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Increased risk of revision of acetabular cups coated with hydroxyapatite: A Swedish Hip Arthroplasty Register study involving 8,043 total hip replacements
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2010 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 81, no 1, 53-59 p.Article in journal (Refereed) Published
Abstract [en]

Background Hydroxyapatite (HA) is the main inorganic component of bone, and HA coating is widely used on acetabular cups in hip arthroplasty. It has been suggested that this surface finish improves cup survival. Methods All patients registered in the Swedish Hip Arthroplasty Register between 1992 and 2007 with an uncemented acetabular implant that was available either with or without HA coating were identified. 8,043 total hip arthroplasties (THAs) with the most common cup types (Harris-Galante, Romanus, and Trilogy) were investigated. A Cox regression model including type of coating, age, sex, primary diagnosis, cup type, and type of stem fixation was used to calculate adjusted risk ratios (RRs) for the risk of revision. Results HA coating was a risk factor for cup revision due to aseptic loosening (adjusted RR 1.7; 95% CI: 1.3-2). Age at primary arthroplasty of < 50 years, a diagnosis of pediatric hip disease, the use of a cemented stem, and the Romanus and Harris-Galante cup types were also associated with statistically significantly increased risk of cup revision due to aseptic loosening. Interpretation Our findings question the routine use of HA-coated cups in primary total hip arthroplasty. With some designs, this practice may even increase the risk of loosening-resulting in revision surgery.

Place, publisher, year, edition, pages
2010. Vol. 81, no 1, 53-59 p.
National Category
Surgery
Research subject
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-112790DOI: 10.3109/17453670903413178ISI: 000276167300011PubMedID: 19968603OAI: oai:DiVA.org:uu-112790DiVA: diva2:288027
Available from: 2010-01-20 Created: 2010-01-20 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Form and Finish of Implants in Uncemented Hip Arthroplasty: Effects of Different Shapes and Surface Treatments on Implant Stability
Open this publication in new window or tab >>Form and Finish of Implants in Uncemented Hip Arthroplasty: Effects of Different Shapes and Surface Treatments on Implant Stability
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The design of an uncemented hip arthroplasty implant affects its long-term survival. Characteristics such as the form and the finish of the implant are crucial in order to achieve the best possible conditions for long-term implant survival. In this thesis we hypothesized that different shapes of stems and cups used in primary and revision total hip arthroplasty (THA), and their finish with hydroxyapatite (HA) coating affect implant stability and thus long-term survival.

In 2 prospective cohort studies the clinical outcome, the stability measured with radiostereometric analysis (RSA), and the periprosthetic changes in bone mineral density (BMD) measured with dual-energy x-ray absorptiometry (DXA) were investigated in 2 uncemented THA implants – the CFP stem and the TOP cup. In 3 register studies the effect of HA coating on uncemented THA implants used in primary and revision arthroplasty was investigated.

Both implants investigated in the prospective cohort studies showed an excellent short-term clinical outcome with good primary stability, but neither their novel form nor the finish with HA protected the implants from the proximal periprosthetic demineralization that usually occurs around other uncemented THA implants.

The register studies revealed that HA coating on cups used in primary and revision THA is a risk factor for subsequent revision of the implant. The use of HA coating on the stem in primary THA did not affect long-term survival. Additionally, the shape of an implant plays a crucial role for implant stability and survival.

In conclusion, this thesis highlights that the finish of implants with HA coating does not prevent periprosthetic proximal femoral bone loss and can even enhance the risk of revision of both primary and secondary cups. Importantly, the shape of uncemented THA implants affect their stability, showing that the implant form is a crucial factor for the long-term survival.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 74 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 845
Keyword
Form, Finish, Total hip arthroplasty, Swedish Hip Arthroplasty Register, Hydroxyapatite, RSA, DXA, BMD, Stability.
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-185299 (URN)978-91-554-8549-8 (ISBN)
Public defence
2013-01-11, Grönwallsalen, Akademiska sjukhuset, Akademiska sjukhus, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-12-21 Created: 2012-11-21 Last updated: 2013-08-06Bibliographically approved

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Lazarinis, StergiosHailer, Nils P.

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