Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite #300, Chicago, IL 60612, USA.
J Bone Joint Surg Am. 2013 Mar 20;95(6):512-8. doi: 10.2106/JBJS.L.00471.
We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). Ten patients (hybrid group) had received a hybrid total hip replacement that consisted of a modular cobalt-alloy femoral stem with a cobalt-alloy femoral head that had been inserted with cement and a titanium acetabular socket that had been inserted without cement. Nine patients (cobalt-chromium [CoCr] group) had received an implant with an extensively porous-coated modular cobalt-alloy femoral stem and femoral head along with a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Eight patients (titanium group) had undergone insertion of a proximally porous-coated modular titanium-alloy femoral stem with a cobalt-alloy femoral head and a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Thirteen patients (control group) from the original control group of patients who had not received an implant served as control subjects. Serum metal levels were measured with use of high-resolution sector field inductively coupled plasma mass spectrometry. The hybrid total hip arthroplasty group had mean cobalt levels that were 3.2 times higher at 120 months than they were at baseline, and the cobalt levels in that group were significantly higher than those in the titanium total hip arthroplasty group at thirty-six, sixty, eighty-four, ninety-six, and 120 months (p < 0.01). The hybrid group had mean chromium levels that were 3.9 times higher at 120 months than they were at baseline, and the CoCr total hip arthroplasty group had chromium levels that were 3.6 times higher at 120 months than they were at baseline. The serum titanium levels were higher in the titanium group at all follow-up time intervals as compared with the levels in all other groups, and the level in the titanium group at 120 months was eighteen times higher than it was at baseline (p < 0.01). Patients with well-functioning primary metal-on-polyethylene total hip replacements had elevated serum metal levels for as many as ten years postoperatively. Furthermore, metal release at the modular femoral head-neck junctions, rather than passive dissolution from porous ingrowth surfaces, was likely the dominant source of serum cobalt and chromium.
我们之前曾报道过初次全髋关节置换术后三年患者血清中的钴、铬和钛金属离子浓度与未植入假体的对照组患者血清中的浓度相比。这项研究是对这些患者髋关节植入十年后发现的血清金属水平的简明更新。在最初的 75 名受试者中，有 40 名（53%）患者的金属离子水平可用。10 名患者（混合组）接受了混合式全髋关节置换术，其中包括一个带有人工关节头的模块化钴合金股骨柄，人工关节头通过骨水泥固定，一个不带骨水泥的钛髋臼窝。9 名患者（钴铬 [CoCr] 组）接受了广泛多孔涂层的模块化钴合金股骨柄和股骨头以及钛髋臼窝植入物；股骨和髋臼组件均未使用骨水泥固定。8 名患者（钛组）接受了带有人工关节头的近端多孔涂层模块化钛合金股骨柄和钛髋臼窝植入物；股骨和髋臼组件均未使用骨水泥固定。最初的未植入假体的对照组患者中有 13 名（对照组）作为对照。使用高分辨率扇形区感应耦合等离子体质谱法测量血清金属水平。混合式全髋关节置换组在 120 个月时钴水平平均升高 3.2 倍，高于基线水平，且该组钴水平在 36、60、84、96 和 120 个月时均显著高于钛全髋关节置换组（p < 0.01）。混合组在 120 个月时的铬水平平均升高 3.9 倍，高于基线水平，而 CoCr 全髋关节置换组在 120 个月时的铬水平平均升高 3.6 倍，高于基线水平。与其他组相比，钛组在所有随访时间间隔的血清钛水平均较高，且钛组在 120 个月时的水平比基线时高 18 倍（p < 0.01）。功能良好的初次金属对聚乙烯全髋关节置换术后患者在术后长达 10 年内血清金属水平升高。此外，模块化股骨头颈交界处的金属释放，而不是多孔植入物表面的被动溶解，可能是血清钴和铬的主要来源。
