Hydroxyapatite-coated total primary hip replacement: 28-year follow-up survivorship

Abstract

Background:

Survival at 25 years’ follow-up for total hip arthroplasty (THA) has been reported at 5%–77%, with hydroxyapatite (HA) coating, due to its osteo-conductive properties, used to enhance implant fixation and survival. The progressive increase in life expectancy raises doubts regarding HA-coated THA survival and THA revision surgery risk. The aim of our study was to retrospectively analyse survival for primary uncemented fully HA-coated THA after 28 years’ follow-up.

Methods:

Our cohort survival study of the JRI Furlong HA-coated system retrospectively included patients aged 18–75 years who had undergone THA between 1992 and 1998 at our centre and who were followed up according to clinical records by orthopaedic surgeons to 2022. Data on THA revision surgery and its causes, follow-up, and death were analysed using Kaplan-Meier survival and Cox regression modelling.

Results:

The cohort included 196 patients (268 hips) followed up to a maximum of 27.5 years (mean 15.54 (SD 6.01) years) with 62 patients (88 hips) >25 years. THA revision surgery was performed in 7.5% of cases, occurring a mean of 11.1 years following primary surgery. Aseptic loosening accounted for 4.4% of these revisions, affecting both the acetabular component (2.2%) and the femoral stem (1.3%). THA survival at 15 years’, 20 years’, and 27.5 years’ follow-up was 95.5%, 88.3%, and 79.3%, respectively. According to the log-rank and Cox regression analysis, no significant relationships were found.

Conclusions:

Furlong HA-coated stem provides excellent long-term bone fixation for a long-term follow-up over 27.5 years with an aseptic loosening stem revision rate of 1.3%.

Keywords

Hydroxyapatite-coated total primary hip replacement total hip arthroplasty total hip arthroplasty failure total hip arthroplasty survivorship

Get full access to this article

View all access options for this article.

References

Evans

Walker

, et al How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019; 393: 647–654.

Hunt

Whitehouse

Beswick

, et al Comparative survivorship modeling of metal-on-metal hip replacements and contemporary alternatives in the national joint registry. J Bone Joint Surg Am 2018; 100: 189–196.

Streit

Schröder

Körber

, et al High survival in young patients using a second generation uncemented total hip replacement. Int Orthop 2012; 36: 1129–1136.

Engesæter

Espehaug

Lie

, et al Does cement increase the risk of infection in primary total hip arthroplasty? Revision rates in 56,275 cemented and uncemented primary THAs followed for 0–16 years in the Norwegian Arthroplasty Register. Acta Orthop 2006; 77: 351–358.

Landor

Vavrik

Sosna

, et al Hydroxyapatite porous coating and the osteointegration of the total hip replacement. Arch Orthop Trauma Surg 2007; 127: 81–89.

Matassi

Botti

Sirleo

, et al Porous metal for orthopedics implants. Clin Cases Miner Bone Metab 2013; 10: 111–115.

Castellini

Andreani

Parchi

, et al Hydroxyapatite in total hip arthroplasty. Our experience with a plasma spray porous titanium alloy/hydroxyapatite double-coated cementless stem. Clin Cases Miner Bone Metab 2016; 13: 221–227.

Geesink

RG.

Experimental and clinical experience with hydroxyapatite-coated hip implants. Orthopedics 1989; 12: 1239–1242.

Shetty

Slack

Tindall

, et al Results of a hydroxyapatite-coated (Furlong) total hip replacement. A 13- to 15-year follow-up. J Bone Joint Surg Br 2005; 87: 1050–1054.

10.

Epinette

J-A

Manley

D’Antonio

, et al A 10-year minimum follow-up of hydroxyapatite-coated threaded cups: clinical, radiographic and survivorship analyses with comparison to the literature. J Arthroplasty 2003; 18: 140–148.

11.

