Grammatopoulos George, Munemoto Mitsuru, Pollalis Athanasios, Athanasou Nicholas A
Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK.
Nuffield Department Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK.
Arch Orthop Trauma Surg. 2017 Aug;137(8):1129-1137. doi: 10.1007/s00402-017-2723-x. Epub 2017 Jun 28.
Metal-on-metal-hip-resurfacing arthroplasties (MoMHRAs) have been associated with an increased failure rates due to an adverse-response-to-metal-debris (ARMD) associated with a spectrum of pathological features. Serum levels of cobalt (Co) and chromium (Cr) are used to assess MoMHRAs, with regard to ARMD, but it is not certain whether ion levels correlate with pathological changes in periprosthetic tissues.
Serum Co and Cr levels were correlated with histological findings in 38 revised MoMHRAs (29 pseudotumour cases and 9 non-pseudotumour cases revised for pain). The extent of necrosis and macrophage infiltrate as well as the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) response was assessed semi-quantitatively; the prosthesis linear wear rate (PLWR) was also determined in ten cases.
Cr levels were elevated in 82% and Co levels elevated in 53% of cases; the PLWR correlated with Cr level (rho = 0.8, p = 0.006). Tissue necrosis and macrophage infiltration were noted in all, most of which also exhibited significant ALVAL. Although a discrete correlation was not seen between Co and/or Cr ion levels and the extent of necrosis, degree of macrophage infiltration, or ALVAL score, it was noted that cases with acceptable metal ions levels had high ALVAL score.
Histological features of both innate and adaptive immune response to metal wear are seen in periprosthetic tissues in cases with both elevated and non-elevated metal ion levels. MoMHRA failures with acceptable ion levels exhibited a pronounced ALVAL response. Although metal ion levels are elevated in most cases of MoMHRA failure due to ARMD, the finding of a normal metal ion level does not exclude this diagnosis.
金属对金属髋关节表面置换术（MoMHRAs）因与一系列病理特征相关的金属碎片不良反应（ARMD）而导致失败率增加。血清钴（Co）和铬（Cr）水平用于评估MoMHRAs的ARMD情况，但尚不确定离子水平是否与假体周围组织的病理变化相关。
对38例翻修的MoMHRAs（29例假肿瘤病例和9例因疼痛翻修的非假肿瘤病例）的血清Co和Cr水平与组织学结果进行相关性分析。对坏死程度、巨噬细胞浸润以及无菌性淋巴细胞为主的血管炎相关病变（ALVAL）反应进行半定量评估；还对10例病例测定了假体线性磨损率（PLWR）。
82%的病例Cr水平升高，53%的病例Co水平升高；PLWR与Cr水平相关（rho = 0.8，p = 0.006）。所有病例均出现组织坏死和巨噬细胞浸润，其中大多数也表现出明显的ALVAL。虽然未发现Co和/或Cr离子水平与坏死程度、巨噬细胞浸润程度或ALVAL评分之间存在明确的相关性，但注意到金属离子水平可接受的病例ALVAL评分较高。
在金属离子水平升高和未升高的病例中，假体周围组织均可见对金属磨损的先天性和适应性免疫反应的组织学特征。离子水平可接受的MoMHRA失败病例表现出明显的ALVAL反应。虽然由于ARMD导致的大多数MoMHRA失败病例中金属离子水平升高，但金属离子水平正常并不能排除该诊断。
