Corrosion at the Head-Neck Taper as a Cause for Adverse Local Tissue Reactions After Total Hip Arthroplasty
Corrosion at the Head-Neck Taper as a Cause for Adverse Local Tissue Reactions After Total Hip Arthroplasty
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DOI：
10.2106/jbjs.k.01352
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发表时间：
2012-09-19
影响因子：
5.3
通讯作者：
Jacobs, Joshua J.
中科院分区：
文献类型：
--
作者：
Cooper, H. John;Della Valle, Craig J.;Jacobs, Joshua J.
背景：在全髋关节置换术中，股骨假体的模块头颈交界处的腐蚀一直被认为是一个潜在的问题，尽管继发于腐蚀的症状性不良局部组织反应很少被描述。方法：我们回顾了来自三个不同制造商的10例金属对聚乙烯全髋关节假体患者的记录，他们因模块头颈交界处的腐蚀而接受翻修手术。结果：所有患者都表现出髋部周围的疼痛或肿胀，2名患者表现为复发的不稳定。血清钴水平在翻修关节置换手术前升高，且通常比血清铬水平升高得更多。手术发现包括大量软组织肿块和周围组织损伤，股骨头-颈部交界处有明显的腐蚀；两名表现为不稳定的患者髋部外展肌群严重受损。病理标本始终显示有组织坏死区。8例行清创、股骨头内衬垫置换、钛套筒陶瓷股骨头置换。平均Harris髋关节评分由术前的58.1分提高到术后平均13.0个月的89.7分(p=0.01)。6名患者在修订后平均8.0个月测量的重复血清钴水平下降到平均1.61 ng/毫升，铬水平与修订前水平相似。1例中度髋外展肌坏死患者在翻修后复发不稳定，需要二次翻修关节成形术。结论：金属对聚乙烯支架的患者可能会发生不良的局部组织反应，继发于模块化股骨头颈部锥形处的腐蚀，其表现与金属对金属支架患者的不良局部组织反应相似。血清金属水平升高，尤其是血清钴水平相对于铬水平的不同升高，有助于建立这一诊断。
Background: Corrosion at the modular head-neck junction of the femoral component in total hip arthroplasty has been identified as a potential concern, although symptomatic adverse local tissue reactions secondary to corrosion have rarely been described.Methods: We retrospectively reviewed the records of ten patients with a metal-on-polyethylene total hip prosthesis, from three different manufacturers, who underwent revision surgery for corrosion at the modular head-neck junction.Results: All patients presented with pain or swelling around the hip, and two patients presented with recurrent instability. Serum cobalt levels were elevated prior to the revision arthroplasty and were typically more elevated than were serum chromium levels. Surgical findings included large soft-tissue masses and surrounding tissue damage with visible corrosion at the femoral head-neck junction; the two patients who presented with instability had severe damage to the hip abductor musculature. Pathology specimens consistently demonstrated areas of tissue necrosis. The patients were treated with debridement and a femoral head and liner exchange, with use of a ceramic femoral head with a titanium sleeve in eight cases. The mean Harris hip score improved from 58.1 points preoperatively to 89.7 points at a mean of 13.0 months after the revision surgery (p = 0.01). Repeat serum cobalt levels, measured in six patients at a mean of 8.0 months following revision, decreased to a mean of 1.61 ng/mL, and chromium levels were similar to prerevision levels. One patient with moderate hip abductor muscle necrosis developed recurrent instability after revision and required a second revision arthroplasty.Conclusions: Adverse local tissue reactions can occur in patients with a metal-on-polyethylene bearing secondary to corrosion at the modular femoral head-neck taper, and their presentation is similar to the adverse local tissue reactions seen in patients with a metal-on-metal bearing. Elevated serum metal levels, particularly a differential elevation of serum cobalt levels with respect to chromium levels, can be helpful in establishing this diagnosis.