Hydroxyapatite-Coated Acetabular Cups in Primary Total Hip Arthroplasty: A Meta-Analysis

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Medical device engineering

Background:

• Cementless fixation is standard in primary total hip arthroplasty (THA), with porous and hydroxyapatite (HA)-coated implants being most common.
• Preclinical data suggest HA coating enhances implant fixation and stability over porous surfaces alone, but clinical adoption is inconsistent.
• Limited meta-analyses exist comparing HA-coated versus non-HA-coated acetabular cups.

Purpose of the Study:

• To compare the efficacy of HA-coated versus non-HA-coated acetabular cups in primary THA.
• To evaluate the impact of HA coating on revision rates, osteolysis, radiolucent lines, and patient-reported outcomes.
• To determine if HA-coated cups offer superior clinical outcomes in THA.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
• Searches were performed in Medline, Embase, and Cochrane libraries through November 2024.
• Outcomes assessed included Harris Hip Score (HHS), bone formation, radiolucent lines, wear rate, aseptic loosening revisions, and heterotopic ossification.

Main Results:

• HA-coated acetabular cups were associated with significantly fewer radiolucent lines (P < 0.00001).
• No significant differences were observed between HA-coated and non-HA-coated cups regarding HHS (P = 0.20), endosteal bone formation (P = 0.23), linear wear rate (P = 0.44), revisions for aseptic loosening (P = 0.29), or heterotopic ossification (P = 0.71).

Conclusions:

• HA-coated acetabular cups in primary THA demonstrate a significant reduction in radiolucent lines compared to non-HA-coated cups.
• No significant advantages were found for HA-coated cups concerning patient-reported outcomes, bone formation, wear, or revision rates.
• These findings suggest a preference for HA-coated acetabular cups in primary THA due to the reduction in radiolucencies.