Clinical and Radiographic Outcomes at 25-30 Years of a Hip Stem Fully Coated With Hydroxylapatite

doi:10.1016/j.arth.2017.09.040

The Journal of Arthroplasty

Volume 33, Issue 2, February 2018, Pages 482-490

https://doi.org/10.1016/j.arth.2017.09.040 Get rights and content

Abstract

Background

Little is known about the survival of total hip arthroplasty implants with bioactive coatings beyond the first 20 years. The authors aimed to report survival of a tapered hip stem fully coated with hydroxylapatite (HA) at follow-up of 25-30 years.

Methods

Of the original series of 320 patients (347 hips), 12 patients (12 hips) had stem and cup revisions, 54 patients (55 hips) had cup revisions, 17 patients (17 hips) had liner exchange. A total of 207 patients (225 hips) died with stems in place and 21 patients (24 hips) could not be reached. This left a cohort of 80 patients (86 hips) with their original stem for assessment. Survival was analyzed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF).

Results

Considering stem revision as endpoint, the revision risk calculated using the KM method was 6.3%, whereas using the CIF it was 3.7%. Considering any reoperation as endpoint, the revision risk calculated using the KM method was 41.2%, whereas using the CIF it was 25.9%. The Harris Hip Score for 77 patients (18 hips) was 81.6 ± 15.2. Standard x-rays were available for 52 hips (49 patients), and 10 (19.2%) showed radiolucencies <2 mm thick.

Conclusion

This study is the first to report outcomes of an HA-coated stem beyond 25 years. The survival of stem compares favorably with long-term survival of the Charnley cemented stem, and with shorter-term registry studies. The stem achieved its intended purpose of total osteointegration in the long-term, although the proximolateral region remains susceptible to radiolucencies.

Section snippets

Materials and Methods

The records of all 347 consecutive THAs performed between 1986 and 1990 by one surgeon (AM) using the CORAIL stem (DePuy, Leeds, UK) were reviewed. The series comprised 320 patients aged 63.3 ± 11.3 years (median 65 years; range 20-89 years) at the index operation, with body mass index of 25.8 ± 4.0 kg/m² (median 25.5 kg/m²; range 16.4-41.3 kg/m²). Their gender distribution was balanced, with 167 men (181 hips) aged 62.0 ± 11.2 years (median 63 years; range 20-87 years) and 153 women (166 hips)

Results

From the original 320 patients (347 hips), aged 63.3 ± 11.3 years (median 65 years; range 20-89 years) at the index operation, only 80 patients (86 hips) were confirmed to be presently living with the original stem in place (Fig. 1), now aged 83.0 ± 8.4 years (median 84 years; range 57-101 years). It is worth noting that for this series, the cumulative risk of mortality was greater than the cumulative risk of revision. The remaining cohort comprised 40 men (43 hips) and 40 women (43 hips),

Discussion

The aim of the present study was to report the long-term outcomes and survival of the CORAIL hip stem. By virtue of their advanced age at index operation (63.3 ± 11.3 years; range 20-89 years), and because of the long follow-up period (26.8 ± 1.2 years; range 25-30 years), many patients had died (64.6%) and some were lost to follow-up (6.5%). The 80 remaining patients represent a quarter of the initial cohort (25%), some of whom have impaired function and mobility due to pathologies unrelated

Conclusion

The present study is the first to report outcomes and survival of an HA-coated hip stem beyond 25 years of follow-up. The KM survival considering stem revision as end point, is 93.7%, which compares favorably with long-term survival of the Charnley cemented stem, and with shorter-term arthroplasty registry studies. The fully HA-coated stem achieved its intended purpose of total osteointegration in the long-term, although the proximolateral region remains susceptible to radiolucencies.

Acknowledgments

The authors would like to thank Sonia Dubreuil, Hugo Bothorel, and Luca Nover for their support in data management and manuscript preparation.

