Sessa Giuseppe, Testa Gianluca, Gioitta Iachino Salvatore, Costarella Luciano, Puma Pagliarello Calogero, Ferrante Margherita, Grasso Alfina, Pavone Vito
Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
Department of Medical, Surgical and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy.
Eur J Orthop Surg Traumatol. 2018 May;28(4):637-643. doi: 10.1007/s00590-018-2129-7. Epub 2018 Jan 22.
Beginning in 2008, metal-on-metal prostheses have been in the spotlight owing to much higher revision rates than expected. Adverse local tissue reactions have been well described in the literature as potential complications.
Between 2012 and 2013, 13 patients with metal-on-metal total hip replacements were evaluated clinically and radiologically and with laboratory samples. The same tests were repeated between 2015 and 2016 on eight patients to assess any changes. In the laboratory assessment, we searched for chromium, cobalt, molybdenum, and nickel in blood and urine samples over 24 h.
Clinical assessment has shown good score in all patients except one. On a second examination, between 2015 and 2016, all patients obtained results similar to those obtained in the first assessment, except a patient, who reported a recent fall. In the radiological assessment between 2012 and 2013, results were optimal, apart from a case of aseptic mobilization. The patients reassessed 3 years after the first examination showed radiological results similar to those previously obtained, apart from a patient, who showed signals of mobilization. Metal levels found in their blood decreased in most cases after 3 years. Urine levels of nickel increased in five subjects, and chromium levels increased in four, but levels of cobalt and molybdenum decreased in four patients.
It could be hypothesized that the decreasing trend of metal ion levels is associated with a stable wear status. On the contrary, a progressive increase in metal ion levels must be considered as early proof of implant loosening.
自2008年起，金属对金属假体因其翻修率远高于预期而备受关注。文献中已充分描述了局部组织不良反应是潜在的并发症。
在2012年至2013年期间，对13例接受金属对金属全髋关节置换术的患者进行了临床、放射学及实验室样本评估。2015年至2016年对8例患者重复进行相同检测以评估有无变化。在实验室评估中，我们在24小时内的血液和尿液样本中检测铬、钴、钼和镍。
临床评估显示，除1例患者外，所有患者评分良好。在2015年至2016年的第二次检查中，除1例报告近期跌倒的患者外，所有患者的结果与首次评估相似。在2012年至2013年的放射学评估中，除1例无菌性松动病例外，结果均为最佳。首次检查3年后重新评估的患者，除1例显示松动信号的患者外，放射学结果与之前相似。大多数患者3年后血液中的金属水平下降。5名受试者尿液中的镍水平升高，4名受试者尿液中的铬水平升高，但4名患者尿液中的钴和钼水平下降。
可以推测金属离子水平的下降趋势与稳定的磨损状态相关。相反，金属离子水平的逐渐升高必须被视为植入物松动的早期证据。
