the importance of plasma sprayed hydroxyapatite … importance of plasma sprayed hydroxyapatite...
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The Importance of Plasma Sprayed Hydroxyapatite Coating on Titanium Plasma Spray in the Osseointegration of Total Ankle
Arthroplasty Implants
Robert Flavin, MD, Mark Steeves, MD, Alastair Younger, MD
Department of Foot & Ankle Surgery, St Paul’s Hospital, Vancouver, Canada
The Importance of Plasma Sprayed Hydroxyapatite Coating on Titanium
Plasma Spray in the Osseointegration of Total Ankle Arthroplasty Implants
Robert Flavin
My Disclosure is in the Final AOFAS Program Book, I have no potential
conflicts with this presentation
Introduction
Predicted 4-8.5 million North Americans will be afflicted by Ankle Arthritis by 2020
Ankle Arthritis is a major disability similar to Hip Arthritis
Ankle Arthrodesis remains the Gold Standard of care
Increasing patient preference for Total Ankle Arthroplasty
Introduction Many Implants with Many Differences
Implant Geometry, Surface Coating, 2 or 3 component designs (fixed or mobile)
Mode of Bonding: Ingrowth Osseointegration Principle Mode of Failure: Aseptic Loosening Our Instituition has used implants of two
ingrowth coating surface types CoCr Alloy with porous coated sintered titanium
beads without Hydroxyapatite (HA) CoCr alloy with porous coated surface with plasma
sprayed titanium with HA
Hypothesis The revision rates for Cobalt Chrome Alloy TAA
stemmed prostheses may be higher without Hydroxyapatite coating.
Therefore the objectives of this study were to analyze two separate total ankle arthroplasty designs with regards to; revision rates, loose components diagnosed both clinically and
radiologically by SPECT-CT, the description of implant ingrowth material on
explantation at the time of revision surgery symptomatic Impingement rates.
Materials & Methods Retrospective Analysis 2 Different Total Ankle Arthroplasty
Mobility (Dupuy International, Leeds, UK) Hintegra (Newdeal SA, Lyon, France)
33 Mobility TAA performed 37 Hintegra TAA performed Standardized Postoperative protocol Parameters collected from Medical Records Coronal and Sagittal tibial implant angles of
implantation measured on 6 week weight bearing Radiographs
Results TAA type Mobility TAA Hintegra TAA
Age (p=0.51)
63.9 Years (SD 9.9) 62.2 Years (SD 10.8)
Gender (p=0.58)
13 (43%) ♂ 17 (57%) ♀ 11 (31%) ♂ 24 (69%) ♀
Weight (p=0.617)
75.2 Kg (SD 15) 77 Kg (SD 14.6)
Rheumatoid Arthritis
10 (31.2%) 10 (28%)
Osteoarthritis 11 (34.4%) 14 (39%)
Posttraumatic Arthritis
11 (34.4%) 13 (33%)
(p=0.8081)
Results Revision & Impingement Rates
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Com
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Tala
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Tibi
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Tala
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Loosening on SPECT-CT
Requiring Revision ImpingementPain
No.
of p
atie
nts
HintegraMobility
Discussion The question of optimum implant geometry and surface
coating has not been debated in the literature to the best of our knowledge.
The literature shows clinical results of revision similar to our study but the studies are small case series or from the designer. All studies describe a “steep learning curve” phenomenon.
Geometrical analysis would show the anterior cortical window and the absence of HA as the potential attributing factors to failure to osseointegrate
References Glazebrook, M; Daniels, T; Younger, A, et al.: Comparison of health-related
quality of life between patients with end-stage ankle and hip arthrosis. J Bone Joint Surg Am. 90: 499-505. 2008 90/3/499
Hintermann, B; Valderrabano, V; Dereymaeker, G; Dick, W: The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res. 57-68. 2004
Pagenstert, GI; Barg, A; Leumann, AG, et al.: SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg Br. 91: 1191-1196. 2009
Rippstein, PF; Huber, M; Coetzee, JC; Naal, FD: Total ankle replacement with use of a new three-component implant. J Bone Joint Surg Am. 93: 1426-1435. 2011
Rothman, RH; Hozack, WJ; Ranawat, A; Moriarty, L: Hydroxyapatite-coated femoral stems. A matched-pair analysis of coated and uncoated implants. J Bone Joint Surg Am. 78: 319-324. 1996
Wood, PL; Karski, MT; Watmough, P: Total ankle replacement: the results of 100 mobility total ankle replacements. J Bone Joint Surg Br. 92: 958-962. 2010