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Risk factors for intraoperative femoral fractures in cementless bipolar hip arthroplasty for femoral neck fracture in multicenter: The TRON group study
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Intraoperative femoral fractures are more common in cementless bipolar hip arthroplasty (BHA) for displaced femoral neck fractures than they are in cemented BHA and remain one of the major concerns. This study aimed to investigate the risk factors for intraoperative femoral fractures in cementless BHA.
The study included 1,392 patients who underwent cementless BHA for displaced femoral neck fractures from January 2015 to December 2019 in 14 hospitals of the Trauma Research Group. They were divided into two groups according to the presence or absence of intraoperative femoral fractures, and factors associated with intraoperative fractures were statistically examined.
Forty (2.9 %) intraoperative and 28 (2.0 %) postoperative, totally 68 (4.9 %) femoral fractures occurred. The mean age of the patients, presence of opposite-side proximal femoral fracture, approach, and cementless stem design were significantly different between the two groups (P < 0.05). The logistic regression analysis model showed that a fully HA-coated stem (odds ratio, 4.12; 95 % confidence interval, 1.43–11.9) was an independent factor associated with intraoperative femoral fractures.
This study investigated the risk factors associated with intraoperative fractures and showed that fully HA-coated stems were an independent factor associated with intraoperative femoral fractures. Surgeons should be cautious in the early stages of introducing fully HA-coated stems.
Alignment and mechanics evaluation for a compaction broach stem versus a blade style proximal press fit stem using 3-Dimensional planning
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Three-dimensional (3D) preoperative planning tools can be used to help plan and compare component alignment scenarios for different total hip arthroplasty systems to ultimately improve postoperative outcomes and patient satisfaction. The objective of this study is to use 3D preoperative planning tools based on patient-specific bone models to compare two different stem designs, specifically a compaction broach stem and a proximal press fit stem. The planner uses patient-specific proximal femoral bone morphology to suggest a specific implant size and placement. The planner then allows for preoperative predictions of component head positioning, stem fit within the canal, and potential cortical bone reaming that must be done, as well as postoperative predictions of stability and mechanics. The stems were evaluated to determine the accuracy of stem placement, the theoretical volumetric bone removal/reaming required to achieve a desired fit, and the associated postoperative mechanics. This study demonstrated that there was a difference in component alignment and predicted postoperative mechanics between a compaction broach stem and a press fit stem, with the compaction broach stem allowing for more accurate alignment with less required bone removal, resulting in improved postoperative stability and mechanics. This study also demonstrated that much of the stem misalignment for both systems occurred in the anterior/posterior direction. Overall, 3D preoperative planning offers significant benefits and novel intraoperative insight, and the industry should continue to enhance their THA preoperative planning tools.
Thirty-Year Minimum Follow-Up Outcome of a Straight Cementless Rectangular Stem
2024, Journal of Arthroplasty
Meta-diaphyseal fixation of straight, tapered, uncemented stems has been proven to be very reliable for total hip arthroplasty in 10 to 20 years of follow-up studies. The aim of the study was to evaluate whether the implant survival as well as radiological and functional outcome have changed in patients with a minimum follow-up of 30 years.
From a total of 210 patients, who received a straight, rectangular, tapered cementless stem and a threaded cup, there were 37 total hip arthroplasties (33 patients) still available for follow-up after a minimum of 30 years. Patients were examined clinically and radiographically, and revision surgeries were recorded.
There was a low rate of revisions of the femoral stem with a survival probability of 0.92 (confidence interval 0.85 to 0.96) at 30 years. Survival probability of the acetabular component decreased drastically with 0.45 (confidence interval 0.30 to 0.59). Radiographic analysis of the stem revealed radiolucencies in 73% (n = 16), but only in the proximal/metaphyseal part and none of the stems were radiographically loose.
In this minimum 30-year follow-up study, a straight rectangular cementless implant continues to provide excellent implant survival and high patient satisfaction. However, survival rates of the whole total hip replacement system were reduced by a high revision rate due to wear-related problems.
Rectangular Taper Stem Designs Are Associated With a Higher Risk for Periprosthstic Femoral Fractures After Cementless Total Hip Arthroplasty
2023, Journal of Arthroplasty
Periprosthetic femoral fractures (PFFs) remain a major concern following cementless total hip arthroplasty (THA). This study aimed to evaluate the association between different types of cementless tapered stems and the risk of postoperative PFF.
