Barry Janie, Kiss Marc-Olivier, Massé Vincent, Lavigne Martin, Matta Jihad, Vendittoli Pascal-Andre
Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard de l'Assomption, Montreal, Canada.
Open Orthop J. 2017 Nov 29;11:1337-1344. doi: 10.2174/1874325001711011337. eCollection 2017.
In recent decades, the popularity of modular necks in total hip arthroplasty (THA) has increased since modular necks offer the potential to restore the patient's native anatomy, and thus improve stability. Unfortunately, modular necks are associated with higher complication rates, including implant fracture and modular junction corrosion with adverse local tissue reaction to metal debris.
The objective of this study was to determine the impact of modular neck material on titanium (Ti), chrome (Cr), and cobalt (Co) metal ion levels in patients who underwent a THA with Ti femoral stem, Ti or CrCo modular neck, and ceramic-on-ceramic (CoC) bearing.
Whole blood Ti, Cr, and Co levels were compared at a minimum 1-year follow-up in 36 patients who underwent unilateral, primary CoC large-diameter head THA with Profemur Preserve modular femoral stems (MicroPort, Arlington, TX, USA).
Higher Co concentrations were observed in the CrCo modular neck group (0.46 versus 0.26 µg/l in the Ti neck group, P=0.004) and higher Ti concentrations were observed in the Ti modular neck group (1.98 1.59 µg/l in the CrCo neck group, P=0.007). However, these differences were not clinically meaningful since the absolute values remained within what is considered the safe range of Ti, Cr, and Co ions in whole blood. No patients were re-operated or revised.
Modular neck materials had an impact on whole blood metal ion levels but the concentrations measured remained within the safe range at 1-year follow-up. There were no indirect signs of modular junction corrosion with either CrCo or Ti femoral necks.
近几十年来，模块化颈在全髋关节置换术（THA）中的应用越来越广泛，因为模块化颈有可能恢复患者的原生解剖结构，从而提高稳定性。不幸的是，模块化颈与较高的并发症发生率相关，包括植入物骨折和模块化连接处腐蚀，以及对金属碎屑的局部组织不良反应。
本研究的目的是确定模块化颈材料对接受THA的患者全血中钛（Ti）、铬（Cr）和钴（Co）金属离子水平的影响，这些患者使用钛股骨柄、钛或铬钴模块化颈以及陶瓷对陶瓷（CoC）轴承。
对36例接受单侧初次CoC大直径股骨头THA并使用Profemur Preserve模块化股骨柄（美国德克萨斯州阿灵顿市MicroPort公司）的患者进行至少1年的随访，比较其全血Ti、Cr和Co水平。
铬钴模块化颈组的Co浓度较高（钛颈组为0.46 μg/l，而铬钴颈组为0.26 μg/l，P = 0.004），钛模块化颈组的Ti浓度较高（铬钴颈组为1.59 μg/l，而钛颈组为1.98 μg/l，P = 0.007）。然而，这些差异在临床上并无意义，因为绝对值仍在全血中Ti、Cr和Co离子的安全范围内。没有患者进行再次手术或翻修。
模块化颈材料对全血金属离子水平有影响，但在1年随访时测得的浓度仍在安全范围内。铬钴或钛股骨颈均未出现模块化连接处腐蚀的间接迹象。
