Due to their similarity to the major mineral constituent of bone, synthetic ceramic hydroxylapatite implants have been shown to provide strong attachment to hard tissue via chemical bonding mechanisms. This unique property has been utilized for over a decade in experimental and clinical applications of hard tissue augmentation and reconstruction. Recently, hydroxylapatite coatings have been investigated as mechanisms to provide fixation of metallic implant devices to bone. Clinical experience using HA coated revision stemmed prostheses supports the positive findings of earlier animal investigations, where decreased time to healing and the development of stress-transferring trabeculae to the implant surface were observed despite minor imprecisions in the initial fit.