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Comparison of a Hydroxyapatite-Coated Sleeve and a Porous-Coated Sleeve with a Modular Revision Hip Stem

A Prospective, Randomized Study

¹ Division of Orthopaedic Surgery, Duke University Medical Center, Box 3332, Durham, NC 27710
² Triangle Orthopaedic Associates, 120 William Penn Plaza, Durham, NC 27704

Investigation performed at the Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (DePuy, a Johnson and Johnson company) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: Between August 1992 and December 1996, fifty-three consecutive femoral revisions performed with an S-ROM stem in fifty-two patients were prospectively randomized at the time of surgery to either a hydroxyapatite-coated or a porous-coated sleeve. All patients were evaluated clinically and radiographically at three months, six months, and yearly for a minimum of two years (average, four years; range, two to 7.5 years). Femoral defects were classified according to the criteria of Paprosky et al. Six patients died and four patients were lost to follow-up, leaving forty-two patients (forty-three hips) as the final study group.

Results: For the entire group, two femoral stems, one of which had been implanted in a hip with a Paprosky type-II femoral defect and the other in a hip with a Paprosky type-IIIB femoral defect, required a repeat revision, one for pain and the other for aseptic loosening. Radiographic evidence of bone ingrowth was observed in 96% (twenty-six) of the twenty-seven femora with type-I or II defects and in 81% (thirteen) of the sixteen femora with type-III defects. Femoral component survival, with use of revision as the end point, was 95% at four years for the entire group. The Harris hip scores were not significantly different when stratified by implant type, but were significantly different when stratified by bone loss (p < 0.05). In the femora with type-I or II defects, no difference was detected between those treated with a hydroxyapatite-coated implant and those that received a porous-coated implant with respect to bone ingrowth. However, in femora with type-III defects, the likelihood of the development of bone ingrowth was 2.6 (95% confidence interval, 1.3 to 5.17) times greater in hips that received a hydroxyapatite-coated implant (all eight developed ingrowth) than in hips that had a porous-coated implant (five of eight developed ingrowth) (p = 0.05).

Conclusions: Bone fixation was achieved more often with hydroxyapatite-coated sleeves in femora with Paprosky type-III defects, but no significant difference was noted in outcomes between the two implant types when used in bone with type-I or type-II femoral defects. Overall, the S-ROM modular hip stem performed better in femora with type-I or II bone defects than in femora with type-III defects.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

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