Hydroxylapatite-coated hip implants. Multicenter three-year clinical and roentgenographic results

The application of a thin coating of hydroxylapatite to total hip implants has provided the opportunity to realize stable fixation of a press-fit prosthesis without a porous coating or an intervening fibrous tissue layer. This series consists of 436 total hip arthroplasties, of which 320 cases have a minimum two-year follow-up period and 142 cases have a minimum three-year follow-up period. The femoral prosthesis used was a roughened titanium alloy with a 50-microns surface treatment of hydroxylapatite applied to the proximal one third. The acetabular components implanted included porous-coated implants (132), hydroxylapatite-coated acetabular shells of varying geometries (285), and bipolar implants (16). Analysis of the clinical results demonstrates a mean Harris Hip Score of 93 at six-months postarthroplasty, 95 at one and two years, and 96 at three years. At the three-year follow-up evaluation, 4.2% of patients complained of mild to moderate pain in the operative limb, whereas only 2.2% at two years and 1.4% at three years complained of activity-related thigh pain. The femoral mechanical loosening rate representing stems revised for aseptic loosening (two) plus roentgenographically unstable stems (zero) is 0.46%. Three hydroxylapatite-coated acetabular cups (1%) have shown measurable migration at two years, but none have been revised for aseptic loosening. The roentgenographic evaluation provides evidence for excellent proximal femoral fixation with distal stress transfer. Radiolucencies typically occur around the uncoated distal tip of the femoral stem (74%), but rarely in the proximal hydroxylapatite-coated anterior (3%) and lateral (2%) zones. Femoral cancellous condensation characteristically is seen at the transition zone of hydroxylapatite coated-to-uncoated stems (86%), whereas up to 32% of cases show cortical hypertrophy at the medial distal stem. These roentgenographic changes are progressive from one through three years postoperatively.