Do Retrieval Analysis and Blood Metal Measurements Contribute to Our Understanding of Adverse Local Tissue Reactions?
Do Retrieval Analysis and Blood Metal Measurements Contribute to Our Understanding of Adverse Local Tissue Reactions?
复制标题
DOI：
10.1007/s11999-014-3893-2
复制
发表时间：
2014-12-01
影响因子：
4.2
通讯作者：
Jacobs, Joshua J.
中科院分区：
文献类型：
--
作者：
Campbell, Patricia A.;Kung, Michael S.;Jacobs, Joshua J.
金属对金属（MoM）全髋关节置换术（THA）以及模块化THA中的头颈和颈体连接处与其相关磨损和腐蚀产物的各种局部和全身反应有关。虽然实验室检测是可用的，但实验室值（包括血清金属离子水平）和不良局部组织反应（ALTRs）之间的关系仍然存在争议，并且不完全表征。(1)在有MoM tha或在头颈和颈-体连接处金属对聚乙烯（或陶瓷对聚乙烯）tha有腐蚀的患者中，与ALTR相关的血清金属水平范围是什么？(2) MoM全髋患者发生多少磨损？(3)磨损与ALTR之间是否存在剂量响应关系？方法回顾PubMed和Embase数据库中评估ALTR存在时血清金属水平的英语研究，并系统回顾描述改良MoM种植体磨损测量结果和ALTR组织病理学的论文。报告的线性磨损数据被分成有ALTR和没有ALTR的两组，分别在个别论文中列出，并绘制图表，以确定磨损和ALTR之间是否存在剂量-反应关系。总共有15项研究，包括338例ALTR患者，并对相应的血清金属水平进行了识别和分析。12项研究报告了来自各种局部反应患者的MoM组件的磨损深度或体积。两项研究调查了金属对聚乙烯THA头颈和颈体连接处的腐蚀。存在高度的可变性和研究异质性，因此无法进行数据汇总（meta分析）。结果ALTR患者报告的平均金属浓度高于正常值（钴浓度范围为5至40 ppb，铬水平范围为5至54 ppb）。虽然有几项研究表明ALTR患者的轴承表面有更高的平均线性磨损，但这一发现并非在我们在本系统综述中确定的所有研究中都有。由于这种高度的可变性，磨损和ALTR之间没有明确的剂量-反应关系。结论血清金属水平分析和种植体回收分析有助于对ALTR的认识。ALTR存在时，血清金属水平通常升高，但不应单独用于临床决策。许多但不是所有的ALTR患者，包括假肿瘤患者，都表现出高度磨损，但需要更多的数据和更系统的组织病理学描述来确定引起不良反应的磨损程度。
Background Metal-on-metal (MoM) total hip arthroplasties (THAs) and the head-neck and neck-body junctions in modular THA are associated with a variety of local and systemic reactions to their related wear and corrosion products. Although laboratory testing is available, the relationship between laboratory values-including serum metal ion levels-and adverse local tissue reactions (ALTRs) remains controversial and incompletely characterized.Questions/purposes (1) What is the range of serum metal levels associated with ALTR in patients who have MoM THAs or corrosion at the head-neck and neck-body junctions in metal-on-polyethylene (or ceramic-on-polyethylene) THAs? (2) How much wear occurs in patients with MoM total hips? (3) Is there evidence of a doseresponse relationship between wear and ALTR?Methods PubMed and Embase databases were reviewed for English-language studies assessing serum metal levels in the presence of ALTR and papers describing the results of wear measurements from revised MoM implants and ALTR histopathology were systematically reviewed. Reported linear wear data were separated into groups with ALTR and without ALTR as listed in individual papers and graphed to determine whether a dose-response relationship was present between wear and ALTR. Overall, 15 studies including 338 hips with ALTR with corresponding serum metal levels were identified and analyzed. Twelve studies reported the wear depth or volume of MoM components from patients with a variety of local reactions. Two studies investigated corrosion at the head-neck and neck-body junctions in metal-on-polyethylene THA. There was a high level of variability and study heterogeneity, and so data pooling (meta-analysis) could not be performed.Results Average reported metal concentrations were elevated above established normal values in patients with ALTR (cobalt concentrations ranged from 5 to 40 ppb, and chromium levels ranged from 5 to 54 ppb). Whereas several studies demonstrated that patients with ALTR had higher average linear wear of the bearing surfaces, this finding was not made in all studies that we identified in this systematic review. Because of this high degree of variability, no clear dose-response relationship between wear and ALTR could be established.Conclusions Serum metal level analysis and implant retrieval analysis both contribute to the understanding of ALTR. Serum metal levels generally are elevated in the presence of ALTR but should not be used in isolation for clinical decision-making. Many but not all patients with ALTR, including those with pseudotumors, demonstrate high wear, but more data and more systematic descriptions of the histopathology are needed to define the amount of wear that induces adverse reactions.