Tyagi Vineet, Harris Alex H S, Giori Nicholas J
VA Palo Alto Health Care System, Palo Alto, California; Department of Orthopedic Surgery, Stanford University, Stanford, California.
VA Palo Alto Health Care System, Palo Alto, California; Department of Surgery, Stanford University, Stanford, California.
J Arthroplasty. 2022 Jun;37(6):1143-1145. doi: 10.1016/j.arth.2022.02.067. Epub 2022 Feb 25.
Hydroxyapatite (HA) coatings were introduced to improve uncemented implant osteointegration and to prevent loosening and osteolysis. However, data regarding these implants have been inconsistent. We studied the effect of HA coating of femoral stems and acetabular cups on component revision after primary total hip arthroplasty (THA) in the veteran population.
We identified patients who underwent uncemented primary THA at any Veterans Health Administration (VHA) hospital from 2000 to 2017 and who had implants that were available as either HA-coated or non-HA-coated models. The endpoint was removal of the component of interest for any reason. For each individual stem and shell, unadjusted and adjusted (for age and body mass index) Cox proportional hazards models were used to estimate hazard ratios for the risk of explantation between HA-coated and non-HA-coated implants of the same type.
A total of 262 HA-coated cups, 4580 non-HA-coated cups, 4767 HA-coated stems, and 9397 non-HA-coated stems were available for analysis. The mean follow-up time was 9.01 years (43,627 total implant-years) for cups and 7.13 years (101,004 total implant-years) for stems. One of the two shells reviewed had significantly lower survivorship and an elevated hazard ratio for explantation with HA coating. Among the five implant pairs of stems, and the other shell, implant survival and hazard ratios for explantation were not affected by HA coating.
HA coating did not improve THA implant survival in our veteran population. Although HA-coated versions of hip implants tend to be more costly than their noncoated counterparts, these results do not support their general use.
羟基磷灰石（HA）涂层被用于改善非骨水泥型植入物的骨整合，并预防松动和骨溶解。然而，关于这些植入物的数据并不一致。我们研究了股骨柄和髋臼杯的HA涂层对退伍军人初次全髋关节置换术（THA）后假体翻修的影响。
我们确定了2000年至2017年期间在任何退伍军人健康管理局（VHA）医院接受非骨水泥型初次THA且植入物有HA涂层或非HA涂层型号的患者。终点是因任何原因取出感兴趣的组件。对于每个单独的柄和髋臼杯，使用未调整和调整（年龄和体重指数）的Cox比例风险模型来估计相同类型的HA涂层和非HA涂层植入物之间取出风险的风险比。
共有262个HA涂层髋臼杯、4580个非HA涂层髋臼杯、4767个HA涂层股骨柄和9397个非HA涂层股骨柄可供分析。髋臼杯的平均随访时间为9.01年（总植入物年数43,627），股骨柄为7.13年（总植入物年数101,004）。审查的两个髋臼杯之一的生存率显著较低，HA涂层取出的风险比升高。在五对股骨柄植入物和另一个髋臼杯中，植入物生存率和取出风险比不受HA涂层影响。
在我们的退伍军人人群中，HA涂层并未提高THA植入物的生存率。尽管HA涂层的髋关节植入物往往比未涂层的同类产品成本更高，但这些结果不支持其普遍使用。
