Hydroxyapatite-coated Femoral Components: 15-Year Minimum Followup

Hydroxyapatite-coated femoral components were introduced to enhance fixation, but concerns were raised about whether the coating would be maintained over time. We therefore determined the long-term clinical and radiographic results of a proximally hydroxyapatite-coated femoral component and compared the mechanical failure rate to other fixation methods at similar lengths of followup. The study group, culled from a large, multicenter prospective study population, consisted of 146 patients (166 hips) with followup of 15 to 18 years. Average age at time of the index procedure was 51 years, and the most common diagnoses were osteoarthritis (71%) and osteonecrosis (11%). Average Harris hip scores were 42.7 preoperatively and 91.5 at most recent followup. Radiographically, one stem showed stable fibrous fixation, and all other unrevised stems were bony stable. Of 13 stem revisions in the study population, only one stem has been revised for aseptic loosening. Forty-nine percent of hips have an osteolytic lesion in proximal areas of Gruen Zones 1, 7, 8, or 14 only. Both the femoral aseptic revision and mechanical failure rates are 0.6% at 15-year minimum followup. The data demonstrate excellent long-term survivorship of this hydroxyapatite-coated femoral component used in a relatively young patient group.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.