs exhibited superior mechanical properties than the original GICs. The mechanical properties of HA/ZrO(2)-GICs were found to be much better than those of HA-GICs because ZrO(2) has the attributes of high strength, high modulus, and is significantly harder than glass and HA particles. Furthermore, ZrO(2) does not dissolve with increasing soaking time.

Radio frequency (rf) plasma spheroidized HA powders: powder characterization and spark plasma sintering behavior.

The present study describes the synthesis of spheroidized hydroxyapatite (HA) powders using a radio frequency (rf) inductively coupled plasma (ICP) torch. The spheroidized powders were consolidated through a spark plasma sintering (SPS) system. The microstructure and crystallographic phases in the synthesized powders were characterized using scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffractometry (XRD) and Raman spectrometry. Results showed that the HA feedstock decomposed after rf plasma processing. Crystalline HA, alpha-tri-calcium phosphate (alpha-TCP), tetra-calcium phosphate (TTCP) and calcium oxide (CaO) were detected in the plasma-spheroidized powders. Raman spectra results indicated strong presence of amorphous calcium phosphate (ACP) in the spheroidized powders. The particle size distribution and specific surface area were influenced through the rf plasma working plate power levels. The sintering behavior of the rf plasma synthesized powders was analyzed through the SPS process and the results indicated that the spheroidized powders commence sintering at approximately 900 degrees C and through to 1150 degrees C. After sintering above 1100 degrees C for 3min, the relative densities of the SPS compacts reached 96% of the theoretical value. The SPS compacts were immersed in simulated body fluids (SBF) for different durations and the results confirmed their bioactivities.

Addressing processing problems associated with plasma spraying of hydroxyapatite coatings.

Biomedical coatings generally have to satisfy specific requirements such as a high degree of crystallinity (for positive biological responses), good coating adhesion and optimal porosity. These are necessary to enhance biocompatibility, accelerate post-operative healing and improved fixation. Thermal spray processes have been frequently used to deposit functionally active biomedical coatings, such as hydroxyapatite (HA), onto prosthetic implants. The benefits of HA materials in coated implants have been widely acknowledged, but the occurrence of several poor performances has generated concerns over the consistency and reliability of thermally sprayed HA coatings. Recent investigations using HA coatings have shown that process related variability has significant influence on coating characteristics such as phase composition, structure and chemical composition and performance such as bioresorption, degradation and bone apposition. Variation in process parameters such as powder morphology can induce microstructural and mechanical inconsistencies that have an effect on the service performance of the coating. In order to reach some acceptable level of reliability, it may be necessary to control existing variability in commercially available HA feedstock. In addition, certain opposing factors severely constrain the means to achieve the necessary coating conditions via thermal spraying alone; therefore, creating the need to introduce other innovative or secondary treatment stages to attain the desired results. This paper highlights some of the problems associated with plasma spray coating of HA and suggests that tailoring the powder feedstock morphology and properties through suitable conditioning processes can aid the deposition efficiency and produce an acceptable coating structure.

Titanium dioxide reinforced hydroxyapatite coatings deposited by high velocity oxy-fuel (HVOF) spray.

Hydroxyapatite (HA) coatings with titania addition were produced by the high velocity oxy-fuel (HVOF) spray process. Mechanical properties of the as-sprayed coatings in terms of adhesive strength, shear strength and fracture toughness were investigated to reveal the effect of the titania reinforcement on HA. Qualitative phase analysis with X-ray diffraction (XRD) showed that mutual chemical reaction between TiO2 and HA, that formed CaTiO3 occurred during coating formation. Differential scanning calorimetry (DSC) analysis of the starting powders showed that the mutual chemical reaction temperature was approximately 1410 degrees C and the existence of TiO2 can effectively inhibit the decomposition of HA at elevated temperatures. The positive influence of TiO2 addition on the shear strength was revealed. The incorporation of 10 vol% TiO2 significantly improved the Young's modulus of HA coatings from 24.82 (+/- 2.44) GPa to 43.23 (+/- 3.20) GPa. It decreased to 38.51 (+/- 3.65) GPa as the amount of TiO2 increased to 20 vol%. However, the addition of TiO2 has a negative bias on the adhesive strength of HA coatings especially when the content of TiO2 reached 20 vol%. This is attributed to the weak chemical bonding and brittle phases existing at the splats' interface that resulted from mutual chemical reactions. The fracture toughness exhibited values of 0.48 (+/- 0.08) MPa m0.5, 0.60 (+/- 0.07) MPa m0.5 and 0.67 (+/- 0.06) MPa m0.5 for the HA coating, 10 vol% TiO2 blended HA coating and 20 vol% TiO2 blended HA coating respectively. The addition of TiO2 in HA coating with the amount of less than 20 vol% is suggested for satisfactory toughening effect in HVOF HA coating.

