Grit-blasted and hydroxyapatite-coated total hip arthroplasty: an 11- to 14-year follow-up study

We report long-term results of the first clinical trial of hydroxyapatite-coated total hip arthroplasty conducted in Japan. The hemispherical cup and the straight-tapered stem were made of titanium alloy with a grit-blasted, hydroxyapatite-coated surface. The surface roughness before and after hydroxyapatite coating was 1.4 microm and 3.4 microm, respectively. Thirty-three patients (35 hips) were followed prospectively; of these, 1 patient was lost to follow-up, 5 were deceased at the latest follow-up, and 27 were followed for 11 to 14 years. Two cups and one stem (two patients) were revised. Survivorship, with radiological acetabular loosening as the endpoint, was 62.3% at 14 years. At the latest radiological follow-up, stable fixation with bone ongrowth was achieved in 46% of the acetabular cups and 89% of the femoral stems. Acetabular cups with host bone coverage of less than 60% had a high rate of failure. The suboptimal result of the hydroxyapatite-coated smooth cup indicates that porous coatings under the hydroxyapatite coating would be beneficial for hydroxyapatite-coated total hip implants, especially for the acetabular components.