A retrospective review of primary THAs performed at a single center from January 2011 to December 2018 included 3,315 hips (2,326 patients). Cementless stems were classified according to their design. The incidence of PFF was compared between flat taper porous-coated stems (type A), rectangular taper grit-blasted stems (type B1), and quadrangular taper hydroxyapatite-coated stems (type B2). Multivariate regression analyses were performed to identify independent factors related to PFF. The mean follow-up duration was 61 months (range, 12 to 139). Overall, 45 (1.4%) postoperative PFFs occurred.
The incidence of PFF was significantly higher in type B1 stems than in type A and type B2 stems (1.8 versus 0.7 versus 0.7%; P = .022). Additionally, more surgical treatments (1.7 versus 0.5 versus 0.7%; P = .013) and femoral revisions (1.2 versus 0.2 versus 0%; P = .004) were required for PFF in type B1 stems. After controlling for confounding variables, older age, diagnosis of hip fracture, and use of type B1 stems were significant factors associated with PFF.
Type B1 rectangular taper stems were found to have higher risks for postoperative PFF and PFF requiring surgical management than type A and type B2 stems in THA. Femoral stem geometry should be considered when planning for cementless THA in elderly patients who have compromised bone quality.
Battle of the titans: Survivorship analysis of the 3 most common types of uncemented femoral stems used across national registries
2023, Journal of Orthopaedics
Although many institutions utilize uncemented stems as routine in performing total hip arthroplasty (THA), many surgeons continue to rely on outcomes reported in the literature in the form of small cohorts and patient series when analyzing survivorship for specific implants. The purpose of this study was to identify and analyze the survivorship of the 3 most common uncemented stem types (as opposed to brands) used across multiple national joint registries.
A review of data available from all national joint registries was carried out in July 2022. Analysis of each individual registry and classified uncemented implants into the seven different uncemented stem types. The 3 most common stem types were identified, and average cumulative revision rates calculated. Metal on metal bearings surface implants were excluded from this study due to high revision rates across all implant types.
Our detailed review identified 6 out of 13 (NJR, AOANJRR, LROI, EPRD, MARCQI and the NZJR) international registries reporting implant specific survivorship on uncemented femoral stems; including 960,328 uncemented stems across all registries. The most common type of stem used was type 3c, accounting for 61% (583,724), followed by type 1 stems with 23% (217,897) and type 2 stems with 8% (79,257). Cumulative revision rates at 13 years follow-up for these stems ranged from 6.9% to 7.9%.
Although all stem types have comparable revision rates across all registries, the most common uncemented stem reported was the type 3c, tapered rectangular fully coated stem. Furthermore, out of all type 3c, the Müller design philosophy with full hydroxyapatite coating seems to be the most sought after worldwide. In this study we can conclude, thus far, that there does not appear to clinical or statistical differences in revision rates between the different stem types.
III.
Survival and Clinical Outcomes at 30 to 35 Years Following Primary Total Hip Arthroplasty With a Cementless Femoral Stem Fully Coated With Hydroxyapatite
2023, Journal of Arthroplasty
Citation Excerpt :
Considering revision of the stem for aseptic loosening as endpoint, the revision incidence at 35 years was 3.1% (95%CI, 6.6–15.0) using KM, while it was 2.1% (95%CI, 1.0–4.3) using CIF (See Figure 3). Since the prior publication at 25 to 30 years [27], there were 2 additional cases recorded that required only cup revision, this brought the total to 57 cases of cup revision without stem revision. The majority of acetabular cups were revised for wear of the polyethylene insert which often led to component loosening.
The purpose of the present study was to update and report clinical outcomes and survival of primary total hip arthroplasty using a cementless double-tapered titanium fully hydroxyapatite-coated stem at a follow-up > 30 years.
The outcomes of this series of 347 primary total hip arthroplasties were already published at a follow-up > 25 years, during which only 12 stems were revised. Since then, there were two additional stem revisions, bringing the total to 14 stem revisions (all of which also required cup revision). Patients still living with the original stem were assessed using the modified Harris Hip Score and patient satisfaction (very satisfied, satisfied, dissatisfied, and very dissatisfied). Revision incidence was calculated using the Kaplan-Meier (KM) method and Cumulative Incidence Function (CIF) at 35 years.
At a mean follow-up of 33 years (range, 31 to 35 years), 32 patients (34 hips) were still living with the original stem. Their mean modified Harris Hip Score was 86 points (range, 46 to 100) and all patients (100%) were very satisfied or satisfied with surgery. The revision incidence at 35 years considering (a) stem revision for any reason was 9.5% using KM and 4.5% using CIF; (b) stem revision for aseptic loosening was 3.1% using KM and 2.1% using CIF; and (c) reoperation or revision of any component for any reason was 45.3% using KM and 26.3% using CIF.
The present study has demonstrated excellent survival at 35 years for a cementless double-tapered titanium fully hydroxyapatite-coated stem.
Level IV, Retrospective cohort study.

