Proximal femoral bone loss and increased rate of fracture with a proximally hydroxyapatite-coated femoral component

• Published in: Journal of bone and joint surgery. British volume Vol. 82; no. 8; pp. 1151 - 1155
• Main Authors: RADL, R, AIGNER, C, HUNGERFORD, M, PASCHER, A, WINDHAGER, R
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.11.2000; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - methods; Biocompatible Materials - therapeutic use; Biological and medical sciences; Coated Materials, Biocompatible - therapeutic use; Durapatite - therapeutic use; Early Ambulation - adverse effects; Equipment Failure Analysis; Female; Femoral Fractures - diagnostic imaging; Femoral Fractures - etiology; Humans; Hyperostosis - diagnostic imaging; Hyperostosis - etiology; Male; Medical sciences; Middle Aged; Orthopedic surgery; Osseointegration; Proportional Hazards Models; Prosthesis Design; Prosthesis Failure; Radiography; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Treatment Outcome; Weight-Bearing; Human; Evaluation; Femur; Pathologic fracture; Prognosis; Radiodiagnosis; Diseases of the osteoarticular system; Lower limb; Bone disease; Hydroxyapatite; Hip; Radiography; Orthopedic surgery; Treatment; Risk factor; Non cemented prosthesis; Total; Biomaterial; Medium term; Bone; Technique; Component; Osteopenia
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.82B8.0821151

We performed a retrospective analysis of the clinical and radiological outcomes of total hip replacement using an uncemented femoral component proximally coated with hydroxyapatite. Of 136 patients, 118 who had undergone 124 primary total hip replacements were available for study. Their mean age was 66.5 years (19 to 90) and the mean follow-up was 5.6 years (4.25 to 7.25). At the final follow-up the mean Harris hip score was 92 (47.7 to 100). Periprosthetic femoral fractures, which occurred in seven patients (5.6%), were treated by osteosynthesis in six and conservatively in one. We had to revise five femoral components, one because of aseptic loosening, one because of septic loosening and three because of periprosthetic fracture. At the final follow-up there were definite signs of aseptic loosening in two patients. Radiologically, proximal femoral bone loss in Gruen zones I and VI was evident in 96.8% of hips, while bone hypertrophy in zones III and V was seen in 64.7%. In 24 hips (20.2%) the mean subsidence of the stem was 3.7 mm which occurred within the first 12 postoperative weeks. This indicated poor initial stability, which might have been aggravated by early weight-bearing. The high rate of failure in our study suggests that proximal femoral bone loss affects the long-term survival of the replacement.