No medium-term advantage of electrochemical deposition of hydroxyapatite in cementless femoral stems. 5-year RSA and DXA results from a randomized controlled trial

Bernhard Flatøy, Stephan M Röhrl, Berte Bøe, Lars Nordsletten, Bernhard Flatøy, Stephan M Röhrl, Berte Bøe, Lars Nordsletten

Abstract

Background and purpose: Hydroxyapatite has been used for a long time as an adjunct to enhance cementless fixation. The benefit of this is still debated, but new methods of hydroxyapatite deposition have emerged, offering possible gains. In order to investigate this further, we compared the migration pattern and periprosthetic bone remodeling in a cementless femoral stem with either electrochemically deposited hydroxyapatite-called Bonemaster (BM)-or a conventional plasma-sprayed hydroxyapatite (HA) coating.

Patients and methods: 55 hips were randomized to either BM or HA cementless femoral stems. Patients were followed with radiostereometry (RSA), dual-energy X-ray absorptiometry (DXA), radiographic measurements, and hip questionnaires for 5 years.

Results: For both stems, migration occurred mainly as subsidence and retroversion during the first 3 months. The BM group had a higher retroversion rate of 0.17° per month during this period, as compared to 0.06° per month for the HA group (p = 0.006). Thereafter, there was almost no movement in any direction for both stem types. Bone resorption occurred mainly during the first year, and subsequently decreased to a rate close to what is seen in normal ageing. The greatest total decrease occurred in Gruen zones 1 and 7, similar in the groups at 5 years. There was a slightly higher resorption rate in Gruen zone 7 from 2 to 5 years in the BM group (1.3% per year; p = 0.04), but in a magnitude that would scarcely affect stem stability or survival.

Interpretation: There were no clinically relevant differences between the 2 stems regarding stability or periprosthetic bone loss at 5 years. Electrochemically deposited HA does not appear to affect fixation or bone remodeling when compared to conventional plasma spraying at 5 years. Thus, at this point, Bonemaster appears to be safe.

Trial registration: ClinicalTrials.gov NCT02321683.

Figures

Figure 1.
Figure 1.
Consort flow chart.
Figure 2.
Figure 2.
The postoperative, 3-month and 5-year radiographs from the patient that was excluded from RSA analysis. The stem seems to be undersized in the postoperative image. There is macroscopic subsidence from postoperatively to 3 months, but no visible changes thereafter, consistent with the RSA data.
Figure 3.
Figure 3.
BMD difference from the postoperative scans up to 5 years in all Gruen zones for each group.
Figure 4.
Figure 4.
BMD difference from the postoperative scans in Gruen zone 1 and 7.
Figure 5.
Figure 5.
Y-translation. Individual curves for each stem in both groups.
Figure 6.
Figure 6.
Y-rotation. Individual curves for each stem in both groups.

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