Migration of hydroxyapatite coated femoral prostheses. A Roentgen Stereophotogrammetric study

Søballe, Kjeld; Toksvig‐Larsen, Sören; Gelineck, John; Fruensgaard, Søren; Es, Hansen; Ryd, Leif; Lucht, Ulf; Bünger, Cody

doi:10.1302/0301-620x.75b5.8397213

Cited by 187 publications

(130 citation statements)

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“…Limitations of the study include the small number of patients in this randomized patient group, which originally was powered for radiostereometric migration analysis of the femoral stems [47], and seemingly the small sample size likely explains the lack of statistical significance with comparison of wear and osteolysis (ie, a Type 2 error). Although the groups were randomized, there were an equal number of each gender in the HA group, but more females than males in the Ti group, and this potentially could have contributed to a higher wear rate in the HA group.…”

Section: Discussionmentioning

confidence: 99%

“…In 1991 and 1992, we prospectively enrolled 27 patients (28 hips) scheduled for primary THA and randomly allocated them to receive either a Ti-(n = 13) or an HAcoated (n = 15) implant for a femoral stem migration study [47]; one patient had bilateral surgery with one Ti hip and one HA hip. A followup of those patients is reported here.…”

Section: Methodsmentioning

confidence: 99%

“…The crystallinity was 90%. The surface roughness (Ra) was 41 lm for the HA components and 47 lm for the Ti components [47].…”

Section: Methodsmentioning

confidence: 99%

“…Reliable clinical fixation, osseointegration, and longerterm revision rates less than 1% for HA-coated femoral components have been reported [12,13,30,36,39,47]. Two studies of HA-coated versus nonHA-coated acetabular components showed equal or improved fixation and reduced periprosthetic radiolucencies [14,41], but reports of PE wear rates reveal values higher than expected (range, 0.15-0.32 mm/year) with HA-coated cups and mediumterm revision rates between 13% and 40% [7,13,21,29,40].…”

Section: Introductionmentioning

confidence: 99%

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Inferior Survival of Hydroxyapatite versus Titanium-coated Cups at 15 Years

Stilling

Rahbek²,

Søballe³

2009

Clinical Orthopaedics &Amp; Related Research

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Hydroxyapatite (HA) particles have long been suspected to disintegrate from implant surfaces, become entrapped in joint spaces of orthopaedic bearing couples, and start a cascade leading to progressive polyethylene (PE) wear, increased osteolysis, and aseptic loosening. We compared cup revision at 15 years' followup in a randomized group of patients with 26 cementless THA components with titanium (Ti) versus first-generation HA coating. We also assessed radiographic PE wear and osteolysis to the 12-year followup or end point revision at a minimum of 5 years (mean, 10.9 years; range, 5-12.6 years). Two Ti-coated cups (17%) and eight HA-coated cups (57%) were revised at 15 years' followup. Femoral head penetration rate was 0.46 mm/year (standard deviation, 0.26) with the HAcoated cups (n = 12) and 0.38 mm/year (standard deviation, 0.14) with the Ti-coated cups (n = 10); we observed a wide variance of linear wear with the HA-coated cups. We also observed a positive association between high wear rate and revision, and between a high volume of osteolysis and revision. Our findings suggest inferior survival of mediumthickness spray-dried HA-coated cups with individual cases of excessive PE wear and premature cup failure. These findings apply to first-generation modular cups and may not apply to other cup designs and new HA-coating technologies.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The crystallinity was 90%. The surface roughness (Ra) was 41 lm for the HA components and 47 lm for the Ti components [47].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inferior Survival of Hydroxyapatite versus Titanium-coated Cups at 15 Years

Stilling

Rahbek²,

Søballe³

2009

Clinical Orthopaedics &Amp; Related Research

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“…Compared to the described alternative techniques the accuracy and precision of RSA is very high. In most clinical studies the accuracy has been approximately 0.2 mm [7]. However, in vitro studies show accuracy as low as 0.047mm to 0.121 mm [8].…”

Section: Accuracy Of Rsa and Alternative Techniquesmentioning

confidence: 99%

Radiostereometric Analysis: The Hip

Böttner

Nestor

et al. 2005

HSS Jrnl

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Hydroxyapatite-coating on titanium arc sprayed titanium implants

Nakashima

Hayashi

Inadome

et al. 1997

J. Biomed. Mater. Res.

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We developed a new titanium spray technique using an inert gas shielded arc spray (titanium arc spray). Hydroxyapatite (HA)-coating can be applied to the implant without any surface pore obstruction after the rough surface is made by this technique. Scanning electron microscopy (SEM) of various porous implant surfaces after HA-coating revealed that the bead and fiber metal-coated implants had either a pore obstruction or an uneven HA-coating. On the other hand, the titanium arc sprayed implant demonstrated an even HA-coating all the way to the bottom of the surface pore. In the first set of animal experiments (Exp. 1), the interfacial shear strength to bone of four kinds of cylindrical Ti-6A1-4V (Ti) implants were compared using a canine transcortical push-out model 4 and 12 weeks after implantation. The implant surfaces were roughened by titanium arc spray (group A-C) and sand blasting (group D) to four different degrees (roughness average, Ra = group A: 56.1, B: 44.9, C: 28.3, D: 3.7 microns). The interfacial shear strength increased in a surface roughness-dependent manner at both time periods. However, the roughest implants (group A) showed some failed regions in the sprayed layers after pushout test. In the second set of animal experiments (Exp. 2), four kinds of Ti implants; HA-coated smooth Ti (sHA) with Ra of 3.4 microns, bead-coated Ti (Beads), titanium arc sprayed Ti (Ti-spray) with Ra of 38.1 microns and HA-coated Ti-spray (HA + Ti-spray) with Ra of 28.3 microns were compared using the same model as that in Exp. 1. The interfacial shear strength of HA + Ti-spray was significantly greater than that of sHA and Beads at both time periods, and that of Ti-spray at 4 weeks. Although a histological examination revealed that HA-coating enhanced bone ingrowth, sHA showed the lowest shear strength at both time periods. SEM after pushout test showed that sHA consistently demonstrated some regional failure at the HA-implant substrate interface. HA + Ti-spray had many failed regions either at the HA-bone interface or within the bone tissue rather than at the HA-implant substrate interface. These results suggested that the HA-coated smooth surfaced implants had a mechanical weakness at the HA-substrate interface. Therefore, HA should be coated on the rough surfaced implants to avoid a detachment of the HA-coating layer from the substrate and thus obtain a mechanical anchoring strength to bone. HA-coating on this new type of surface morphology may thus lead to a solution to the problems of conventional HA-coated and porous-coated implants.

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Migration of hydroxyapatite coated femoral prostheses. A Roentgen Stereophotogrammetric study

Cited by 187 publications

References 0 publications

Inferior Survival of Hydroxyapatite versus Titanium-coated Cups at 15 Years

Inferior Survival of Hydroxyapatite versus Titanium-coated Cups at 15 Years

Radiostereometric Analysis: The Hip

Hydroxyapatite-coating on titanium arc sprayed titanium implants

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