Vendittoli P-A, Roy A, Mottard S, Girard J, Lusignan D, Lavigne M
Maisonneueve-Rosemont Hospital, University of Montreal, Quebec, Canada.
J Bone Joint Surg Br. 2010 Jan;92(1):12-9. doi: 10.1302/0301-620X.92B1.22226.
We have updated our previous randomised controlled trial comparing release of chromium (Cr) and cobalt (Co) ions and included levels of titanium (Ti) ions. We have compared the findings from 28 mm metal-on-metal total hip replacement, performed using titanium CLS/Spotorno femoral components and titanium AlloFit acetabular components with Metasul bearings, with Durom hip resurfacing using a Metasul articulation or bearing and a titanium plasma-sprayed coating for fixation of the acetabular component. Although significantly higher blood ion levels of Cr and Co were observed at three months in the resurfaced group than in total hip replacement, no significant difference was found at two years post-operatively for Cr, 1.58 microg/L and 1.62 microg/L respectively (p = 0.819) and for Co, 0.67 microg/L and 0.94 microg/L respectively (p = 0.207). A steady state was reached at one year in the resurfaced group and after three months in the total hip replacement group. Interestingly, Ti, which is not part of the bearing surfaces with its release resulting from metal corrosion, had significantly elevated ion levels after implantation in both groups. The hip resurfacing group had significantly higher Ti levels than the total hip replacement group for all periods of follow-up. At two years the mean blood levels of Ti ions were 1.87 microg/L in hip resurfacing and and 1.30 microg/L in total hip replacement (p = 0.001). The study confirms even with different bearing diameters and clearances, hip replacement and 28 mm metal-on-metal total hip replacement produced similar Cr and Co metal ion levels in this randomised controlled trial study design, but apart from wear on bearing surfaces, passive corrosion of exposed metallic surfaces is a factor which influences ion concentrations. Ti plasma spray coating the acetabular components for hip resurfacing produces significantly higher release of Ti than Ti grit-blasted surfaces in total hip replacement.
我们更新了之前的随机对照试验，该试验比较了铬（Cr）和钴（Co）离子的释放情况，并纳入了钛（Ti）离子水平。我们比较了使用钛CLS/Spotorno股骨部件和钛AlloFit髋臼部件以及Metasul轴承进行的28毫米金属对金属全髋关节置换的结果，与使用Metasul关节或轴承以及用于髋臼部件固定的钛等离子喷涂涂层的Durom髋关节表面置换的结果。尽管在术后三个月时，表面置换组的血液中Cr和Co离子水平明显高于全髋关节置换组，但在术后两年时，Cr的水平分别为1.58微克/升和1.62微克/升（p = 0.819），Co的水平分别为0.67微克/升和0.94微克/升（p = 0.207），未发现显著差异。表面置换组在一年时达到稳定状态，全髋关节置换组在三个月后达到稳定状态。有趣的是，Ti并非轴承表面的组成部分，其释放是由金属腐蚀导致的，两组植入后Ti离子水平均显著升高。在所有随访期间，髋关节表面置换组的Ti水平均显著高于全髋关节置换组。在两年时，髋关节表面置换组Ti离子的平均血液水平为1.87微克/升，全髋关节置换组为1.30微克/升（p = 0.001）。该研究证实，在本随机对照试验研究设计中，即使轴承直径和间隙不同，髋关节置换和28毫米金属对金属全髋关节置换产生的Cr和Co金属离子水平相似，但除了轴承表面磨损外，暴露金属表面的被动腐蚀也是影响离子浓度的一个因素。用于髋关节表面置换的髋臼部件采用Ti等离子喷涂涂层比全髋关节置换中Ti喷砂处理表面产生的Ti释放量显著更高。
