Kim William T, Woodruff Robert, Kalore Niraj V, Vallem Madan M, Cyrus John W, Krumme John W, Patel Nirav K, Golladay Gregory J
Eastern Virginia Medical School, Norfolk, Virginia.
Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina.
J Arthroplasty. 2024 Mar;39(3):846-850.e2. doi: 10.1016/j.arth.2023.08.071. Epub 2023 Aug 28.
Most primary total hip arthroplasties (THAs) performed in the United States utilize cementless fixation with porous or hydroxyapatite (HA) coating. A previous meta-analysis comparing HA-coated versus non-HA-coated stems in primary THA published in 2013 found no significant difference between the 2. However, an updated analysis of the current literature is needed to assess the potential benefit of HA-coated stems in primary THA.
Various libraries were searched through May 2022 according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies included were randomized controlled trials comparing HA-coated femoral stems to non-HA-coated stems in primary THA. Outcomes included Harris Hip Score (HHS), endosteal bone formation, radiolucent lines, linear wear rate, revision for aseptic loosening, thigh pain, and heterotopic ossification.
There were significantly fewer revisions for aseptic loosening (P = .004) and decreased postoperative thigh pain (P = .03) for patients who have with HA-coated stems. There was no significant difference in HHS (P = .20), endosteal bone formation (P = .96), radiolucent lines (P = .75), linear wear rate (P = .41), or heterotopic ossification (P = .71) between HA-coated and non-HA-coated stems.
We found that HA-coated femoral stems in primary THA led to significantly fewer stem revisions for aseptic loosening and less postoperative thigh pain compared to non-HA-coated stems. These findings suggest HA-coated femoral stems should be preferred over non-HA-coated femoral stems in primary THA.
在美国进行的大多数初次全髋关节置换术（THA）采用带有多孔涂层或羟基磷灰石（HA）涂层的非骨水泥固定。2013年发表的一项比较初次THA中HA涂层与非HA涂层股骨柄的荟萃分析发现两者之间无显著差异。然而，需要对当前文献进行更新分析，以评估HA涂层股骨柄在初次THA中的潜在益处。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，检索截至2022年5月的各种数据库。纳入的研究为比较初次THA中HA涂层股骨柄与非HA涂层股骨柄的随机对照试验。结局指标包括Harris髋关节评分（HHS）、骨内膜骨形成、透亮线、线性磨损率、无菌性松动翻修、大腿疼痛和异位骨化。
使用HA涂层股骨柄的患者无菌性松动翻修明显更少（P = 0.004），术后大腿疼痛减轻（P = 0.03）。HA涂层和非HA涂层股骨柄在HHS（P = 0.20）、骨内膜骨形成（P = 0.96）、透亮线（P = 0.75）、线性磨损率（P = 0.41）或异位骨化（P = 0.71）方面无显著差异。
我们发现，与非HA涂层股骨柄相比，初次THA中HA涂层股骨柄导致无菌性松动的柄翻修明显更少，术后大腿疼痛也更少。这些发现表明，在初次THA中，HA涂层股骨柄应优于非HA涂层股骨柄。
