Proximal femoral bone loss and increased rate of fracture with a proximally hydroxyapatite-coated femoral component

Radl, Roman; Aigner, Christian; Hungerford, Marc W.; Pascher, Arnulf; Windhager, Reinhard

doi:10.1302/0301-620x.82b8.0821151

Cited by 19 publications

(12 citation statements)

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“…There are, however, several drawbacks associated with HA coating of surgical implants. Problems include osteolysis and acetabular loosening [33], complete loss of the HA coating in retrieved specimens [34], third body wear due to HA particles from implant coating [24], and femoral bone loss with increased fracture rates [31].…”

Section: Microtornographic (Srpct) $Findingsmentioning

confidence: 99%

Coating of titanium implants with type‐I collagen

Rammelt

Schulze

Bernhardt

et al. 2004

Journal Orthopaedic Research

118

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Purpose: Type-I collagen, the major structural protein in bone, has beneficial properties regarding bone regeneration. Little is known about the potential effects of collagen coating on orthopedic implants. method^ 3 to 6 @cm2 of lyophilized type-I collagen was absorbed on titanium rods. Six coated and uncoated pins of 0.9 mm diameter were inserted into the tibia of adult male Wistar rats for 1, 2, 4, 7, 14, and 28 days. Specimens were embedded in methacrylate-based Technovit 9100N resin. From one portion cutting and grinding sections were obtained. The implant was removed from the other half that was depolymerized, sectioned, and mounted for immunohistochemistry.Results: At day 4, the interface around the collagen-coated implants displayed a granulation tissue with higher numbers of cathepsin D-positive mononucleated cells compared to the uncoated implants @ < 0.05). Active osteoblasts, reactive for osteopontin, were increased around the collagen-coated pins at day 4 and 7 (p < 0.01). After 28 days of implantation, direct bone contact averaged 74.9% around the collagen-coated implants and 62.1% around uncoated implants (NS). The amount of newly formed bone averaged 76.3% around the collagen-coated pins and 67.8% around the uncoated pins (NS). The histomorphometric findings were confirmed by SRpCT in two specimens. Conclusions:The earlier observation of mononuclear phagocytozing cells and the earlier and higher expression of bone-specific matrix proteins suggest an increased early bone remodeling around titanium pins through collagen coating. A tendency towards increased bone formation was observed around the coated implants.

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Section: Microtornographic (Srpct) $Findingsmentioning

confidence: 99%

Coating of titanium implants with type‐I collagen

Rammelt

Schulze

Bernhardt

et al. 2004

Journal Orthopaedic Research

118

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“…25 However, there have been few studies which have examined the incidence of peri-prosthetic femoral fracture after the implantation of uncemented stems, [26][27][28][29][30] and to our knowledge, there have been no long-term studies.…”

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confidence: 99%

Late peri-prosthetic femoral fracture as a major mode of failure in uncemented primary hip replacement

Streit

Merle

Clarius³

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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Peri-prosthetic femoral fracture after total hip replacement (THR) is associated with a poor outcome and high mortality. However, little is known about its long-term incidence after uncemented THR. We retrospectively reviewed a consecutive series of 326 patients (354 hips) who had received a CLS Spotorno replacement with an uncemented, straight, collarless tapered titanium stem between January 1985 and December 1989. The mean follow-up was 17 years (15 to 20). The occurrence of peri-prosthetic femoral fracture during follow-up was noted. Kaplan-Meier survival analysis was used to estimate the cumulative incidence of fracture. At the last follow-up, 86 patients (89 hips) had died and eight patients (eight hips) had been lost to follow-up. A total of 14 fractures in 14 patients had occurred. In ten hips, the femoral component had to be revised and in four the fracture was treated by open reduction and internal fixation. The cumulative incidence of peri-prosthetic femoral fracture was 1.6% (95% confidence interval 0.7 to 3.8) at ten years and 4.5% (95% confidence interval 2.6 to 8.0) at 17 years after the primary THR. There was no association between the occurrence of fracture and gender or age at the time of the primary replacement. Our findings indicate that peri-prosthetic femoral fracture is a significant mode of failure in the long term after the insertion of an uncemented CLS Spotorno stem. Revision rates for this fracture rise in the second decade. Further research is required to investigate the risk factors involved in the occurrence of late peri-prosthetic femoral fracture after the implantation of any uncemented stem, and to assess possible methods of prevention.

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“…The influence of the hydroxylapatite coating on the long term results of hip arthroplasties is not clear yet. An osteolytic potential for hydroxylapatite [27] as well as early aseptic loosening [31], foreign body reactions [2] and interfacial weakness between metal and coating [26] are described.…”

Section: Discussionmentioning

confidence: 99%