Survival of total hip arthroplasty (THA) in younger patients Effect of hydroxyapatite coating and...

Survival of total hip arthroplasty (THA) in younger Survival of total hip arthroplasty (THA) in younger patientspatients

Effect of hydroxyapatite coating and cementEffect of hydroxyapatite coating and cement

Aksel Paulsen, Søren P. Johnsen, Aksel Paulsen, Søren P. Johnsen,

Alma B. Pedersen, Ulf Lucht, Alma B. Pedersen, Ulf Lucht, Søren OvergaardSøren Overgaard

Department of Orthopedics, Aarhus University Hospital, Denmark.Department of Orthopedics, Aarhus University Hospital, Denmark.Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.

Department of Orthopedics, Odense University Hospital, Denmark.Department of Orthopedics, Odense University Hospital, Denmark.University of Southern Denmark, SDU, DenmarkUniversity of Southern Denmark, SDU, Denmark

INTRODUCTION:INTRODUCTION:

Hydroxyapatite (HA) coating of uncemented THA is widely Hydroxyapatite (HA) coating of uncemented THA is widely used; however, the effect of HA on implant survival are used; however, the effect of HA on implant survival are sparse. sparse.

AIM:AIM:

1. What is the effect of HA coating on the survival of 1. What is the effect of HA coating on the survival of uncemented THA, compared to non HA coating, in cups uncemented THA, compared to non HA coating, in cups and stems? and stems?

2. What is the effect compared to cemented THA? 2. What is the effect compared to cemented THA?

MATERIAL:MATERIAL:

This review is a cohort analysisThis review is a cohort analysis based on based on the Danish Hip the Danish Hip Arthroplasty Registry (DHR).Arthroplasty Registry (DHR).

We identified all primary THA in patients less than 70 years We identified all primary THA in patients less than 70 years during 1995-2003. during 1995-2003. The follow-up was 0-9 years.The follow-up was 0-9 years.

MATERIAL:MATERIAL:

Available for analyses:Available for analyses:

Cups : Cups : A A total of 23,516;total of 23,516;

8,556 cemented8,556 cemented3,151 uncemented, HA-coated3,151 uncemented, HA-coated11,809 uncemented, non-HA-coated11,809 uncemented, non-HA-coated

Stems: Stems: A A total of 23,434;total of 23,434;

15,634 cemented15,634 cemented2,318 uncemented, HA-coated2,318 uncemented, HA-coated5,482 uncemented, non-HA-coated5,482 uncemented, non-HA-coated..

METHODS: METHODS:

We defined revision of the components as endpoint, We defined revision of the components as endpoint, divided into two different outcomes; revision because of divided into two different outcomes; revision because of aseptic loosening, and revision due to ”any reason”aseptic loosening, and revision due to ”any reason”

Revision and ”any reason” was defined in accordance to Revision and ”any reason” was defined in accordance to the DHR registration form.the DHR registration form.

METHODS: METHODS:

The relative risk (RR) of revision due to aseptic loosening or The relative risk (RR) of revision due to aseptic loosening or “any reason”, was adjusted for possible confounders using “any reason”, was adjusted for possible confounders using multivariate Cox regression analysis.multivariate Cox regression analysis. The analyzes were adjusted for:The analyzes were adjusted for:

age (< 50, 50-59, 60-69), age (< 50, 50-59, 60-69), gender, gender, primary diagnosisprimary diagnosis, , and and fixationfixation of the opposite of the opposite implant part (Cup /Stem). implant part (Cup /Stem).

METHODS: METHODS:

Statistical analyzes: Statistical analyzes:

age (<60, 60-69), age (<60, 60-69), gender, gender, producer/ model of the components, producer/ model of the components, diagnosis diagnosis (primary arthrosis/ (primary arthrosis/ ““all diagnosis”)all diagnosis”). .

None of the groups had less than 400 patients.

The software we used was SAS. Statistician Anders Riis was of technical assistance in the formulation of the statistical analysis.

Statistical level of significance was set to 5 %.

RESULTS: RESULTS:

Cups; HA-coating VS. non HA-coating Cups; HA-coating VS. non HA-coating (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;

Endpoint: aseptic loosening; Endpoint: aseptic loosening;

N totalN total N revisedN revised RRRR 95 % CI95 % CI

Uncemented - HAUncemented - HA 11,80911,809 4949 11

Uncemented + HAUncemented + HA 3,1513,151 66 0.670.67 0.29 - 1.570.29 - 1.57

RESULTS: RESULTS:

Cups; HA-coating VS. non HA-coating Cups; HA-coating VS. non HA-coating (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;


Endpoint: any reason;Endpoint: any reason;

Same findings for: idiopathic arthrosis, age, gender, component typeSame findings for: idiopathic arthrosis, age, gender, component type







RESULTS: RESULTS:

Cups; Cemented VS. Uncemented Cups; Cemented VS. Uncemented (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;



CementedCemented 8,5568,556 131131 11

Uncemented - HAUncemented - HA 11,80911,809 4949 0.320.32 0.22 - 0.450.22 - 0.45


RESULTS: RESULTS:

Cups; Cemented VS. Uncemented Cups; Cemented VS. Uncemented (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;











RESULTS: RESULTS: Cup; Aseptic loosening:

