TKA implants with vs without hydroxyapatite coating, fixation pegs yielded similar outcomes
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Total knee arthroplasty implants with porous and hydroxyapatite coatings and fixation pegs had similar clinical outcomes and survivorship rates compared with knee implants with a porous coating only, according to published results.
Researchers randomly assigned 197 patients undergoing primary TKA to receive either an implant with porous coating only (LCS Complete Porocoat, DePuy Synthes) or an implant with porous coating plus hydroxyapatite coating and four fixation pegs (LCS Complete Duofix, DePuy Synthes). Researchers compared postoperative pain, radiographic evidence of biological fixation and clinical outcomes between the two groups. Patients completed Oxford Knee Score, American Knee Society Score, SF-12 and VAS pain scores at 3, 6, 12, 60 and 120 months postoperatively, and researchers collected postoperative anteroposterior and lateral calibrated radiographs.
Results showed no significant differences in VAS pain scores and VAS pain score change from preoperative baseline between the two groups, with marked improvements in both groups in pain from preoperative baseline. Researchers also found no significant differences in the American Knee Society Score. Although researchers noted a statistically significant difference in favor of the porous coating group-only with SF-12 physical component and a trend toward a statistically significant difference in favor of the added hydroxyapatite coating and fixation peg group with the Oxford Knee Score, the findings did not reach minimal clinically important difference.
At 10-year follow-up, 63% of patients in the porous coating-only group had radiolucent lines vs. 35% of patients in the added hydroxyapatite coating and four-peg group, according to results. Researchers noted no correlation between radiolucent lines and pain, as well as no instances of loosening or osteolysis in either group. Revision for infection occurred in one patient in the porous coating-only group, results showed. – by Casey Tingle
Disclosures: Hegarty reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Joseph Bosco III, MD
Congratulations to Paul Hegarty, MD Bch, MRCS, and his colleagues on completing the rarest of feats in the pantheon of orthopedic literature: the design, execution and publication of a prospective, randomized and blinded study. In their study, they randomized 205 patients to receive the same uncemented tibial component with either porous coating (group 1, 102 patients) or porous coating and hydroxyapatite with pegs (group 2, 103 patients). They found that at 10 years, the two groups demonstrated similar (excellent) clinical outcomes but that the components without the porous coating or pegs had fewer radiolucent lines.
The question that this study asks is: What is the value of adding pegs and hydroxyapatite to uncemented porous-coated tibial components, ie, are the costs (if any) of adding pegs and hydroxyapatite justified by improved outcomes. The answer is: These hydroxyapatite prostheses are not associated with improved outcomes; hence, no value is created. In fact, value may even be diminished if the hydroxyapatite and pegged components are more expensive than their counterparts. The move toward value-based care dictates that we look at all such outcome studies through the “value lens.” Thus, we cannot expect health care payers to pay any additional coasts for hydroxyapatite-coated tibial components.
NYU Langone Health
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