Goodnough L H, Bala A, Huddleston J, Goodman S B, Maloney W J, Amanatullah D F
Stanford University, 450 Broadway Street, Redwood City, California, 94063, USA.
Bone Joint J. 2018 Jan;100-B(1):28-32. doi: 10.1302/0301-620X.100B1.BJJ-2017-0366.R1.
Many case reports and small studies have suggested that cobalt ions are a potential cause of cardiac complications, specifically cardiomyopathy, after metal-on-metal (MoM) total hip arthroplasty (THA). The impact of metal ions on the incidence of cardiac disease after MoM THA has not been evaluated in large studies. The aim of this study was to compare the rate of onset of new cardiac symptoms in patients who have undergone MoM THA with those who have undergone metal-on-polyethylene (MoP) THA.
Data were extracted from the Standard Analytics Files database for patients who underwent MoM THA between 2005 and 2012. Bearing surface was selected using International Classification of Diseases ninth revision codes. Patients with a minimum five-year follow-up were selected. An age and gender-matched cohort of patients who underwent MoP THA served as a comparison group. New diagnoses of cardiac disease were collected during the follow-up period. Comorbidities and demographics were identified and routine descriptive statistics were used.
We identified 29 483 patients who underwent MoM THA and 24 175 matched patients who underwent MoP THA. Both groups had a mean Charlson comorbidity index score of 4. There were no statistically significant differences in 30 of 31 pre-existing comorbidities. Patients undergoing MoM THA had a slightly lower incidence of cardiac failure compared with those undergoing MoP THA at three years (6.60% 7.06%, odds ratio (OR) 0.93, 95% confidence interval (CI) 0.87 to 0.99) and four years (8.73% 9.49%, OR 0.91, 95% CI 0.86 to 0.97) postoperatively, with no difference in the incidence of new cardiac failure in between the groups at five years. There was no statistically significant difference in the incidence of arrhythmia, myocardial infarction and cardiomyopathy at any time between the two groups.
MoM THA is not associated with cardiac complications. Initial reports may have represented individual instances of cardiac disease in patients with a failing MoM articulation rather than an emerging epidemiological trend. Cite this article: 2018;100-B:28-32.
许多病例报告和小型研究表明，金属对金属（MoM）全髋关节置换术（THA）后，钴离子是心脏并发症尤其是心肌病的潜在病因。大型研究尚未评估金属离子对MoM THA后心脏病发病率的影响。本研究的目的是比较接受MoM THA的患者与接受金属对聚乙烯（MoP）THA的患者出现新的心脏症状的发生率。
从标准分析文件数据库中提取2005年至2012年间接受MoM THA的患者的数据。使用国际疾病分类第九版编码选择承重表面。选择至少随访五年的患者。年龄和性别匹配的接受MoP THA的患者队列作为对照组。在随访期间收集新的心脏病诊断。确定合并症和人口统计学特征，并使用常规描述性统计方法。
我们确定了29483例接受MoM THA的患者和24175例匹配的接受MoP THA的患者。两组的平均查尔森合并症指数评分均为4。31种既往合并症中的30种在两组之间无统计学显著差异。与接受MoP THA的患者相比，接受MoM THA的患者在术后三年（6.60%对7.06%，优势比（OR）0.93，95%置信区间（CI）0.87至0.99）和四年（8.73%对9.49%，OR 0.91，95%CI 0.86至0.97）时心力衰竭的发生率略低，两组在五年时新发生心力衰竭的发生率无差异。两组在任何时候心律失常、心肌梗死和心肌病的发生率均无统计学显著差异。
MoM THA与心脏并发症无关。最初的报告可能代表了MoM关节功能衰竭患者中个别心脏病病例，而非一种新出现的流行病学趋势。引用本文：2018；100-B：28-32。
