Moroni Antonio, Savarino Lucia, Cadossi Matteo, Baldini Nicola, Giannini Sandro
VI Division, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, Bologna, Italy.
Clin Orthop Relat Res. 2008 Mar;466(3):700-7. doi: 10.1007/s11999-007-0106-2. Epub 2008 Jan 9.
Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potential increased metal ion release. We hypothesized there were no differences in serum concentrations of chromium, cobalt, and molybdenum between patients who had metal-on-metal hip resurfacing (Group A; average head diameter, 48 mm; median followup, 24 months) and patients who had 28-mm metal-on-metal THA (Group B; median followup, 25 months). Serum concentrations also were compared with concentrations in healthy subjects. We identified no differences in ion levels between Groups A and B. A distinction was made according to gender. Women showed a higher chromium release in Group A whereas men had a higher cobalt release in Group B. Values obtained from Group A were higher than those of the control subjects. Our data suggest metal-on-metal bearings for THA should not be rejected because of concern regarding potential increased metal ion release; however, patients with elevated ion levels, even without loosening or toxicity, could be at higher risk and should be followed up periodically.
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
现代金属对金属髋关节表面置换术作为一种针对年轻且活跃患者的保留骨质的关节重建方法被引入；然而，较大直径的关节面令人担忧金属离子释放可能增加。我们假设接受金属对金属髋关节表面置换术的患者（A组；平均股骨头直径48mm；中位随访时间24个月）与接受28mm金属对金属全髋关节置换术的患者（B组；中位随访时间25个月）血清中铬、钴和钼的浓度没有差异。还将血清浓度与健康受试者的浓度进行了比较。我们发现A组和B组之间离子水平没有差异。根据性别进行了区分。A组中女性的铬释放较高，而B组中男性的钴释放较高。A组获得的值高于对照组受试者。我们的数据表明，不应因担心金属离子释放可能增加而拒绝用于全髋关节置换术的金属对金属关节；然而，离子水平升高的患者，即使没有松动或毒性，也可能面临更高风险，应定期随访。
III级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
