Clin Orthop Surg.  2010 Dec;2(4):214-220. 10.4055/cios.2010.2.4.214.

Seven-year Results of a Tapered, Titanium, Hydroxyapatite-Coated Cementless Femoral Stem in Primary Total Hip Arthroplasty

• Cho JH
• Garino JP
• Choo SK
• Han KY
• Kim JH
• Oh HK

• KMID: 1719321
• DOI: http://doi.org/10.4055/cios.2010.2.4.214

Abstract

BACKGROUND
Aseptic loosening of cemented hip prostheses is recognized as a long-term problem, and especially in males and younger patients. Much energy has been focused on developing new prostheses that are designed for cementless fixation. We evaluated the performance of and periprosthetic bone response to a tapered, titanium, hydroxyapatite (HA)-coated femoral hip prosthesis at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty.
METHODS
Seventy-eight patients and 86 hips were included in the study. There were 35 men and 43 women; the mean age at the time of the operation was 59 years (range, 41 to 81 years). We used a tapered, titanium (Ti6Al4V), HA-coated femoral implant. We evaluated the patients at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. Clinical evaluation was performed using the scoring system and the hip scores were assigned according to the level of pain, the functional status and the range of motion. The patients who refused to return, but who did forward X-rays for review after being contacted were questioned by phone about the functional status of their hip. Radiographic follow-up was performed at six weeks, at three, six and twelve months and yearly thereafter. All the available radiographs were collected and assessed for implant stability, subsidence, osseointegration, osteolysis, stress shielding and evidence of periprosthetic lucency.
RESULTS
Eighty-six hips (78 patients) were available for review at follow-up of greater than 7 years. In 11 of the 86 cases, acetabular failure required revision of the acetabular component, but the femoral stem survived and it was available for long-term evaluation. The radiographs were obtained at 7-year follow-up for another 20 hips, but the patients would not come in for the 7-year clinical evaluation. Therefore, a phone interview was conducted to assess any change in the functional status at a minimum of 7 years.
CONCLUSIONS
The mechanical fixation of a tapered, titanium, HA-coated femoral implant was excellent in this study. This femoral design provided reliable osseointegration that was durable at a mean of 7 years follow-up.

Keyword

Primary total hip arthroplasty; Hydroxyapatite-coated femoral stem

MeSH Terms

Adult
Aged
Aged, 80 and over
*Arthroplasty, Replacement, Hip
*Coated Materials, Biocompatible
*Durapatite
Female
Follow-Up Studies
Hip Joint/radiography
*Hip Prosthesis
Humans
Male
Middle Aged
Osseointegration
Prosthesis Design
Prosthesis Failure
*Titanium

Figure

• 

  Fig. 1 Corail femoral implant:stepped geometry is oriented to minimize shear forces and maximize compression loading in host cancellous bone and proprietary hydroxyapatite coating for initial osteointegration and fixation clinically demonstrated rapid trabeculae formation leading to rapid fixation.

• 

  Fig. 2 Evidence of osseointegration with the so-called spot welds or periprosthetic diaphyseal endosteal bone formation seen in at least 3 zones. Zones 2 and 3 were the most reliable sites of spot welds. (A) Immediate postoperative anteroposterior radiograph. (B, C) Anteroposterior and lateral radiographs taken 7 years postoperatively. (D) Magnified anteroposterior radiograph showing reliable periprosthetic osteogenesis around the implant at 7 years follow-up.

• 

  Fig. 3 Anteroposterior radiograph of each hip was obtained immediately postoperatively and at 7 years follow-up. Subsidence was assessed by measuring any change in the distance from the tip of the greater trochanter to the lateral shoulder of the femoral stem on sequential radiographs. (A) Immediate postoperative anteroposterior radiograph. (B) Seven-year follow-up anteroposterior radiograph shows 2 mm subsidence in left hip.

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