Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2018 Sep;33(9):2712-2715. doi: 10.1016/j.arth.2018.01.054. Epub 2018 Mar 2.
There has been an increasing use of modularity at the head-neck junction in total hip arthroplasty to more closely mimic the native anatomy, allowing for optimal leg length and stability. Corrosion at this junction in metal-on-polyethylene bearings can lead to an adverse local tissue reaction (ALTR). This increasingly prevalent condition should be considered in the differential diagnosis of hip pain and difficulty ambulating. A recent symposium by the American Academy of Hip and Knee Surgeons described the diagnosis, etiology, management, and prevention of taper corrosion. This article describes the history, physical, plain and advanced imaging findings, laboratory tests, and other diagnoses that should be taken into consideration when diagnosing taper corrosion. The presence of ALTR due to taper corrosion can mimic other diagnoses such as periprosthetic joint infection, instability, or aseptic loosening. Serum metal levels have been found to be the most effective screening tool for identifying corrosion, but other common causes of hip pain and difficulty ambulating should always be ruled out with the use of radiographs and common laboratory techniques before diagnosing ALTR due to corrosion.
在全髋关节置换术中，越来越多地使用头颈部连接的模块来更紧密地模拟自然解剖结构，从而实现最佳的腿部长度和稳定性。金属对聚乙烯轴承在这个连接处的腐蚀会导致局部组织不良反应（ALTR）。这种越来越普遍的情况应在髋关节疼痛和行走困难的鉴别诊断中考虑。美国髋关节和膝关节外科医师学院最近的一次研讨会描述了锥形腐蚀的诊断、病因、处理和预防。本文描述了历史、物理、普通和高级成像结果、实验室检查以及其他在诊断锥形腐蚀时应考虑的诊断。由于锥形腐蚀引起的 ALTR 可能模仿其他诊断，如假体周围关节感染、不稳定或无菌性松动。已经发现血清金属水平是识别腐蚀的最有效筛查工具，但在诊断因腐蚀引起的 ALTR 之前，应始终使用 X 线和常见的实验室技术排除髋关节疼痛和行走困难的其他常见原因。