( * = none in group) N totalN total N revisedN revised RRRR 95 % CI95 % CI

Trilogy Uncemented -HA Trilogy Uncemented -HA 5,1875,187 1515 11

Trilogy Uncemented +HA Trilogy Uncemented +HA 653653 00 ** **

Universal Uncemented / Universal Uncemented / Mallory-Head +HAMallory-Head +HA

1,9971,997 55 0.920.92 0.33 - 2.540.33 - 2.54

Universal Uncemented / Universal Uncemented / Mallory-Head -HAMallory-Head -HA

2,7952,795 1212 1.071.07 0.50 - 2.290.50 - 2.29

Müller CementedMüller Cemented 829829 3030 7.227.22 3.80 - 13.733.80 - 13.73

Lubinus CementedLubinus Cemented 2,2532,253 1919 2.062.06 1.03 - 4.101.03 - 4.10

Exeter CementedExeter Cemented 2,0012,001 3333 3.133.13 1.67 - 5.851.67 - 5.85

ZCA CementedZCA Cemented 1,0671,067 55 1.661.66 0.60 - 4.590.60 - 4.59

Charnley CementedCharnley Cemented 1,6811,681 2727 3.013.01 1.59 - 5.721.59 - 5.72

RESULTS: RESULTS: Cup; Any reason:


Trilogy Uncemented -HA Trilogy Uncemented -HA 5,1875,187 160160 11

Trilogy Uncemented +HA Trilogy Uncemented +HA 653653 2222 1.201.20 0.77 - 1.870.77 - 1.87

Universal Uncemented / Universal Uncemented / Mallory-Head +HAMallory-Head +HA

1,9971,997 4848 0.820.82 0.60 - 1.140.60 - 1.14

Universal Uncemented / Universal Uncemented / Mallory-Head -HAMallory-Head -HA

2,7952,795 9393 0.910.91 0.70 - 1.170.70 - 1.17

Müller CementedMüller Cemented 829829 5353 1.411.41 1.02 - 1.941.02 - 1.94

Lubinus CementedLubinus Cemented 2,2532,253 6464 0.740.74 0.55 - 0.990.55 - 0.99

Exeter CementedExeter Cemented 2,0012,001 9090 0.990.99 0.76 - 1.290.76 - 1.29

ZCA CementedZCA Cemented 1,0671,067 2424 0.730.73 0.48 - 1.130.48 - 1.13

Charnley CementedCharnley Cemented 1,6811,681 6363 0.840.84 0.63 - 1.130.63 - 1.13

RESULTS: RESULTS:

StemsStems; HA-coating VS. non HA-coating ; HA-coating VS. non HA-coating (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;





RESULTS: RESULTS:

Stems; HA-coating VS. non HA-coating Stems; HA-coating VS. non HA-coating (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;










RESULTS: RESULTS:

Stems; Cemented VS. Uncemented Stems; Cemented VS. Uncemented (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;






RESULTS: RESULTS: Stem; Aseptic loosening:


Exeter Cemented 4,5114,511 2020 11

Bi-metric Cemented 3,4253,425 8888 6.826.82 4.19 - 11.104.19 - 11.10

Bi-metric Uncemented +HA

1,7621,762 11 0.250.25 0.03 - 1.870.03 - 1.87

Bi-metric Uncemented -HA

3,5573,557 99 0.710.71 0.32 - 1.580.32 - 1.58

Lubinus SP II Cemented 2,8102,810 2222 1.871.87 1.02 - 3.421.02 - 3.42

CPT Cemented 1,9821,982 66 0.900.90 0.36 - 2.240.36 - 2.24

Charnley Cemented 1,2371,237 3636 5.135.13 2.97 - 8.872.97 - 8.87

RESULTS: RESULTS: Stem; Any reason:


Exeter Cemented 4,5114,511 136136 11

Bi-metric Cemented 3,4253,425 195195 2.002.00 1.61 - 2.491.61 - 2.49

Bi-metric Uncemented +HA

1,7621,762 3737 0.950.95 0.66 - 1.380.66 - 1.38

Bi-metric Uncemented -HA

3,5573,557 114114 1.141.14 0.88 - 1.480.88 - 1.48

Lubinus SP II Cemented 2,8102,810 102102 1.221.22 0.94 - 1.570.94 - 1.57

CPT Cemented 1,9821,982 4343 0.820.82 0.58 - 1.150.58 - 1.15

Charnley Cemented 1,2371,237 5959 1.331.33 0.98 - 1.810.98 - 1.81

CONCLUSION:CONCLUSION:

Use of HA-coated implants was not associated with any Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger implants, in this medium term follow-up study of younger patients (<70).patients (<70).



Cemented implants as a group had higher revision rates Cemented implants as a group had higher revision rates due to aseptic loosening than cementless implants, but not due to aseptic loosening than cementless implants, but not unambiguously higher revision rates due to “any reason” unambiguously higher revision rates due to “any reason” than cementless implants in this study.than cementless implants in this study.



Cemented implants as a group had higher revision rates Cemented implants as a group had higher revision rates due to aseptic loosening than cementless implants, but not due to aseptic loosening than cementless implants, but not unambiguously higher revision rates due to “any reason” unambiguously higher revision rates due to “any reason” than cementless implants in this study.than cementless implants in this study.

Müller, Exeter, and Charnley cups had the highest revision Müller, Exeter, and Charnley cups had the highest revision rates of the cups. Bi-metric Cemented, Charnley and rates of the cups. Bi-metric Cemented, Charnley and Lubinus SP II stems had the highest revision rates for Lubinus SP II stems had the highest revision rates for stems in this medium term follow-up study of younger stems in this medium term follow-up study of younger patients (<70).patients (<70).

Survival of total hip arthroplasty (THA) in younger patients Effect of hydroxyapatite coating and...

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