Revision of cemented hip arthroplasty using a hydroxyapatite-ceramic-coated femoral component

Abstract

We report the clinical and radiological outcome of 86 revisions of cemented hip arthroplasties using JRI-Furlong hydroxyapatite-ceramic-coated acetabular and femoral components. The acetabular component was revised in 62 hips and the femoral component in all hips. The mean follow-up was 12.6 years and no patient was lost to follow-up. The mean age of the patients was 71.2 years. The mean Harris hip and Oxford scores were 82 (59 to 96) and 23.4 (14 to 40), respectively. The mean Charnley modification of the Merle d'Aubigné and Postel score was 5 (3 to 6) for pain, 4.9 (3 to 6) for movement and 4.4 (3 to 6) for mobility. Migration of the acetabular component was seen in two hips and the mean acetabular inclination was 42.6 degrees. The mean linear polyethylene wear was 0.05 mm/year. The mean subsidence of the femoral component was 1.9 mm and stress shielding was seen in 23 (28%) with bony ingrowth in 76 (94%). Heterotopic ossification was seen in 12 hips (15%). There were three re-revisions, two for deep sepsis and one for recurrent dislocation and there were no re-revisions for aseptic loosening. The mean EuroQol EQ-5D description scores and health thermometer scores were 0.69 (0.51 to 0.89) and 79 (54 to 95), respectively. With an end-point of definite or probable loosening, the probability of survival at 12 years was 93.9% and 95.6% for the acetabular and femoral components, respectively. Overall survival at 12 years, with removal or further revision of either component for any reason as the end-point, was 92.3%. Our study supports the continued use of this arthroplasty and documents the durability of hydroxyapatite-ceramic-coated components.

Good results with an uncemented proximally HA-coated stem in hip revision surgery: 62 hips followed for 2–13 years

“…8 of 62 hips had mild-to-moderate thigh pain and no patients suffered from severe thigh pain. This compares favorably with other studies (Moreland and Moreno 2001, Raman et al 2005, Trikha et al 2005. Radiographically, several patients showed signs of load transfer distally, which suggests a possible reason for their mid-thigh pain.…”

“…Removal of such a stem would be more technically demanding and the outcome is likely to be worse thereafter. In an attempt to achieve sufficient initial stability with shorter stems, extensively porous-coated or HAcoated, canal-filling cobalt-chrome or titanium alloy stems have been used with good or excellent results (Lawrence et al 1994, Paprosky et al 1999, Moreland and Moreno 2001, Crawford et al 2004, Raman et al 2005, Trikha et al 2005, Reikerås and Gunderson 2006. At least initially, the biological fixation is probably most pronounced in the distal part of the stem because the contact between the stem surface and the host bone is more intimate in this region, and the surrounding bone stock is of better quality distally than in the compromised proximal bone.…”

“…In active patients with a poor bone stock, hip revision with cement and impacted morselized allograft bone has shown good long-term results (Gie et al 1993, Ornstein et al 2002, Ullmark et al 2002, Halliday et al 2003. Uncemented hip revision after aseptic loosening has been promising in the short to medium term (Bohm and Bischel 2001, Moreland and Moreno 2001, Trikha et al 2005 and also in the long term (Wagner 1987, Paprosky et al 1999, Raman et al 2005, Reikerås and Gunderson 2006. Most stems used in these studies are long-stemmed, extensively coated, or distally anchored.…”

Mechanical, In vitro Antimicrobial, and Biological Properties of Plasma-Sprayed Silver-Doped Hydroxyapatite Coating

“…12, 13 Long term clinical and radiological performance was excellent for fully HA coated femoral component. 13, 14 In spite of the good performance of HA coatings in revision surgery, overall performances of revision prosthesis have inferior results than primary. 15 One of the reasons of implant failure is bacterial infection.…”

Large femoral bone loss after hip revision using the uncemented proximally porous-coated Bi-Metric prosthesis

“…Uncemented hip revision after aseptic loosening has been promising in the short to medium time interval (Böhm and Bischel 2001, Moreland and Moreno 2001, Trikha et al 2005, Salemyr et al 2008) and several authors have reported good results in the long-term perspective as well (Wagner 1987, Paprosky et al 1999, Raman et al 2005, Reikerås and Gunderson 2006). Most stems used in these studies are extensively coated or distally anchored.…”