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Long-term migration of a cementless stem with different bioactive coatings. Data from a "prime" RSA study: lessons

Paul Van Der Voort1, Martijn L D Klein Nulent1, Edward R Valstar1,2

  • 1Department of Orthopaedics, Leiden University Medical Center, Leiden.

Acta Orthopaedica
|November 4, 2020
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Summary

Long-term studies show cementless hip stems with hydroxyapatite, fluorapatite, or no coating exhibit similar migration patterns. Bioactive coatings did not significantly impact stem fixation or revision rates over 25 years.

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Area of Science:

  • Orthopedic surgery
  • Biomaterials science
  • Radiostereometric analysis

Background:

  • Long-term migration patterns of cementless stems in total hip arthroplasty (THA) are not well understood.
  • The influence of bioactive coatings, such as hydroxyapatite (HA) and fluorapatite (FA), on cementless stem fixation and migration remains uncertain.
  • Concerns exist regarding potential delamination of HA coatings and the thermostability of FA coatings.

Purpose of the Study:

  • To assess the long-term migration patterns of cementless total hip arthroplasty stems with hydroxyapatite (HA), fluorapatite (FA), or uncoated bioactive coatings.
  • To establish a reference for acceptable stem migration using radiostereometric analysis (RSA).
  • To evaluate the comparative effect of different coatings on stem fixation and clinical outcomes (Harris Hip Score).

Main Methods:

  • A randomized controlled trial involving 61 total hip arthroplasties (THAs) in 53 patients, randomized to receive HA-coated, FA-coated, or uncoated Mallory-Head Porous cementless stems.
  • Radiostereometric analysis (RSA) was used to measure stem migration (subsidence and rotation) preoperatively and at multiple follow-up points up to 25 years.
  • The Harris Hip Score (HHS) was used as a secondary outcome measure.

Main Results:

  • All stems demonstrated initial migration within the first year, followed by stabilization.
  • No statistically significant differences in 25-year migration patterns were observed between HA-coated, FA-coated, and uncoated stems.
  • No stems required revision surgery, and Harris Hip Scores were comparable across all groups at 15-year follow-up.

Conclusions:

  • Bioactive coatings (HA and FA) did not demonstrate a significant beneficial or detrimental effect on the long-term migration or fixation of cementless total hip arthroplasty stems.
  • The migration patterns observed in this study can serve as a benchmark for evaluating future cementless stem designs.
  • Long-term clinical outcomes and migration stability are comparable regardless of the presence or type of bioactive coating used on cementless stems.