Higher early proximal migration of hemispherical cups with electrochemically applied hydroxyapatite (BoneMaster) on a porous surface compared with porous surface alone: a randomized RSA study with 53 patients

Jørgensen, Peter Bo; Daugaard, Henrik; Jakobsen, Stig Storgaard; Lamm, Martin; Søballé, Kjeld; Stilling, Maiken

doi:10.1080/17453674.2019.1687860

Cited by 13 publications

(15 citation statements)

References 28 publications

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“…While contact surface for the bone might be increased by an HA coating, bone mineralization becomes weaker [ 9 ]. HA coatings may not only increase but also reduce primary stability of hip implants, with consecutively increased migration [ 29 , 30 ]. Increased porosity, however, reduces mechanical resistance of HA coatings [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

New Insights into Osteointegration and Delamination from a Multidisciplinary Investigation of a Failed Hydroxyapatite-Coated Hip Joint Replacement

et al. 2020

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Hydroxyapatite (HA) coatings have become very popular in uncemented total hip arthroplasty (THA). Analysis of retrievals and tissue samples from an HA-coated femoral stem, which failed within 14 months after THA, provides exceptional insights into the failure mechanism, as well as the process of osteointegration of such an implant. Methods: Retrievals were photo-documented. Samples were examined by micro-computed tomography, X-ray diffraction (XRD) and embedded in polymethylmethacrylate for histology. Results: The coating had partially delaminated. The sandblasted surface of the stem was partially polished by the delaminated HA coating, indicating failure before revision. In the tissue samples, the HA coating was well integrated by newly formed bone trabeculae. No adverse biological reaction was observed. XRD analysis showed that residues of the HA coating were still present and could clearly be differentiated from the surrounding bone. Preferential orientation of the HA crystallites could be identified within the newly formed bone, representing a potential mechanical weakness induced either by physiologic strain or by the coating. Conclusion: current HA coatings, relatively thick and made of high crystallinity HA, may be prone to delamination, as also seen in our study. Recent efforts have aimed towards thinner (<1 μm) coatings with nanocrystalline HA structures that possibly relate to lower delamination risks. However, the question arises if HA coatings are beneficial since sandblasted non-coated stems offer similar results without the risk of delamination. XRD not only permits differentiation between the HA from the coating and the HA of the ongrown bone, it also provides new insights into the microstructure of this newly formed bone.

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Section: Discussionmentioning

confidence: 99%

New Insights into Osteointegration and Delamination from a Multidisciplinary Investigation of a Failed Hydroxyapatite-Coated Hip Joint Replacement

et al. 2020

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“…The two-year data for the cementless acetabular components in the same patients have been published. 6 Randomization was performed in blocks of ten patients (five to each group) by drawing concealed labels from sequentially numbered envelopes. The inclusion criteria were age between 55 and 75 years, The sample size calculation was based on a difference in combined early stem migration of 0.6 mm (standard deviation (SD) 0.6).…”

Section: Methodsmentioning

confidence: 99%

“…The RSA setup has previously been described. 6 RSA was performed by the same blinded investigators (MBK, PBJ) using computer-aided design surface implant models with Model-Based RSA 4.2 (RSAcore, the Netherlands) (Figure 2). The maximum rigid body error was set to 0.35 mm, the maximum accepted condition number (CN) was set to 150, 12 and the mean CN was 72 (SD 29).…”

Section: Methodsmentioning

confidence: 99%

“…5 BoneMaster (BM; Zimmer Biomet, USA) is a product in which HA is electrochemically applied in a considerably thinner layer (5 µm) compared with plasma-sprayed HA (thickness between 30 µm and 250 µm). The topographic needle-like structure, and irregular surface distribution, 6 of Bonemaster has been shown to enhance early fixation between the implant and bone. 3,7 In a canine model, BoneMaster coating has been shown to be capable of maintaining bone stimulation and implant fixation in spite of being quickly resorbed.…”

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confidence: 99%

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Electrochemically applied hydroxyapatite on the cementless porous surface of Bi-Metric stems reduces early migration and has a lasting effect

