17 year review of hydroxyapatite ceramic coated hip implants - A clinical and histological evaluation

Cemented implants used in hip arthroplasty often loosen after ten or more years of use. This is partly mechanical but also associated with debris disease where particulate plastic is taken up by macrophages creating an aggressive granulation tissue which destroys the bone. The particulate plastic can arise from the cement and the polythene acetabular material. Cementing techniques have been improved and the Swedish Hip Register [1] demonstrates that the revision rates have been reduced with improved cementing techniques. However, uncemented hip arthroplasty is now having a revival. In particular, bioactive materials are being used and this paper presents the results of a consecutive series of primary hip arthroplasties carried out over a total period of over 17 years. All the patients are included being of any age and with any diagnosis including some femoral neck fractures. Patients are assessed using the Harris Hip Score [2]. 13% of the hips scored less than 80 on the Harris Hip Score but only 9.4% scored poor pain scores. These represent the results of poor hip arthroplasty, of which an even smaller percentage are related to failed HA hip arthroplasty.