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Meta-Analysis
. 2020 May 12;15(5):e0232378.
doi: 10.1371/journal.pone.0232378. eCollection 2020.

Hydroxyapatite-coated implants provide better fixation in total knee arthroplasty. A meta-analysis of randomized controlled trials

Tamara Horváth  1 , Lilla Hanák  2 , Péter Hegyi  2 , Edina Butt  3 , Margit Solymár  2 , Ákos Szűcs  4 , Orsolya Varga  5 , Bui Quoc Thien  5 , Zsolt Szakács  2   6 , Endre Csonka  3 , Petra Hartmann  1
Affiliations
Meta-Analysis

Hydroxyapatite-coated implants provide better fixation in total knee arthroplasty. A meta-analysis of randomized controlled trials

Tamara Horváth et al. PLoS One. .

Abstract

Background: The potential advantages of hydroxyapatite (HA)-coated cementless total knee arthroplasty (TKA) implants are bone stock preservation and biological fixation. Studies comparing the outcomes of HA-coated cementless, non HA-coated cementless (uncemented) and cemented TKA implants reported contradictory data. Our aim was to provide a comparison of the effects of HA coating of tibial stem on the stability and functionality of TKA implants.

Methods: A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the CENTRAL databases up to May 31st, 2019. The primary outcome was Maximum Total Point Motion (MTPM) of the tibial stem. This parameter is determined by radiosterometric analysis and refers to the migration pattern of the prosthesis stems. The clinical outcomes of the implanted joints were evaluated by the Knee Society Knee Score (KSS) and the Knee Society Function Score (KFS). Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated with the random-effects model.

Results: Altogether, 11 randomized controlled trials (RCTs) with 902 patients for primary TKA implants were included. There was a statistically significant difference in the MTPM values with the use of HA-coated and uncoated uncemented implants (WMD = +0.28, CI: +0.01 to +0.56, P<0.001). However, HA-coated stems showed significantly higher migration when compared with the cemented prostheses (WMD = -0.29, CI: -0.41 to -0.16, P<0.001). The KSS values of HA-coated implants were significantly higher than those for the uncemented implants; moreover, KSS and KFS outcome scores were statistically not different between the HA-coated and cemented prosthesis cases.

Conclusion: HA-coating yields better stability than other, uncemented prostheses. More importantly, the HA-coating is not outperformed by cemented prosthesis in providing good functional outcome.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of the meta-analysis.
Fig 2
Fig 2. Risk of bias—Review of authors’ judgments about each risk of bias item for each study included.
Fig 3
Fig 3
A MTPM analysis of the cemented and HA-coated cementless group. The value of cemented MTPM lesser than HA-coated cementless group. B MTPM analysis of uncemented vs. HA-coated cementless group. The MTPM values of uncemented prostheses are significantly higher than HA-coated. C Funnel plot 2 years follow-up; HA-coated cementless vs. uncemented group. D Funnel plot 2 years follow-up; HA-coated cementless vs. cemented group.
Fig 4
Fig 4
A KSS analysis 2 years follow-up; HA-coated. cementless vs uncemented. The value of the uncemented is lesser than of HA-coated cementless group. B KSS of the HA-coated cementless vs. cemented group. The value of cemented KSS did not differ significantly from that of HA-coated. C Funnel plot 2 years follow-up; HA-coated cementless vs. uncemented group. D Funnel plot 2 years follow-up; HA-coated cementless vs. cemented group.
Fig 5
Fig 5
A KFS value of the cemented and the HA-coated cementless group. The value of cemented is not significantly different from the HA-coated cementless group. B Funnel plot 2 years follow-up; HA-coated cementless vs. uncemented group.
See this image and copyright information in PMC

References

    1. Newman JM, Sodhi N, Khlopas A, Sultan AA, Chughtai M, Abraham R, et al. Cementless Total Knee Arthroplasty. A Comprehensive Review of the Literature, Orthop. 2018; 1;41(5): 263–273. - PubMed
    1. Bauer TW, Geesink RC, Zimmerman R, McMahon JT. Hydroxyapatite-coated femoral stems. Histological analysis of components retrieved at autopsy. J Bone Joint Surg Am. 1991; 73(10): 1439–52. - PubMed
    1. Hamadouche M, Sedel L. Ceramics in orthopaedics. J Bone Joint Surg Br. 2000; 82(8):1095–9. 10.1302/0301-620x.82b8.11744 - DOI - PubMed
    1. Carlsson A, Bjorkman A, Besjakov J, Onsten I. Cemented tibial component fixation performs better than cementless fixation: a randomized radiostereometric study comparing porous-coated, hydroxyapatite-coated and cemented tibial components over 5 years. Acta Orthop. 2005;76 (3): 362–9. - PubMed
    1. Röhrl SM, Nivbrant B, Ström H, Nilsson KG. Effect of augmented cup fixation on stability, wear, and osteolysis: a 5-year follow-up of total hip arthroplasty with RSA. J Arthroplasty. 2004; 19(8):962–71. 10.1016/j.arth.2004.06.024 - DOI - PubMed

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