Van Der Straeten Catherine, De Smet Koen A
Ghent University Hospital, De Pintelaan, Ghent - Belgium.
ANCA Medical Centre, Xavier De Cocklaan, Deurle, Ghent - Belgium.
Hip Int. 2016 Jan-Feb;26(1):1-7. doi: 10.5301/hipint.5000288. Epub 2015 Oct 6.
This paper reports the consensus of an international faculty of expert metal-on-metal (MoM) hip resurfacing surgeons, with a combined experience of over 40,000 cases, on the current status of hip resurfacing arthroplasty. Indications, design and metallurgy issues, release of metal ions and adverse soft tissue reactions to particles, management of problematic cases and revisions, as well as required experience and training are covered. The overall consensus is that MoM hip resurfacing should not be banned and should be viewed separately from MoM total hip arthroplasty (THA) with a large diameter head because of the different design and wear behaviour related to the taper/trunnion connection. The use of hip resurfacing has decreased worldwide but specialist centres continue to advocate hip resurfacing in young and active male patients. Regarding age the general recommendation is to avoid hip resurfacing in men older than 65 and in women older than 55, depending on the patient activity and bone quality. Female gender is considered a relative contraindication. Most surgeons would not implant a MoM hip in women who would still like a child. Regardless of gender, there is a consensus not to perform hip resurfacing in case of a femoral head size smaller than 46 mm and in patients with renal insufficiency or with a known metal allergy. Regarding follow-up of hip resurfacing and detection of adverse local tissue reactions, metal ion measurements, MRI and ultrasound are advocated depending on the local expertise. The consensus is that hip resurfacing should be limited to high volume hip surgeons, who are experienced in hip resurfacing or trained to perform hip resurfacing in a specialist centre.
本文报告了一个国际专家团队的共识，这些专家均为金属对金属（MoM）髋关节表面置换手术医生，他们的联合经验超过40000例，内容涉及髋关节表面置换术的现状。涵盖了手术指征、设计与冶金问题、金属离子释放以及对颗粒的不良软组织反应、疑难病例和翻修的处理，还有所需的经验和培训。总体共识是，不应禁止MoM髋关节表面置换术，并且由于与锥度/耳轴连接相关的不同设计和磨损行为，应将其与大直径股骨头的MoM全髋关节置换术（THA）分开看待。髋关节表面置换术在全球范围内的使用有所减少，但专业中心仍继续主张在年轻、活跃的男性患者中进行髋关节表面置换术。关于年龄，一般建议是，根据患者的活动情况和骨质，65岁以上男性和55岁以上女性避免进行髋关节表面置换术。女性被视为相对禁忌证。大多数外科医生不会为仍想要孩子的女性植入MoM髋关节。无论性别如何，对于股骨头尺寸小于46mm的患者、肾功能不全患者或已知有金属过敏的患者，共识是不进行髋关节表面置换术。关于髋关节表面置换术的随访和不良局部组织反应的检测，建议根据当地专业知识进行金属离子测量、MRI和超声检查。共识是髋关节表面置换术应限于经验丰富的髋关节外科医生，这些医生在髋关节表面置换方面经验丰富或在专业中心接受过髋关节表面置换手术培训。
