Superior 11-Year Survival but Higher Polyethylene Wear of Hydroxyapatite-Coated Mallory-Head Cups

Abstract

Hydroxyapatite (HA) coating of implant surfaces is believed to improve longevity of uncemented total hip arthroplasty (THA). However; it is speculated that HA particles may cause third body wear of the polyethylene (PE) liner with subsequent osteolysis and aseptic loosening of implants. We performed a retrospective comparison of two patient populations with cementless Mallory-Head acetabular components. The patients were identified in the Danish hip arthroplasty Registry (DHR); 77 patients had HA-coated cups and 73 patients had non-HA coated cups. Anteroposterior (AP) radiographs were analysed for PE wear, osteolysis was quantified and survival of the acetabular components was compared. The mean follow-up was 11 years. There were no cup revisions in the HA group and 7 cup revisions in the non-HA group (P<0.01). The reason for revision in all cases was aseptic loosening of both stem and cup. The amount of osteolysis was significantly increased around cups in the non-HA group. The two-dimensional linear PE wear-rate of 0.18 mm/year was higher (P<0.001) in the group with HA coated cups compared with 0.12 mm/year in the group with non-HA coated cups. The mean age was lower (P=0.001) in the HA group (57 years) compared with the non-HA group (63 years). After 11.1 years of follow-up non-HA coated cups had a higher revision rate. Increased PE wear with HA-coated cups did not have a negative influence on the revision rate, but may result in a need for revision surgery over time.

Minimum 10-Year Wear Analysis of Highly Cross-Linked Polyethylene in Cementless Total Hip Arthroplasty

“…In comparison with those data, our analysis revealed that the linear wear rate of highly cross-linked polyethylene was very low. No risk factors for high wear rates were found, although the type of porous coating, type of zirconia, age, body weight, cup inclination angle, and polyethylene thickness were frequently addressed in previous studies [16][17][18][19][20].…”

No superior performance of hydroxyapatite-coated acetabular cups over porous-coated cups

“…But register and long-term clinical studies also reveal discrepancies regarding the performance of HA-coated hip prostheses. Gottliebsen et al (2012) reported superior survival of HA-coated Mallory-Head cups in their 11-year follow-up clinical study, but a higher annual PE wear rate in the HA group than in the non-HA group. This was a retrospective non-randomized study and the mean age in the HA group was 6 years younger than that in the non-HA group, indicating that a higher activity level could contribute to the PE wear.…”

“…On the contrary, our results show a clear tendency of less migration and lower wear rates in the HA-coated group. Gottliebsen et al (2012) presented 11-year follow-up data comparing HA-coated and non-HA-coated Mallory-Head cups. They concluded that PE wear was increased in HA-coated cups.…”

“…The increasing use of HA-coated components has given rise to controversy regarding HA debris-induced osteolysis and PE wear (Morscher et al 1998). Recently, a retrospective study on Mallory-Head cups confirmed that PE wear is greater in HA-coated cups, but without this having a negative influence on revision rate (Gottliebsen et al 2012). The finding of increased wear in HA-coated cups partially confirms the mechanism of failure for these cups: third-body wear, osteolysis, and loosening.…”

Titania nanotube morphologies for osseointegration via models of in vitro osseointegrative potential and in vivo intramedullary fixation

“…Additionally, these coatings may dislodge during implantation or cyclic loading, leading to the generation of debris capable of inducing osteoclast activation and synovial cyst formation, as well as the acceleration of bearing component wear, which may result in periprosthetic osteolysis (Grandjean‐Laquerriere, Laquerriere, Guenounou, Laurent‐Maquin, & Phillips, ; Lange et al, ; Nehme, Oakes, Marcheix, Gomez‐Brouchet, & Puget, ; Otsuka, Kojima, & Mutoh, ; Sabokbar et al, ). Clinical studies performed by Stilling et al and Gottliebsen et al demonstrated the impact of hydroxyapatite particulate on the in vivo wear behavior of polyethylene acetabular liners after more than 10 years of in vivo implantation (Gottliebsen, Rahbek, Ottosen, Soballe, & Stilling, ; Stilling, Rahbek, & Soballe, ).…”