Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis.
Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis.
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DOI：
10.1302/2058-5241.6.200146
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发表时间：
2021-05
影响因子：
3.4
通讯作者：
Sandiford NA
中科院分区：
文献类型：
--
作者：
French JMR;Bramley P;Scattergood S;Sandiford NA
模块化双活动(MDM)结构可用于降低全髋关节置换术(THR)后脱位率。然而，人们担心由于金属衬里和外壳之间的微动腐蚀而对金属碎片(ARMD)产生不良反应。这项系统审查报告了使用MDM组件实施THR后的结果。它是在普罗斯佩罗注册的，并按照Cochrane和Prisma的建议进行。共纳入16篇文章，使用随机截距Logistic回归模型对相关子集进行荟萃分析。在研究随访期内需要翻修手术的ARMD的中位发病率估计为0.3%(11项队列研究包含1312例，95%可信区间为0.1-1.8%)。7.9%的患者血清金属离子水平轻度升高，1.8%的患者血清金属离子水平明显升高，但与临床髋关节功能评分的恶化无关。脱位率为0.8%。翻修率为3.3%。关于髋臼壳和螺丝头在金属衬里背面的磨损，有各种报道。植入物设计和部件错位都有牵连，但目前尚不清楚每个因素在多大程度上负有责任。研究的质量很差，混杂的风险很高，尤其是耳轴腐蚀。我们对进一步的工作提出了建议。同时，当考虑使用MDM假体时，外科医生应该意识到ARMD的潜在风险，如果选择一个假体，必须确保术中衬垫和螺钉的正确就位。引用本文：Efort Open Rev 2021；6：343-353。电话：10.1302/2058-5241.6.200146
Modular dual-mobility (MDM) constructs can be used to reduce dislocation rates after total hip replacement (THR). However, there are concerns about adverse reaction to metal debris (ARMD) as a result of fretting corrosion between the metal liner and shell. This systematic review reports outcomes following THR using MDM components. It was registered with PROSPERO and conducted in line with Cochrane and PRISMA recommendations. Sixteen articles were included overall, with meta-analysis performed on relevant subsets using a random intercept logistic regression model. Estimated median incidence of ARMD requiring revision surgery within study follow-up period was 0.3% (95% CI 0.1 – 1.8%, from 11 cohort studies containing 1312 cases). Serum metal ion levels were mildly raised in 7.9% of cases, and significantly raised in 1.8%, but there was no correlation with worse clinical hip function scores within studies. Dislocation rate was 0.8%. Revision rate was 3.3%. There are mixed reports of wear on the backside of the metal liner from the acetabular shell and screw heads. Both implant design and component malseating are implicated, but currently it is unclear to what extent each factor is responsible. Studies were poor quality with high risk of confounding, especially from trunnion corrosion. We have made recommendations for further work. In the meantime, surgeons should be aware of the potential risk of ARMD when considering using an MDM prosthesis, and, if selecting one, must ensure proper seating of the liner and screws intraoperatively. Cite this article: EFORT Open Rev 2021;6:343-353. DOI: 10.1302/2058-5241.6.200146
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DOI：
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