Fixation and metal release from the Tifit femoral stem prosthesis. 5-year follow-up of 64 cases.

We stratified the fixation of the femoral component in 64 hips with degenerative joint disease into 3 groups, cemented (C), proximal hydroxyapatite coating (HA) or proximal porous coating (P). All implants had the same basic design and were made of TiAIV alloy. The migration of the implants was assessed by radiostereometry. After 5 years, the mean subsidences in the cemented and porous-coated groups were 0.16 and 0.31 mm, whereas the HA-coated implants displayed a mean proximal migration of 0.1 mm. 7 stems (2 C, 1 HA, 4 P) showed a continuous subsidence (> 0.25 mm) between the 2- and 5-year follow-up. 1 porous-coated stem was revised after the 2-year follow-up, because of pain and implant failure (previously reported) and 1 cemented stem was revised after 5 years because of pain and osteolysis. In a subset of patients, all with a femoral head made of aluminum oxide, the levels of metal were determined using atomic adsorption spectrometry. Subsidence of the stem between the 2- and 5-year follow-up was associated with increased levels of aluminum in the blood at 2 years. Generation of metallic particles from abrasive wear of the stem followed by third body abrasion of the ceramic femoral head could be one explanation of this finding. 5 hips which had shown high levels of titanium and aluminum in joint fluid at the 2-year follow-up displayed increased subsidence and developed proximal radiolucencies or osteolysis at the 5-year follow up. One of these was the cemented hip which was subsequently revised.

[1]  R. Geesink,et al.  Six-year results of hydroxyapatite-coated total hip replacement. , 1995, The Journal of bone and joint surgery. British volume.

[2]  J. Besjakov,et al.  Migration and wear of a hydroxyapatite-coated hip prosthesis. A controlled roentgen stereophotogrammetric study. , 1996, The Journal of bone and joint surgery. British volume.

[3]  P. Delincé,et al.  Bonding of hydroxyapatite-coated femoral prostheses. Histopathology of specimens from four cases. , 1991, The Journal of bone and joint surgery. British volume.

[4]  K. Bachus,et al.  Postmortem comparative analysis of titanium and hydroxyapatite porous-coated femoral implants retrieved from the same patient. A case study. , 1993, The Journal of arthroplasty.

[5]  M. Fidler,et al.  The Harris-Galante cementless femoral component: poor results in 57 hips followed for 3 years. , 1996, Acta orthopaedica Scandinavica.

[6]  V. Goldberg,et al.  The influence of a hydroxyapatite and tricalcium-phosphate coating on bone growth into titanium fiber-metal implants. , 1994, The Journal of bone and joint surgery. American volume.

[7]  B. Espehaug,et al.  Early revision among 12,179 hip prostheses. A comparison of 10 different brands reported to the Norwegian Arthroplasty Register, 1987-1993. , 1995, Acta orthopaedica Scandinavica.

[8]  H. Willert,et al.  Crevice corrosion of cemented titanium alloy stems in total hip replacements. , 1996, Clinical orthopaedics and related research.

[9]  J. Kärrholm,et al.  Increased metal release from cemented femoral components made of titanium alloy. 19 hip prostheses followed with radiostereometry (RSA). , 1994, Acta orthopaedica Scandinavica.

[10]  B. Espehaug,et al.  Early aseptic loosening of uncemented femoral components in primary total hip replacement. A review based on the Norwegian Arthroplasty Register. , 1995, The Journal of bone and joint surgery. British volume.

[11]  R. Huiskes.  The various stress patterns of press-fit, ingrown, and cemented femoral stems. , 1990, Clinical orthopaedics and related research.

[12]  W. Hozack,et al.  Clinical and roentgenographic evaluation of hydroxyapatite-augmented and nonaugmented porous total hip arthroplasty. , 1994, The Journal of arthroplasty.

[13]  W. Hozack,et al.  Hydroxyapatite-Coated Femoral Stems. A Matched-Pair Analysis of Coated and Uncoated Implants* , 1996, The Journal of bone and joint surgery. American volume.

[14]  K. Søballe,et al.  Hydroxyapatite ceramic coating for bone implant fixation. Mechanical and histological studies in dogs. , 1993, Acta orthopaedica Scandinavica. Supplementum.

[15]  R. Vedantam,et al.  The fully hydroxyapatite-coated total hip implant. Clinical and roentgenographic results. , 1996, The Journal of arthroplasty.

[16]  R. Bloebaum,et al.  Retrieval analysis of a hydroxyapatite-coated hip prosthesis. , 1991, Clinical orthopaedics and related research.

[17]  R. E. Jensen,et al.  Loss of hydroxyapatite coating on retrieved, total hip components. , 1993, The Journal of arthroplasty.

[18]  J. Kärrholm,et al.  Subsidence, tip, and hump micromovements of noncoated ribbed femoral prostheses. , 1993, Clinical orthopaedics and related research.

[19]  P. Buma,et al.  Tissue reactions around a hydroxyapatite-coated hip prosthesis. Case report of a retrieved specimen. , 1995, The Journal of arthroplasty.

[20]  K. Tanner,et al.  Fatigue failure of cancellous bone: a possible cause of implant migration and loosening , 1997 .

[21]  T. Bauer,et al.  Hydroxyapatite-coated femoral stems. Histological analysis of components retrieved at autopsy. , 1991, The Journal of bone and joint surgery. American volume.

[22]  J Kärrholm,et al.  Micromotion of femoral stems in total hip arthroplasty. A randomized study of cemented, hydroxyapatite-coated, and porous-coated stems with roentgen stereophotogrammetric analysis. , 1994, The Journal of bone and joint surgery. American volume.

[23]  John A. Anderson,et al.  Hydroxyapatite‐Coated Hip Prostheses: Early Results From an International Study , 1995, Clinical orthopaedics and related research.

[24]  J Kärrholm,et al.  Evaluation of Boneloc. Chemical and mechanical properties, and a randomized clinical study of 30 total hip arthroplasties. , 1995, Acta orthopaedica Scandinavica.

[25]  H. Amstutz,et al.  "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. , 1979, Clinical orthopaedics and related research.

[26]  W. Capello,et al.  Remodeling of Bone around Hydroxyapatite-Coated Femoral Stems* , 1996, The Journal of bone and joint surgery. American volume.

[27]  M. Freeman,et al.  Hydroxyapatite coating of hip prostheses. Effect on migration into the femur. , 1992, The Journal of bone and joint surgery. British volume.

[28]  W J Maloney,et al.  The Otto Aufranc Award. Skeletal response to well fixed femoral components inserted with and without cement. , 1996, Clinical orthopaedics and related research.

[29]  J. Kärrholm,et al.  Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses. , 1994, The Journal of bone and joint surgery. British volume.

[30]  K. Bachus,et al.  Comparative study of human cancellous bone remodeling to titanium and hydroxyapatite-coated implants. , 1993, The Journal of arthroplasty.

[31]  S. Toksvig-Larsen,et al.  Migration of hydroxyapatite coated femoral prostheses. A Roentgen Stereophotogrammetric study. , 1993, The Journal of bone and joint surgery. British volume.