Hydroxyapatite-Coated Femoral Stems. A Matched-Pair Analysis of Coated and Uncoated Implants*

Rothman, Richard H.; Hozack, William J.; Ranawat, Amar S.; Moriarty, Lisa

doi:10.2106/00004623-199603000-00001

Cited by 99 publications

(33 citation statements)

References 12 publications

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“…Analyses of patients who underwent bilateral THA with an HA-coated implant on one side and a porouscoated implant on the other side failed to show any differences [43,44,46]. However, a radiographic review of Dorr's patients [43] showed that RLs tended to be less numerous in the HA group.…”

Section: Discussionmentioning

confidence: 94%

Good results with an uncoated grit-blasted tapered straight stem at ten years

Zweymüller

2007

Interact Surg

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In the literature, there is no consensus on the value of uncoated cementless femoral stems. We asked whether the results obtained with a grit-blasted titanium surface would prove the usefulness of this implant at an intermediate follow-up time. Three hundred and sixty five patients (376 hips) underwent primary total hip arthroplasty (THA) using the SL-Plus stem in combination with a ceramic-PE articulation. At a minimum follow-up time of 10.0 years (mean 10.2 years; range, 10.0 to 12.6 years), 229 stems (60.9%) were available for analysis. Five revisions were performed, one because of low-grade infection, one because of an aseptic loosening, another one because of a traumatic subsidence and two because of periprosthetic fractures. The 10-year survivorship with revision for any reason as event of interest was 98.3% (95% CI: 96.0%-99.3%). Radiologically two stems were diagnosed to be loosened at follow-up. Osteolytic lesions were detected in 5 patients. The implant survivorship with revision and radiographic sign of loosening as event of interest was 95.7% (95% CI: 89.0%-98.4%) at the time of maximum follow-up (12.6 years). Radiolucent lines (RLs) occurred in 27.9% mostly in positions 1 and 7. In the age group less than 70 years of age, 35% were found to show RLs, in the age group older than 70 years of age only 12.5% showed RLs. The five patients with osteolytic lesions were all from the age group 70 years. These intermediate results document that primary implants with a grit-blasted titanium surface ensure an excellent intermediate-term outcome clinically and with regards to the survival rate. It also confirms our approach not to accept any age limits for selecting patients for cementless THAs. A prospective study will have to show whether additional hydroxyapatite (HA)-coating can improve the radiologic outcome.

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Section: Discussionmentioning

confidence: 94%

Good results with an uncoated grit-blasted tapered straight stem at ten years

Zweymüller

2007

Interact Surg

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“…31,32 Other investigators have reported no clinical improvement with use of the hydroxyapatite coating within a relatively short time frame of followup study. 17,33 More important, hydroxyapatite coated components have been suggested to have the potential for producing greater amounts of particulate debris. 34 Despite encouraging basic science and preliminary clinical reports, justification for the additional expense incurred with the use of hydroxyapatite in primary total hip arthroplasty still is not well established.…”

Section: Discussionmentioning

confidence: 99%

“…Rothman et al, using a retrospective, matched-pair analysis, demonstrated that there appeared to be no clinical or radiographic advantage to the use of hydroxyapatite in primary total hip arthroplasties. 17 Activated macrophages may play a role in the direct lysis of bone. Human monocytes can resorb devitalized rat bone in vitro, 18,19 and they exhibit osteoclastlike characteristics, including formation of clear zones and release of the lysosomal enzyme acid phosphatase at the bone-cell interface.…”

Section: Introductionmentioning

confidence: 99%

The influence of hydroxyapatite particles on osteoclast cell activities

Sun

Lin

Hung

et al. 1999

J. Biomed. Mater. Res.

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Aseptic loosening after total joint arthroplasty is a major problem in orthopedic surgery. Small particles from material wear have been reported as the main cause of implant failure. For this reason, investigation into possible wear particles from the materials used in the implant may lead to longevity after arthroplasty. Hydroxyapatite (HA) has been extensively investigated and reported as an excellent biomaterial with excellent biocompatibility. In this study, we used an in vitro osteoblast/osteoclast model to test the biocompatibility of various-sized HA particles. Primary osteoclasts/osteoblasts were co-cultured with different-sized HA particles (0.5-3.0 microm, 37-53 microm, 177-205 microm, and 420-841 microm) for 3 h, 1 day, 3 days, and 7 days. Cellular responses to the HA particles were evaluated by changes in cell counts and the secretion of transforming growth factor (TGF-beta1), alkaline phosphatase (ALP), tumor necrosis factor (TNF-alpha), prostaglandin (PGE2), and lactate dehydrogenase (LDH) in the supernatant of the culture media. The results showed that osteoblasts/osteoclasts co-cultured with HA particles smaller than 53 microm undergo the most significant changes. Cellular counts significantly decreased, and the changes were more obvious in the osteoblast population. There also was a significant decrease in TGF-beta1 concentration and a significant increase in PGE2 and LDH concentration, but there were no changes in the TNF-alpha or ALP titer. It can be concluded that larger HA particles may be quite compatible with bone cells while smaller-sized HA particles can both activate the osteoclasts and decrease the cell population of the osteoblasts. Justification for the additional expense incurred with the use of hydroxyapatite in primary total hip arthroplasty should be further evaluated.

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“…To eliminate stress shielding around hip stems numerous shape and material modifications have been proposed and introduced to the designs throughout the past decades, i.e. proximally porous-coated stems (Rothman et al, 1996), composite implants (Glassman et al, 2001) or porous tantalum prostheses (Levine et al, 2006;Tarala et al, 2011a).…”

Section: Introductionmentioning

confidence: 99%

Numerical analysis of an osseointegrated prosthesis fixation with reduced bone failure risk and periprosthetic bone loss

Tomaszewski

Diest

Bulstra

et al. 2012

Journal of Biomechanics

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Currently available implants for direct attachment of prosthesis to the skeletal system after transfemoral amputation (OPRA system, Integrum AB, Sweden and ISP Endo/Exo prosthesis, ESKA Implants AG, Germany) show many advantages over the conventional socket fixation. However, restraining biomechanical issues such as considerable bone loss around the stem and peri-prosthetic bone fractures are present. To overcome these limiting issues a new concept of the direct intramedullary fixation was developed. We hypothesize that the new design will reduce the peri-prosthetic bone failure risk and adverse bone remodeling by restoring the natural load transfer in the femur. Generic CT-based finite element models of an intact femur and amputated bones implanted with 3 analyzed implants were created and loaded with a normal walking and a forward fall load. The strain adaptive bone remodeling theory was used to predict long-term bone changes around the implants and the periprosthetic bone failure risk was evaluated by the von Mises stress criterion. The results show that the new design provides close to physiological distribution of stresses in the bone and lower bone failure risk for the normal walking as compared to the OPRA and the ISP implants. The bone remodeling simulations did not reveal any overall bone loss around the new design, as opposed to the OPRA and the ISP implants, which induce considerable bone loss in the distal end of the femur. This positive outcome shows that the presented concept has a potential to considerably improve safety of the rehabilitation with the direct fixation implants.

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Hydroxyapatite-Coated Femoral Stems. A Matched-Pair Analysis of Coated and Uncoated Implants*

Cited by 99 publications

References 12 publications

Good results with an uncoated grit-blasted tapered straight stem at ten years

Good results with an uncoated grit-blasted tapered straight stem at ten years

The influence of hydroxyapatite particles on osteoclast cell activities

Numerical analysis of an osseointegrated prosthesis fixation with reduced bone failure risk and periprosthetic bone loss

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