Hydroxyapatite (HA) coating appears to be of benefit for implant durability of tibial components in primary total knee arthroplasty

Figures & data

Figure 1. PRISMA 2009 flow diagram used to identify studies for inclusion in HA tibial analysis.

Table 1. The number of evaluable knees used from each trial and included in outcome analysis

Study	No. of knees	HA group	Other group	Country
Beaupré 2007	81	40	41	Canada
Carlsson 2005	150	50	100	Sweden
Findlay 2007	171	94	77	UK
Hansson 2008	49	24	25	Sweden
Nilsson 1999	57	29	28	Sweden
Nilsson 2006	95	62	33	Sweden
Petersen 2005	16	8	8	Denmark
Pijls 2010	29	9	20	Netherlands
Regnér 1998	40	20	20	Sweden
Regnér 2000	51	25	26	Sweden
Toksvig-Larsen 2000	47	28	19	Sweden
van der Linde 2006	22	12	10	Netherlands
van der Linde 2008	78	38	40	Netherlands
Walker 2000	40	12	28	UK
Total	926	451	475

Table 2. Durability (pooled data)

Comparisons made	Trials included	Endpoint	HA pooled sample size	MB pooled sample size	RR (95% CI)	Model used
HA coated (with and without porous coated tibial undersurface) with and without screw fixation vs. MB cemented and porous coated tibial components with and without screw fixation (see Figure 2)	Regnér et al. 1998, Nilsson et al. 1999, Toksvig-Larsen et al. 2000, Carlsson et al. 2005, Nilsson et al. 2006, Hansson et al. 2008, Pijls et al. 2010	MTPM >0.2 mm/2 years	197	147	RR=0.63(0.36–1.11);p=0.11;I^2 = 50%	M-H random effects
HA coated (with and without porous coated tibial undersurface) without screw fixation vs. MB cemented and porous coated tibial components without screw fixation (see Figure 3)	Nilsson et al. 1999, Toksvig-Larsen et al. 2000, Carlsson et al. 2005, Nilsson et al. 2006, Hansson et al. 2008	MTPM >0.2 mm/2 years	149	139	RR=0.58(0.34–0.98); p=0.04,I^2 = 39%	M-H random effects
HA coated (with and without porous coated tibial undersurface) without screw fixation vs. MB porous coated components without screw fixation (figure not shown)	Toksvig-Larsen et al. 2000, Hansson et al. 2008	MTPM >0.2 mm/2 years	52	44	RR=0.16 (0.00–5.75);p=0.32;I^2 = 84%	M-H random effects
HA coated (with and without porous coated tibial undersurface) without screw fixation vs. cemented MB tibial components (figure not shown)	Nilsson et al. 1999, Carlsson et al. 2005, Nilsson et al. 2006	MTPM >0.2 mm/2 years	97	85	RR=0.65(0.41–1.04); p=0.07;I^2 = 29%	M-H fixed effects
HA coated (with and without porous coated tibial undersurface) vs. cemented MB tibial components (figure not shown)	Nilsson et al. 1999, Carlsson et al. 2005, Beaupré et al. 2007	5 year durability – need for replacement	97	87	RR=1.83(0.34–9.86); p=0.48;I^2 = 0%	M-H fixed effects
HA coated (with and without porous coated tibial undersurface) vs. cemented MB component (figure not shown)	Findlay et al. 2007, Pijls et al. 2010	8–10 year period – need for replacement	104	88	RR=3.28(0.37–28.7); p=0.28;I^2 = not applicable	M-H fixed effects

Figure 2. RSA analysis year 2; HA-coated vs. other tibial fixation; all implants.

Figure 3. RSA analysis year 2; HA-coated vs. other tibial fixation; all implants except for those with screw fixation of tibial baseplate.

Table 3. Function scores from data at 2 years and 5 years. Statistical method used: Inverse variance, fixed effects analysis model

Comparisons made	Trials included	Endpoint	HA sample size	MB sample size	Differencemean (95% Ci)	p-value
HA coated (porous & press fit) vs. porous MB tibial components	Carlsson et al. 2005	Knee Society Score clinical assessment – 2 year	50	37	1.00 (-3.63 to 5.63)	0.67
HA coated with porous coated tibial undersurface vs. cemented MB tibial components	Carlsson et al. 2005	Knee Society Score clinical assessment – 2 year	50	29	3.00 (-4.35 to 10.35)	0.42
HA coated with porous coated tibial undersurface with screw fixation vs. porous MB tibial components with screw fixation	Regnér et al. 1998	Hospital for Special Surgery (HSS) clinical assessment – 2 year	20	20	-1.00 (-3.60 to 5.66)	0.67
HA coated with porous coated tibial undersurface without screw fixation vs. porous MB tibial components without screw fixation	van der Linde et al. 2008	Hospital for Special Surgery (HSS) clinical assessment – 2 year	38	48	0.00 (-3.86 to 3.86)	1.00
HA coated press fit vs. cemented MB tibial component	Beaupré et al. 2007	RAND-35 at 5 years	40	41	3.46 (-8.23 to 15.15)	0.56
HA coated press fit vs. cemented MB tibial component	Beaupré et al. 2007	WOMAC at 5 years	40	41	-1.40 ( -10.36 to 7.56)	0.76

Figure 4. Adverse events; complications resulting from the surgical procedure and/or subsequent need for surgical intervention or immediate medical attention.

Figure 5. RSA analysis year 2; HA-coated vs. other tibial fixation; all implants except for those with screw fixation of tibial baseplate using an expanded definition of MPTM ≥ 0.2 mm in 2 years.

Figure 6. Risk-of-bias graph summary – review of authors' judgments about each risk-of-bias item presented as percentages across all the studies included.

Figure 7. Review of authors' judgments about each risk of bias item for each study included.

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