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Randomized Controlled Trial
. 2011 Feb;82(1):13-9.
doi: 10.3109/17453674.2010.548027. Epub 2010 Dec 29.

A prospective randomized study comparing electrochemically deposited hydroxyapatite and plasma-sprayed hydroxyapatite on titanium stems

Berte Grimsmo Bøe  1 , Stephan M Röhrl, Tore Heier, Finnur Snorrason, Lars Nordsletten
Affiliations
Randomized Controlled Trial

A prospective randomized study comparing electrochemically deposited hydroxyapatite and plasma-sprayed hydroxyapatite on titanium stems

Berte Grimsmo Bøe et al. Acta Orthop. 2011 Feb.

Abstract

Background and purpose: Plasma-sprayed hydroxyapatite (HA) is a successful coating for fixation of uncemented femoral stems. There may be alternative coatings with advantages in bone remodeling and transport of bone-active substances. We investigated whether an electrochemically deposited hydroxyapatite, Bonemaster (BM), might be a safe alternative in total hip arthroplasty. Our hypothesis was that the new coating would not be inferior to the conventional one.

Patients and methods: 50 patients (55 hips) were included. The stem was tapered and porous-coated proximally. On top of the porous coating was either HA or BM. Patients were evaluated postoperatively and after 3, 6, 12, and 24 months to measure fixation by radiostereometric analysis (RSA), bone mineral density by dual-energy X-ray absorptiometry (DXA), and conventional radiography. Clinical evaluation was performed with Harris hip score and Oxford hip score, both preoperatively and after 2 years.

Results: After 2 years, the stems had subsided 0.25 (HA) and 0.28 (BM) mm and there were no statistically significant differences between the groups in any direction, regarding both migration and rotation. The BM group retained significantly more bone than the HA group in Gruen zone 1 during the first 2 years. The Harris and Oxford hip scores were similar in both groups.

Interpretation: Electrochemically deposited hydroxyapatite on an uncemented stem does not appear to be inferior to plasma-sprayed HA regarding clinical and radiological results, bone remodeling, and micromotion after 2 years follow-up.

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Figures

Figure 1.
Figure 1.
Taperloc stem coated with Bonemaster.
Figure 2.
Figure 2.
Flow chart of the patients with DXA and RSA measurements. The patient lost to follow-up had an HA-coated stem inserted at hospital A. 17 BM-coated stems were inserted at hospital A and 14 BM-coated stems were inserted at hospital B. 13 HA-coated stems were inserted at hospital A and 11 HA-coated stems were inserted at hospital B. Those patients who were not analyzed by RSA did not meet the criteria of a maximum condition number of 100 or mean error of less than 0.3.
Figure 3.
Figure 3.
Subsidence (0.25 (HA) and 0.28 (BM) mm in the first 2 years) after implantation of hydroxyapatite- (HA-) and Bonemaster- (BM-) coated Taperloc stems, analyzed by radiostereometric analysis (RSA). Results are given in mm with standard error of the mean after 3 months, 6 months, 1 year, and 2 years.
Figure 4.
Figure 4.
Retroversion of hydroxyapatite- (HA-) and Bonemaster- (BM-) coated Taperloc stems after 2 years, analyzed by radiostereometric analysis. Results are in degrees with standard error of the mean.
See this image and copyright information in PMC

References

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