Hip Pelvis.  2015 Dec;27(4):209-215. 10.5371/hp.2015.27.4.209.

The Results of Long-term Follow-up of Total Hip Arthroplasty Using Hydroxyapatite-coated Cups

• Han CD
• Shin KY
• Lee HH
• Park KK
• Yang IH
• Lee WS

• KMID: 2150508
• DOI: http://doi.org/10.5371/hp.2015.27.4.209

Abstract

PURPOSE
The aim of this study was to report the long-term outcome and the failure mechanism of cementless total hip arthroplasty (THA) using hydroxyapatite (HA)-coated acetabular cup.
MATERIALS AND METHODS
From January 1992 to May 1994, a total of 123 consecutive cementless primary THAs were performed using a HA-coated acetabular cup with metal-on-polyethylene articulation. We retrospectively evaluated 66 hips available for follow-up at a mean 18.3 years (range, 10.4-23.6 years). The survival analysis was performed by the Kaplan-Meier method. We defined end point as any failure that required a reoperation of acetabular component.
RESULTS
Thirty-nine of 66 hips (59.1%) were defined as a failure for progressive acetabular osteolysis or aseptic loosening of the cup. Acetabular osteolysis was observed in 47 hips (71.2%) and 33 hips (50.0%) were revised because of cup loosening. The Kaplan-Meier method showed the survival rate of the acetabular cup to be 46.3% at 15 years and 34.8% at 20 years for any failure that required a reoperation of acetabular component.
CONCLUSION
The long-term survival rate of THA using HA-coated acetabular cup was unsatisfactory, and it was attributed to vulnerable property of HA coating and progressive osteolysis.

Keyword

Total hip arthroplasty; Hydroxyapatite-coated; Acetabular cup; Long-term outcome

MeSH Terms

Acetabulum
Arthroplasty, Replacement, Hip*
Durapatite
Follow-Up Studies*
Hip
Osteolysis
Reoperation
Retrospective Studies
Survival Rate
Durapatite

Figure

• 

  Fig. 1 (A) Radiograph of a 36 year old patient at 4 years of follow-up. A focal acetabular osteolysis was seen in zone 1. (B) The osteolysis was progressive at 6 years of follow-up. (C) Curettage and allobone grafting was done for progressive acetabular osteolysis. The polyethylene liner was changed and screws were removed. (D) Radiograph shows that the acetabular cup has moved to a more vertical position at 4 months after the reoperation.

• 

  Fig. 2 (A) Radiograph of a 51 year old patient at 10 years of follow-up. (B) A focal acetabular osteolysis was seen in zone 1 at 13 years of follow-up. (C) Progression of the osteolysis and cup migration were seen at 19 years of follow-up. (D) Revision total hip arthroplasty was performed.

• 

  Fig. 3 Kaplan-Meier survivorship curve of the hydroxyapatite-coated acetabular cup. End-point criteria: any failure that required a reoperation of acetabular component.

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  Fig. 4 The acetabular cup, which was retrieved at 4 years after index operation, showed extensive loss of hydroxyapatite coating.

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