Impact formation and microstructure characterization of thermal sprayed hydroxyapatite/titania composite coatings.

Formation mechanism of hydroxyapatite (HA)/titania (TiO(2)) composite coating deposited by high velocity oxy-fuel (HVOF) thermal spray process was studied, and its structural characterization was conducted and elaborated in this paper. The impact theory was employed to analyze the formation procedure of the HA/titania composite coatings. Results revealed that the crater caused by the impact of entirely unmelted TiO(2) particles on the HA matrix during coating formation was of smaller dimensions than the original size of the reinforcements. It was found that chemical reaction between the mechanically blended HA and TiO(2) powder took place exclusively during the impingement stage, and calcium titanate, CaTiO(3), was one notable by-product. The bonding between the HA matrix and TiO(2) reinforcement might have been achieved predominantly through a chemical bond that resulted from the mutual chemical reactions among the components. Differential scanning calorimetry analyses showed that the chemical reaction between HA and TiO(2) was at approximately 1410 degrees C. The TiO(2) addition was found to exert particular effects on the thermal behavior of HA at elevated temperatures, during both heating and cooling cycles. Transmission electron microscopy observation identified the chemical reaction zone between HA and TiO(2), which revealed an improved splats' interface. The reaction zone demonstrated some influence on the grain size of HA nearby during resolidification of the melted portion. A structural model was proposed to illustrate the location of the different phases in the HA/titania composite coating.

Characterization of the bone-like apatite precipitated on high velocity oxy-fuel (HVOF) sprayed calcium phosphate deposits.

Bone-like apatite was precipitated on the surface of thermal sprayed calcium phosphate coatings following in vitro incubation in a simulated body fluid. The coatings were initially deposited on titanium alloy substrates by the high velocity oxy-fuel (HVOF) spray technique. Structural characterization and mechanical evaluation of the precipitated apatite layer were conducted. Results showed that the precipitation rate was directly influenced by the local Ca(2+) concentration in the vicinity of the coating's surface and that preferential dissolution of certain phases was found to accelerate the precipitation of the bone-like apatite. The dense precipitates exhibited a competitive Young's modulus value of approximately 120GPa, which was obtained through nanoindentation. This compared favorably to the calcium phosphate matrix. Differences in microstructure at various locations within the layer resulted in altered Young's modulus and microhardness values. Precipitation mechanism investigation was carried out through a comparative experiment. Chemical analysis showed that the precipitation of bone-like apatite on the calcium phosphate coating was quite conceivably a partial diffusion-controlled process.

Significance of melt-fraction in HVOF sprayed hydroxyapatite particles, splats and coatings.

Microstructure characterization and property evaluation of high velocity oxy-fuel (HVOF) sprayed hydroxyapatite (HA) splats and coatings were conducted in the present study as a function of the proportion of melting that occurred in HA particles during HVOF spray. In vitro behavior of single and folded HA splats in simulated body fluid was also investigated. Results showed that phase composition of as-sprayed HA coatings was influenced significantly by the melt fraction in HVOF sprayed particles. Melt fraction of the HA powders were experimentally determined from particle morphology analysis. It was found that the spray parameters and starting powder size influenced the melt fraction of the particles. In vitro investigation of individual HA splats made from different HA particles revealed decisive role of local phase composition in influencing their dissolution/precipitation behavior during the test. Furthermore, Raman spectroscopy qualitative inspection on the sprayed HA particles (partial melted) revealed that thermal decomposition occurred within the melted part rather than the unmelted zone. Young's modulus and micro-hardness of the as-sprayed particles and coatings were determined using nano-indentation technique. The resolidified zone of the sprayed HA particles exhibited an average Young's modulus value of 41.25 GPa. The measured values ranged from 23.1 to 65.3 GPa. The unmelted part of the HA powders showed a markedly narrower range. Young's modulus value of 83.9 GPa (+/-9.4 GPa) was recorded for this region. This succinctly highlight the difference between the unmelted region and melted regions of a HA particle. Young's moduli values measured on HVOF coatings were found to mirror the trend found in the spheroidised particles and splats with apt fidelity.

Bone-like apatite layer formation on hydroxyapatite prepared by spark plasma sintering (SPS).

