Rajpura Asim, Porter Martyn L, Gambhir Anil K, Freemont Anthony J, Board Timothy N
Centre for Hip Surgery, Wrightington Hospital, Wigan, UK.
Hip Int. 2011 Jan-Mar;21(1):43-51. doi: 10.5301/hip.2011.6276.
There has been growing concern regarding the systemic and local effects of metal ions released from metal-on-metal hip resurfacings and total hip replacements, including the development of aseptic lymphocyte dominated vasculitis associated lesions (ALVAL). We describe our experience of treating 13 patients with failed metal on metal bearing hip prostheses secondary to this condition. Hip revision occurred at mean of 45 months following primary surgery. Groin pain was present in all patients. Other common features included large bursal swelling and mechanical symptoms. 3 patients developed their symptoms immediately postoperatively. The mean time to presentation was 21 months. Radiographic abnormalities noted included 3 patients with cup loosening and 2 patients with neck thinning. The mean cup inclination was 52 degrees. Surgical findings included bursal swellings and creamy brown fluid. Osteolysis was rarely seen. 12 revisions were achieved with primary implants and all patients had immediate symptomatic improvement. One patient was left with a pseudoarthrosis due to extensive soft tissue destruction. Diagnosis of ALVAL was confirmed histologically. The diagnosis of ALVAL should be considered in patients with unexplained pain from a metal on metal bearing hip arthroplasty. Surgical findings are typical and symptoms tend to resolve reliably following conversion to an alternative bearing surface.
人们越来越关注金属对金属髋关节表面置换术和全髋关节置换术中释放的金属离子的全身和局部影响，包括无菌性淋巴细胞为主的血管炎相关病变（ALVAL）的发生。我们描述了治疗13例因这种情况导致金属对金属承重髋关节假体失败患者的经验。髋关节翻修术在初次手术后平均45个月进行。所有患者均有腹股沟疼痛。其他常见特征包括大的滑囊肿胀和机械症状。3例患者术后立即出现症状。出现症状的平均时间为21个月。影像学异常包括3例髋臼松动和2例股骨颈变细。髋臼平均倾斜度为52度。手术所见包括滑囊肿胀和乳脂状棕色液体。很少见到骨溶解。12例翻修术采用初次植入物，所有患者症状立即改善。1例患者因广泛软组织破坏而遗留假关节。ALVAL的诊断经组织学证实。对于金属对金属承重髋关节置换术出现不明原因疼痛的患者，应考虑ALVAL的诊断。手术所见典型，转换为替代承重表面后症状往往能可靠缓解。
