Standard anatomical medullary locking (AML) versus tricalcium phosphate-coated AML femoral prostheses.

OBJECTIVES To compare the preliminary rate and amount of bony ingrowth and calcar resorption between patients receiving either a standard anatomical medullary locking (AML) or a tricalcium phosphate (TCP)-coated AML femoral prosthesis and to compare preliminary clinical results. DESIGN A prospective, randomized, double-blind clinical trial. SETTING An acute care tertiary institution. PATIENTS Between January 1993 and March 1995, 92 patients underwent primary total hip arthroplasty (THA). They were randomized to 2 groups of 46--a control group or a treatment group. Of the 46 subjects enrolled in each group, no significant differences were seen preoperatively with respect to age, sex, diagnosis, clinical and radiographic assessment. Seventy-one patients were followed up for 24 months. INTERVENTIONS Insertion of either a standard AML femoral implant (control group) or a TCP-coated AML femoral implant (treatment group). OUTCOME MEASURES The degree of hypertrophy, calcar atrophy and the number of spot welds on standard postoperative radiographs at 6, 12 and 24 months. Clinically, assessment according to the Société internationale de chirurgie orthopédique et de traumatologie (SICOT) scale and a 100-point visual analogue scale (VAS) for pain. RESULTS There were no prosthetic stem revisions in either group at the 24-month follow-up. Radiographically, bony ingrowth was not significantly different in the TCP-coated stem, by chi2 analysis of the degree of hypertrophy and number of spot welds present. Also by chi2 analysis, the degree of calcar atrophy was not significantly different between groups. The mean VAS score for pain at 24 months was 12.5 for the control and 12.1 for the treatment group. No significant differences were seen in any of the clinical categories of the SICOT Scale over the 24-month interval. CONCLUSION The objective of TCP-coating--to increase the rate and amount of bony ingrowth while reducing the rate of calcar resorption in non-cemented THA--was not achieved by 24 months postoperatively in our study.

[1]  吳在熙.  CERAMICS , 1986, Arkansas Made, Volume 1.

[2]  A. Yee,et al.  A randomized trial of hydroxyapatite coated prostheses in total hip arthroplasty. , 1999, Clinical orthopaedics and related research.

[3]  W. Head,et al.  Effect of circumferential plasma-spray porous coating on the rate of femoral osteolysis after total hip arthroplasty. , 1999, The Journal of bone and joint surgery. American volume.

[4]  C. Colwell,et al.  Omnifit-HA stem in total hip arthroplasty. A 2- to 5-year followup. , 1999, Clinical orthopaedics and related research.

[5]  C. Bünger,et al.  Improved bone anchorage of hydroxypatite coated implants compared with tricalcium-phosphate coated implants in trabecular bone in dogs. , 1999, Biomaterials.

[6]  A. Tonino,et al.  Hydroxyapatite-coated femoral stems , 1999 .

[7]  C. Bünger,et al.  A review of ceramic coatings for implant fixation. , 1999, Journal of long-term effects of medical implants.

[8]  W. Capello,et al.  Hydroxyapatite in Total Hip Arthroplasty: Clinical Results and Critical Issues , 1998, Clinical orthopaedics and related research.

[9]  L. Dorr,et al.  Bilateral total hip arthroplasty comparing hydroxyapatite coating to porous-coated fixation. , 1998, The Journal of arthroplasty.

[10]  J. Elting,et al.  The effect of surface coating of femoral prostheses implanted without cement: a 2- to 4-year follow-up study. , 1998, American journal of orthopedics.

[11]  W. Capello,et al.  Hydroxyapatite coated implants. Total hip arthroplasty in the young patient and patients with avascular necrosis. , 1997, Clinical orthopaedics and related research.

[12]  D. Hungerford,et al.  Proximally coated ingrowth prostheses. A review. , 1997, Clinical orthopaedics and related research.

[13]  W. Capello,et al.  Hydroxyapatite-Coated Total Hip Femoral Components in Patients Less Than Fifty Years Old. Clinical and Radiographic Results after Five to Eight Years of Follow-up* , 1997, The Journal of bone and joint surgery. American volume.

[14]  K. Søballe,et al.  Hydroxyapatite and Fluorapatite Coatings for Fixation of Weight Loaded Implants , 1997, Clinical orthopaedics and related research.

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

[16]  J. Zerwekh,et al.  Porous ceramics as bone graft substitutes in long bone defects: A biomechanical, histological, and radiographic analysis , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[17]  J. Lane,et al.  Total hip arthroplasty. , 1996, Current opinion in rheumatology.

