Implant Research Center, Drexel University, Philadelphia, Pennsylvania.
Hartzband Center for Hip & Knee Replacement, Paramus, New Jersey.
J Arthroplasty. 2018 Oct;33(10):3313-3319. doi: 10.1016/j.arth.2018.05.020. Epub 2018 May 17.
The purpose of this study was to determine the incidence of metal release in contemporary total knee arthroplasty and the patient-related factors associated with this release.
In total, 256 retrieved cobalt-chromium femoral components were collected through a multi-institutional orthopedic implant retrieval program (implanted: 1-15 years). Implants were mainly revised for loosening (84/256), instability (62/256), and infection (46/256). Third-body damage was assessed using a semiquantitative scoring method. Microscale electro-corrosion damage (MECD) was evaluated using digital optical microscopy. Radii of curvature were measured from representative components to calculate anterior-posterior and medial-lateral ratios. Femoral component surface roughness was measured using a white light interferometer. Using a multivariable linear model, associations between damage score, implant, and patient factors were tested. Spearman's ρ correlation tests were performed to determine the association between roughness measurements and damage score.
Mild to severe damage was observed in 52% (134/256) of the components. In the multivariable linear model, anterior-posterior ratio (β = -8.07; P < .001), loosening (β = -0.52; P = .006), and patient weight (β = 0.01; P = .007) were associated with damage score. Suspected MECD damage was observed in 82% (209/256) of components. The R value (ρ = 0.196; P = .002) and R value (ρ = 0.157; P = .012) increased as the damage score increased.
The findings of this retrieval study support that similar damage mechanisms exist in contemporary and long-term total knee arthroplasty devices. Additionally, we observed associations between loosening, anterior-posterior conformity, and patient weight with increased surface damage.
本研究旨在确定当代全膝关节置换术中金属释放的发生率以及与金属释放相关的患者因素。
通过多机构骨科植入物检索计划共收集了 256 个钴铬股骨组件（植入：1-15 年）。植入物主要因松动（84/256）、不稳定（62/256）和感染（46/256）而被翻修。使用半定量评分法评估了第三体损伤。使用数字光学显微镜评估了微尺度电腐蚀损伤（MECD）。从代表性组件测量曲率半径以计算前后和内外比。使用白光干涉仪测量股骨组件表面粗糙度。使用多变量线性模型测试了损伤评分、植入物和患者因素之间的关联。使用 Spearman's ρ 相关检验确定了粗糙度测量值与损伤评分之间的关联。
在 52%（134/256）的组件中观察到轻度至重度损伤。在多变量线性模型中，前后比（β=-8.07；P<.001）、松动（β=-0.52；P=.006）和患者体重（β=0.01；P=.007）与损伤评分相关。在 82%（209/256）的组件中观察到疑似 MECD 损伤。R 值（ρ=0.196；P=.002）和 R 值（ρ=0.157；P=.012）随着损伤评分的增加而增加。
本检索研究的结果支持在当代和长期全膝关节置换装置中存在类似的损伤机制。此外，我们观察到松动、前后一致性和患者体重与表面损伤增加之间存在关联。
