Jaffe W L, Scott D F
Department of Orthopaedic Surgery, Hospital for Joint Diseases Orthopaedic Institute, New York.
Semin Arthroplasty. 1993 Jul;4(3):159-66.
Although the long-term clinical results of cemented total hip arthroplasty are quite good, there is a significant problem with failure after approximately 10 years, especially with younger patients. Uncemented total hip arthroplasty has been developed in response to prosthesis loosening due to cement fragmentation and osteolysis. Porous-coated hip stems have been used, with generally promising results. However, clinical studies of porous-coated prostheses have revealed findings of concern such as thigh pain, subsidence of the femoral prosthesis, and radiographic lucencies at the bone-prosthesis interface. Hydroxyapatite coatings were developed to improve the fixation of uncemented prostheses. This article discusses the chemical, mechanical, and biological properties of hydroxyapatite coatings, and reviews the biologic behavior of experimental hydroxyapatite-coated implants. The clinical and radiographic results of a 4-year prospective trial are presented. The authors conclude that the reported experimental evidence, as well as the early clinical experience of this series and others, support the continued clinical evaluation of hydroxyapatite-coated titanium for total hip arthroplasty in younger, active patients.
尽管骨水泥型全髋关节置换术的长期临床效果相当不错，但大约10年后会出现显著的失败问题，尤其是对于年轻患者。非骨水泥型全髋关节置换术是为应对因骨水泥碎裂和骨溶解导致的假体松动而研发的。多孔涂层髋关节柄已被使用，总体效果良好。然而，多孔涂层假体的临床研究揭示了一些令人担忧的结果，如大腿疼痛、股骨假体下沉以及骨-假体界面的影像学透亮区。羟基磷灰石涂层的研发旨在改善非骨水泥型假体的固定。本文讨论了羟基磷灰石涂层的化学、机械和生物学特性，并回顾了实验性羟基磷灰石涂层植入物的生物学行为。还展示了一项为期4年的前瞻性试验的临床和影像学结果。作者得出结论，所报道的实验证据以及本系列和其他研究的早期临床经验，支持对年轻、活跃患者的全髋关节置换术中使用羟基磷灰石涂层钛进行持续的临床评估。
