Osteoinductive gel in cementless hip joint replacement: a randomized prospective study

Background Since the first publication concerning osteoinductive proteins by Urist in 1965, much progress in the identification, characterization and clinical use of these growth factors has been made in orthopaedics. Methods From June 2004 to July 2006, we led a randomized prospective study with 120 cementless hip joint arthroplasties. Sixty hip replacements were performed by the same senior surgeon using an osteoinductive gel placed on the fixation surface of the implants. We compared these patients with 60 patients who had hip replacements without osteoinductive material (control group). The gel contains three elements: cancellous bone chips, platelet-rich plasma and bone marrow. Blood loss, operation time, hemoglobin drop values and clinical results were collected, and statistical analyses were done. Dual energy x-ray absorptiometry (DEXA) analysis also was performed. Results There was a statistically significant difference in the operation time, while the blood loss was statistically significantly less in the group treated with gel. The Harris Hip Score moved from an average of 43.5 points preoperatively to 82.9 points at 40 days, 89.8 points at 3 months, 92 points at 6 months and 93.7 points at 12 months in the study group. For the control group the preoperative values were 41.2 points and moved to 74.1 points at 40 days, 80.7 points at 3 months, 85.4 points at 6 months and 93.9 points at 12 months. At 40 days, 3 months and 6 months follow-up, statistically significant differences were measured (P<0.0001). At 1 year no more significant differences were noted. DEXA data showed a faster osteointegration within 40 days in the study group. No complications such as dislocations, deep vein thrombosis, infection, stem subsidence, or mobilization were observed. Conclusions Our procedure shows a faster clinical and functional recovery using osteoinductive gel without major complications. The procedure is safe because it includes only autologous factors without risk of disease transmission or immune response.