Current Concepts Review   |    
Hydroxyapatite-Coated Prostheses in Total Hip and Knee Arthroplasty
John Dumbleton, PhD, DSc1; Michael T. Manley, PhD2
1 Consultancy in Medical Devices and Biomaterials, 512 East Saddle River Road, Ridgewood, NJ 07450. E-mail address: boffin@worldnet.att.net
2 12A Chestnut Street, Ridgewood, NJ 07450. E-mail address: mtmanley@mindspring.com
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Stryker Orthopaedics. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Stryker Orthopaedics). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Nov 01;86(11):2526-2540
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Hydroxyapatite-coated implants have demonstrated extensive bone apposition in animal models. The osseous interface develops even in the presence of gaps of 1 mm and relative motion of up to 500 µm.

Development of implant-bone interfacial strength is due to the biological effects of released calcium and phosphate ions, although surface roughness leads to increased interface strength in the absence of interface gaps.

The clinical results at fifteen years after total hip replacements have demonstrated that hydroxyapatite-coated femoral stems perform as well as, and possibly better than, other types of cementless devices, with the added benefit of providing a seal against wear debris.

Hydroxyapatite-coated acetabular components must have a mechanical interlock with bone in order to take advantage of the coating effects. Clinical analyses of these types of designs at seven years have indicated good survivorship.

The performance of a hydroxyapatite-coated implant depends on coating properties (thickness, porosity, hydroxyapatite content, and crystallinity), implant roughness, and overall design. The most reliable predictor of the performance of a device is success in long-term clinical studies.

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