Survival of total hip arthroplasty (THA) Survival of total hip arthroplasty (THA) in younger patients in younger patients Effect of hydroxyapatite coating and Effect of hydroxyapatite coating and cement cement Aksel Paulsen, Søren P. Johnsen, Aksel Paulsen, Søren P. Johnsen, Alma B. Pedersen, Ulf Lucht, Alma B. Pedersen, Ulf Lucht, Søren Overgaard Søren Overgaard Department of Orthopedics, Aarhus University Hospital, Department of Orthopedics, Aarhus University Hospital, Denmark. Denmark. Department of Clinical Epidemiology, Aarhus University Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. Hospital, Denmark. Department of Orthopedics, Odense University Hospital, Department of Orthopedics, Odense University Hospital, Denmark. Denmark. University of Southern Denmark, SDU, Denmark University of Southern Denmark, SDU, Denmark
22
Embed
Survival of total hip arthroplasty (THA) in younger patients Effect of hydroxyapatite coating and cement Aksel Paulsen, Søren P. Johnsen, Alma B. Pedersen,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Survival of total hip arthroplasty (THA) in younger Survival of total hip arthroplasty (THA) in younger patientspatients
Effect of hydroxyapatite coating and cementEffect of hydroxyapatite coating and cement
Aksel Paulsen, Søren P. Johnsen, Aksel Paulsen, Søren P. Johnsen,
Alma B. Pedersen, Ulf Lucht, Alma B. Pedersen, Ulf Lucht, Søren OvergaardSøren Overgaard
Department of Orthopedics, Aarhus University Hospital, Denmark.Department of Orthopedics, Aarhus University Hospital, Denmark.Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
Department of Orthopedics, Odense University Hospital, Denmark.Department of Orthopedics, Odense University Hospital, Denmark.University of Southern Denmark, SDU, DenmarkUniversity of Southern Denmark, SDU, Denmark
INTRODUCTION:INTRODUCTION:
Hydroxyapatite (HA) coating of uncemented THA is widely Hydroxyapatite (HA) coating of uncemented THA is widely used; however, the effect of HA on implant survival are used; however, the effect of HA on implant survival are sparse. sparse.
AIM:AIM:
1. What is the effect of HA coating on the survival of 1. What is the effect of HA coating on the survival of uncemented THA, compared to non HA coating, in cups uncemented THA, compared to non HA coating, in cups and stems? and stems?
2. What is the effect compared to cemented THA? 2. What is the effect compared to cemented THA?
MATERIAL:MATERIAL:
This review is a cohort analysisThis review is a cohort analysis based on based on the Danish Hip the Danish Hip Arthroplasty Registry (DHR).Arthroplasty Registry (DHR).
We identified all primary THA in patients less than 70 years We identified all primary THA in patients less than 70 years during 1995-2003. during 1995-2003. The follow-up was 0-9 years.The follow-up was 0-9 years.
MATERIAL:MATERIAL:
Available for analyses:Available for analyses:
Cups : Cups : A A total of 23,516;total of 23,516;
We defined revision of the components as endpoint, We defined revision of the components as endpoint, divided into two different outcomes; revision because of divided into two different outcomes; revision because of aseptic loosening, and revision due to ”any reason”aseptic loosening, and revision due to ”any reason”
Revision and ”any reason” was defined in accordance to Revision and ”any reason” was defined in accordance to the DHR registration form.the DHR registration form.
METHODS: METHODS:
The relative risk (RR) of revision due to aseptic loosening or The relative risk (RR) of revision due to aseptic loosening or “any reason”, was adjusted for possible confounders using “any reason”, was adjusted for possible confounders using multivariate Cox regression analysis.multivariate Cox regression analysis. The analyzes were adjusted for:The analyzes were adjusted for:
age (< 50, 50-59, 60-69), age (< 50, 50-59, 60-69), gender, gender, primary diagnosisprimary diagnosis, , and and fixationfixation of the opposite of the opposite implant part (Cup /Stem). implant part (Cup /Stem).
METHODS: METHODS:
Statistical analyzes: Statistical analyzes:
age (<60, 60-69), age (<60, 60-69), gender, gender, producer/ model of the components, producer/ model of the components, diagnosis diagnosis (primary arthrosis/ (primary arthrosis/ ““all diagnosis”)all diagnosis”). .
None of the groups had less than 400 patients.
The software we used was SAS. Statistician Anders Riis was of technical assistance in the formulation of the statistical analysis.
Statistical level of significance was set to 5 %.
RESULTS: RESULTS:
Cups; HA-coating VS. non HA-coating Cups; HA-coating VS. non HA-coating (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;
Cups; HA-coating VS. non HA-coating Cups; HA-coating VS. non HA-coating (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;
StemsStems; HA-coating VS. non HA-coating ; HA-coating VS. non HA-coating (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;
Stems; HA-coating VS. non HA-coating Stems; HA-coating VS. non HA-coating (all diagnosis) (all diagnosis) Adjusted RRs of revision; Adjusted RRs of revision;
Use of HA-coated implants was not associated with any Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger implants, in this medium term follow-up study of younger patients (<70).patients (<70).
CONCLUSION:CONCLUSION:
Use of HA-coated implants was not associated with any Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger implants, in this medium term follow-up study of younger patients (<70).patients (<70).
Cemented implants as a group had higher revision rates Cemented implants as a group had higher revision rates due to aseptic loosening than cementless implants, but not due to aseptic loosening than cementless implants, but not unambiguously higher revision rates due to “any reason” unambiguously higher revision rates due to “any reason” than cementless implants in this study.than cementless implants in this study.
CONCLUSION:CONCLUSION:
Use of HA-coated implants was not associated with any Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger implants, in this medium term follow-up study of younger patients (<70).patients (<70).
Cemented implants as a group had higher revision rates Cemented implants as a group had higher revision rates due to aseptic loosening than cementless implants, but not due to aseptic loosening than cementless implants, but not unambiguously higher revision rates due to “any reason” unambiguously higher revision rates due to “any reason” than cementless implants in this study.than cementless implants in this study.
Müller, Exeter, and Charnley cups had the highest revision Müller, Exeter, and Charnley cups had the highest revision rates of the cups. Bi-metric Cemented, Charnley and rates of the cups. Bi-metric Cemented, Charnley and Lubinus SP II stems had the highest revision rates for Lubinus SP II stems had the highest revision rates for stems in this medium term follow-up study of younger stems in this medium term follow-up study of younger patients (<70).patients (<70).