Mäntymäki H, Junnila M, Lankinen P, Seppänen M, Vahlberg T, Mäkelä K T
1 Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland.
2 Department of Surgery, Vaasa Central Hospital, Vaasa, Finland.
Scand J Surg. 2017 Dec;106(4):342-349. doi: 10.1177/1457496916683093. Epub 2017 Mar 1.
An adverse reaction to metal debris is a known complication after large diameter head metal-on-metal total hip arthroplasty. However, the failure rate varies depending on the implant design. Therefore, we investigated the prevalence of adverse reaction to metal debris, as well as the symptoms and risk factors after undergoing a ReCap-M2a-Magnum large diameter head metal-on-metal total hip arthroplasty.
Between 2005 and 2012, 1188 patients (1329 hips) underwent ReCap-M2a-Magnum total hip arthroplasty at our institution. Systematic screening for adverse reaction to metal debris was arranged using the Oxford Hip Score questionnaire, hip and pelvic radiographs, and assessments of the serum chromium and cobalt ion levels. Clinical evaluation and magnetic resonance imaging were performed for the symptomatic patients, as well as those with either chromium or cobalt ion levels ⩾5 µg/L. The prevalence of adverse reaction to metal debris after ReCap-M2a-Magnum total hip arthroplasty was assessed, and the risk factors for adverse reaction to metal debris were evaluated using logistic regression. The mean follow-up time was 5.2 (0.003-9.1) years. This study was an extension of a previous study conducted at our institution with 80 patients.
In total, 33 patients (33 hips, 2.5% of all hips) required a revision operation due to adverse reaction to metal debris. Moreover, 157 hips exhibited definitive adverse reaction to metal debris, but a revision operation was not performed (157 of 1329 hips, 11.8% of all hips). Overall, 190 out of 1329 (14.3%) hips had definitive adverse reaction to metal debris. Pain, subluxation sensation, clicking, swelling, a small head size, and a fair/poor Oxford Hip Score were associated with definitive adverse reaction to metal debris.
We found a high prevalence of adverse reaction to metal debris in the ReCap-M2a-Magnum total hip arthroplasty patients in this study; however, most of the patients did not require revision operations.
金属碎屑不良反应是大直径股骨头金属对金属全髋关节置换术后已知的并发症。然而，失败率因植入物设计而异。因此，我们调查了接受ReCap-M2a-Magnum大直径股骨头金属对金属全髋关节置换术后金属碎屑不良反应的发生率、症状及危险因素。
2005年至2012年期间，1188例患者（1329髋）在我院接受了ReCap-M2a-Magnum全髋关节置换术。使用牛津髋关节评分问卷、髋关节和骨盆X线片以及血清铬和钴离子水平评估对金属碎屑不良反应进行系统筛查。对有症状的患者以及铬或钴离子水平≥5μg/L的患者进行临床评估和磁共振成像。评估ReCap-M2a-Magnum全髋关节置换术后金属碎屑不良反应的发生率，并使用逻辑回归评估金属碎屑不良反应的危险因素。平均随访时间为5.2（0.003 - 9.1）年。本研究是我院之前对80例患者进行的一项研究的扩展。
总共有33例患者（33髋，占所有髋关节的2.5%）因金属碎屑不良反应需要翻修手术。此外，157髋表现出明确的金属碎屑不良反应，但未进行翻修手术（1329髋中的157髋，占所有髋关节的11.8%）。总体而言，1329髋中有190髋（14.3%）对金属碎屑有明确的不良反应。疼痛、半脱位感、弹响、肿胀、小头尺寸以及牛津髋关节评分中等/差与对金属碎屑的明确不良反应相关。
在本研究中，我们发现ReCap-M2a-Magnum全髋关节置换术患者中金属碎屑不良反应的发生率较高；然而，大多数患者不需要翻修手术。
