Korovessis P, Petsinis G, Repanti M, Repantis T
Orthopaedic Department, General Hospital Agios Andreas, 65-67 Haralabi Street, 26224 Patras, Greece.
J Bone Joint Surg Am. 2006 Jun;88(6):1183-91. doi: 10.2106/JBJS.D.02916.
Authors of recent studies have reported early periprosthetic osteolysis in patients who have been treated with a contemporary metal-on-metal total hip arthroplasty and have suggested that metal hypersensitivity associated with an immunologic response to metal may be of etiologic importance. We evaluated the results and histologic findings in patients who had undergone revision of a failed contemporary metal-on-metal total hip arthroplasty.
Two hundred and seventeen total hip arthroplasties (SL-Plus stem and Bicon-Plus cup) with a Sikomet metal-on-metal articulation were implanted in 194 consecutive patients, and the results were retrospectively reviewed at a mean of seventy-seven months postoperatively. Clinical follow-up with the Harris hip score and plain radiographic evaluation were performed. Periprosthetic tissues from fourteen hips that had undergone revision arthroplasty were subjected to histologic analysis.
The mean Harris hip score improved from 45 points preoperatively to 88 points at the final evaluation. Fourteen hips (6.5%) were revised: nine because of aseptic loosening, two because of technical failure, and three because of septic failure. Histologic examination of the retrieved periprosthetic tissues from the eleven patients who had undergone revision because of aseptic loosening or technical failure showed metallosis and extensive lymphocytic and plasma-cell infiltration around the metal debris. With removal of the component because of aseptic loosening as the end point, survivorship was 93% for the stem and 98% for the cup.
Our findings are in agreement with those in recent publications and support the possibility that periprosthetic osteolysis and aseptic loosening in hips with a metal-on-metal articulation are possibly associated with hypersensitivity to metal debris. Prospective, comparative, randomized long-term studies are necessary to determine the cause(s) of loosening of prostheses with this particular articulation.
近期研究的作者报告了接受现代金属对金属全髋关节置换术治疗的患者早期假体周围骨溶解情况，并指出与对金属的免疫反应相关的金属超敏反应可能具有病因学意义。我们评估了接受失败的现代金属对金属全髋关节置换术翻修的患者的结果和组织学发现。
将217例采用西科梅特金属对金属关节的全髋关节置换术（SL-Plus柄和Bicon-Plus臼杯）植入194例连续患者体内，并在术后平均77个月时对结果进行回顾性分析。采用Harris髋关节评分进行临床随访，并进行X线平片评估。对14例接受翻修关节成形术的髋关节的假体周围组织进行组织学分析。
Harris髋关节评分均值从术前的45分提高到最终评估时的88分。14例髋关节（6.5%）进行了翻修：9例因无菌性松动，2例因技术失败，3例因感染性失败。对11例因无菌性松动或技术失败而接受翻修的患者取出的假体周围组织进行组织学检查，结果显示有金属沉着病，金属碎屑周围有广泛的淋巴细胞和浆细胞浸润。以因无菌性松动取出假体为终点，柄的生存率为93%，臼杯的生存率为98%。
我们的发现与近期出版物中的发现一致，并支持金属对金属关节的髋关节假体周围骨溶解和无菌性松动可能与对金属碎屑超敏反应相关的可能性。需要进行前瞻性、对比性、随机长期研究以确定这种特殊关节假体松动的原因。
