小尺寸金属对金属全髋关节置换术后 10 年以上患者的 MRI 检查结果。

MRI Findings in Patients After Small-Head Metal-on-Metal Total Hip Arthroplasty with a Minimum Follow-up of 10 Years.

机构信息

1Center for Orthopedics, Trauma Surgery and Spinal Cord Injury (T.R., M.C.K., F.H., K.S., and T.G.), and Department of Diagnostic and Interventional Radiology (T.D.D. and M.-A.W.), Heidelberg University Hospital, Heidelberg, Germany 2Institute for Pathology, University of Heidelberg, Heidelberg, Germany.

出版信息

J Bone Joint Surg Am. 2017 Sep 20;99(18):1540-1546. doi: 10.2106/JBJS.16.01021.

DOI:10.2106/JBJS.16.01021

PMID:28926383

Abstract

BACKGROUND

Concern has been raised about the late onset of adverse reactions to metal debris (ARMD) in patients with a small-head metal-on-metal total hip replacement. The aims of this study were to assess the frequency and characteristic appearance of ARMD in patients with a small-head (28-mm) metal-on-metal total hip replacement and elevated blood ion levels (>1 μg/L) after a minimum follow-up of 10 years and to analyze the possible risk factors associated with the prevalence of these lesions.

METHODS

In the present study, we used metal artifact reduction sequence magnetic resonance imaging (MARS MRI) to investigate the cases of 53 patients (66 hips) with a small-head (28-mm) metal-on-metal total hip replacement and elevated blood ion levels at a mean follow-up interval of 15.5 years (range, 10.6 to 19.3 years). Whole blood metal ion levels (cobalt and chromium), clinical outcome scores (Harris hip score), and radiographs were obtained for each patient. Tissue samples from patients who had revision surgery were histologically examined.

RESULTS

MARS MRI revealed ARMD in 27 hips (41%). Most hips with ARMD (67%) were asymptomatic. ARMD were generally small, with a median lesion size of 2.3 cm (range, 0.3 to 71.4 cm) and predominantly cystic in nature. Multivariate regression analysis revealed positive correlation between cobalt ion levels and the presence of ARMD. In this case series, the risk for the development of ARMD was 2.87 times higher for every 1 μg/L increase of blood cobalt ion concentration (95% confidence interval, 1.01 to 8.17; p = 0.048).

CONCLUSIONS

In this case series, ARMD were seen in 41% of the hips following small-head metal-on-metal total hip arthroplasty at long-term follow-up, and most patients with ARMD were asymptomatic. Blood cobalt ion levels could be identified as a risk factor for ARMD. However, ARMD also occurred in patients with low metal ion levels. Further studies are necessary to investigate the role of ARMD in asymptomatic patients with this bearing type.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

人们对小直径金属-金属全髋关节置换术后金属颗粒迟发不良反应（ARMD）的发生表示担忧。本研究旨在评估小直径（28mm）金属-金属全髋关节置换术后、血液离子水平升高（>1μg/L）患者至少 10 年随访后 ARMD 的发生频率和特征表现，并分析与这些病变发生相关的可能危险因素。

方法

本研究采用金属伪影减少序列磁共振成像（MARS MRI）对 53 例（66 髋）小直径（28mm）金属-金属全髋关节置换术后、随访时间平均为 15.5 年（10.6-19.3 年）、血液离子水平升高的患者进行了研究。每位患者均获得全血金属离子水平（钴和铬）、临床评分（Harris 髋关节评分）和 X 线片。对接受翻修手术的患者进行组织学检查。

结果

MARS MRI 显示 27 髋（41%）存在 ARMD。大多数存在 ARMD（67%）的髋关节无症状。ARMD 通常较小，中位数病变大小为 2.3cm（范围，0.3-71.4cm），主要为囊性。多变量回归分析显示钴离子水平与 ARMD 存在正相关。在本病例系列中，血液钴离子浓度每增加 1μg/L，ARMD 的发生风险增加 2.87 倍（95%置信区间，1.01-8.17；p=0.048）。