Abstract
Aim
To study the efficacy of Hydroxyapatite (HAC) Ceramic Coated hip arthroplasty. Is it suitable for the younger patient?
Methods
This series of 2390 primary HAC hip arthroplasties has been studied for up to 21 years. (569 hips over 10 years including 98 hips over 15 years) Patients are assessed by Harris Hip Score and plain X-ray. The prosthesis consists of a fully coated stem and a fully coated acetabulum. A ceramic head articulates with an acetabular liner which is either plastic (UHMW polythene) or ceramic. No cement is used. HA coated implants are physiologically fixed to cancellous bone by a process of osseointegration. Other uncemented implants are pathologically fixed by fibrous scar tissue. These two methods of fixation should be considered separately and not combined as ‘uncemented’.
Results
Aseptic loosening in this series is 0.63 %. The revision rate in this series for all reasons is only 3.5%. Harris Hip Score (HHS) demonstrates excellent medium to long term results in 97% of cases (i.e. up to 20 years). Poor HHS results (36 cases: 1.51%) are mostly related to medical or other joint problems. HA fixation will outlast some of the components and wear in polythene acetabular liners can be a problem after 15 years. A sub-group of 629 hips using alumina ceramic/ ceramic bearings is successful but five components fractured (out of 1258 individual components). Wear debris from ceramic materials appears to be benign. Zirconia Toughened Alumina (ZTA) has been introduced to replace alumina and should obviate problems of ceramic implant fracture. An HA coated implant with ZTA bearings is suggested for the younger patient of either sex.
