De l'Yvette Private Hospital, 67, route de Corbeil, 91160 Longjumeau, France.
Orthop Traumatol Surg Res. 2010 Dec;96(8):894-904. doi: 10.1016/j.otsr.2010.05.008. Epub 2010 Sep 15.
With certain concerns recently reported on metal-on-metal bearing couples in total hip arthroplasty, this study's objective is to review the current knowledge concerning release of metal ions and its potential consequences. Each metal-on-metal implant presents different tribological properties. The analytical techniques for metals are accurate and the Co ion rates seem acceptable up to 2 μg/L. A delayed type IV hypersensitivity reaction (atypical lymphocytic vasculitis-associated lesion [ALVAL]) may be the source of arthroplasty failure. Idiosyncratic, it remains unpredictable even using cutaneous tests and apparently is rare (0.3%). Today, there are no scientific or epidemiologic data supporting a risk of carcinogenesis or teratogenesis related to the use of a metal-on-metal bearings couple. Solid pseudotumors nearly exclusively are observed with resurfacing procedures, carrying a high annual revision rate in women under 40 years of age, occurring particularly in cases of acetabular malposition and with use of cast molded Cr-Co alloys. Osteolysis manifests through complete and progressive radiolucent lines or through cavitary lesions stemming from ALVAL-type alterations or impingement problems or implant incompatibility. The formation of wear debris exceeding the biological tolerance is possible with implant malposition, subluxation, and jamming of the femoral head in cases of cup deformity. Moreover, each implant presents different metal ion production; assessment of their performance and safety is required before their clinical use. With the knowledge available today, metal-on-metal bearing couples are contraindicated in cases of metal allergies or end stage renal dysfunction and small size resurfacing should cautiously be used.
由于最近有报道称金属对金属关节在全髋关节置换术中存在一些问题，本研究旨在综述目前关于金属离子释放及其潜在后果的相关知识。每一种金属对金属植入物都具有不同的摩擦学特性。金属的分析技术非常准确，Co 离子的释放率似乎在 2μg/L 以下是可以接受的。迟发型 IV 型超敏反应（非典型淋巴细胞性脉管炎相关病变 [ALVAL]）可能是导致关节置换失败的原因。它是一种特发性疾病，即使使用皮肤试验也无法预测，而且似乎很少见（0.3%）。目前，没有科学或流行病学数据支持与使用金属对金属关节有关的致癌或致畸风险。实体假瘤几乎仅见于表面置换手术，在 40 岁以下的女性中具有较高的年翻修率，尤其是在髋臼位置不良和使用铸造模压 Cr-Co 合金的情况下。溶骨性病变通过完全和进行性的透亮线或源自 ALVAL 样改变、撞击问题或植入物不匹配的腔性病变表现出来。在植入物位置不良、半脱位和髋臼变形导致股骨头卡压的情况下，可能会出现超过生物耐受的磨屑形成。此外，每种植入物的金属离子产生量都不同；在临床使用之前，需要评估它们的性能和安全性。根据目前的知识，金属对金属关节在金属过敏或终末期肾功能衰竭以及小尺寸表面置换的情况下是禁忌的，应谨慎使用。
