Hydroxyapatite-coated Collars Reduce Radiolucent Line Progression in Cemented Distal Femoral Bone Tumor Implants

Abstract

Background Aseptic loosening of massive bone tumor implants is a major cause of prosthesis failure. Evidence suggests that an osteointegrated hydroxyapatite (HA)-coated collar would reduce the incidence of aseptic loosening around the cemented intramedullary stem in distal femoral bone tumor prostheses. Because these implants often are used in young patients with a tumor, such treatment might extend the longevity of tumor implants. Questions/purposes We asked whether (1) HA-coated collars were more likely to osteointegrate; (2) HA collars were associated with fewer progressive radiolucent lines around the stem-cement interface; and (3) HA-coated collars were associated with less bone loss at the boneshoulder implant junction? Methods Twenty-two patients were pair-matched to one of two groups-either (1) implants with a HA-coated ingrowth collar (HA Collar Group); or (2) implants without an ingrowth collar (Noncollar Group). Age, sex, and length of followup were similar in both groups. HA-coated collars were developed and used at our institution from 1992 to address the high failure rate attributable to aseptic loosening in patients with massive bone tumor implants. Before this, smooth titanium shafts were used routinely adjacent to bone at the transection site. The minimum followup was 2 years (mean, 7 years; range, 2-12 years). Radiographs obtained throughout the followup period were analyzed and osteointegration at the shaft of the implant quantified. Radiolucent line progression around the cemented stem was semi-quantitatively assessed and cortical bone loss at the bone-shoulder implant junction was measured during the followup period.

The effect of bone growth onto massive prostheses collars in protecting the implant from fracture

“…Recent radiographic and histological study investigating bone ingrowth into a HA collar in the distal femoral implants used to treat patients of all ages showed increased survivorship and reduced radiolucent line progression when osseointegration at the shoulder could be identified compared to implants where ingrowth was not evident [24,37].…”

Experimental Validation of an ITAP Numerical Model and the Effect of Implant Stem Stiffness on Bone Strain Energy

“…Managing aseptic loosening of SAAP due to periprosthetic bone resorption is key to clinical success, as studies using similar endoprostheses have shown. 4,8,9 Endosteal resorption will destabilise the implant, conversely if osseointegration and bone growth into the collar can be achieved without radiolucency, then the implant will be stabilised. 8,15 The damage repair theory suggests that when damage from fatigue or impact occur, bone can detect, remove and replace it within resorption cavities.…”

The use of hydroxyapatite bone substitute grafting for alveolar ridge preservation, sinus augmentation, and periodontal bone defect: A systematic review

“… Study Reason for exclusion No. Study Reason for exclusion 1 Singh A et al., 2014 [34] Only one patient 17 Cook DC et al., 2013 [35] Not comparing a synthetic bone substitute 2 Coathup MJ et al., 2015 [36] Treatment not for alveolar bone 18 Menezes LM et al., 2012 [37] Not comparing a synthetic bone substitute 3 Kato E et al., 2015 [38] Outcome measure not related to alveolar bone regeneration 19 Horvarth A et al., 2013 [39] Not comparing a synthetic bone substitute 4 Gupta G et al., 2014 [40] Not comparing a synthetic bone substitute 20 Ghanaati S et al., 2013 [25] Control group not available 5 Troedan A et al., 2014 [41] Outcome measure not related to alveolar bone regeneration 21 Pietruska M et al., 2012 [42] Outcome measure not related to alveolar bone regeneration 6 Reichert C et al., 2014 [43] Outcome measure not related to alveolar bone regeneration 22 Emam H et al., 2011 [44] Not comparing a synthetic bone substitute and control group not available 7 Cosso MG et al., 2014 [3] Not comparing a synthetic bone substitute 23 Lee CY et al., 2011 [45] Not comparing a synthetic bone substitute 8 Ghanaati S et al., 2014 [46] Outcome measure not related to alveolar bone regeneration 24 Mairoana C et al., 2011 [47] …”