Nikolaou Vassilios S, Petit Alain, Debiparshad Kevin, Huk Olga L, Zukor David J, Antoniou John
Division of Orthopaedic Surgery, McGill University, and SMBD-Jewish General Hospital, Montreal, Quebec, Canada.
Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S77-83.
Metal-on-metal (MoM) total hip arthroplasty (THA) has been introduced in an attempt to reduce the wear rate and the consequent osteolysis around implants. The aim of this study was to present the intermediate to long-term clinical and radiological outcomes and to investigate the metal ion levels in the blood of patients who had undergone primary uncemented MoM THA in our institution. Between July 1997 and November 2003, 166 patients (193 hips), with a mean age of 50 years (range, 18-65 years), underwent primary MoM THA. Clinical data, radiographs, and blood samples were obtained at regular follow-up visits. Cobalt (Co), chromium (Cr), and molybdenum (Mo) ions were measured by inductively coupled plasma-mass spectrometry (ICP-MS) from the patient's whole blood. All patients were prospectively followed for a minimum of 5 years (mean, 7 years; range, 5-11 years). The mean Harris hip score (HHS) and the University of California at Los Angeles (UCLA) activity score at the latest follow-up was 88 ± 11 and 7 ± 1.8 points, respectively. Thirteen hips have been revised. Ten acetabular components had early failure, due to factory manufacturing problems. All other implants have been found stable, with no signs of aseptic loosening. The probability of survival at 11 years, if the hips that were revised due to manufacturing problems were excluded, was 98.4%. The Co and Cr metal ion levels, after increasing significantly during the first 4 to 5 years post-surgery, remained stable, with a tendency to decrease thereafter, but not significantly. During the same follow-up period, Mo ion levels remained stable. In this 5-to-11 year follow-up study of MoM THA patients, excellent survivorship, with low complications rates, was found. Results of longer follow-up studies are necessary to clarify the possible long-term effects of metal ion release.
金属对金属（MoM）全髋关节置换术（THA）已被引入，旨在降低磨损率以及植入物周围随之而来的骨溶解。本研究的目的是呈现中长期临床和放射学结果，并调查在我们机构接受初次非骨水泥型MoM THA的患者血液中的金属离子水平。在1997年7月至2003年11月期间，166例患者（193髋）接受了初次MoM THA，平均年龄为50岁（范围18 - 65岁）。在定期随访时获取临床数据、X线片和血液样本。通过电感耦合等离子体质谱法（ICP - MS）测量患者全血中的钴（Co）、铬（Cr）和钼（Mo）离子。所有患者均进行前瞻性随访至少5年（平均7年；范围5 - 11年）。最新随访时的平均Harris髋关节评分（HHS）和加利福尼亚大学洛杉矶分校（UCLA）活动评分分别为88±11分和7±1.8分。13髋进行了翻修。10个髋臼组件因工厂制造问题出现早期失败。所有其他植入物均稳定，无无菌性松动迹象。如果排除因制造问题而翻修的髋关节，11年时的生存率为98.4%。Co和Cr金属离子水平在术后最初4至5年显著升高后保持稳定，此后有下降趋势，但不显著。在同一随访期内，Mo离子水平保持稳定。在这项对MoM THA患者进行的5至11年随访研究中，发现生存率极佳，并发症发生率低。需要更长随访研究的结果来阐明金属离子释放可能产生的长期影响。
