Hip Pelvis.  2014 Sep;26(3):143-149. 10.5371/hp.2014.26.3.143.

The Effect of Hydroxyapatite Coating on Long-term Results of Total Hip Arthroplasty with Hydroxyapatite-coated Anatomic Femoral Stem

• Chung YY
• Im CH
• Kim DH
• Heo JY
• Jang YJ

• KMID: 2054177
• DOI: http://doi.org/10.5371/hp.2014.26.3.143

Abstract

PURPOSE
To evaluate the clinical and radiological results, as well as the survival rate, associated with total hip arthroplasty using a hydroxyapatite (HA)-coated anatomical femoral stem at a follow-up of > or =12 years.
MATERIALS AND METHODS
From April 1992 to May 1997, 86 patients (102 hips) underwent total hip arthroplasty with a HA-coated ABG I (Anatomical Benoist Giraud; Howmedica) hip prosthesis. The average age at the time of surgery was 53.4 years and the mean duration of follow-up was 17.1 years (range, 12.1-21.0 years). The Harris hip score (HHS) and radiographic assessments of thigh pain were used to evaluate the clinical results. We observed osteointegration, cortical hypertrophy, reactive line, calcar resorption and osteolysis around the femoral stems. The survival rate of the femoral stems was evaluated by using the span of time to a revision operation for any reasons was defined as the end point.
RESULTS
The mean HHS was 50.5 preoperatively and 84.2 at the time of last follow-up. Osteolysis only around the HA-coated proximal portion of the femoral stem was observed in 72 hips, cortical hypertrophy all around the distal portion of the femoral stem was observed in 38 hips, and calcar resorption was observed in 44 hips. A reactive line was observed in 13 hips, but was unrelated to component loosening. Stem revision operations were performed in 24 (23%) hips due to osteolysis (14 hips), fracture (5 hips) and infection (5 hips). The femoral stem survival rate was 75% over the mean duration of follow-up.
CONCLUSION
Total hip arthroplasty using a HA-coated anatomical femoral stem showed necessitated a high rate of revision operations due to osteolysis around the femoral stem in this long term follow-up study.

Keyword

Total hip arthroplasty; Hydroxyapatite coating; Anatomical femoral stem

MeSH Terms

Arthroplasty, Replacement, Hip*
Durapatite*
Follow-Up Studies
Hip
Hip Prosthesis
Humans
Hypertrophy
Osteolysis
Survival Rate
Thigh
Durapatite

Figure

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  Fig. 1 Kaplan-Meier survival curve of femoral component with the endpoint of revision for any reason (with 95% confidence intervals).

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  Fig. 2 (A) Spot welding and mild cortical hypertrophy was seen at Gruen zones 2 and 6 at 5 years after total hip arthroplasty (THA) with hydroxyapatite (HA)-coated ABG-I (Anatomical Benoist Giraud; Howmedica) femoral stems. (B) Cortical hypertrophy was obvious at the uncoated distal portion of the femoral stem at 10 years after THA and (C) this cortical hypertrophy extended to more distal portions. Grade 2 stress shielding was also seen at the proximal coated portion at the last follow-up.

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  Fig. 3 (A) Extensive proximal femoral osteolysis with pathologic fracture of the lesser trochanter was noted on follow-up radiographs at 18 years after total hip arthroplasty with hydroxyapatite (HA)-coated femoral components. (B) Biological bonding between the HA-coated femoral stem and the femur was disturbed by osteolysis. (C) Revision was conducted with an extensive porous-coated cementless femoral stem.

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