Hydroxyapatite coated stems in younger and older patients with hip arthritis

A primary aim of research in total hip arthroplasty is to extend longevity through improved fixation and decreased wear and osteolysis. Age range of patients receiving hip implants is ever increasing as technology improves and average life span increases. The current report focuses on minimum 10-year results of a proximally hydroxyapatite-coated stem in patients with degenerative joint disease, comparing those 45 years and older (n = 229 hips) with younger patients (n = 41 hips). Clinically, the average Harris hip score is 91 points and 88 points in the older and younger groups, respectively. Mechanical failure rates for the stem are 0.4% and 2.4%, with one stem revision for aseptic loosening and no radiographically loose stems in each age group. Proximal femoral osteolysis is seen more often in younger patients (48% versus 38%), and younger patients (six hip arthroplasties) had reoperation for wear or osteolysis. Therefore, this stem has performed well at a 10-year minimum followup. However, polyethylene wear and osteolysis have led the authors to begin a United States Food and Drug Administration study of an alumina ceramic-on-alumina ceramic bearing surface in conjunction with the same stem. At 2 years minimum followup, there have been no complications related to the ceramic bearing surfaces, no cortical erosions, and no stem revisions for aseptic loosening.