[18]  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.

[19]  E. Munting.  The contributions and limitations of hydroxyapatite coatings to implant fixation , 1996, International Orthopaedics.

[20]  D. Davy,et al.  Effects of hydroxyapatite tricalcium phosphate coating and intracancellous placement on bone ingrowth in titanium fibermetal implants. , 1995, The Journal of arthroplasty.

[21]  R. Barrack,et al.  Effects of indomethacin on biologic fixation of porous-coated titanium implants. , 1995, The Journal of arthroplasty.

[22]  L. Dorr,et al.  Hydroxyapatite-coated proximal ingrowth femoral stems. A matched pair control study. , 1995, Clinical orthopaedics and related research.

[23]  S. Cook,et al.  The effect of warfarin on the attachment of bone to hydroxyapatite-coated and uncoated porous implants. , 1995, The Journal of bone and joint surgery. American volume.

[24]  S. Cook,et al.  The effect of operative fit and hydroxyapatite coating on the mechanical and biological response to porous implants. , 1995, The Journal of bone and joint surgery. American volume.

[25]  L. Dorr,et al.  Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study. , 1994, The Journal of arthroplasty.

[26]  W. Dhert.  Retrieval studies on calcium phosphate-coated implants. , 1994, Medical progress through technology.

[27]  D. Scott,et al.  Rationale and clinical application of hydroxyapatite coatings in pressfit total hip arthroplasty. , 1993, Seminars in arthroplasty.

[28]  J. Callaghan,et al.  The clinical results and basic science of total hip arthroplasty with porous-coated prostheses. , 1993, The Journal of bone and joint surgery. American volume.

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

[30]  S D Cook,et al.  Hydroxylapatite coating of porous implants improves bone ingrowth and interface attachment strength. , 1992, Journal of biomedical materials research.

[31]  W. Harris,et al.  Porous-coated uncemented components in experimental total hip arthroplasty in dogs. Effect of plasma-sprayed calcium phosphate coatings on bone ingrowth. , 1992, Clinical orthopaedics and related research.

[32]  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.

[33]  B. Wroblewski,et al.  Charnley low-friction arthroplasty: 19- to 25-year results. , 1992, Orthopedics.

[34]  M. B. Coventry,et al.  Lessons learned in 30 years of total hip arthroplasty. , 1992, Clinical orthopaedics and related research.

[35]  M. Mayor,et al.  Enhanced ingrowth of porous-coated CoCr implants plasma-sprayed with tricalcium phosphate. , 1992, Journal of biomedical materials research.

[36]  P. Greis,et al.  A long-term study on defect filling and bone ingrowth using a canine fiber metal total hip model. , 1992, Clinical orthopaedics and related research.

[37]  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.

[38]  E. Munting.  Ingrowth and formation of bone in defects in an uncemented fiber-metal total hip-replacement model in dogs. , 1991, The Journal of bone and joint surgery. American volume.

[39]  J. Orr,et al.  An Investigation into the Fixation of Hip Replacements , 1991, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[40]  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.

[41]  D. Collis.  Long-term (twelve to eighteen-year) follow-up of cemented total hip replacements in patients who were less than fifty years old. A follow-up note. , 1991, The Journal of bone and joint surgery. American volume.

[42]  R. Furlong,et al.  HYDROXYAPATITE CERAMIC COATINGS , 1991 .

[43]  T W Phillips,et al.  Loosening of cementless femoral stems: a biomechanical analysis of immediate fixation with loading vertical, femur horizontal. , 1991, Journal of biomechanics.

[44]  C. Engh,et al.  The case for porous-coated hip implants. The femoral side. , 1990, Clinical orthopaedics and related research.

[45]  W. Capello.  Technical aspects of cementless total hip arthroplasty. , 1990, Clinical orthopaedics and related research.

[46]  S. Radin,et al.  Effect of calcium phosphate coating characteristics on early post-operative bone tissue ingrowth. , 1990, Biomaterials.

[47]  C. Engh,et al.  Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. , 1990, Clinical orthopaedics and related research.

[48]  R. Rothman,et al.  Cemented versus cementless total hip arthroplasty. A critical review. , 1990, Clinical orthopaedics and related research.

[49]  R Poss,et al.  Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. , 1990, The Journal of bone and joint surgery. American volume.

[50]  Christopher C. Berndt,et al.  Thermal spraying for bioceramic applications , 1990 .

