Trepman E, Ewald F C
Department of Orthopaedic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
J Arthroplasty. 1991 Mar;6(1):59-65. doi: 10.1016/s0883-5403(06)80158-0.
Three cases of early recurrent synovitis of the rheumatoid elbow following silicone radial head implant arthroplasty are presented. All three patients underwent synovectomy with silicone radial head implant for pain and loss of function due to rheumatoid synovitis. All three implants failed within 4-9 months after surgery. This failure was associated with radiographic medial joint space widening. At reexploration, recurrent synovitis with hemosiderin pigmentation was noted. Patterns of prosthetic failure included fracture, fraying, and compressive deformation or rotary wear ("motar and pestle") of the silicone radial head; a prosthetic stem fracture was also present. Histologic examination of the synovium revealed evidence of silicone-induced synovitis; particulate, refractile silicone debris was associated with inflammatory and foreign body giant cells. The presence of rheumatoid destruction of the joint surface may have accelerated this process and may be a relative contraindication to silicone radial head implant arthroplasty.
本文报告了3例硅胶桡骨头置换术后类风湿性肘关节早期复发性滑膜炎的病例。所有3例患者均因类风湿性滑膜炎导致疼痛和功能丧失，接受了硅胶桡骨头置换滑膜切除术。所有3个植入物均在术后4至9个月内失效。这种失效与影像学上内侧关节间隙增宽有关。再次探查时，发现复发性滑膜炎伴有含铁血黄素沉着。假体失效的模式包括硅胶桡骨头骨折、磨损、压缩变形或旋转磨损（“臼杵”样）；还存在假体柄骨折。滑膜组织学检查显示有硅胶诱导的滑膜炎证据；颗粒状、折光性硅胶碎片与炎症和异物巨细胞有关。关节表面类风湿性破坏的存在可能加速了这一过程，可能是硅胶桡骨头置换术的相对禁忌证。
