Abstract
We used a proximally hydroxyapatite-coated femoral stem in revision arthroplasty of 48 cases with aseptic loosening and Paprosky defect class 1 or 2. We reviewed the outcome after 6.1 (4–9.3) years. The clinical outcome was good, with a mean postoperative HHS of 90 (51–100) points. There were five reoperations all on the acetabular side and none for the femoral stem. At follow-up, we observed cancellous sclerosis radiographically in 19 cases—especially in non-tightly fitted stems and mainly in Gruen zones 2 and 6. In 13 cases, cortical thickening was seen, mainly in Gruen zones 3 and 5 and especially in tightly fitted stems. These bony changes were significant and not related to any clinical parameter. They started to appear from 6 months onward, with increasing frequency with longer follow-up. We find that the standard Mallory–Head hydroxyapatite-coated femoral stem is suitable for revision in cases with lower-class femoral defects.
Résumé
Nous avons utilisé une tige fémorale enduite d’hydroxyapatite proximale dans l’arthroplastie de révision de 48 cas avec descellement aseptique et défauts osseux de classe 1 ou 2 selon Paprosky. Nous avons examiné le résultat après 6,1 (4–9,3) années. Le résultat clinique était bon avec un score HHS postopératoire moyen de 90 (51–100) points. Il y avait cinq réopérations, toujours pour des problèmes acétabulaires et jamais pour des problèmes de tige fémorale. Àu dernier recul nous avons observé radiologiquement des densifications spongieuses dans 19 cas—surtout pour des tiges imparfaitement ajustées et principalement dans les zones 2 et 6 de Gruen. Dans 13 cas un épaississement cortical a été noté, principalement dans les zones 3 et 5 et surtout pour les prothèses bien ajustées. Ces différences osseuses étaient significatives, sans rapport avec aucun paramètre clinique. Elles ont commencé à paraître à 6 mois avec une fréquence croissante au cours du suivi. Nous trouvons que la tête-Mallory standard–tige fémorale enduite d’hydroxyapatite est convenable pour les révisions avec défauts osseux fémoraux de bas grade.
Full Text
The Full Text of this article is available as a PDF (97.7 KB).
References
- 1.Bourne RB, Rorabeck CH, Ghazal ME, Lee MH. Pain in the thigh following total hip replacement with a porous coated anatomic prosthesis for osteoarthrosis. J Bone Joint Surg Am. 1994;76:1464–1470. doi: 10.2106/00004623-199410000-00005. [DOI] [PubMed] [Google Scholar]
- 2.Coathup MJ, Blunn GW, Flynn N, Williams C, Thomas NP. A comparison of bone remodelling around hydroxyapatite-coated porous-coated and grit-blasted hip replacements retrieved at post-mortem. J Bone Joint Surg Br. 2000;83:118–123. doi: 10.1302/0301-620X.83B1.10062. [DOI] [PubMed] [Google Scholar]
- 3.D’Antonio JA, Capello WN, Jaffe WL. Hydroxylapatite-coated hip implants: multicentre three year clinical and roentgenographic results. Clin Ortop. 1992;285:102–115. [PubMed] [Google Scholar]
- 4.Dohmae Y, Bechtold JE, Sherman RE, Puno RM, Gustilo RB. Reduction in cement–bone interface shear strength between primary and revision arthroplasty. Clin Ortop. 1988;236:214–220. [PubMed] [Google Scholar]
- 5.Engh CA, Bobyn JD, Glassman AH. Porous coated hip replacement. The factors governing bone ingrowth, stress shielding and clinical results. J Bone Joint Surg Br. 1987;69:44–55. doi: 10.1302/0301-620X.69B1.3818732. [DOI] [PubMed] [Google Scholar]
- 6.Gosens T, Hoefnagels NHM, Dhert WJA, van Langelaan EJ, Geesink RGT, Bulstra SK (2005) Translation and validation of the 12 item questionnaire on the perceptions of patients about total hip replacement. Acta Orthop Scand in press [DOI] [PubMed]
