International Orthopaedics

, Volume 35, Issue 2, pp 195–200

Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up

  • Alexander M. Kress
  • Rainer Schmidt
  • Ulrich Holzwarth
  • Raimund Forst
  • Lutz A. Mueller
Original Paper


Ceramic-on-ceramic coupling is thought to be a durable alternative to metal- or alumina-on-polyethylene pairing. No evidence exists suggesting superior clinical and radiological results for hydroxyapatite-coated stems versus uncoated stems. The aim of this study is to report the performance of an alumina-on-alumina bearing cementless total hip arthroplasty and to compare stems with a tapered design with and without hydroxyapatite coating. We prospectively analysed the results of cementless tapered femoral stems (40 hydroxyapatite-coated versus 22 uncoated stems), a metal-backed fibre mesh hydroxyapatite-coated socket and alumina-on-alumina pairing. Of 75 hips studied, 62 were available for follow-up (mean of 10.5 years after surgery). The average Harris hip score was 90. Only one hydroxyapatite-coated stem was revised for aseptic loosening. One instance of non-progressive osteolysis was detected around a screw of a cup. All other components showed radiographic signs of stable ingrowth. Hydroxyapatite coating of the stem had no significant impact on the clinical or radiological results. Total hip arthroplasty with the presented implant and pairing provides a durable standard for all patients requiring hip joint replacement against which all newer generations of cementless implants should be judged.


