JOA - 2026-05-13 - Journal Article
Fully Hydroxyapatite-Coated, Collared, Triple-Taper Stems May Be Safe for All Patients Undergoing Primary Total Hip Arthroplasty: Minimum Two-Year Follow-Up.
Salehi N, Stratton A, Restrepo C, Smith EB, Ong AC, Hozack WJ
Topics
Key Takeaway
Fully HA-coated, collared, triple-taper cementless stems achieved 98.1% two-year survivorship with zero aseptic femoral loosening across an unselected population aged 39–89.
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Summary
This single-institution retrospective study evaluated whether a fully HA-coated, collared, triple-taper cementless stem could be used universally in primary THA regardless of age or bone quality. Among 265 stems with minimum 2-year follow-up, HOOS JR improved 18.8 points (41.6 to 60.4, p<0.0001), survivorship was 98.1%, and all radiographic implants were well-fixed at final follow-up. Five revisions occurred—two for PJI, two for dislocation, one acetabular PPFx—with no femoral component revisions for aseptic loosening.
Key Limitation
Two-year minimum follow-up is insufficient to detect late aseptic loosening, stress shielding, or osteolysis that typically manifest beyond 5–10 years, making survivorship conclusions premature.
Original Abstract
INTRODUCTION
The triple-tapered, collared, hydroxyapatite-coated stems for cementless total hip arthroplasty (THA) show a low rate of early failure and excellent performance. The purpose of this study was to evaluate the possibility of implanting these stems for any patient undergoing THA, regardless of age and bone quality.
METHODS
This was a retrospective study at a single institution using a prospectively collected data registry of 265 triple-tapered, collared, fully HA-coated stems implanted for primary cementless THA. We collected data on demographics and clinical outcomes, including the 12-item Short Form/Veterans RAND (SF/VR-12) health survey and Hip Dysfunction and Osteoarthritis Outcomes Score for Joint Replacement (HOOS, JR). Survivorship, revision etiology, and radiographic outcomes were also assessed. The minimum follow-up was two years. The average patient age was 68 years (range, 39 to 89), and their average body mass index was 29.9 (range, 17 to 45).
RESULTS
The Physical Health SF/VR-12 score increased 0.4 points from a preoperative average of 34.8 (range, 18.4 to 56.6) to a postoperative average of 35.2 (range, 18.1 to 56.6, P = 0.516). The Mental Health SF/VR-12 improvement was 0.7 points from a preoperative average of 50.3 (range, 19.1 to 69.0) to a postoperative average of 51.1 (range, 26.9 to 68.6, P = 0.412). There was a significant improvement of 18.8 points in the HOOS, JR score from a preoperative average of 41.6 (range, 8.1 to 76.8) to a postoperative average of 60.4 (range, 8.1 to 100, P < 0.0001). The two-year survivorship was 98.1%. There were five revisions: two for infection, two for dislocation, and one acetabular periprosthetic fracture (PPFx). Another two patients had a femoral PPFx without requiring femoral component revision. Radiographs demonstrated well-fixed implants in 100%.
CONCLUSION
Fully HA-coated, triple-tapered cementless component THA offers excellent results at two-year follow-up in an unselected patient population.