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Abstract
We stratified the fixation of the femoral component in 64 hips with degenerative joint disease into 3 groups, cemented (C), proximal hydroxyapatite coating (HA) or proximal porous coating (P). All implants had the same basic design and were made of TiAIV alloy. The migration of the implants was assessed by radioste-reometry. After 5 years, the mean subsidences in the cemented and porous-coated groups were 0.16 and 0.31 mm, whereas the HA-coated implants displayed a mean proximal migration of 0.1 mm. 7 stems (2 C, 1 HA, 4 P) showed a continuous subsidence (> 0.25 mm) between the 2- and 5-year follow-up. 1 porous-coated stem was revised after the 2-year follow-up, because of pain and implant failure (previously reported) and 1 cemented stem was revised after 5 years because of pain and osteolysis.
In a subset of patients, all with a femoral head made of aluminum oxide, the levels of metal were determined using atomic adsorption spectrometry. Subsidence of the stem between the 2- and 5-year follow-up was associated with increased levels of aluminum in the blood at 2 years. Generation of metallic particles from abrasive wear of the stem followed by third body abrasion of the ceramic femoral head could be one explanation of this finding.
5 hips which had shown high levels of titanium and aluminum in joint fluid at the 2-year follow-up displayed increased subsidence and developed proximal radiolucencies or osteolysis at the 5-year follow up. One of these was the cemented hip which was subsequently revised.