Metal release in patients who have has a primary total hip arthroplasty - A prospective, controlled, longitudinal study
Metal release in patients who have has a primary total hip arthroplasty - A prospective, controlled, longitudinal study
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DOI：
10.2106/00004623-199810000-00006
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发表时间：
1998-10-01
影响因子：
5.3
通讯作者：
Galante, JO
中科院分区：
文献类型：
--
作者：
Jacobs, JJ;Skipor, AK;Galante, JO
越来越多的人认识到，从长远来看，全关节置换术可能与假体材料降解产物介导的局部和远端不良组织反应有关。特别关注的是全关节置换术的金属降解产物，因为构成植入物中所用合金的金属元素具有已知的毒性。在一项为期三年的前瞻性纵向研究中，我们测量了75名患者血清中钛、铝、钴和铬的浓度以及尿中铬的浓度。20名患者接受了所谓的混合型全髋关节置换术（使用骨水泥插入组配式钴合金股骨柄和股骨头以及不使用骨水泥的钛髋臼杯），15例患者插入了广泛多孔涂层的钴合金股骨柄（带钴合金股骨头）和钛合金髋臼杯（无骨水泥），20例患者插入了近端多孔涂层的钛合金股骨柄（带钴合金股骨头）和钛合金髋臼杯（无骨水泥）。剩下的20名患者没有植入假体，作为对照组。我们的研究结果显示，术后36个月，具有功能良好的含有钛的部件的假体的患者血清中钛的浓度增加多达三倍，而具有功能良好的含有钴的假体的患者血清中钛的浓度增加多达三倍。AHoy组分使血清和尿中的铬浓度分别增加多达5倍和8倍。散布的铬降解产物的主要来源可能是组配式头颈连接处，并且可能是耦合几何形状的函数，未发现广泛多孔涂层钴合金股骨柄的被动溶解是金属释放的主要模式，临床相关性：循环金属浓度增加-来自骨科植入物的降解产物可能具有长期的有害生物学效应，需要进行研究，由于最近的临床趋势，包括金属对金属支承表面的重新引入和具有大的暴露金属表面积的广泛多孔涂覆的装置的日益普及。准确监测全髋关节置换术后血清和尿液中的金属浓度也可以深入了解金属释放的机制，我们的研究结果表明，头颈部耦合处的微动腐蚀是金属释放的重要来源，可导致血清中铬浓度增加，测定血清和尿液中金属的浓度可用于诊断全关节置换术后有症状的患者，因为升高的水平指示至少一种机械损伤模式。器械功能障碍（例如，微动腐蚀）。
There is an increasing recognition that, in the long term, total joint replacement may be associated with adverse local and remote tissue responses that are mediated by the degradation products of prosthetic materials. Particular interest has centered on the metal-degradation products of total joint replacements because of the known toxicities of the metal elements that make up the alloys used in the implants. We measured the concentrations of titanium, aluminum, cobalt, and chromium in the serum and the concentration of chromium in the urine of seventy-five patients during a three-year prospective, longitudinal study, Twenty patients had had a so-called hybrid total hip replacement (insertion of a modular cobalt-ahoy femoral stem and head with cement and a titanium acetabular cup without cement), fifteen had had insertion of an extensively porous-coated cobalt-alloy stem with a cobalt-alloy head and a titanium-alloy socket without cement, and twenty had had insertion of a proximally porous-coated titanium-alloy stem with a cobalt-ahoy head and a titanium socket without cement. The remaining twenty patients did not have an implant and served as controls,The results of our study showed that, thirty-six months postoperatively, patients who have a well functioning prosthesis with components containing titanium have as much as a threefold increase in the concentration of titanium in the serum and those who have a well functioning prosthesis with cobalt-ahoy components have as much as a fivefold and an eightfold increase in the concentrations of chromium in the serum and urine, respectively. The predominant source of the disseminated chromium-degradation products is probably the modular head-neck junction and may be a function of the geometry of the coupling, Passive dissolution of extensively porous-coated cobalt-alloy stems was not found to be a dominant mode of metal release,CLINICAL RELEVANCE: Increased concentrations of circulating metal-degradation products derived from orthopaedic implants may have deleterious biological effects over the long term that warrant investigation, This is a particularly timely concern because of recent clinical trends, including the reintroduction of metal-on-metal bearing surfaces and the increasing popularity of extensively porous-coated devices with large surface areas of exposed metal. Accurate monitoring of the concentrations of metal in the serum and urine after total hip replacement also can provide insights into the mechanisms of metal release, Our findings suggest that fretting corrosion at the head-neck coupling is an important source of metal release that can lead to increased concentrations of chromium in the serum, Determinations of the concentrations of metal in the serum and urine may be useful in the diagnosis of patients who are symptomatic after a total joint replacement as increased levels are indicative of at least one mode of mechanical dysfunction (for example, fretting corrosion) of the device.