In vivo wear of 3 types of metal on metal hip prostheses during 2 decades of use
In vivo wear of 3 types of metal on metal hip prostheses during 2 decades of use
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DOI：
10.1097/00003086-199608001-00013
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发表时间：
1996-08-01
影响因子：
4.2
通讯作者：
Amstutz, H
中科院分区：
文献类型：
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作者：
McKellop, H;Park, SH;Amstutz, H
对21例金属对金属髋关节置换术（包括McKee-Farrar、Muller和Ring）的磨损进行了分析，这些置换术是在长达25年后从患者体内取出的。光学和扫描电子显微镜表明，早期磨损包括大量的第三体磨损，可能是由于在消除原始抛光划痕时产生的颗粒和表面碳化物脱落。然而，主要的接触区仅仅是最终磨损光滑比原来的表面。通过在坐标测量机上数字化部件的形状并识别偏离原始球面的区域来量化磨损。在股骨头上，磨损通常集中在上内侧区域，即载荷轴上。3例病例也有明显的纵向磨损，但没有病例有周向（赤道）磨损。长期磨损率平均约为每年6 μ m或更少，每年产生的金属磨屑平均约为6 mm（3）或更少。磨损率随着间隙在127 - 386 μ m范围内的增加而增加，最大间隙为1.7 mm的McKee-Farrar假体磨损速度约为平均值的16倍。但间隙与翻修时间之间无明显关系。平均而言，较大的McKee-Farrar球的体积磨损小于较小的球，而Muller球的磨损最大，这可能是由于与Muller髋臼杯轴承区中加工的凹槽边缘接触。
Wear was analyzed on 21 metal on metal hip replacements, including McKee-Farrar, Muller, and Ring, that were retrieved from patients after as many as 25 years. Light and scanning electron microscopy indicated that early wear included substantial third body abrasion, possibly from particles generated while scratches from the original polishing were being eradicated and from dislodged surface carbides. However, the main contact zones mere eventually worn smoother than the original surfaces. Wear was quantified by digitizing the shapes of the components on a coordinate measuring machine and identifying those areas that deviated from the original spheric surface. On the femoral heads, wear was typically concentrated in the superomedial region, that is, on the load axis. Three cases also had substantial wear inferiorly, but there were no cases with circumferential (equatorial) wear. The long term wear rates averaged approximately 6 mu m per year or less and produced an average of approximately 6 mm(3) of metallic wear debris per year or less. Wear rate tended to increase as clearance increased over the range of 127 to 386 mu m, and a McKee-Farrar prosthesis with the extreme clearance of 1.7 mm wore approximately 16 times faster than the average, but there was no apparent relationship between clearance and time to revision. Larger McKee-Farrar balls had less volumetric wear, on average,than smaller balls, and the Muller balls had the greatest wear, which may have been due to contact with the edges of recesses machined into the bearing zones of the Muller cups.