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Comparison of a hydroxyapatite-coated sleeve and a porous-coated sleeve with a modular revision hip stem. A prospective, randomized study.

Publication ,  Journal Article
Bolognesi, MP; Pietrobon, R; Clifford, PE; Vail, TP
Published in: J Bone Joint Surg Am
December 2004

BACKGROUND: Bone ingrowth into a cementless prosthesis can be achieved by both porous and hydroxyapatite coatings. The purpose of this study was to compare the performance of a hydroxyapatite-coated proximal sleeve and a porous bead-coated sleeve in patients managed with a modular revision hip system. METHODS: Between August 1992 and December 1996, fifty-three consecutive femoral revisions performed with an S-ROM stem in fifty-two patients were prospectively randomized at the time of surgery to either a hydroxyapatite-coated or a porous-coated sleeve. All patients were evaluated clinically and radiographically at three months, six months, and yearly for a minimum of two years (average, four years; range, two to 7.5 years). Femoral defects were classified according to the criteria of Paprosky et al. Six patients died and four patients were lost to follow-up, leaving forty-two patients (forty-three hips) as the final study group. RESULTS: For the entire group, two femoral stems, one of which had been implanted in a hip with a Paprosky type-II femoral defect and the other in a hip with a Paprosky type-IIIB femoral defect, required a repeat revision, one for pain and the other for aseptic loosening. Radiographic evidence of bone ingrowth was observed in 96% (twenty-six) of the twenty-seven femora with type-I or II defects and in 81% (thirteen) of the sixteen femora with type-III defects. Femoral component survival, with use of revision as the end point, was 95% at four years for the entire group. The Harris hip scores were not significantly different when stratified by implant type, but were significantly different when stratified by bone loss (p < 0.05). In the femora with type-I or II defects, no difference was detected between those treated with a hydroxyapatite-coated implant and those that received a porous-coated implant with respect to bone ingrowth. However, in femora with type-III defects, the likelihood of the development of bone ingrowth was 2.6 (95% confidence interval, 1.3 to 5.17) times greater in hips that received a hydroxyapatite-coated implant (all eight developed ingrowth) than in hips that had a porous-coated implant (five of eight developed ingrowth) (p = 0.05). CONCLUSIONS: Bone fixation was achieved more often with hydroxyapatite-coated sleeves in femora with Paprosky type-III defects, but no significant difference was noted in outcomes between the two implant types when used in bone with type-I or type-II femoral defects. Overall, the S-ROM modular hip stem performed better in femora with type-I or II bone defects than in femora with type-III defects. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Duke Scholars

Published In

J Bone Joint Surg Am

DOI

ISSN

0021-9355

Publication Date

December 2004

Volume

86

Issue

12

Start / End Page

2720 / 2725

Location

United States

Related Subject Headings

  • Surface Properties
  • Reoperation
  • Prosthesis Failure
  • Prosthesis Design
  • Porosity
  • Osseointegration
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
 

Citation

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MLA
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Bolognesi, M. P., Pietrobon, R., Clifford, P. E., & Vail, T. P. (2004). Comparison of a hydroxyapatite-coated sleeve and a porous-coated sleeve with a modular revision hip stem. A prospective, randomized study. J Bone Joint Surg Am, 86(12), 2720–2725. https://doi.org/10.2106/00004623-200412000-00020
Bolognesi, Michael P., Ricardo Pietrobon, Phillip E. Clifford, and T Parker Vail. “Comparison of a hydroxyapatite-coated sleeve and a porous-coated sleeve with a modular revision hip stem. A prospective, randomized study.J Bone Joint Surg Am 86, no. 12 (December 2004): 2720–25. https://doi.org/10.2106/00004623-200412000-00020.
Bolognesi MP, Pietrobon R, Clifford PE, Vail TP. Comparison of a hydroxyapatite-coated sleeve and a porous-coated sleeve with a modular revision hip stem. A prospective, randomized study. J Bone Joint Surg Am. 2004 Dec;86(12):2720–5.
Bolognesi, Michael P., et al. “Comparison of a hydroxyapatite-coated sleeve and a porous-coated sleeve with a modular revision hip stem. A prospective, randomized study.J Bone Joint Surg Am, vol. 86, no. 12, Dec. 2004, pp. 2720–25. Pubmed, doi:10.2106/00004623-200412000-00020.
Bolognesi MP, Pietrobon R, Clifford PE, Vail TP. Comparison of a hydroxyapatite-coated sleeve and a porous-coated sleeve with a modular revision hip stem. A prospective, randomized study. J Bone Joint Surg Am. 2004 Dec;86(12):2720–2725.
Journal cover image

Published In

J Bone Joint Surg Am

DOI

ISSN

0021-9355

Publication Date

December 2004

Volume

86

Issue

12

Start / End Page

2720 / 2725

Location

United States

Related Subject Headings

  • Surface Properties
  • Reoperation
  • Prosthesis Failure
  • Prosthesis Design
  • Porosity
  • Osseointegration
  • Orthopedics
  • Middle Aged
  • Male
  • Humans