磨损能否解释金属对金属全髋关节周围的组织学变化？
Can wear explain the histological variation around metal-on-metal total hips?
作者信息
Ebramzadeh Edward, Campbell Patricia, Tan Timothy L, Nelson Scott D, Sangiorgio Sophia N
机构信息
The J. Vernon Luck, Sr, MD Orthopaedic Research Center, UCLA, Los Angeles, CA, USA,
出版信息
Clin Orthop Relat Res. 2015 Feb;473(2):487-94. doi: 10.1007/s11999-014-3874-5.
BACKGROUND
There is a general perception that adverse local tissue reactions in metal-on-metal hip arthroplasties are caused by wear, but the degree to which this is the case remains controversial.
QUESTIONS/PURPOSES: To what extent is the magnitude of wear associated with (1) the histological changes; (2) presence of metallosis; and (3) likelihood of pseudotumor formation in the periprosthetic tissues?
METHODS
One hundred nineteen metal-on-metal total hip arthroplasties and hip resurfacings were selected from a retrieval collection of over 500 implants (collected between 2004 and 2012) based on the availability of periprosthetic tissues collected during revision, clinical data including presence or absence of pseudotumor or metallosis observed intraoperatively, and wear depth measured using a coordinate measurement machine. Histological features of tissues were scored for aseptic lymphocytic vasculitis-associated lesions (ALVAL). Correlation analysis was performed on the three endpoints of interest.
RESULTS
With the sample size available, no association was found between wear magnitude and ALVAL score (ρ=-0.092, p=0.423). Median wear depth (ball and cup) was greater in hips with metallosis (137 μm; range, 8-873 μm) than in those without (18 μm; range, 8-174 μm; p<0.0001). With the numbers available, no statistically significant association between wear depth and pseudotumor formation could be identified; median wear depth was 74 μm in hips with pseudotumors and 26 μm in those without (p=0.741).
CONCLUSIONS
Wear alone did not explain the histopathological changes in the periprosthetic tissues. A larger sample size and more sensitive outcome variable assessments may have revealed a correlation. However, wear depth has been inconsistently associated with pseudotumor formation, perhaps because some patients with hypersensitivity may develop pseudotumors despite low wear.
CLINICAL RELEVANCE
Metal wear alone may not explain the histological reactions and pseudotumors around metal-on-metal hip implants.
背景
人们普遍认为金属对金属髋关节置换术中局部组织不良反应是由磨损引起的，但实际情况的程度仍存在争议。
问题/目的：磨损程度与（1）组织学变化；（2）金属沉着病的存在；以及（3）假体周围组织中假肿瘤形成的可能性在多大程度上相关？
方法
从一个超过500例植入物的回收样本（收集于2004年至2012年之间）中，根据翻修时收集的假体周围组织的可用性、临床数据（包括术中观察到的假肿瘤或金属沉着病的存在与否）以及使用坐标测量机测量的磨损深度，选择了119例金属对金属全髋关节置换术和髋关节表面置换术。对组织的组织学特征进行无菌性淋巴细胞性血管炎相关病变（ALVAL）评分。对三个感兴趣的终点进行相关性分析。
结果
根据现有样本量，未发现磨损程度与ALVAL评分之间存在关联（ρ=-0.092，p=0.423）。有金属沉着病的髋关节的中位磨损深度（球头和髋臼杯）（137μm；范围，8-873μm）大于无金属沉着病的髋关节（18μm；范围，8-174μm；p<0.0001）。根据现有数据，无法确定磨损深度与假肿瘤形成之间存在统计学上的显著关联；有假肿瘤形成的髋关节的中位磨损深度为74μm，无假肿瘤形成的髋关节为26μm（p=0.741）。
结论
仅磨损并不能解释假体周围组织的组织病理学变化。更大的样本量和更敏感的结局变量评估可能会揭示相关性。然而，磨损深度与假肿瘤形成之间的关联并不一致，可能是因为一些过敏患者尽管磨损程度低也可能形成假肿瘤。
临床意义
仅金属磨损可能无法解释金属对金属髋关节植入物周围的组织学反应和假肿瘤。
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