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: Funding sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

: One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2017.09.040.

View full text

Primary ArthroplastyClinical and Radiographic Outcomes at 25-30 Years of a Hip Stem Fully Coated With Hydroxylapatite

Abstract

Background

Methods

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Conclusion

Acknowledgments

J Arthroplasty

J Arthroplasty

Orthop Traumatol Surg Res

J Arthroplasty

J Arthroplasty

J Arthroplasty

Orthop Traumatol Surg Res

J Arthroplasty

What works best, a cemented or cementless primary total hip arthroplasty?: minimum 17-year followup of a randomized controlled trial

Clin Orthop Relat Res

Twenty-year followup of an uncemented stem in primary THA

Clin Orthop Relat Res

Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years

Acta Orthop

The Nordic Arthroplasty Register Association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs

Acta Orthop

Risk of revision following total hip arthroplasty: metal-on-conventional polyethylene compared with metal-on-highly cross-linked polyethylene bearing surfaces: international results from six registries

J Bone Joint Surg Am

Comparative effectiveness of ceramic-on-ceramic implants in stemmed hip replacement: a multinational study of six national and regional registries

J Bone Joint Surg Am

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

Acta Orthop

Maintaining a hip registry for 25 years. Mayo Clinic Experience

Clin Orthop Relat Res

Results of the anatomic medullary locking total hip arthroplasty at a minimum of twenty years. A concise follow-up of previous reports

J Bone Joint Surg Am

What can we learn from 20-year followup studies of hip replacement?

Clin Orthop Relat Res

Twenty-year results of the cementless Corail stem

Int Orthop

Charnley total hip arthroplasty with cement. Minimum twenty-five-year follow-up

J Bone Joint Surg Am

Charnley low-friction arthroplasty: survival patterns to 38 years

J Bone Joint Surg Br

Survivorship of a Charnley total hip arthroplasty. A concise follow-up, at a minimum of thirty-five years, of previous reports

J Bone Joint Surg Am

Over 25 years survival after Charnley's total hip arthroplasty

Int Orthop

Thirty-five-year results after Charnley total hip arthroplasty in patients less than fifty years old. A concise follow-up of previous reports

J Bone Joint Surg Am

Primary Arthroplasty
Clinical and Radiographic Outcomes at 25-30 Years of a Hip Stem Fully Coated With Hydroxylapatite