Sandiford

Doctor

Rajaratnam

, et al Primary total hip replacement with a Furlong fully hydroxyapatite-coated titanium alloy femoral component: Results at a minimum follow-up of 20 years. Bone Joint J 2013; 95 B: 467–471.

12.

Valera Pertegàs

Vergara-Valladolid

Crusi-Sererols

, et al Fully hydroxyapatite-coated total hip replacement: ten-year results. Hip Int 2010; 20(Suppl. 7): 79–85.

13.

Natera

Valera

Gómez

, et al Survival of hydroxyapatite-coated cups: Acetabular screws involve a lower rate of revision surgery due to aseptic loosening. Hip Int 2017; 27: 153–161.

14.

Gandhi

Davey

Mahomed

NN.

Hydroxyapatite coated femoral stems in primary total hip arthroplasty: a meta-analysis. J Arthroplasty 2009; 24: 38–42.

15.

Goosen

Kums

Kollen

, et al Porous-coated femoral components with or without hydroxyapatite in primary uncemented total hip arthroplasty: a systematic review of randomized controlled trials. Arch Orthop Trauma Surg 2009; 129: 1165–1169.

16.

Charnley

Arthroplasty of the hip. A new operation. Lancet 1961; 1: 1129–1132.

17.

Engh

Bobyn

Glassman

AH.

Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br 1987; 69: 45–55.

18.

Cameron

Macnab

Pilliar

RM.

A porous metal system for joint replacement surgery. Int J Artif Organs 1978; 1: 104–109.

19.

Pilliar

RM.

Porous-surfaced metallic implants for orthopedic applications. J Biomed Mater Res 1987; 21: 1–33.

20.

Furlong

Osborn

JF.

Fixation of hip prostheses by hydroxyapatite ceramic coatings. J Bone Joint Surg Br 1991; 73: 741–745.

21.

Dhert

Klein

Jansen

, et al A histological and histomorphometrical investigation of fluorapatite, magnesiumwhitlockite, and hydroxylapatite plasma-sprayed coatings in goats. J Biomed Mater Res 1993; 27: 127–138.

22.

Hailer

Lazarinis

Mäkelä

, et al

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

Acta Orthop 2015; 86: 18–25.

23.

Van Der Voort

D Klein Nulent

Valstar

, et al Long-term migration of a cementless stem with different bioactive coatings. Data from a ‘prime’ RSA study: lessons learned. Acta Orthop 2020; 91: 660–668.

24.

Chen

Y-L

Lin

Liu

, et al Does hydroxyapatite coating have no advantage over porous coating in primary total hip arthroplasty? A meta-analysis. J Orthop Surg 2015; 10: 21.

25.

Inacio

Lorimer

Davidson

, et al What is the risk of revision surgery in hydroxyapatite-coated femoral hip stems? Findings from a large national registry. Clin Orthop Relat Res 2018; 476: 2353–2366.

26.

Rajaratnam

Jack

Tavakkolizadeh

, et al Long-term results of a hydroxyapatite-coated femoral component in total hip replacement: a 15- to 21-year follow-up study. J Bone Joint Surg Br 2008; 90: 27–30.

27.

García-Rey

Carbonell-Escobar

Cordero-Ampuero

, et al Outcome of a hemispherical porous-coated acetabular component with a proximally hydroxyapatite-coated anatomical femoral component: an update at 23 to 26 years’ follow-up. Bone Joint J 2019; 101-B: 378–385.

28.

Jacquot

Machenaud

Bonnin

, et al Survival and clinical outcomes at 30 to 35 years following primary total hip arthroplasty with a cementless femoral stem fully coated with hydroxyapatite. J Arthroplasty 2023; 38: 880–885.

29.

Ling

Lin

, et al Recent advances in multifunctional hydroxyapatite coating by electrochemical deposition. J Mater Sci 2020; 55: 6352–6374.

30.

Mondal

Park

Choi

, et al Hydroxyapatite: a journey from biomaterials to advanced functional materials. Adv Colloid Interface Sci 2023; 321: 103013.