Langton D J, Sidaginamale R P, Joyce T J, Bowsher J G, Holland J P, Deehan D, Nargol A V F, Natu S
Freeman Hospital, Newcastle upon Tyne, UK.
Newcastle University, Newcastle upon Tyne, UK.
Bone Joint Res. 2018 Jul 7;7(6):388-396. doi: 10.1302/2046-3758.76.BJR-2018-0037. eCollection 2018 Jun.
We have encountered patients who developed large joint fluid collections with massive elevations in chromium (Cr) and cobalt (Co) concentrations following metal-on-metal (MoM) hip arthroplasties. In some cases, retrieval analysis determined that these ion concentrations could not be explained simply by the wear rates of the components. We hypothesized that these effects may be associated with aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL).
We examined the influence of the ALVAL grade on synovial fluid Co and Cr concentrations following adjustment for patient and device variables, including volumetric wear rates. Initially restricting the analysis to include only patients with one MoM hip resurfacing device, we performed multiple regression analyses of prospectively collected data. We then repeated the same statistical approach using results from a larger cohort with different MoM designs, including total hip arthroplasties.
In the resurfacing cohort (n = 76), the statistical modelling indicated that the presence of severe ALVAL and a large fluid collection were associated with greater joint fluid Co concentrations after adjustment for volumetric wear rates (p = 0.005). These findings were replicated in the mixed implant group (n = 178), where the presence of severe ALVAL and a large fluid collection were significantly associated with greater fluid Co concentrations (p < 0.001).
The development of severe ALVAL is associated with elevations in metal ion concentrations far beyond those expected from the volumetric loss from the prosthetic surfaces. This finding may aid the understanding of the sequence of events leading to soft-tissue reactions following MoM hip arthroplasties.: D. J. Langton, R. P. Sidaginamale, T. J. Joyce, J. G. Bowsher, J. P. Holland, D. Deehan, A. V. F. Nargol, S. Natu. Aseptic lymphocyte-dominated vasculitis-associated lesions are related to changes in metal ion handling in the joint capsules of metal-on-metal hip arthroplasties. 2018;7:388-396. DOI: 10.1302/2046-3758.76.BJR-2018-0037.
我们遇到过一些患者，他们在金属对金属（MoM）髋关节置换术后出现大关节积液，同时铬（Cr）和钴（Co）浓度大幅升高。在某些情况下，翻修分析确定这些离子浓度不能简单地用假体部件的磨损率来解释。我们推测这些影响可能与无菌性淋巴细胞为主的血管炎相关病变（ALVAL）有关。
在对患者和假体变量（包括体积磨损率）进行调整后，我们研究了ALVAL分级对滑液中Co和Cr浓度的影响。最初将分析限制在仅使用一个MoM髋关节表面置换假体的患者，我们对前瞻性收集的数据进行了多元回归分析。然后，我们使用来自更大队列、不同MoM设计（包括全髋关节置换）的结果重复相同的统计方法。
在表面置换队列（n = 76）中，统计模型表明，在调整体积磨损率后，严重ALVAL的存在和大量积液与关节液中更高的Co浓度相关（p = 0.005）。这些发现也在混合植入物组（n = 178）中得到验证，在该组中，严重ALVAL的存在和大量积液与更高的滑液Co浓度显著相关（p < 0.001）。
严重ALVAL的发生与金属离子浓度升高有关，其升高幅度远远超过假体表面体积损失所预期的水平。这一发现可能有助于理解MoM髋关节置换术后导致软组织反应的一系列事件。：D. J. 兰顿、R. P. 西达吉纳马勒、T. J. 乔伊斯、J. G. 鲍舍尔、J. P. 霍兰德、D. 迪汉、A. V. F. 纳戈尔、S. 纳图。无菌性淋巴细胞为主的血管炎相关病变与金属对金属髋关节置换术关节囊中金属离子处理的变化有关。2018；7：388 - 396。DOI：10.1302/2046 - 375
