MRI, Retrieval Analysis, and Histologic Evaluation of Adverse Local Tissue Reaction in Metal-on-Polyethylene Total Hip Arthroplasty
MRI, Retrieval Analysis, and Histologic Evaluation of Adverse Local Tissue Reaction in Metal-on-Polyethylene Total Hip Arthroplasty
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DOI：
10.1016/j.arth.2016.11.046
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发表时间：
2017-05-01
影响因子：
3.5
通讯作者：
Padgett, Douglas E.
中科院分区：
文献类型：
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作者：
Nodzo, Scott R.;Esposito, Christina I.;Padgett, Douglas E.
背景：金属对聚乙烯人工全髋关节置换术(THA)中不良局部组织反应的严重程度和部位尚未得到很好的描述。方法：我们回顾了使用我们的生物力学数据库进行全髋关节翻修术的患者的记录。我们纳入了所有接受翻修手术以诊断ALTR的患者，这些患者的THA植入物仅在头颈交界处具有模块化，而排除了在头颈交界处以外的部位具有植入模块化的患者。磁共振成像(MRI)由一位受过团契培训的放射科医生进行评估，他专门评估金属伪影，减少MRI序列以量化ALTR病变。结果：我们在数据库中识别了11名患者。根据组织学评分，8名患者的MRI ALTR分级为严重，7名患者为重度。平均滑膜体积218,658 mm(23,461~451,435 mm)，平均最大滑膜厚度15.3 mm(3~34.3 mm)。67%的患者因假包膜侵犯导致外展肌受累，3例患者未见外展肌受累。术前钴和铬的平均水平分别为5.4 ppb(范围1-12.3 ppb)和1.1 ppb(范围0.6-2.4 ppb)。术前血清钴和铬离子的平均水平仍然相对较低，MRI是确定这些病变的大小和位置的有效方法。(C)2016 Elsevier Inc.保留所有权利。
Background: The severity and location of adverse local tissue reaction (ALTR) seen in metal-on-polyethylene total hip arthroplasty (THA) is not well described.Methods: We retrospectively reviewed the records of patients who underwent a revision THA using our biomechanics database. We included all patients who underwent revision surgery for the diagnosis of ALTR with THA implants that had modularity solely at the head-neck junction and excluded patients with implant modularity at sites other than the head-neck junction. Magnetic resonance imaging (MRI) was evaluated by a fellowship-trained radiologist who specializes in evaluating metal artifact reducing MRI sequences to quantify the ALTR lesions. Histology was evaluated for findings of ALTR using the Campbell score.Results: We identified 11 patients in the database. Eight patients had an MRI ALTR grade of severe and 7 did based on the histology score. The mean synovial volume was 218,658 mm(3) (range 23,461-451,435 mm3) with a mean maximal synovial thickness of 15.3 mm (range 3-34.3 mm). A disruptive infiltration of the abductors due to pseudocapsule invasion was seen in 67% of the patients with 3 not having abductor involvement. Mean preoperative cobalt and chromium levels were 5.4 ppb (range 1-12.3 ppb) and 1.1 ppb (range 0.6-2.4 ppb), respectively.Conclusion: Patients with ALTR from head-neck junction corrosion in metal-on-polyethylene THA may present with large pseudotumors that have previously been under appreciated. Mean preoperative serum cobalt and chromium ion levels remained relatively low, and MRI was an effective way to characterize the size and location of these lesions. (C) 2016 Elsevier Inc. All rights reserved.