Carlson Bayard C, Bryan Andrew J, Carrillo-Villamizar Nazly T, Sierra Rafael J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2017 Sep;32(9S):S214-S219. doi: 10.1016/j.arth.2017.02.031. Epub 2017 Feb 20.
There is a paucity of data examining metal ion levels over time.
We retrospectively reviewed 59 patients (69 hips) with an articular surface replacement total hip arthroplasty. We reviewed prerevision cobalt and chromium concentrations over time.
Seventy-one percent of patients who were revised and had multiple ion measurements (12/17) demonstrated increasing cobalt ion levels or elevated ion levels over time. There was a trend toward an elevated risk of revision for increasing cobalt and chromium levels starting at 12 and 4 ppb, respectively; this was significant for chromium levels above 7 ppb (hazard ratio 22.35, P = .001). Similarly, there was a trend toward an elevated risk of pseudotumor formation for increasing cobalt and chromium levels starting at 5 and 2.5 ppb, respectively; this was significant for cobalt levels above 7 ppb (hazard ratio 6.88, P = .027).
In this paper, cobalt and chromium levels levels above 5 and 2.5 ppb started to demonstrate an increased risk of ARMD, and should be considered as a lower cutoff for discussion with patients about the potential for future revision.
目前缺乏长期监测金属离子水平的数据。
我们回顾性分析了59例（69髋）接受关节表面置换全髋关节置换术的患者。我们回顾了翻修前不同时间的钴和铬浓度。
在接受翻修且进行了多次离子测量的患者中（12/17），71% 的患者钴离子水平随时间升高或离子水平升高。钴和铬水平分别从12 ppb和4 ppb开始，翻修风险有升高趋势；铬水平高于7 ppb时具有统计学意义（风险比22.35，P = 0.001）。同样，钴和铬水平分别从5 ppb和2.5 ppb开始，假肿瘤形成风险有升高趋势；钴水平高于7 ppb时具有统计学意义（风险比6.88，P = 0.027）。
本文中，钴和铬水平分别高于5 ppb和2.5 ppb时开始显示出人工关节磨损碎屑病风险增加，应将其视为与患者讨论未来翻修可能性的较低阈值。
