Hydroxyapatite-coated femoral stems in primary total hip arthroplasty: A meta-analysis of randomized controlled trials

Li, Shuzhen; Baohua, Huang; Chen, Yueping; Gao, Hui; Fan, Qie; Zhao, Jinmin; Su, Wei-Ren

doi:10.1016/j.ijsu.2013.04.003

Cited by 17 publications

(10 citation statements)

References 22 publications

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“…The excellent stability of HA-coated implants has been demonstrated even in elderly patients [ 97 ]. Other studies find no advantage in HA-coated implants over metallic-coated designs, mainly in the acetabular cups [ 98 – 104 ]. Some even believe that HA coating is a risk factor which contributes to loosening and is associated with poor long-term results in acetabular cups [ 105 ] in the HA coating stems, finding no advantage over metallic-coated implants [ 106 ].…”

Section: Discussionmentioning

confidence: 99%

Cementless Hydroxyapatite Coated Hip Prostheses

Herrera

Mateo

Albarova

et al. 2015

BioMed Research International

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More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

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Section: Discussionmentioning

confidence: 99%

Cementless Hydroxyapatite Coated Hip Prostheses

Herrera

Mateo

Albarova

et al. 2015

BioMed Research International

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“…Auto alerts of searches set up to capture relevant articles published after the dates of the searches identified three new relevant systematic reviews which compared the effectiveness of THR using different articulations (metal-on-metal vs. metal-on-polyethylene) [58], implant fixation methods (cemented vs. cementless) [59], or femoral stem coating materials (hydroxyapatite-coated vs. non-hydroxyapatite-coated) [60]. Outcomes measured were risk of revision, Harris Hip score, mortality, and complications.…”

Section: Discussionmentioning

confidence: 99%

Total Hip Replacement for the Treatment of End Stage Arthritis of the Hip: A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundEvolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR) have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip.MethodsA comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs) and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included.ResultsFourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78) or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89). Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture) was inconclusive.ConclusionsThe majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition), methodological limitations (small sample size, low event counts, short follow-up), and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s) as well CONSORT, PRISMA and STROBE guidelines to ensure better reporting and more reliable production and assessment of evidence.

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“…On the other hand, a number of studies on stem survival in the setting of randomized trials or smaller observational studies have failed to show beneficial effects of HA coating on clinical outcome and implant survival when compared to alternatives such as porous coating and sand-blasted rough surfaces ( McPherson et al 1995 , Tanzer et al 2001 , Kim et al 2003 , Parvizi et al 2004 , Sanchez-Sotelo et al 2004 ). Meta-analyses that have pooled data from randomized or cohort studies have come to the conclusion that there is “[…] no clinically beneficial effect to the addition of HA to porous coating alone in primary uncemented hip arthroplasty” ( Gandhi et al 2009 , Li et al 2013 ). In addition, a Danish registry analysis found that the use of HA coating does not reduce the risk of stem revision ( Paulsen et al 2007 ).…”

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confidence: 99%

Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!

Hailer¹,

Lazarinis²,

Mäkelä³

et al. 2014

Acta Orthopaedica

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Background and purposeIt is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival.Patients and methodsWe identified 152,410 THA procedures using uncemented stems that were performed between 1995 and 2011 and registered in the Nordic Arthroplasty Register Association (NARA) database. We excluded 19,446 procedures that used stem brands less than 500 times in each country, procedures performed due to diagnoses other than osteoarthritis or pediatric hip disease, and procedures with missing information on the type of coating. 22 stem brands remained (which were used in 116,069 procedures) for analysis of revision of any component. 79,192 procedures from Denmark, Norway, and Sweden were analyzed for the endpoint stem revision. Unadjusted survival rates were calculated according to Kaplan-Meier, and Cox proportional hazards models were fitted in order to calculate hazard ratios (HRs) for the risk of revision with 95% confidence intervals (CIs).ResultsUnadjusted 10-year survival with the endpoint revision of any component for any reason was 92.1% (CI: 91.8–92.4). Unadjusted 10-year survival with the endpoint stem revision due to aseptic loosening varied between the stem brands investigated and ranged from 96.7% (CI: 94.4–99.0) to 99.9% (CI: 99.6–100). Of the stem brands with the best survival, stems with and without HA coating were found. The presence of HA coating was not associated with statistically significant effects on the adjusted risk of stem revision due to aseptic loosening, with an HR of 0.8 (CI: 0.5–1.3; p = 0.4). The adjusted risk of revision due to infection was similar in the groups of THAs using HA-coated and non-HA-coated stems, with an HR of 0.9 (CI: 0.8–1.1; p = 0.6) for the presence of HA coating. The commonly used Bimetric stem (n = 25,329) was available both with and without HA coating, and the adjusted risk of stem revision due to aseptic loosening was similar for the 2 variants, with an HR of 0.9 (CI: 0.5–1.4; p = 0.5) for the HA-coated Bimetric stem.InterpretationUncemented HA-coated stems had similar results to those of uncemented stems with porous coating or rough sand-blasted stems. The use of HA coating on stems available both with and without this surface treatment had no clinically relevant effect on their outcome, and we thus question whether HA coating adds any value to well-functioning stem designs.

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Hydroxyapatite-coated femoral stems in primary total hip arthroplasty: A meta-analysis of randomized controlled trials

Abstract: This meta-analysis demonstrates that the use of HA-coated femoral stems in primary THA has no clinical or radiological benefits.

Cited by 17 publications

References 22 publications

Cementless Hydroxyapatite Coated Hip Prostheses

Cementless Hydroxyapatite Coated Hip Prostheses

Total Hip Replacement for the Treatment of End Stage Arthritis of the Hip: A Systematic Review and Meta-Analysis

Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!

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