Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours
Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours
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DOI：
10.1302/0301-620x.92b3.23281
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发表时间：
2010-03-01
影响因子：
--
通讯作者：
Murray, D. W.
中科院分区：
文献类型：
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作者：
Kwon, Y. -M.;Glyn-Jones, S.;Murray, D. W.
金属对金属髋关节表面置换术后出现假瘤（与髋关节相关的软组织肿块）与血清中金属离子水平升高有关，表明磨损增加时会发生假瘤。我们的目的是量化因假性肿瘤而翻修的种植体（8个）和因其他原因而翻修的种植体（22个）的体内磨损。我们发现，假性肿瘤种植体组股骨部件的平均线性磨损率明显更高，为8.1 μ m/年（2.75至25.4）比1.79亩/年（0.82至4.15; p = 0.002）的非假瘤组。对于髋臼假体，假瘤组中观察到的中位线性磨损率显著更高，为7.36 μ m/年（1.61 - 24.9），而另一组为1.28 μ m/年（0.81 - 3.33，p = 0.001）。假瘤组髋臼假体的磨损总是发生在植入物的边缘，这表明边缘负荷已经发生。我们的研究结果是第一个直接证据表明，假瘤与金属对金属关节的磨损增加有关。此外，边缘加载与流体膜润滑的损失可能是一个重要的机制，产生磨损的患者与假瘤。
The presence of pseudotumours, which are soft-tissue masses relating to the hip, after metal-on-metal hip resurfacing arthroplasty has been associated with elevated levels of metal ions in serum, suggesting that pseudotumours occur when there is increased wear. We aimed to quantify the wear in vivo of implants revised for pseudotumours (eight) and of a control group of implants (22) revised for other reasons of failure.We found that the implant group with pseudotumours had a significantly higher rate of median linear wear of the femoral component at 8.1 mu m/year (2.75 to 25.4) than the 1.79 mu m/year (0.82 to 4.15; p = 0.002) of the non-pseudotumour group. For the acetabular component a significantly higher rate of median linear wear of 7.36 mu m/year (1.61 to 24.9) was observed in the pseudotumour group compared with 1.28 mu m/year (0.81 to 3.33, p = 0.001) in the other group. Wear of the acetabular component in the pseudotumour group always involved the edge of the implant, indicating that edge-loading had occurred.Our findings are the first direct evidence that pseudotumour is associated with increased wear at the metal-on-metal articulation. Furthermore, edge-loading with the loss of fluid-film lubrication may be an important mechanism of generation of wear in patients with a pseudotumour.