Patel Sonika, Talmo Carl T, Nandi Sumon
Tufts University School of Medicine, Boston - USA.
New England Baptist Hospital, Boston - USA.
Hip Int. 2016 Nov 10;26(6):e49-e51. doi: 10.5301/hipint.5000440.
Taper corrosion at the modular junctions of total hip arthroplasty (THA) femoral stems are known to cause locally destructive adverse local tissue reaction (ALTR). However, the implants at risk remain to be fully elucidated.
We report the case of a 76-year-old woman with hip pain, abductor weakness, and sciatic nerve symptoms 2 years following metal-on-polyethylene THA. Serum cobalt levels were elevated, while chromium levels were normal. Magnetic resonance imaging demonstrated ALTR. The patient's symptoms resolved following head and liner exchange with ceramic head and titanium sleeve.
Previous studies have reported ALTR secondary to head-neck taper corrosion in cobalt chrome alloy and titanium alloy stems used in metal-on-polyethylene (MoP) THA. The stems described above span 4 manufacturers with varying taper geometries. To our knowledge, this is the first report of ALTR due to head-neck taper corrosion in a Stryker Meridian titanium-molybdenum-zirconium-iron (TMZF) alloy stem.
Close surveillance for ALTR may be considered in patients with this prosthesis. Further investigation of the TMZF alloy and V40 taper geometry of this stem may guide future implant design.
全髋关节置换术（THA）股骨柄模块化连接处的锥形腐蚀已知会导致局部破坏性不良局部组织反应（ALTR）。然而，有风险的植入物仍有待充分阐明。
我们报告了一名76岁女性的病例，该患者在聚乙烯对金属全髋关节置换术后2年出现髋关节疼痛、外展肌无力和坐骨神经症状。血清钴水平升高，而铬水平正常。磁共振成像显示存在ALTR。患者在将股骨头和内衬换成陶瓷头和钛套筒后症状得到缓解。
先前的研究报告了在聚乙烯对金属（MoP）全髋关节置换术中使用的钴铬合金和钛合金柄因头颈锥形腐蚀继发的ALTR。上述柄来自4个制造商，锥形几何形状各异。据我们所知，这是第一例关于史赛克子午线钛 - 钼 - 锆 - 铁（TMZF）合金柄因头颈锥形腐蚀导致ALTR的报告。
对于使用这种假体的患者，可考虑密切监测ALTR。对该柄的TMZF合金和V40锥形几何形状的进一步研究可能会指导未来的植入物设计。