Knudsen

Thillemann

Jørgensen

et al. 2022

The Bone & Joint Journal

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Aims BoneMaster is a thin electrochemically applied hydroxyapatite (HA) coating for orthopaedic implants that is quickly resorbed during osseointegration. Early stabilization is a surrogacy marker of good survival of femoral stems. The hypothesis of this study was that a BoneMaster coating yields a fast early and lasting fixation of stems. Methods A total of 53 patients were randomized to be treated using Bi-Metric cementless femoral stems with either only a porous titanium plasma-sprayed coating (P group) or a porous titanium plasma-sprayed coating with an additional BoneMaster coating (PBM group). The patients were examined with radiostereometry until five years after surgery. Results At three months, the mean total translation (TT) was 0.95 mm (95% confidence interval (CI) 0.68 to 1.22) in the P group and 0.57 mm (95% CI 0.31 to 0.83) in the PBM group (p = 0.047). From two to five years, the TT increased by a mean of 0.14 mm (95% CI 0.03 to 0.25) more in the P group than in the PBM group (p = 0.021). In osteopenic patients (n = 20), the mean TT after three months was 1.61 mm (95% CI 1.03 to 2.20) in the P group and 0.73 mm (95% CI 0.25 to 1.21) in the PBM group (p = 0.023). After 60 months, the mean TT in osteopenic patients was 1.87 mm (95% CI 1.24 to 2.50) in the P group and 0.82 mm (95% CI 0.30 to 1.33) in the PBM group (p = 0.011). Conclusion There was less early and midterm migration of cementless stems with BoneMaster coating compared with those with only a porous titanium plasma-sprayed coating. Although a BoneMaster coating seems to be important for stem fixation, especially in osteopenic patients, further research is warranted . Cite this article: Bone Joint J 2022;104-B(6):647–656.

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“…16 Later came the Leiden uniplanar extrapolation carbon calibration cage, which has been used for research in hips, knees and shoulders (Medis Specials). [17][18][19] Furthermore, the smaller Leiden perspex calibration cage (Medis Specials) was developed for hand and elbow anatomy and improved the accuracy and precision for these anatomic regions. 20,21 The Umeaa calibration cage and Leiden uniplanar extrapolation carbon calibration cage have a thickness of 208-250 mm, respectively.…”

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confidence: 99%

Development, construction, and validation of a thinner uniplanar calibration cage for radiostereometry

Jürgens-Lahnstein

Petersen

Laursen

et al. 2021

Journal Orthopaedic Research

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Radiostereometric analysis (RSA) is an accurate and precise radiographic method that can be used to measure micromotion of implants and study joint kinematics in vivo. A calibration cage with radiopaque markers is used to calibrate the RSA images; however, the thickness (250 mm) of the calibration cage restricts the available area for the patient and equipment during RSA recordings. A thinner calibration cage would increase the recording area, facilitate handling of the cage, and ease integration of the cage with the RSA system. We developed a thinner calibration cage without compromise of accuracy and precision. First, we performed numerical simulations of an RSA system, and showed that the calibration cage thickness could be decreased to 140 mm maintaining accuracy and precision using 40 fiducial and 30 control markers. Second, we constructed a new calibration cage (NRT cage) according to the simulation results. Third, we validated the new calibration cage against two state‐of‐the‐art calibration cages (Umeaa cage and Leiden cage) in a phantom study. All cages performed similar for marker‐based analysis, except for y‐rotation, where the Umeaa cage (SD = 0.064 mm) was less precise compared to the NRT (SD = 0.038 mm) and Leiden cages (0.042 mm) (p = .01). For model‐based analysis the NRT cage had superior precision for translations (SD ≤ 0.054 mm) over the Leiden cage (SD ≤ 0.118 mm) and Umeaa cage (SD ≤ 0.093 mm) (p < .01). The combined study confirmed that the new and thinner calibration cage maintained accuracy and precision at the level of existing thicker calibration cages.

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Higher early proximal migration of hemispherical cups with electrochemically applied hydroxyapatite (BoneMaster) on a porous surface compared with porous surface alone: a randomized RSA study with 53 patients

Abstract: 2020) Higher early proximal migration of hemispherical cups with electrochemically applied hydroxyapatite (BoneMaster) on a porous surface compared with porous surface alone: a randomized RSA study with 53 patients, Acta Orthopaedica, 91:1, 26-32,

Cited by 13 publications

References 28 publications

New Insights into Osteointegration and Delamination from a Multidisciplinary Investigation of a Failed Hydroxyapatite-Coated Hip Joint Replacement

New Insights into Osteointegration and Delamination from a Multidisciplinary Investigation of a Failed Hydroxyapatite-Coated Hip Joint Replacement

Electrochemically applied hydroxyapatite on the cementless porous surface of Bi-Metric stems reduces early migration and has a lasting effect

Development, construction, and validation of a thinner uniplanar calibration cage for radiostereometry

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