Survival of total hip arthroplasty (THA) in younger patients Effect of hydroxyapatite coating and cement Aksel Paulsen, Søren P. Johnsen, Alma B. Pedersen,

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Survival of total hip arthroplasty (THA) in younger patients Effect of hydroxyapatite coating and cement Aksel Paulsen, Søren P. Johnsen, Alma B. Pedersen, Ulf Lucht, Søren Overgaard Department of Orthopedics, Aarhus University Hospital, Denmark. Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. Department of Orthopedics, Odense University Hospital, Denmark. University of Southern Denmark, SDU, Denmark

INTRODUCTION: Hydroxyapatite (HA) coating of uncemented THA is widely used; however, the effect of HA on implant survival are sparse. AIM: 1. What is the effect of HA coating on the survival of uncemented THA, compared to non HA coating, in cups and stems? 2. What is the effect compared to cemented THA?

MATERIAL: This review is a cohort analysis based on the Danish Hip Arthroplasty Registry (DHR). We identified all primary THA in patients less than 70 years during The follow-up was 0-9 years.

MATERIAL: Available for analyses: Cups : A total of 23,516; 8,556 cemented 3,151 uncemented, HA-coated 11,809 uncemented, non-HA-coated Stems: A total of 23,434; 15,634 cemented 2,318 uncemented, HA-coated 5,482 uncemented, non-HA-coated.

METHODS: We defined revision of the components as endpoint, divided into two different outcomes; revision because of aseptic loosening, and revision due to ”any reason” Revision and ”any reason” was defined in accordance to the DHR registration form. METHODS: We defined revision of the components as endpoint, divided into two different outcomes; revision because of aseptic loosening, and revision due to ”any reason” Revision and ”any reason” was defined in accordance to the DHR registration form.

METHODS: The relative risk (RR) of revision due to aseptic loosening or “any reason”, was adjusted for possible confounders using multivariate Cox regression analysis. The analyzes were adjusted for: age (< 50, 50-59, 60-69), gender, primary diagnosis, and fixation of the opposite implant part (Cup /Stem). METHODS: The relative risk (RR) of revision due to aseptic loosening or “any reason”, was adjusted for possible confounders using multivariate Cox regression analysis. The analyzes were adjusted for: age (< 50, 50-59, 60-69), gender, primary diagnosis, and fixation of the opposite implant part (Cup /Stem).

METHODS: Statistical analyzes: age (<60, 60-69), gender, producer/ model of the components, diagnosis (primary arthrosis/ “all diagnosis”). METHODS: Statistical analyzes: age (<60, 60-69), gender, producer/ model of the components, diagnosis (primary arthrosis/ “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: Cups; HA-coating VS. non HA-coating (all diagnosis) Adjusted RRs of revision; Endpoint: aseptic loosening; N total N total N revised N revised RR RR 95 % CI 95 % CI Uncemented - HA 11,809 11, Uncemented + HA 3,151 3,

RESULTS: Cups; HA-coating VS. non HA-coating (all diagnosis) Adjusted RRs of revision; Endpoint: aseptic loosening; Endpoint: any reason; Same findings for: idiopathic arthrosis, age, gender, component type N total N total N revised N revised RR RR 95 % CI 95 % CI Uncemented - HA 11,809 11, Uncemented + HA 3,151 3, N total N total N revised N revised RR RR 95 % CI 95 % CI Uncemented - HA 11,809 11, Uncemented + HA 3,151 3,

RESULTS: Cups; Cemented VS. Uncemented (all diagnosis) Adjusted RRs of revision; Endpoint: aseptic loosening; N total N total N revised N revised RR RR 95 % CI 95 % CI Cemented 8,556 8, Uncemented - HA 11,809 11, Uncemented + HA 3,151 3,

RESULTS: Cups; Cemented VS. Uncemented (all diagnosis) Adjusted RRs of revision; Endpoint: aseptic loosening; Endpoint: any reason; Same findings for: idiopathic arthrosis, age, gender, component type N total N total N revised N revised RR RR 95 % CI 95 % CI Cemented 8,556 8, Uncemented - HA 11,809 11, Uncemented + HA 3,151 3, Cemented 8,556 8, Uncemented - HA 11,809 11, Uncemented + HA 3,151 3,

