title: Ceramic bearings with bilayer coating in cementless total hip arthroplasty. A safe solution. A retrospective study of one hundred and twenty six cases with more than ten years' follow-up.
abstract: Using a ceramic-ceramic bearings, cementless total hip arthroplasty (THA) has provided good clinical results. To ensure longevity a good quality fixation of the implants is mandatory. Different surface treatments had been used, with inconsistent results. We hypothesized that a "bilayer coating" applied to both THA components using validated technology will provide a long-lasting and reliable bone fixation.
  
  
  
  We studied the survival and bone integration of a continuous, single-surgeon, retrospective series of 126 THA cases (116 patients) with an average follow-up of 12.2 years (minimum 10 years). The THA consisted of cementless implants with a bilayer coating of titanium and hydroxyapatite and used a ceramic-ceramic bearing.
  
  
  
  With surgical revision for any cause (except infection) as the end point, THA survival was 95.1 % at 13 years. Stem (98.8 %) and cup (98.6 %) survival was similar at 13 years. Bone integration was confirmed in 100 % of implants (Engh-Massin score of 17.42 and ARA score of 5.94). There were no instances of loosening. Revisions were performed because of instability (1.6 %), prosthetic impingement or material-related issues.
  
  
  
  A bilayer titanium and hydroxyapatite coating provides strong, fast, reliable osseo integration, without deterioration at the interface or release of damaging particles. The good clinical outcomes expected of ceramic bearings were achieved, as were equally reliable stem and cup fixation.
authors.affiliation: Clinique du Parc-Lyon, 155 ter boulevard de Stalingrad, 69006, Lyon, France. a.ferreira@cliniqueduparclyon.com.
authors.forename: André
authors.identifier: 0000-0002-6616-8629
authors.initials: A
authors.lastname: Ferreira
authors.affiliation: Groupe Lépine, Genay, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Aslanian
authors.affiliation: Anatomy Laboratory, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Thibaud
authors.initials: T
authors.lastname: Dalin
authors.affiliation: Clinique Saint-Jean, Cagnes sur Mer, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Picaud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D002484:Cementation; D002516:Ceramics; D020099:Coated Materials, Biocompatible; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D020099:Coated Materials, Biocompatible
keywords: Bilayer coating; Bone integration; Cementless fixation; Ceramic bearing; THA