[51]  R. Geesink.  Hydroxyapatite-coated total hip protheses : two-year clinical roentenografic results of 100 cases , 1990 .

[52]  T. Trancik,et al.  The effect of indomethacin, aspirin, and ibuprofen on bone ingrowth into a porous-coated implant. , 1989, Clinical orthopaedics and related research.

[53]  R G Geesink,et al.  Experimental and clinical experience with hydroxyapatite-coated hip implants. , 1989, Orthopedics.

[54]  A. Rosenberg.  Cementless total hip arthroplasty: femoral remodeling and clinical experience. , 1989, Orthopedics.

[55]  H Weinans,et al.  Adaptive bone remodeling and biomechanical design considerations for noncemented total hip arthroplasty. , 1989, Orthopedics.

[56]  G. Kieckhefer,et al.  Measuring Human Responses Using Visual Analogue Scales , 1989, Western journal of nursing research.

[57]  T. Trancik,et al.  Effects of indomethacin on bone ingrowth , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[58]  P. Ducheyne,et al.  The effect of plasma-sprayed calcium phosphate ceramic coatings on the metal ion release from porous titanium and cobalt-chromium alloys. , 1988, Journal of biomedical materials research.

[59]  J. Galante,et al.  Calcium phosphate-coated porous titanium implants for enhanced skeletal fixation. , 1988, Journal of biomedical materials research.

[60]  C. Klein,et al.  Chemical implant fixation using hydroxyl-apatite coatings. The development of a human total hip prosthesis for chemical fixation to bone using hydroxyl-apatite coatings on titanium substrates. , 1987, Clinical orthopaedics and related research.

[61]  T Albrektsson,et al.  Osseointegration of bone implants. A review of an alternative mode of fixation. , 1987, Acta orthopaedica Scandinavica.

[62]  C. Wright,et al.  Handbook of biomaterials evaluation: Scientific, technical, and clinical testing of implant materials , 1987 .

[63]  Mclaughlin Re,et al.  Enhanced stabilization of porous-coated metal implants with tricalcium phosphate granules. , 1987 .

[64]  M. Spector.  Noncemented hip implants. Factors augmenting or inhibiting biological fixation. , 1987, The Hip.

[65]  J. Galante,et al.  A comparative study of porous coatings in a weight-bearing total hip-arthroplasty model. , 1986, The Journal of bone and joint surgery. American volume.

[66]  J. Zerwekh,et al.  Granular tricalcium phosphate in large cancellous defects. , 1986, Annals of clinical and laboratory science.

[67]  A. F. Recum.  Handbook of biomaterials evaluation: Scientific, technical, and clinical testing of implant materials , 1986 .

[68]  J. S. Skraba,et al.  Use of tricalcium phosphate or electrical stimulation to enhance the bone-porous implant interface. , 1986, Journal of biomedical materials research.

[69]  W. Harris.  Factors controlling optimal bone ingrowth of total hip replacement components. , 1986, Instructional course lectures.

[70]  J. Rueger,et al.  Time sequence of osteoinduction and osteostimulation elicited by biologic bone replacement materials. , 1985, Life support systems : the journal of the European Society for Artificial Organs.

[71]  D. Collis.  Cemented total hip replacement in patients who are less than fifty years old. , 1984, The Journal of bone and joint surgery. American volume.

[72]  A. Uchida,et al.  The use of ceramics for bone replacement. A comparative study of three different porous ceramics. , 1984, The Journal of bone and joint surgery. British volume.

[73]  Michael Jarcho,et al.  Calcium phosphate ceramics as hard tissue prosthetics. , 1981, Clinical orthopaedics and related research.

[74]  J. Osborn,et al.  The material science of calcium phosphate ceramics. , 1980, Biomaterials.

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

[76]  R. Pilliar,et al.  Evaluation of biodegradable ceramic. , 1977, Journal of biomedical materials research.

[77]  L. Riley,et al.  Ectopic ossification following total hip replacement. Incidence and a method of classification. , 1973, The Journal of bone and joint surgery. American volume.

[78]  J. Charnley,et al.  The nine and ten year results of the low-friction arthroplasty of the hip. , 1973, Clinical orthopaedics and related research.

[79]  J. Galante,et al.  Sintered fiber metal composites as a basis for attachment of implants to bone. , 1971, The Journal of bone and joint surgery. American volume.

[80]  S F Hulbert,et al.  Potential of ceramic materials as permanently implantable skeletal prostheses. , 1970, Journal of biomedical materials research.