RESULTS: RESULTS: Cup; Aseptic loosening: ( * = none in group) N total N total N revised N revised RR RR 95 % CI 95 % CI Trilogy Uncemented -HA 5, Trilogy Uncemented +HA 6530** Universal Uncemented / Mallory-Head +HA 1, Universal Uncemented / Mallory-Head -HA 2, Müller Cemented Lubinus Cemented 2, Exeter Cemented 2, ZCA Cemented 1, Charnley Cemented 1,

RESULTS: RESULTS: Cup; Any reason: N total N total N revised N revised RR RR 95 % CI 95 % CI Trilogy Uncemented -HA 5, Trilogy Uncemented +HA Universal Uncemented / Mallory-Head +HA 1, Universal Uncemented / Mallory-Head -HA 2, Müller Cemented Lubinus Cemented 2, Exeter Cemented 2, ZCA Cemented 1, Charnley Cemented 1,

RESULTS: Stems; HA-coating VS. non HA-coating (all diagnosis) Adjusted RRs of revision; Endpoint: aseptic loosening; N total N total N revised N revised RR RR 95 % CI 95 % CI Uncemented - HA 5,482 5, Uncemented + HA 2,318 2,

RESULTS: Stems; HA-coating VS. non HA-coating (all diagnosis) Adjusted RRs of revision; Endpoint: aseptic loosening; Endpoint: any reason; Same findings for: idiopathic arthrosis, age, gender, component type N total N total N revised N revised RR RR 95 % CI 95 % CI Uncemented - HA 5,482 5, Uncemented + HA 2,318 2, N total N total N revised N revised RR RR 95 % CI 95 % CI Uncemented - HA 5,482 5, Uncemented + HA 2,318 2,

RESULTS: Stems; Cemented VS. Uncemented (all diagnosis) Adjusted RRs of revision; Endpoint: aseptic loosening; N total N total N revised N revised RR RR 95 % CI 95 % CI Cemented 15,634 15, Uncemented - HA 5,482 5, Uncemented + HA 2,318 2,

RESULTS: Stems; Cemented VS. Uncemented (all diagnosis) Adjusted RRs of revision; Endpoint: aseptic loosening; Endpoint: any reason; Same findings for: idiopathic arthrosis, age, gender, component type N total N total N revised N revised RR RR 95 % CI 95 % CI Cemented 15,634 15, Uncemented - HA 5,482 5, Uncemented + HA 2,318 2, Cemented 15,634 15, Uncemented - HA 5,482 5, Uncemented + HA 2,318 2,

RESULTS: RESULTS: Stem; Aseptic loosening: N total N total N revised N revised RR RR 95 % CI 95 % CI Exeter Cemented4, Bi-metric Cemented3, Bi-metric Uncemented +HA1, Bi-metric Uncemented - HA3, Lubinus SP II Cemented2, CPT Cemented1, Charnley Cemented1,

RESULTS: RESULTS: Stem; Any reason: N total N total N revised N revised RR RR 95 % CI 95 % CI Exeter Cemented4, Bi-metric Cemented3, Bi-metric Uncemented +HA1, Bi-metric Uncemented - HA3, Lubinus SP II Cemented2, CPT Cemented1, Charnley Cemented1,

CONCLUSION: Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger patients (<70). CONCLUSION: Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger patients (<70).

CONCLUSION: Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger patients (<70). Cemented implants as a group had higher revision rates due to aseptic loosening than cementless implants, but not unambiguously higher revision rates due to “any reason” than cementless implants in this study. CONCLUSION: Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger patients (<70). Cemented implants as a group had higher revision rates due to aseptic loosening than cementless implants, but not unambiguously higher revision rates due to “any reason” than cementless implants in this study.

CONCLUSION: Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger patients (<70). Cemented implants as a group had higher revision rates due to aseptic loosening than cementless implants, but not unambiguously higher revision rates due to “any reason” than cementless implants in this study. Müller, Exeter, and Charnley cups had the highest revision rates of the cups. Bi-metric Cemented, Charnley and Lubinus SP II stems had the highest revision rates for stems in this medium term follow-up study of younger patients (<70). CONCLUSION: Use of HA-coated implants was not associated with any overall reduced risk of revision compared with uncoated implants, in this medium term follow-up study of younger patients (<70). Cemented implants as a group had higher revision rates due to aseptic loosening than cementless implants, but not unambiguously higher revision rates due to “any reason” than cementless implants in this study. Müller, Exeter, and Charnley cups had the highest revision rates of the cups. Bi-metric Cemented, Charnley and Lubinus SP II stems had the highest revision rates for stems in this medium term follow-up study of younger patients (<70).