TY - JOUR
T1 - The beneficial effect of hydroxyapatite lasts
T2 - A randomized radiostereometric trial comparing hydroxyapatite-coated, uncoated, and cemented tibial components for up to 16 years
AU - Pijls, Bart G.
AU - Valstar, Edward R.
AU - Kaptein, Bart L.
AU - Fiocco, Marta
AU - Nelissen, Rob G.H.H.
N1 - Funding Information:
The authors thank the Atlantic Innovation Fund (Atlantic Canada Opportunities Agency) and the Dutch Arthritis Association (LRR 13) for providing funding for this study. The sponsor did not take part in the design or conduction of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors also thank Dr Maiken Stilling and Dr Anders Henricson for their very helpful reviews of the manuscript.
PY - 2012/4
Y1 - 2012/4
N2 - Background and purpose In contrast to early migration, the long-term migration of hydroxyapatite- (HA-) coated tibial components in TKA has been scantily reported. This randomized controlled trial investigated the long-term migration measured by radiostereometric analysis (RSA) of HA-coated, uncoated, and cemented tibial components in TKA. Patients and methods 68 knees were randomized to HA-coated (n = 24), uncoated (n = 20), and cemented (n = 24) components. All knees were prospectively followed for 1116 years, or until death or revision. RSA was used to evaluate migration at yearly intervals. Clinical and radiographic evaluation was according to the Knee Society system. A generalized linear mixed model (GLMM, adjusted for age, sex, diagnosis, revisions, and BMI) was used to take into account the repeated-measurement design. Results The present study involved 742 RSA analyses. The mean migration at 10 years was 1.66 mm for HA, 2.25 mm for uncoated and 0.79 mm for the cemented group (p < 0.001). The reduction of migration by HA as compared to uncoated components was most pronounced for subsidence and external rotation. 3 tibial components were revised for aseptic loosening (2 uncoated and 1 cemented), 3 for septic loosening (2 uncoated and 1 cemented), and 1 for instability (HA-coated). 2 of these cases were revised for secondary loosening after a period of stability: 1 case of osteolysis and 1 case of late infection. There were no statistically significant differences between the fixation groups regarding clinical or radiographic scores. Interpretation HA reduces migration of uncemented tibial components. This beneficial effect lasts for more than 10 years. Cemented components showed the lowest migration. Longitudinal follow-up of TKA with RSA allows early detection of secondary loosening.
AB - Background and purpose In contrast to early migration, the long-term migration of hydroxyapatite- (HA-) coated tibial components in TKA has been scantily reported. This randomized controlled trial investigated the long-term migration measured by radiostereometric analysis (RSA) of HA-coated, uncoated, and cemented tibial components in TKA. Patients and methods 68 knees were randomized to HA-coated (n = 24), uncoated (n = 20), and cemented (n = 24) components. All knees were prospectively followed for 1116 years, or until death or revision. RSA was used to evaluate migration at yearly intervals. Clinical and radiographic evaluation was according to the Knee Society system. A generalized linear mixed model (GLMM, adjusted for age, sex, diagnosis, revisions, and BMI) was used to take into account the repeated-measurement design. Results The present study involved 742 RSA analyses. The mean migration at 10 years was 1.66 mm for HA, 2.25 mm for uncoated and 0.79 mm for the cemented group (p < 0.001). The reduction of migration by HA as compared to uncoated components was most pronounced for subsidence and external rotation. 3 tibial components were revised for aseptic loosening (2 uncoated and 1 cemented), 3 for septic loosening (2 uncoated and 1 cemented), and 1 for instability (HA-coated). 2 of these cases were revised for secondary loosening after a period of stability: 1 case of osteolysis and 1 case of late infection. There were no statistically significant differences between the fixation groups regarding clinical or radiographic scores. Interpretation HA reduces migration of uncemented tibial components. This beneficial effect lasts for more than 10 years. Cemented components showed the lowest migration. Longitudinal follow-up of TKA with RSA allows early detection of secondary loosening.
UR - http://www.scopus.com/inward/record.url?scp=84860227955&partnerID=8YFLogxK
U2 - 10.3109/17453674.2012.665330
DO - 10.3109/17453674.2012.665330
M3 - Article
C2 - 22329667
AN - SCOPUS:84860227955
SN - 1745-3674
VL - 83
SP - 135
EP - 141
JO - Acta Orthopaedica
JF - Acta Orthopaedica
IS - 2
ER -