Hydroxyapatite (HA) compacts with high density and superior mechanical properties were fabricated by spark plasma sintering (SPS) using spray-dried HA powders as feedstock. The formation of bone-like apatite layer on SPS consolidated HA compacts were investigated by soaking the HA compacts in simulated body fluid (SBF) for various periods (maximum of 28 days). The structural changes in HA post-SBF were analyzed with scanning electron microscopy, grazing incidence X-ray diffraction and X-ray photoelectron spectroscopy. It was found that a layer consisting microcrystalline carbonate-containing hydroxyapatite was formed on the surface of HA compacts after soaking for 24h. The formation mechanism of apatite on the surface of HA compacts after soaking in SBF was attributed to the ion exchange between HA compacts and the SBF solution. The increase in ionic concentration of calcium and phosphorus as well as the increase in pH after SBF immersion resulted in an increase in ionic activity product of apatite in the solution, and provided a specific surface with a low interface energy that is conducive to the nucleation of apatite on the surface of HA compacts.

Thermal sprayed hydroxyapatite splats: nanostructures, pore formation mechanisms and TEM characterization.

Microstructure of thermal sprayed hydroxyapatite (HA) splats was characterized using transmission electron microscopy (TEM), and the formation mechanisms of micropores within the splats were investigated with the aid of simulated body fluids (SBF). High-velocity oxy-fuel and direct current (DC) plasma spray techniques were both utilized for the splats' deposition. The microstructure features of individual HA splats were revealed through TEM observation of as-sprayed, and ion-milled splats. Amorphous calcium phosphate and tricalcium phosphate phases were observed at the splats' fringes, which indicated that extensive decomposition of HA had occurred at these locations. The fringes of the HA splats are essentially nanostructured ( approximately 20-50 nm grains), while calcium phosphate grains up to 5 microm, depending on flattening state, are present at the center of the splats. Morphological observation classified the pores within the HA splats into three main categories according to distinctive features in their microstructure: open pores, sealed pores and through-thickness pores. It was found that particle velocity with which the particle impinged on the substrate surface, particle melt state, and structure of starting particle (mainly porosity) are the key variables in determining the formation and morphology of the micropores within the flattened splats. Influence of subsequent splats on the pores of prior deposited splat was also studied using an in vitro incubation test in SBF. Obvious pore-sealing action on the open pores was revealed, which was achieved through liquid filling of subsequent droplets. It was postulated that the overall porosity of a bulk coating could be attributed primarily to the sealed pores and flaws among the splats, and, it could be adequately governed through appropriate particle melt state and optimized velocity of the particles during coating formation.

Radio frequency (RF) suspension plasma sprayed ultra-fine hydroxyapatite (HA)/zirconia composite powders.

Ultra-fine hydroxyapatite (HA)/ZrO(2) composite powders was synthesised by radio frequency (RF) induction suspension plasma spray. A wet suspension of HA/ZrO(2) was employed as feedstock. The suspension was injected axially into the RF plasma to produce the nano-composite powders, which were subsequently accumulated in cyclone collectors. The particle size and morphology was resolved by using the Zeta potential nano-particle size analyser, scanning electron microscopy, transmission electron microscopy, field emission microscopy techniques. The phase composition, phase concentration, and, molecular structure of the powders were characterised using differential scanning calorimetry, Fourier transform infra-red and X-ray diffractometry with quantitative phase analysis empowered by the Rietveld method. Results indicated that nano-size, spherical HA/ZrO(2) composite powders were produced with varying morphological features that depend on the thermal treatment. Calcium zirconate (CaZrO(3)) was produced as a byproduct whose biocompatibility is not well documented. Results also showed that the HA decomposed into alpha and beta-TCP due to decreasing Ca/P ratio with the formation of CaZrO(3).

Processing-microstructure-property relations in HVOF sprayed calcium phosphate based bioceramic coatings.

Hydroxyapatite (HA) based bioceramic coatings were deposited onto titanium alloy substrates using the high velocity oxy-fuel (HVOF) spray technique. This study aimed to reveal the relations among processing parameters, microstructure, and properties of the bioceramic coatings. The processing conditions were altered through changing the starting HA powder size, content of bioinert ceramic additives or composite powder preparation techniques. Coating structure was characterized through scanning electron microscopy (SEM) and transmission electron microscopy (TEM); and the mechanical properties, Young's modulus and fracture toughness, of the coatings were evaluated through indentation techniques. Results demonstrated dominant influence of the melt state of HA powders on the phase composition of resultant coatings, and it was found that the HVOF HA coatings possess competitive mechanical properties. Furthermore, addition of titania or zirconia, as secondary phase in HA, showed promising effect on improving the mechanical properties of the HVOF HA-based coatings. Chemical reactions between HA and titania; and, HA and zirconia during coating deposition were revealed and characterized. Incorporation modes of the additives into HA and their reinforcing mechanisms were elucidated. The relationship among the processing, microstructure, and mechanical properties of the HVOF sprayed bioceramic coatings was summarily examined.

