Raju Sivashanmugam, Chinnakkannu Karthikeyan, Puttaswamy Mohan K, Phillips Matthew J
From Wake Forest University School of Medicine, Winston Salem, NC (Dr. Raju), Shri Sathya Sai Medical College and Research Institute, Ammapettai, India (Dr. Chinnakkannu), IORI Clinic, Bangalore, India (Dr. Puttaswamy), and Buffalo Medical Center, Buffalo, NY (Dr. Philips).
J Am Acad Orthop Surg. 2017 Feb;25(2):133-139. doi: 10.5435/JAAOS-D-16-00352.
Modular total hip arthroplasty implants can help the operating surgeon reproduce the optimum limb length and offset; however, the modularity can lead to fretting and corrosion with associated metal-related problems. Although metal-on-metal bearings are often reported to have problems, recent case reports suggest that the problems can occur with any articulation, usually as a result of problems at the head/neck junction.
We retrospectively reviewed three cases of a specific implant combination with nontraumatic trunnion failure, with two cases presenting as acute complete dissociation of the femoral head from the neck.
All three cases had failure of the Accolade TMZF plus stem and trunnion (Stryker) that progressed rapidly from the onset of symptoms. The most likely contributing factors to failure were large femoral head size, high horizontal offset, a low angled neck, and a β titanium alloy taper with a cobalt-chromium head.
We recommend regular follow-up of all patients with Accolade TMZF stems, and patients should be advised to seek immediate medical attention if they have any new mechanical symptoms in a metal-on-polyethylene total hip arthroplasty. Providers should specifically look for any alteration of alignment between the femoral head and neck in follow-up radiographs.
模块化全髋关节置换植入物有助于手术医生重现最佳肢体长度和偏移；然而，模块化可能导致微动和腐蚀以及相关的金属相关问题。尽管金属对金属轴承经常被报道存在问题，但最近的病例报告表明，任何关节都可能出现这些问题，通常是由于股骨头/颈交界处的问题所致。
我们回顾性分析了三例因非创伤性耳轴故障导致特定植入物组合的病例，其中两例表现为股骨头与颈部急性完全分离。
所有三例均出现Accolade TMZF加柄和耳轴（史赛克公司）故障，从症状出现起进展迅速。最可能导致故障的因素是股骨头尺寸大、水平偏移高、颈角度低以及β钛合金锥度搭配钴铬合金头。
我们建议对所有使用Accolade TMZF柄的患者进行定期随访，并且应告知患者，如果他们在聚乙烯对金属全髋关节置换术中出现任何新的机械症状，应立即就医。医疗服务提供者应在随访X光片中特别留意股骨头与颈部之间对线的任何改变。
