Effects of hydroxyapatite coating on survival of an uncemented femoral stem
Effects of hydroxyapatite coating on survival of an uncemented femoral stem
复制标题
羟基磷灰石涂层对非骨水泥股骨柄存活的影响
作者：
Stergios Lazarinis;J. Kärrholm;N. Hailer
背景和目的羟基磷灰石（HA）被广泛用作非骨水泥型全髋关节置换术部件的涂层。这被认为可以改善植入物长入和长期稳定性。然而，在股骨柄上使用HA涂层的证据尚不明确。我们研究了带或不带HA涂层（Bi-Metric）的非骨水泥型锥形钛股骨柄的存活率。患者和方法1992年至2009年期间，在瑞典髋关节置换术登记中心登记的4，169例患者中，4，772例全髋关节置换术（THA）中使用了股骨柄。研究的股骨柄中有59%有HA涂层，41%无涂层。Kaplan-Meier生存分析和校正年龄、性别、初步诊断和髋臼杯固定类型的考克斯回归模型用于计算生存率和各种原因翻修风险的校正风险比（RR）。结果当我们以任何原因的翻修作为终点时，HA涂层版本和未涂层版本的10年生存率大致相等：分别为98%（95%CI：98-99）和98%（CI：97-99）。调整上述协变量的考克斯回归模型显示，HA涂层的存在对任何原因（RR = 1.0，95% CI：0.6-1.6）或无菌性松动（RR = 0.5，CI：0.2-1.5）导致的股骨柄翻修风险没有任何影响。HA涂层对因感染、脱位或骨折导致的股骨柄翻修风险没有影响。解释非骨水泥型Bi-Metric股骨柄显示出极好的10年生存率。我们的研究结果不支持在股骨柄上使用HA涂层来提高植入物存活率。
Background and purpose Hydroxyapatite (HA) is widely used as a coating for uncemented total hip arthroplasty components. This has been suggested to improve implant ingrowth and long-term stability. However, the evidence behind the use of HA coating on femoral stems is ambiguous. We investigated survival of an uncemented, tapered titanium femoral stem that was available either with or without HA coating (Bi-Metric). Patients and methods The stem had been used in 4,772 total hip arthroplasties (THAs) in 4,169 patients registered in the Swedish Hip Arthroplasty Register between 1992 and 2009. 59% of the stems investigated were coated with HA and 41% were uncoated. Kaplan-Meier survival analysis and a Cox regression model with adjustment for age, sex, primary diagnosis, and the type of cup fixation were used to calculate survival rates and adjusted risk ratios (RRs) of the risk of revision for various reasons. Results The 10-year survival rates of the HA-coated version and the uncoated version were about equal when we used revision for any reason as the endpoint: 98% (95% CI: 98–99) and 98% (CI: 97–99), respectively. A Cox regression model adjusting for the covariates mentioned above showed that the presence of HA coating did not have any influence on the risk of stem revision for any reason (RR = 1.0, 95% CI: 0.6–1.6) or due to aseptic loosening (RR = 0.5, CI: 0.2–1.5). There was no effect of HA coating on the risk of stem revision due to infection, dislocation, or fracture. Interpretation The uncemented Bi-Metric stem showed excellent 10-year survival. Our findings do not support the use of HA coating on this stem to enhance implant survival.