In vitro studies of plasma-sprayed hydroxyapatite/Ti-6Al-4V composite coatings in simulated body fluid (SBF).

The bioactivity of plasma-sprayed hydroxyapatite (HA)/Ti-6Al-4V composite coatings was studied by soaking the coatings in simulated body fluid (SBF) for up to 8 weeks. This investigation was aimed at elucidating the biological behaviour of plasma-sprayed HA/Ti-6Al-4V composite coatings by analyzing the changes in chemistry, and crystallinity of the composite coating in a body-analogous solution. Phase composition, microstructure and calcium ion concentration were analyzed before, and after immersion. The mechanical properties, such as tensile bond strength, microhardness and Young's modulus were appropriately measured. Results demonstrated that the tensile bond strength of the composite coating was significantly higher than that of pure HA coatings even after soaking in the SBF solution over an 8-weeks period. Dissolution of Ca-P phases in SBF was evident after 24h of soaking, and, a layer of carbonate-apatite covered the coating surface after 2 weeks of immersion. The mechanical properties were found to diminish with soaking duration. However, slight variation in mechanical properties was found after supersaturation of the calcium ions was attained with the precipitation of the calcium phosphate layers.

Properties of heat-treated calcium phosphate coatings deposited by high-velocity oxy-fuel (HVOF) spray.

The influence of crystallization, upon heat treatment, on the properties of high-velocity oxy-fuel (HVOF) sprayed hydroxyapatite (HA) coatings was investigated. The characterization of the HA coating was performed by X-ray diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR). Differential Scanning Calorimeter (DSC) was employed to determine the crystallization temperature of the amorphous phase in an as-sprayed HA coating. The study demonstrated the effect of crystallization on the coating properties by considering the changes in materials chemistry, crystallinity level, and mechanical performance. Results showed that complete crystallization of the amorphous phase occurred at approximately 700 degrees C and the crystallization temperature was dependent on sample heating rate in the DSC test. The changes of ion groups were detected by FTIR, before and after the phase transformation. The crystallization of the coating after annealing at 750 degrees C resulted in a significant increase of the coatings' adhesive strength and shear strength, which attained maximum values 34 +/- 3 and 14.1 -/+ 0.8 MPa, respectively. Young's modulus increased from 21 +/- 1 to 25 +/- 2 GPa. Microhardness measurements confirmed the changes in coating properties. It is also found that the transformation from the amorphous phase has crystalline HA as the only resultant phase detected by XRD.

Plasma-sprayed hydroxyapatite (HA) coatings with flame-spheroidized feedstock: microstructure and mechanical properties.

Flame-spheroidized feedstock, with excellent known heat transfer and consistent melting capabilities, were used to produce hydroxyapatite (HA) coatings via plasma spraying. The characteristics and inherent mechanical properties of the coatings have been investigated and were found to have direct and impacting relationship with the feedstock characteristics, processing parameters as well as microstructural deformities. Processing parameters such as particle sizes (SHA: 20-45, 45-75 and 75-125 microm) and spray distances (10, 12 and 14 cm) have been systematically varied in the present study. It was found that the increase of particle sizes and spray distances weakened the mechanical properties (microhardness, modulus, fracture toughness and bond strength) and structural stability of the coatings. The presence of inter- and intralamellar thermal microcracks, voids and porosities with limited true contact between lamellae were also found to degrade the mechanical characteristics of the coatings, especially in coatings produced from large-sized HA particles. An effort was made to correlate the effects of microstructural defects with the resultant mechanical properties and structural integrity of the plasma-sprayed hydroxyapatite (HA) coatings. The effects of different heat treatment temperatures (600, 800 and 900 degrees C) on the mechanical properties of the coatings were also studied. It was found that a heat treatment temperature of 800 degrees C does enhance the microhardness and elastic modulus of the coatings significantly (P < 0.05) whereas a further increment in heat treatment temperature to 900 degrees C did not show any discernable improvements (P > 0.1). The elastic response behaviour and fracture toughness of both the as-sprayed and heat-treated HA coatings using Knoop and Vickers indentations at different loadings have been investigated. Results have shown that the mechanical properties of the coatings have improved significantly despite increasing crack density after heat treatment in air. Coatings produced from the spheroidized feedstock of 20-45 microm (SHA 20-45 microm) sprayed at a stand-off distance of 10 cm were found to possess the most favourable mechanical properties.