Quale J L, Murphey M D, Huntrakoon M, Reckling F W, Neff J R
Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City 66103.
Radiology. 1992 Mar;182(3):855-8. doi: 10.1148/radiology.182.3.1535907.
Complications of total joint replacements are not infrequent. The authors describe five patients with displacement of the polyethylene component in two knee (metal-backed patellar component) and three hip joint replacements. Clinical, radiographic, surgical, and pathologic findings were reviewed in all cases. Conventional radiographs revealed abnormal position of the metal components in all patients and opaque curvilinear periarticular deposits in four. Arthropathy caused by deposition of small titanium particles from metal friction (in the absence of interposed polyethylene) was pathologically proved to correspond to the periarticular opacity. The subtle radiolucent polyethylene component was identified in all patients; adequate visualization in some cases may necessitate imaging with additional methods such as magnification, phosphor plate, and soft-tissue radiographic techniques; conventional tomography; and arthrography. Early recognition of these abnormalities in patients with painful joint replacements may allow less extensive surgical revision and prevent development of titanium-induced arthropathy.
全关节置换的并发症并不罕见。作者描述了5例聚乙烯部件移位的患者，其中2例为膝关节置换（金属背衬髌骨部件），3例为髋关节置换。对所有病例的临床、影像学、手术及病理结果进行了回顾。常规X线片显示所有患者金属部件位置异常，4例可见关节周围不透明曲线状沉积物。病理证实，由金属摩擦产生的小钛颗粒沉积（无聚乙烯夹层）导致的关节病与关节周围不透明影相符。所有患者均识别出了细微的透X线聚乙烯部件；在某些情况下，可能需要采用放大、磷光板、软组织X线摄影技术、传统体层摄影及关节造影等额外方法进行成像，以实现充分显影。对于关节置换术后疼痛的患者，早期识别这些异常情况可能使手术翻修范围更小，并预防钛诱导性关节病的发展。
