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Cementless hydroxyapatite coated hip prostheses.

Herrera A, Mateo J, Gil-Albarova J, Lobo-Escolar A, Ibarz E, Gabarre S, Más Y, Gracia L - Biomed Res Int (2015)

Bottom Line: The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem.The results corresponding to survival and stability of implants were very satisfactory in the long-term.From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Medicine School, University of Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain ; Aragón Health Sciences Institute, Avenida San Juan Bosco 13, 50009 Zaragoza, Spain.

ABSTRACT
More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

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X-ray image of patient with follow-up at 12 y. Excessive polyethylene wear. Osteolysis in metaphyseal of femur.
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fig7: X-ray image of patient with follow-up at 12 y. Excessive polyethylene wear. Osteolysis in metaphyseal of femur.

Mentions: The most important problem we have experienced with the ABG I model is excessive wear of conventional polyethylene and subsequent periprosthetic osteolysis (Figures 7 and 8), although fortunately implants remained stable at 20 years of follow-up. Concerning the ABG II model, with Duration highly crosslinked polyethylene, it has shown much lower wear rates and osteolityc lesions have been significantly less frequent. We believe that sealing unused cup holes has limited the migration of wear debris to acetabular bone, helping to reduce the incidence of osteolytic acetabular lesions. Good peripheral osseointegration of the cup could also have acted as a barrier to wear debris migration [58]. The lower incidence of osteolytic lesions that we have also found in the femur can be explained by the reduced rate of wear debris particles in the ABG II model. But in addition, changes in design of the stem and improved HA crystallinity could have played a role in enhanced osseointegration, which would prevent debris migration into the femoral implant-bone interface [59].


Cementless hydroxyapatite coated hip prostheses.

Herrera A, Mateo J, Gil-Albarova J, Lobo-Escolar A, Ibarz E, Gabarre S, Más Y, Gracia L - Biomed Res Int (2015)

X-ray image of patient with follow-up at 12 y. Excessive polyethylene wear. Osteolysis in metaphyseal of femur.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352755&req=5

fig7: X-ray image of patient with follow-up at 12 y. Excessive polyethylene wear. Osteolysis in metaphyseal of femur.
Mentions: The most important problem we have experienced with the ABG I model is excessive wear of conventional polyethylene and subsequent periprosthetic osteolysis (Figures 7 and 8), although fortunately implants remained stable at 20 years of follow-up. Concerning the ABG II model, with Duration highly crosslinked polyethylene, it has shown much lower wear rates and osteolityc lesions have been significantly less frequent. We believe that sealing unused cup holes has limited the migration of wear debris to acetabular bone, helping to reduce the incidence of osteolytic acetabular lesions. Good peripheral osseointegration of the cup could also have acted as a barrier to wear debris migration [58]. The lower incidence of osteolytic lesions that we have also found in the femur can be explained by the reduced rate of wear debris particles in the ABG II model. But in addition, changes in design of the stem and improved HA crystallinity could have played a role in enhanced osseointegration, which would prevent debris migration into the femoral implant-bone interface [59].

Bottom Line: The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem.The results corresponding to survival and stability of implants were very satisfactory in the long-term.From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Medicine School, University of Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain ; Aragón Health Sciences Institute, Avenida San Juan Bosco 13, 50009 Zaragoza, Spain.

ABSTRACT
More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.

Show MeSH
Related in: MedlinePlus