Osteointegration of hydroxyapatite-coated collars in cemented massive endoprostheses following revision surgery

Abstract

Aims Hydroxyapatite (HA)-coated collars have been shown to reduce aseptic loosening of massive endoprostheses following primary surgery. Limited information exists about their effectiveness in revision surgery. The aim of this study was to radiologically assess osteointegration to HA-coated collars of cemented massive endoprostheses following revision surgery. Methods Retrospective review of osseointegration frequency, pattern, and timing to a specific HA-coated collar on massive endoprostheses used in revision surgery at our tertiary referral centre between 2010 to 2017 was undertaken. Osseointegration was radiologically classified on cases with a minimum follow-up of six months. Results In all, 39 patients underwent radiological review at mean 43.5 months; 22/39 (56.4%) showed no osseointegration to the collar. Revision endoprostheses for aseptic loosening were less likely to show osseointegration compared with other indications for revision. Oncological cases with previous or current infection were more likely to show osseointegration to ≥ 1 collar side than those without evidence of prior infection. Conclusion This seven-year review identified osseointegration of HA-coated collars after revision surgery is less likely (43.6%, 17/39) than after primary surgery. Young patients who undergo revision surgery following initial oncological indication may benefit the most from this collar design. Use in revision oncological cases with a history of infection may be beneficial. HA-coated collars showed limited benefit for patients undergoing revision for failed arthroplasty with history of infection. Cite this article: Bone Jt Open 2021;2(6):371–379.

Early radiographic osseointegration of a novel highly porous 3D-printed titanium collar for megaprostheses compared to a previous generation smooth HA-coated collar

“…A recent study observed osseointegration around HA-coated collars in megaprostheses in less than half of reviewed cases [2]. Previous implant failure due to aseptic loosening, arguably the indication that would benefit most from collar osseointegration, was associated with an even worse ongrowth rate with the percentage dropping down to 27% [2]. Evolution of additive manufacturing technology not only allowed for emergence of custom-made patientspecific implants but also facilitated the incorporation of highly complex materials and surfaces in implant design and production processes [13,14].…”

“…In complex revision arthroplasty and orthopaedic oncology, a commonly used mode of reconstruction is endoprosthetic replacement using megaprostheses [1,2]. Despite recent advancements in implant design and refinements of implantation techniques resulting in improved prosthesis survival rates, tumour prosthesis remain associated with high complication and revision rates [1,2]. Available literature demonstrates all-cause revision rates of more than 40% in the first 10 years after implantation [1].…”

“…Available literature demonstrates all-cause revision rates of more than 40% in the first 10 years after implantation [1]. Particularly aseptic loosening was repeatedly reported to be a common mode of failure and cause for revision surgery [2][3][4][5]. One study reported around 30% of patients with tumour prosthesis required at least one revision due to aseptic loosening within 15 years after surgery [1].…”

“…In an effort to improve ongrowth capacity at the bone-prosthesis interface different techniques have been employed with mixed results. Aside from bone grafting around the prosthesis shoulder coating of the prosthesis collar with hydroxy-apatite (HA) was utilized [2,3,6,[10][11][12]. A recent study observed osseointegration around HA-coated collars in megaprostheses in less than half of reviewed cases [2].…”

“…Aside from bone grafting around the prosthesis shoulder coating of the prosthesis collar with hydroxy-apatite (HA) was utilized [2,3,6,[10][11][12]. A recent study observed osseointegration around HA-coated collars in megaprostheses in less than half of reviewed cases [2]. Previous implant failure due to aseptic loosening, arguably the indication that would benefit most from collar osseointegration, was associated with an even worse ongrowth rate with the percentage dropping down to 27% [2].…”