Revision for adverse local tissue reaction following metal-on-polyethylene total hip arthroplasty is associated with a high risk of early major complications
Revision for adverse local tissue reaction following metal-on-polyethylene total hip arthroplasty is associated with a high risk of early major complications
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DOI：
10.1302/0301-620x.100b6.bjj-2017-1466.r1
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发表时间：
2018-06-01
影响因子：
4.6
通讯作者：
Duncan, C. P.
中科院分区：
文献类型：
--
作者：
Waterson, H. B.;Whitehouse, M. R.;Duncan, C. P.
目的在全髋关节置换术(THA)中，头颈部模块连接处的摩擦和腐蚀是金属碎片不良反应(ARMD)的原因之一。我们描述了翻修金属-聚乙烯(MOP)人工全髋关节置换术的结果，强调了主要并发症的风险。患者和方法共36名患者，他们接受了翻修术的ARMD由于股骨头隆起。其中三个被排除在外，因为他们的修改是对另一个金属头的修改。其余33个被改装成带钛套的陶瓷头。我们描述了这些患者的表现、翻修结果和并发症的风险。结果患者表现为疼痛、肿胀、僵硬或不稳定，炎性肿块经放射学证实。所有患者耳轴均可见肉眼可见的物质沉积，与ARMD相关。翻修后，6例(18.2%)脱位，其中4例需要进一步翻修。3例(9.1%)发生深部感染，6例(18.2%)有明显的持续性疼痛，原因不明。其中1例在髂股假瘤切除后发生股动脉血栓形成，需行血栓摘除。结论ARMD合并粗隆病变翻修术后严重并发症的风险较高。在存在广泛的组织损伤的情况下，建议在这些患者中使用约束性衬里或双移位结构。
AimsFretting and corrosion at the modular head/neck junction, known as trunnionosis, in total hip arthroplasty (THA) is a cause of adverse reaction to metal debris (ARMD). We describe the outcome of revision of metal-on-polyethylene (MoP) THA for ARMD due to trunnionosis with emphasis on the risk of major complications.Patients and MethodsA total of 36 patients with a MoP THA who underwent revision for ARMD due to trunnionosis were identified. Three were excluded as their revision had been to another metal head. The remaining 33 were revised to a ceramic head with a titanium sleeve. We describe the presentation, revision findings, and risk of complications in these patients.ResultsThe patients presented with pain, swelling, stiffness, or instability and an inflammatory mass was confirmed radiologically. Macroscopic material deposition on the trunnion was seen in all patients, associated with ARMD. Following revision, six (18.2%) dislocated, requiring further revision in four. Three (9.1%) developed a deep infection and six (18.2%) had significant persistent pain without an obvious cause. One developed a femoral artery thrombosis after excision of an iliofemoral pseudotumor, requiring a thrombectomy.ConclusionThe risk of serious complications following revision MoP THA for ARMD associated with trunnionosis is high. In the presence of extensive tissue damage, a constrained liner or dual mobility construct is recommended in these patients.