The Results of Long-term Follow-up of Total Hip Arthroplasty Using Hydroxyapatite-coated Cups

Abstract

PurposeThe aim of this study was to report the long-term outcome and the failure mechanism of cementless total hip arthroplasty (THA) using hydroxyapatite (HA)-coated acetabular cup.Materials and MethodsFrom January 1992 to May 1994, a total of 123 consecutive cementless primary THAs were performed using a HA-coated acetabular cup with metal-on-polyethylene articulation. We retrospectively evaluated 66 hips available for follow-up at a mean 18.3 years (range, 10.4-23.6 years). The survival analysis was performed by the Kaplan-Meier method. We defined end point as any failure that required a reoperation of acetabular component.ResultsThirty-nine of 66 hips (59.1%) were defined as a failure for progressive acetabular osteolysis or aseptic loosening of the cup. Acetabular osteolysis was observed in 47 hips (71.2%) and 33 hips (50.0%) were revised because of cup loosening. The Kaplan-Meier method showed the survival rate of the acetabular cup to be 46.3% at 15 years and 34.8% at 20 years for any failure that required a reoperation of acetabular component.ConclusionThe long-term survival rate of THA using HA-coated acetabular cup was unsatisfactory, and it was attributed to vulnerable property of HA coating and progressive osteolysis.

Biomedical Applications of Titanium Alloys: A Comprehensive Review

“…Results clearly show that titanium arthroprostheses have a high survival rate up to about 10 years of follow-up, but then show a steep decrease between 10 and 30 years. These devices are extremely reliable, and the failure is prevalently caused by patient-associated conditions, such as advanced age [ 372 , 373 , 374 , 375 , 376 , 377 , 378 , 379 , 380 , 381 , 382 , 383 , 384 , 385 , 386 , 387 , 388 ]. Most late failures are caused by osteoporosis and other risk factors that were not present (or not as advanced) at the time of implantation and, overall, mechanical failures and infections only account for about 15% of the total [ 389 ].…”

Strengthening Adhesion of the Hydroxyapatite and Titanium Interface by Substituting Silver and Zinc: A First Principles Investigation

“…Owning to their structural and chemical similarities to the inorganic composition of teeth and bone, including the same bioactivity and osteoconductivity, hydroxyapatite (2­(Ca 5 (PO 4 ) 3 (OH)), HA) is the important biological active materials coated on titanium and its alloys for medical devices, implants, and tissue engineering. , In such applications, especially in total hip joint replacements and artificial teeth sockets, HA-coated Ti implants suffer from sustained shock and stress, with which coating exfoliation, interfacial cracks, and debris granules occur frequently due to huge differences in physical attributes and the low adhesion strength of the interface between the HA film and Ti substrate. − Furthermore, infection caused by either bacterial colonization at the wound site or foreign body response to the implant material is a main reason causing the failure of the HA-coated Ti implants in clinical applications. − Clearly, the establishment of a sufficiently strong and durable mechanical link between the bone and implant is highly desirable, which will be the main focus of the current paper. One of the main structural characteristics of biological and synthetic HA is the ability to incorporate a great variety of isomorphic substitutions, such as cations (Zn 2+ , Mg 2+ , Sr 2+ , Y 3+ , Ag + ) ,,− and anions (SiO 4 4– , CO 3 2– ), − while keeping its hexagonal symmetry.…”

In Vitro Evaluation of Laser-Induced Periodic Surface Structures on New Zirconia/Tantalum Biocermet for Hard-Tissue Replacement

“…Multiple techniques have been proposed to increase osteointegration in metals. Probably the most accepted and used are the creation of a plasma coating with hydroxyapatite in some situations and the texturization of the metal in the microscale [2][3][4][5][6].…”