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双模块化锥形全髋关节置换术患者管理的风险分层算法:美国髋膝关节外科医师协会、美国骨外科医师学会和髋关节协会的共识声明

Risk stratification algorithm for management of patients with dual modular taper total hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons and the Hip Society.

作者信息

Kwon Young-Min, Fehring Thomas K, Lombardi Adolph V, Barnes C Lowry, Cabanela Miguel E, Jacobs Joshua J

机构信息

Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Ortho Carolina Hip and Knee Center, Charlotte, NC.

出版信息

J Arthroplasty. 2014 Nov;29(11):2060-4. doi: 10.1016/j.arth.2014.07.029. Epub 2014 Jul 31.

Abstract

Although 'dual taper' modular stems with interchangeable modular necks have the potential to optimize hip biomechanical parameters, there is increasing concern regarding the occurrence of adverse local tissue reactions from mechanically assisted crevice corrosion at the neck-stem taper junction. A systematic treatment approach (risk stratification algorithm) based on the currently available data is recommended to optimize patient management. While specialized tests such as metal ion analysis and MARS MRI are useful modalities in evaluating for adverse tissue reactions, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. There should be a low threshold to perform a systematic evaluation of patients with dual taper stem total hip arthroplasty as early recognition and diagnosis will facilitate the initiation of appropriate treatment.

摘要

尽管带有可互换模块化颈的“双锥度”模块化柄有潜力优化髋关节生物力学参数,但人们越来越担心在柄-颈锥度交界处因机械辅助缝隙腐蚀而出现局部组织不良反应。建议采用基于现有数据的系统治疗方法(风险分层算法)来优化患者管理。虽然金属离子分析和MARS MRI等专门测试是评估组织不良反应的有用方式,但在临床决策过程中应避免过度依赖任何单一的检查工具。对于接受双锥度柄全髋关节置换术的患者,应保持较低的阈值进行系统评估,因为早期识别和诊断将有助于启动适当的治疗。

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