S Lazarinis1, K T Mäkelä2, A Eskelinen3, L Havelin4, G Hallan5, S Overgaard6, A B Pedersen7, J Kärrholm8, N P Hailer9. 1. Department of Surgical Sciences/Orthopaedics, Uppsala University Hospital, Uppsala, Sweden; Swedish Hip Arthroplasty Register and Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: lazarinis.stergios@surgsci.uu.se. 2. Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland. Electronic address: Keijo.Makela@tyks.fi. 3. Coxa Hospital for Joint Replacement, Tampere, Finland. Electronic address: antti.eskelinen@fimnet.fi. 4. The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. Electronic address: leif.ivar.havelin@helse-bergen.no. 5. The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Electronic address: geir.hallan@helse-bergen.no. 6. The Danish Hip Arthroplasty Register, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: overgard@post7.tele.dk. 7. The Danish Hip Arthroplasty Register, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: abp@clin.au.dk. 8. Swedish Hip Arthroplasty Register and Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: johan.karrholm@vgregion.se. 9. Department of Surgical Sciences/Orthopaedics, Uppsala University Hospital, Uppsala, Sweden; Swedish Hip Arthroplasty Register and Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: nils.hailer@surgsci.uu.se.
Abstract
OBJECTIVE: It is unclear whether hydroxyapatite (HA) coating of uncemented cups used in primary total hip arthroplasty (THA) improves bone ingrowth and reduces the risk of aseptic loosening. We therefore investigated survival of different uncemented cups that were available with or without HA coating. METHOD: We investigated three different cup types used with or without HA coating registered in the Nordic Arthroplasty Register Association (NARA) database that were inserted due to osteoarthritis (n = 28,605). Cumulative survival rates and adjusted hazard ratios (HRs) for the risk of revision were calculated. RESULTS: Unadjusted 13-year survival for cup revision due to aseptic loosening was 97.9% (CI: 96.5-99.4) for uncoated and 97.8% (CI: 96.3-99.4) for HA-coated cups. Adjusted HRs were 0.66 (CI 0.42-1.04) for the presence of HA coating during the first 10 years and 0.87 (CI 0.14-5.38) from year 10-13, compared with uncoated cups. When considering the endpoint cup revision for any reason, unadjusted 13-year survival was similar for uncoated (92.5% [CI: 90.1-94.9]) and HA-coated (94.7% [CI: 93.2-96.3]) cups. The risk of revision of any component due to infection was higher in THA with HA-coated cups than in THA with uncoated cups (adjusted HR 1.4 [CI 1.1-1.9]). CONCLUSIONS: HA-coated cups have a similar risk of aseptic loosening as uncoated cups, thus the use of HA coating seems to not confer any added value in terms of implant stability. The risk of infection seemed higher in THA with use of HA-coated cups, an observation that must be investigated further.
OBJECTIVE: It is unclear whether hydroxyapatite (HA) coating of uncemented cups used in primary total hip arthroplasty (THA) improves bone ingrowth and reduces the risk of aseptic loosening. We therefore investigated survival of different uncemented cups that were available with or without HA coating. METHOD: We investigated three different cup types used with or without HA coating registered in the Nordic Arthroplasty Register Association (NARA) database that were inserted due to osteoarthritis (n = 28,605). Cumulative survival rates and adjusted hazard ratios (HRs) for the risk of revision were calculated. RESULTS: Unadjusted 13-year survival for cup revision due to aseptic loosening was 97.9% (CI: 96.5-99.4) for uncoated and 97.8% (CI: 96.3-99.4) for HA-coated cups. Adjusted HRs were 0.66 (CI 0.42-1.04) for the presence of HA coating during the first 10 years and 0.87 (CI 0.14-5.38) from year 10-13, compared with uncoated cups. When considering the endpoint cup revision for any reason, unadjusted 13-year survival was similar for uncoated (92.5% [CI: 90.1-94.9]) and HA-coated (94.7% [CI: 93.2-96.3]) cups. The risk of revision of any component due to infection was higher in THA with HA-coated cups than in THA with uncoated cups (adjusted HR 1.4 [CI 1.1-1.9]). CONCLUSIONS: HA-coated cups have a similar risk of aseptic loosening as uncoated cups, thus the use of HA coating seems to not confer any added value in terms of implant stability. The risk of infection seemed higher in THA with use of HA-coated cups, an observation that must be investigated further.
Authors: Marcel Haversath; Martin Lichetzki; Sebastian Serong; André Busch; Stefan Landgraeber; Marcus Jäger; Tjark Tassemeier Journal: Arch Orthop Trauma Surg Date: 2020-05-30 Impact factor: 3.067
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Authors: Mika J Niemeläinen; Keijo T Mäkelä; Otto Robertsson; Annette W-Dahl; Ove Furnes; Anne M Fenstad; Alma B Pedersen; Henrik M Schrøder; Aleksi Reito; Antti Eskelinen Journal: Acta Orthop Date: 2020-01-13 Impact factor: 3.717