Chen Yun-Lin, Lin Tiao, Liu An, Shi Ming-Min, Hu Bin, Shi Zhong-Li, Yan Shi-Gui
Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, P.R. China.
J Orthop Surg Res. 2015 Jan 28;10:21. doi: 10.1186/s13018-015-0161-4.
There are some arguments between the use of hydroxyapatite and porous coating. Some studies have shown that there is no difference between these two coatings in total hip arthroplasty (THA), while several other studies have shown that hydroxyapatite has advantages over the porous one. We have collected the studies in Pubmed, MEDLINE, EMBASE, and the Cochrane library from the earliest possible years to present, with the search strategy of "(HA OR hydroxyapatite) AND ((total hip arthroplasty) OR (total hip replacement)) AND (RCT* OR randomiz* OR control* OR compar* OR trial*)". The randomized controlled trials and comparative observation trials that evaluated the clinical and radiographic effects between hydroxyapatite coating and porous coating were included. Our main outcome measurements were Harris hip score (HHS) and survival, while the secondary outcome measurements were osteolysis, radiolucent lines, and polyethylene wear. Twelve RCTs and 9 comparative observation trials were included. Hydroxyapatite coating could improve the HHS (p < 0.01), reduce the incidence of thigh pain (p = 0.01), and reduce the incidence of femoral osteolysis (p = 0.01), but hydroxyapatite coating had no advantages on survival (p = 0.32), polyethylene wear (p = 0.08), and radiolucent lines (p = 0.78). Hydroxyapatite coating has shown to have an advantage over porous coating. The HHS and survival was duration-dependent-if given the sufficient duration of follow-up, hydroxyapatite coating would be better than porous coating for the survival. The properties of hydroxyapatite and the implant design had influence on thigh pain incidence, femoral osteolysis, and polyethylene wear. Thickness of 50 to 80 μm and purity larger than 90% increased the thigh pain incidence. Anatomic design had less polyethylene wear.
在羟基磷灰石涂层与多孔涂层的使用方面存在一些争议。一些研究表明，在全髋关节置换术（THA）中这两种涂层之间没有差异，而其他一些研究则表明羟基磷灰石涂层比多孔涂层具有优势。我们从最早年份到现在收集了PubMed、MEDLINE、EMBASE和Cochrane图书馆中的研究，检索策略为“(HA或羟基磷灰石) AND ((全髋关节置换术) 或 (全髋关节翻修术)) AND (RCT或randomiz或control或compar或trial*)”。纳入了评估羟基磷灰石涂层与多孔涂层之间临床和影像学效果的随机对照试验和比较观察试验。我们的主要结局指标是Harris髋关节评分（HHS）和生存率，次要结局指标是骨溶解、透亮线和聚乙烯磨损。纳入了12项随机对照试验和9项比较观察试验。羟基磷灰石涂层可改善HHS（p < 0.01），降低大腿疼痛发生率（p = 0.01），并降低股骨骨溶解发生率（p = 0.01），但羟基磷灰石涂层在生存率（p = 0.32）、聚乙烯磨损（p = 0.08）和透亮线方面没有优势（p = 0.78）。羟基磷灰石涂层已显示出比多孔涂层具有优势。HHS和生存率与随访时间有关——如果给予足够的随访时间，羟基磷灰石涂层在生存率方面将优于多孔涂层。羟基磷灰石的特性和植入物设计对大腿疼痛发生率、股骨骨溶解和聚乙烯磨损有影响。50至80μm的厚度和大于90%的纯度会增加大腿疼痛发生率。解剖设计的聚乙烯磨损较少。
