ArticleMaterials (Basel, Switzerland)2020
New Insights into Osteointegration and Delamination from a Multidisciplinary Investigation of a Failed Hydroxyapatite-Coated Hip Joint Replacement.
Article in Materials (Basel, Switzerland), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 22 citations in OpenAlex.
- ZnO-Hydroxyapatite-Coated Ti-6Al-4V With Curcumin and Ginger Extract for Load-Bearing Implants.Journal of the American Ceramic Society. American Ceramic Society · 2026Article
- Ultra-thin porous calcium phosphate coatings show extensive remodeling and high osseointegration after 24 weeks in a rabbit femoral condyle model.Frontiers in bioengineering and biotechnology · 2026Article
- Long-term Performance and Durability of Biomaterials and Implant Designs in Total Joint Arthroplasty and Spinal Fusion.Journal of orthopaedics and sports medicine · 2026Article
- Stepwise Total Hip Arthroplasty with Lateral and Posterolateral Approaches: Intraoperative Imaging, Fixation Strategy, and Early Functional Outcomes.Life (Basel, Switzerland) · 2025Article
- Cementless fixation in total joint arthroplasty: Factors impacting osseointegration.Journal of clinical orthopaedics and trauma · 2025Review
- Hydroxyapatite-Coated Ti6Al4V ELI Alloy: In Vitro Cell Adhesion.Nanomaterials (Basel, Switzerland) · 2024Article
- Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis.EFORT open reviews · 2024Article
- The history of the development of the regular straight stem in hip arthroplasty.EFORT open reviews · 2023Review
- Evaluation of the Cathodic Electrodeposition Effectiveness of the Hydroxyapatite Layer Used in Surface Modification of Ti6Al4V-Based Biomaterials.Materials (Basel, Switzerland) · 2022Article
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Authors and funding
8 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Hydroxyapatite (HA) coatings have become very popular in uncemented total hip arthroplasty (THA). Analysis of retrievals and tissue samples from an HA-coated femoral stem, which failed within 14 months after THA, provides exceptional insights into the failure mechanism, as well as the process of osteointegration of such an implant.
methodsRetrievals were photo-documented. Samples were examined by micro-computed tomography, X-ray diffraction (XRD) and embedded in polymethylmethacrylate for histology.
resultsThe coating had partially delaminated. The sandblasted surface of the stem was partially polished by the delaminated HA coating, indicating failure before revision. In the tissue samples, the HA coating was well integrated by newly formed bone trabeculae. No adverse biological reaction was observed. XRD analysis showed that residues of the HA coating were still present and could clearly be differentiated from the surrounding bone. Preferential orientation of the HA crystallites could be identified within the newly formed bone, representing a potential mechanical weakness induced either by physiologic strain or by the coating.
conclusioncurrent HA coatings, relatively thick and made of high crystallinity HA, may be prone to delamination, as also seen in our study. Recent efforts have aimed towards thinner (<1 μm) coatings with nanocrystalline HA structures that possibly relate to lower delamination risks. However, the question arises if HA coatings are beneficial since sandblasted non-coated stems offer similar results without the risk of delamination. XRD not only permits differentiation between the HA from the coating and the HA of the ongrown bone, it also provides new insights into the microstructure of this newly formed bone.
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