Does hydroxyapatite coating have no advantage over porous coating in primary total hip arthroplasty? A meta-analysis

Abstract

There are some arguments between the use of hydroxyapatite and porous coating. Some studies have shown that there is no difference between these two coatings in total hip arthroplasty (THA), while several other studies have shown that hydroxyapatite has advantages over the porous one. We have collected the studies in Pubmed, MEDLINE, EMBASE, and the Cochrane library from the earliest possible years to present, with the search strategy of “(HA OR hydroxyapatite) AND ((total hip arthroplasty) OR (total hip replacement)) AND (RCT* OR randomiz* OR control* OR compar* OR trial*)”. The randomized controlled trials and comparative observation trials that evaluated the clinical and radiographic effects between hydroxyapatite coating and porous coating were included. Our main outcome measurements were Harris hip score (HHS) and survival, while the secondary outcome measurements were osteolysis, radiolucent lines, and polyethylene wear. Twelve RCTs and 9 comparative observation trials were included. Hydroxyapatite coating could improve the HHS (p < 0.01), reduce the incidence of thigh pain (p = 0.01), and reduce the incidence of femoral osteolysis (p = 0.01), but hydroxyapatite coating had no advantages on survival (p = 0.32), polyethylene wear (p = 0.08), and radiolucent lines (p = 0.78). Hydroxyapatite coating has shown to have an advantage over porous coating. The HHS and survival was duration-dependent—if given the sufficient duration of follow-up, hydroxyapatite coating would be better than porous coating for the survival. The properties of hydroxyapatite and the implant design had influence on thigh pain incidence, femoral osteolysis, and polyethylene wear. Thickness of 50 to 80 μm and purity larger than 90% increased the thigh pain incidence. Anatomic design had less polyethylene wear.

A Comparative Evaluation of Primary Total Hip Arthroplasty via Lateral and Posterolateral Approaches

“…The HHS was doubled (from 40 to 80) at 12 months after the surgery, and patients had greater pain relief with better functional outcomes. This result is consistent with the Chen et al (1) reports that indicated longer duration of follow-up tends to have higher HSS, and the postoperative HHS reduces the incidence of thigh pain and femoral osteolysis. Moreover, based on our results there was no significant difference between the two surgery approaches, which is consistent with other researcher's findings (8)(9)(10).…”

“…In the postoperative period, the incidence of early complications was low in both cases. The incidence rate of bleeding in lateral and posterolateral approach was low and since there was no significant difference between the two approaches, they are characterized by less bleeding and more recovery function (1,8,11). Patients treated with lateral and posterolateral approaches had overall and better function, low number of infections, gradual decrease in the hemoglobin level, less blood transfusion after the surgery.…”

“…Total hip arthroplasty (THA) is one of the most wide operation in orthopedic surgery (1). It is regarded as a successful and reliable technique (2).…”

Hydroxyapatite in total hip arthroplasty. Our experience with a plasma spray porous titanium alloy/hydroxyapatite double-coated cementless stem

“…HA coating had higher HHS, less incidence of thigh pain, superior proximal femoral osteointegration and better preservation of periprosthetic bone quality (26).…”

Influence of Hydroxyapatite Coating for the Prevention of Bone Mineral Density Loss and Bone Metabolism after Total Hip Arthroplasty: Assessment Using 18F-Fluoride Positron Emission Tomography and Dual-Energy X-Ray Absorptiometry by Randomized Controlled Trial

“…Total hip arthroplasty (THA) is recognized as achieving stable long-term clinical results and excellent patient satisfaction; as for tapered rectangular Zweymüller type, the longterm reported survival rates were 98% at 20 years by Kolb et al or 95% at 18 years by Reigstad et al regarded as almost satisfactory. However, despite the stable clinical results, several issues concerning radiographic assessment after THA remain unresolved [1]. One of the major issues on the femoral side is a decrease in bone mineral density (BMD) around the implant.…”