Comparison of Porous-Coated Titanium Femoral Stems with and without Hydroxyapatite Coating

Background: The purpose of this prospective, randomized study was to evaluate the clinical and radiographic results associated with proximally porous-coated titanium stems that were identical in geometry but differed with regard to proximal surface treatment (with or without hydroxyapatite coating).

Methods: A prospective, randomized study was performed to evaluate fifty patients (100 hips) who had undergone sequential bilateral primary total hip replacement. A proximally porous-coated titanium stem with hydroxyapatite coating was implanted on one side and a proximally porous-coated titanium stem without hydroxyapatite coating was implanted on the other side during the same operative setting in all fifty patients. A cementless acetabular component made of titanium was used in all hips. There were thirty-six men and fourteen women; the mean age at the time of the operation was 45.3 years. The mean duration of follow-up was 6.6 years. Clinical and radiographic evaluations were performed preoperatively; at six weeks; at three, six, and twelve months; and yearly thereafter.

Results: The Harris hip scores in the hydroxyapatite-coated group (mean, 94 points) and non-hydroxyapatite-coated group (mean, 92 points) were similar at the final follow-up examination. The prevalence of transient pain in the thigh was 4% in each group. No acetabular or femoral component demonstrated aseptic loosening. Bone-remodeling patterns, including calcar atrophy, were similar in the two groups. No acetabular or femoral osteolysis was seen.

Conclusions: At a mean of 6.6 years postoperatively, the clinical and radiographic results associated with proximally porous-coated femoral prostheses with identical geometries that differed only with regard to the presence or absence of hydroxyapatite coating were similar.

Level of Evidence: Therapeutic study, Level I-1b (randomized controlled trial [no significant difference but narrow confidence intervals]). See Instructions to Authors for a complete description of levels of evidence.