- 7.Gruen TA, McNeice JM, Amstutz HC. Modes of failure of cemented stem type femoral components. A radiographic analysis of loosening. Clin Ortop. 1979;141:17–29. [PubMed] [Google Scholar]
- 8.Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755. [PubMed] [Google Scholar]
- 9.Head WC, Wagner RA, Emerson RH, Jr, Malinin TI. Revision total hip arthroplasty in the deficient femur with aproximal load bearing prosthesis. Clin Ortop. 1994;298:119–126. [PubMed] [Google Scholar]
- 10.Huiskes R. Failed innovation in total hip replacement: diagnosis and proposals for a cure. Acta Orthop Scand. 1993;64:699–716. doi: 10.3109/17453679308994602. [DOI] [PubMed] [Google Scholar]
- 11.Izquerdo RJ, Northmore-Ball MD. Long-term results of revision hip arthroplasty: survival analysis with special reference to the femoral component. J Bone Joint Surg Br. 1994;76:34–39. [PubMed] [Google Scholar]
- 12.Kadoya Y, Kobayashi A, Ohashi H. Wear and osteolysis in total joint replacements. Acta Orthop Scand Suppl. 1998;278:1–16. [PubMed] [Google Scholar]
- 13.Krause WR, Krug W, Miller J. Strength of the cement–bone interface. Clin Ortop. 1992;163:290–299. [PubMed] [Google Scholar]
- 14.Mulliken BD, Bourne RB, Rorabeck CH, Nayak N. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. J Bone Joint Surg Am. 1996;78:1214–1225. doi: 10.2106/00004623-199608000-00012. [DOI] [PubMed] [Google Scholar]
- 15.Paprosky WG, Greidanus NV, Antoniou J. Minimum 10-year results of extensively porous-coated stems in revision hip arthroplasty. Clin Ortop. 1999;369:230–242. doi: 10.1097/00003086-199912000-00024. [DOI] [PubMed] [Google Scholar]
- 16.Peters CL, Rivero DP, Kull LR, Jacobs JJ, Rodsenberg AG, Galante JO. Revision total hip arthroplasty without cement: subsidence of proximally porous coated femoral components. J Bone Joint Surg Am. 1995;67:1217–1226. doi: 10.2106/00004623-199508000-00012. [DOI] [PubMed] [Google Scholar]
- 17.Rahmy AIA, Gosens T, Blake GM, Tonino AJ, Fogelman I. Periprosthetic bone remodeling of two types of uncemented femoral implants with a proximal hydroxyapatite coating: a 3-year follow up study addressing the influence of prosthesis design and preoperative bone quality on periprosthetic bone loss. Osteoporos Int. 2004;15:281–284. doi: 10.1007/s00198-003-1546-5. [DOI] [PubMed] [Google Scholar]
- 18.Robinson AHN, Palmer CR, Villar RN. Is revision as good as primary hip replacement? A comparison of quality of life. J Bone Joint Surg Br. 1999;81:42–45. doi: 10.1302/0301-620X.81B1.8728. [DOI] [PubMed] [Google Scholar]
- 19.Søballe K, Hansen ES, Brockstedt-Rasmussen H, Bunger C. Hydroxyapatite coating converts fibrous tissue to bone around loaded implants. J Bone Joint Surg Br. 1993;75:270–278. doi: 10.1302/0301-620X.75B2.8444949. [DOI] [PubMed] [Google Scholar]
- 20.Tonino AJ, Therin M, Doyle C. Hydroxyapatite coated femoral stems: histology and histomorphometry around five components retrieved at autopsy. J Bone Joint Surg Br. 1999;81:148. doi: 10.1302/0301-620X.81B1.8948. [DOI] [PubMed] [Google Scholar]
- 21.Tonino AJ, Rahmy AIA. The International ABG Study Group. The hydroxyapatite-ABG hip system. J Arthroplast. 2000;11:534–542. doi: 10.1016/s0883-5403(00)90486-8. [DOI] [PubMed] [Google Scholar]
- 22.Woolson ST, Delaney TJ. Failure of proximally porous coated femoral prostheses in revision total hip arthroplasty. J Arthroplast. 1994;10(suppl):S22–S28. doi: 10.1016/S0883-5403(05)80227-X. [DOI] [PubMed] [Google Scholar]
- 23.Yee AJM, Kreder HK, Bookman I, Davey JR. A randomised trial of hydroxyapatite coated prostheses in total hip arthroplasty. Clin Ortop. 1999;366:120–132. doi: 10.1097/00003086-199909000-00016. [DOI] [PubMed] [Google Scholar]