Peters P C, Engh G A, Dwyer K A, Vinh T N
Anderson Orthopaedic Research Institute, Arlington, Virginia 22206.
J Bone Joint Surg Am. 1992 Jul;74(6):864-76.
The prevalence and characteristics of osteolysis were studied after 174 consecutive total knee arthroplasties, performed without cement; 16 per cent (twenty-seven) of the implants (in twenty-six patients) were identified as being associated with osteolysis. The diagnosis was made an average of thirty-five months after the operation. Fifteen (56 per cent) of the twenty-seven prostheses were revised after an average of forty-five months in situ. The remaining twelve implants were still in situ five years or more postoperatively. In the patients who were managed with revision, six implants were judged to be stable radiographically and intraoperatively. The remaining nine implants were loose. The average age of the patients who had osteolysis was sixty-three years, and the average weight was seventy-six kilograms (168 pounds). Eighteen of the twenty-six patients who had osteolysis were women. The medial aspect of the tibial metaphysis was the most common site for resorption of bone (twenty-four knees). Sequential radiographs demonstrated progressive extension of the osteolytic process around the tibial base-plate of the prosthesis and distally into the tibial metaphysis along the screw-bone interface in all patients. Histological evaluation of tissue obtained at the revision procedures revealed sheets of histiocytes and occasional giant cells. Intracellular particulate polyethylene and metal were found; most particles were less than one micrometer in size, although particles as large as three micrometers were identified. Mechanical failure of the thin, modular, polyethylene tibial insert; excessive abrasion of the prominent polyethylene tibial eminence, with secondary wear and impingement of the pin on the femoral component; and failure of the metal-backed patellar component all contributed to the extensive amount of polyethylene and the variable amount of metal debris that were generated. Corrosion between the angulated titanium screws and the cobalt-chromium base-plate also contributed particulate metal to the osteolytic process locally. This study demonstrated that osteolysis occurs in association with cementless total knee replacement.
对174例连续进行的非骨水泥全膝关节置换术后骨溶解的发生率及特征进行了研究；16%（27例）的植入物（26例患者）被确定与骨溶解有关。诊断平均在术后35个月做出。27个假体中的15个（56%）平均在位45个月后进行了翻修。其余12个植入物在术后5年或更长时间仍在位。在接受翻修治疗的患者中，6个植入物在影像学和术中被判定为稳定。其余9个植入物松动。发生骨溶解的患者平均年龄为63岁，平均体重为76千克（168磅）。26例发生骨溶解的患者中有18例为女性。胫骨近端内侧是最常见的骨吸收部位（24个膝关节）。连续X线片显示，所有患者的溶骨过程均围绕假体的胫骨基板逐渐扩展，并沿螺钉-骨界面向远端延伸至胫骨近端。翻修手术时获取的组织的组织学评估显示有组织细胞片和偶尔的巨细胞。发现了细胞内颗粒状聚乙烯和金属；大多数颗粒小于1微米，尽管也发现了直径达3微米的颗粒。薄的模块化聚乙烯胫骨衬垫的机械故障；突出的聚乙烯胫骨隆起过度磨损，继发磨损以及销钉撞击股骨部件；以及金属背衬的髌骨部件故障，均导致产生大量的聚乙烯和数量不等的金属碎屑。成角的钛螺钉与钴铬基板之间的腐蚀也局部地为溶骨过程贡献了颗粒状金属。这项研究表明，骨溶解与非骨水泥全膝关节置换有关。