  1. 1.
    Harris WH (1995) The problem is osteolysis. Clin Orthop Relat Res 311:46–53PubMedGoogle Scholar
  2. 2.
    Garcia-Cimbrelo E, Garcia-Rey E, Murcia-Mazón A, Blanco-Pozo A, Martí E (2008) Alumina-on-alumina in THA: a multicenter prospective study. Clin Orthop Relat Res 466(2):309–316. doi:10.1007/s11999-007-0042-1 CrossRefPubMedGoogle Scholar
  3. 3.
    Gandhi R, Davey JR, Mahomed NN (2009) Hydroxyapatite coated femoral stems in primary total hip arthroplasty: a meta-analysis. J Arthroplasty 24(1):38–42. doi:10.1016/j.arth.2008.01.299 CrossRefPubMedGoogle Scholar
  4. 4.
    Sedel L (2000) Evolution of alumina-on-alumina implants: a review. Clin Orthop Relat Res 379:48–54CrossRefPubMedGoogle Scholar
  5. 5.
    Nizard R, Pourreyron D, Raould A, Hannouche D, Sedel L (2008) Alumina-on-alumina hip arthroplasty in patients younger than 30 years old. Clin Orthop Relat Res 466(2):317–323. doi:10.1007/s11999-007-0068-4 CrossRefPubMedGoogle Scholar
  6. 6.
    Bascarevic Z, Vukasinovic Z, Slavkovic N, Dulic B, Trajkovic G, Bascarevic V, Timotijevic S (2009) Alumina-on-alumina ceramic versus metal-on-highly cross-linked polyethylene bearings in total hip arthroplasty: a comparative study. Int Orthop. doi:10.1007/s00264-009-0899-6 PubMedGoogle Scholar
  7. 7.
    Søballe K, Hansen ES, B-Rasmussen H, Jørgensen PH, Bünger C (1992) Tissue ingrowth into titanium and hydroxyapatite-coated implants during stable and unstable mechanical conditions. J Orthop Res 10(2):285–299. doi:10.1002/jor.1100100216 CrossRefPubMedGoogle Scholar
  8. 8.
    Blacha J, Gagala J (2004) Clinical and radiological results of hydroxyapatite-coated acetabular cups. Int Orthop 28(6):362–365. doi:10.1007/s00264-004-0563-0 CrossRefPubMedGoogle Scholar
  9. 9.
    Røkkum M, Reigstad A, Johansson CB (2002) HA particles can be released from well-fixed HA-coated stems: histopathology of biopsies from 20 hips 2–8 years after implantation. Acta Orthop Scand 73(3):298–306. doi:10.1080/000164702320155293 CrossRefPubMedGoogle Scholar
  10. 10.
    Lazarinis S, Kärrholm J, Hailer NP (2010) Increased risk of revision of acetabular cups coated with hydroxyapatite. Acta Orthop 81:53–59. doi:10.3109/17453670903413178 CrossRefPubMedGoogle Scholar
  11. 11.
    Rajaratnam SS, Jack C, Tavakkolizadeh A, George MD, Fletcher RJ, Hankins M, Shepperd JA (2008) Long-term results of a hydroxyapatite-coated femoral component in total hip replacement: a 15- to 21-year follow-up study. J Bone Joint Surg Br 90(1):27–30. doi:10.1302/0301-620X.90B1.19731 CrossRefPubMedGoogle Scholar
  12. 12.
    Sanchez-Sotelo J, Lewallen DG, Harmsen WS, Harrington J, Cabanela ME (2004) Comparison of wear and osteolysis in hip replacement using two different coatings of the femoral stem. Int Orthop 28(4):206–210. doi:10.1007/s00264-004-0558-x CrossRefPubMedGoogle Scholar
  13. 13.
    Swamy G, Pace A, Quah C, Howard P (2010) The Bicontact cementless primary total hip arthroplasty: long-term results. Int Orthop. doi:10.1007/s00264-010-1123-4 PubMedGoogle Scholar
  14. 14.
    Reikerås O, Gunderson RB (2003) Excellent results of HA coating on a grit-blasted stem: 245 patients followed for 8–12 years. Acta Orthop Scand 74(2):140–145. doi:10.1080/00016470310013851 CrossRefPubMedGoogle Scholar
  15. 15.
    Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Müller ME, Sledge CB (1990) Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am 72(2):161–168PubMedGoogle Scholar
  16. 16.
    Engh CA, Bobyn JD, Glassman AH (1987) Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br 69(1):45–55PubMedGoogle Scholar
  17. 17.
    Willert HG, Bertram H, Buchhorn GH (1990) Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles. Clin Orthop Relat Res 258:95–107PubMedGoogle Scholar
  18. 18.
    Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS (1988) The anatomic basis of femoral component design. Clin Orthop Relat Res 235:148–165PubMedGoogle Scholar
  19. 19.
    Aldinger PR, Jung AW, Breusch SJ, Ewerbeck V, Parsch D (2009) Survival of the cementless Spotorno stem in the second decade. Clin Orthop Relat Res 467(9):2297–2304. doi:10.1007/s11999-009-0906-7 CrossRefPubMedGoogle Scholar
  20. 20.
    Spotorno L, Schenk RK, Dietschi C, Romagnoli S, Mumenthaler A (1987) Personal experiences with uncemented prostheses (in German). Orthopade 16(3):225–238PubMedGoogle Scholar
  21. 21.
    DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32PubMedGoogle Scholar
  22. 22.
    Engh CA, McGovern TF, Bobyn JD, Harris WH (1992) A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg Am 74(7):1009–1020PubMedGoogle Scholar
  23. 23.
    Manaster BJ (1996) From the RSNA refresher courses. Total hip arthroplasty: radiographic evaluation. Radiographics 16(3):645–660PubMedGoogle Scholar
  24. 24.
    Parvizi J, Sharkey PF, Hozack WJ, Orzoco F, Bissett GA, Rothman RH (2004) Prospective matched-pair analysis of hydroxyapatite-coated and uncoated femoral stems in total hip arthroplasty. A concise follow-up of a previous report. J Bone Joint Surg Am 86-A(4):783–786PubMedGoogle Scholar
  25. 25.
    Yoon KS, Kim HJ, Lee JH, Kang SB, Seong NH, Koo KH (2007) A randomized clinical trial of cementless femoral stems with and without hydroxyapatite/tricalcium-phosphate coating: an 8- to 12-year follow-up study. J Arthroplasty 22(4):504–508. doi:10.1016/j.arth.2006.06.005 CrossRefPubMedGoogle Scholar
  26. 26.
    Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P (2005) Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0–22 years. Acta Orthop 76(1):28–41. doi:10.1080/00016470510030292 CrossRefPubMedGoogle Scholar
  27. 27.
    Havelin LI, Espehaug B, Engesaeter LB (2002) The performance of two hydroxyapatite-coated acetabular cups compared with Charnley cups. From the Norwegian Arthroplasty Register. J Bone Joint Surg Br 84(6):839–845CrossRefPubMedGoogle Scholar
  28. 28.
    Anseth SD, Pulido PA, Adelson WS, Patil S, Sandwell JC, Colwell CW Jr (2010) Fifteen-year to twenty-year results of cementless Harris-Galante porous femoral and Harris-Galante porous I and II acetabular components. J Arthroplasty 25:687–691. doi:10.1016/j.arth.2009.05.033 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Alexander M. Kress
    • 1
  • Rainer Schmidt
    • 1
  • Ulrich Holzwarth
    • 2
  • Raimund Forst
    • 1
  • Lutz A. Mueller
    • 1
  1. 1.Department of Orthopaedic SurgeryFriedrich-Alexander-University of Erlangen-NurembergErlangenGermany
  2. 2.Med-Titan, Innovationszentrum Medizintechnik und PharmaErlangenGermany

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