Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement A CONSEQUENCE OF EXCESS WEAR
Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement A CONSEQUENCE OF EXCESS WEAR
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DOI：
10.1302/0301-620x.92b1.22770
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发表时间：
2010-01-01
影响因子：
--
通讯作者：
Nargol, A. V. F.
中科院分区：
文献类型：
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作者：
Langton, D. J.;Jameson, S. S.;Nargol, A. V. F.
与金属碎屑不良反应相关的早期失败是髋关节表面置换术后出现的问题，但确切机制尚不清楚。我们分析了整个系列的660例金属对金属表面置换术（关节面置换术（ASR）和伯明翰髋关节表面置换术（BHR））和大关节面ASR全髋关节置换术，以确定与金属碎屑相关失效的相关性。进行了临床和放射学结局、金属离子水平、外植体研究和淋巴细胞转化试验。共发现17例患者（3.4%）（均为ASR关节面）对金属碎屑有不良反应，需要翻修。与无症状患者相比，该组患者的髋臼组件明显更小，髋臼组件前倾明显更高，血液和关节铬和钴离子的总浓度明显更高（所有p < 0.001）。该组翻修后淋巴细胞转化试验显示对铬或钴离子无反应性。对于无并发症的骨折，这些翻修的取出物的表面磨损大于取出物。植入物位置良好的患者对金属碎屑没有不良反应通常意味着部件磨损较高，外科医生必须考虑植入物设计、预期部件尺寸和髋臼部件定位，以便在进行大关节面金属对金属髋关节表面置换和置换时减少早期失败。
Early failure associated with adverse reactions to metal debris is an emerging problem after hip resurfacing but the exact mechanism is unclear. We analysed our entire series of 660 metal-on-metal resurfacings (Articular Surface Replacement (ASR) and Birmingham Hip Resurfacing (BHR)) and large-bearing ASR total hip replacements, to establish associations with metal debris-related failures. Clinical and radiological outcomes, metal ion levels, explant studies and lymphocyte transformation tests were performed. A total of 17 patients (3.4%) were identified (all ASR bearings) with adverse reactions to metal debris, for which revision was required. This group had significantly smaller components, significantly higher acetabular component anteversion, and significantly higher whole concentrations of blood and joint chromium and cobalt ions than asymptomatic patients did (all p < 0.001). Post-revision lymphocyte transformation tests on this group showed no reactivity to chromium or cobalt ions. Explants from these revisions had greater surface wear than retrievals for uncomplicated fractures. The absence of adverse reactions to metal debris in patients with well-positioned implants usually implies high component wear.Surgeons must consider implant design, expected component size and acetabular component positioning in order to reduce early failures when performing large-bearing metal-on-metal hip resurfacing and replacement.