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The Journal of Bone and Joint Surgery (American) 83:817-825 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Hydroxyapatite-Coated Acetabular Components

Histological and Histomorphometric Analysis of Six Cups Retrieved at Autopsy Between Three and Seven Years After Successful Implantation

Alfons Tonino, MD, PhD, Cees Oosterbos, MD, Ali Rahmy, MD, Michel Thèrin, MD and Christina Doyle, PhD

Investigation performed at the Department of Orthopaedics, De Wever Hospital, Heerlen, The Netherlands
Alfons Tonino, MD, PhD
Cees Oosterbos, MD
Ali Rahmy, MD
Department of Orthopaedics, De Wever Hospital, PO Box 4446, 6401 CX Heerlen, The Netherlands. E-mail address for A. Tonino: a.tonino{at}inter.nl.net

Michel Thèrin, MD
R & D Department, Sofradim, 116, Avenue du Formans, 01600 Trévoux, France. E-mail address: m.therin@sofradim.com

Christina Doyle, PhD
Howmedica International, Ash House, Fairfield Avenue, Staines, Middlesex TW18 4AN, England
One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other nonprofit organization with which one or more of the authors is associated. No funds were received in support of this study.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our CD-ROM (call 781-449-9780, ext. 140, to order).

Background: Important questions remain regarding the use of hydroxyapatite-coated acetabular components in total hip arthroplasty. What is the relation of resorption of the hydroxyapatite coating to enduring fixation? Will unresorbed or dislodged hydroxyapatite particles cause adverse tissue reactions? Retrieval studies of clinically well-functioning acetabular components should help to answer these questions.

Methods: We examined six clinically successful hydroxyapatite-coated cementless acetabular components that were retrieved at autopsy between 3.3 and 6.6 years after implantation. All components were of the same design. The prostheses and the surrounding bone were prepared for qualitative histological and quantitative histomorphometric analysis. The percentage of bone growth onto the implant, the relative bone area around the implant, the extent of residual hydroxyapatite coating, and the coating thickness were measured.

Results: All of the cups showed bone ongrowth, with a mean bone-implant contact (and standard deviation) of 36.5% ± 13.5%. The contact area was the same in all three zones delineated by DeLee and Charnley. The extent and thickness of the hydroxyapatite layer were much reduced in the specimens from older patients and in those associated with a longer duration of implantation. Degradation of the hydroxyapatite coating by osteoclasts was observed. We did not observe loose hydroxyapatite granules far from the coating, nor did we note any adverse tissue reaction to these granules. In contrast, polyethylene debris was noted in approximately half of the empty screw-holes.

Conclusions: Cell-mediated hydroxyapatite resorption seems to be the main reason for loss of hydroxyapatite coating. The area of bone ongrowth was within a certain range (20% to 50%) of the measured surfaces, and it was independent of the amount of hydroxyapatite residue. The hydroxyapatite coating showed a slow rate of resorption with time, without any adverse tissue reactions.


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J. Dumbleton and M. T. Manley
Hydroxyapatite-Coated Prostheses in Total Hip and Knee Arthroplasty
J. Bone Joint Surg. Am., November 1, 2004; 86(11): 2526 - 2540.
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