Trevisan Carlo, Piscitello Stefano, Klumpp Raymond, Mascitti Tonino
UOC Ortopedia e Traumatologia, Ospedale Bolognini ASST Bergamo Est, Seriate, Italy.
J Orthop Traumatol. 2018 Dec 7;19(1):21. doi: 10.1186/s10195-018-0514-y.
Large-diameter head metal-on-metal (MoM) bearings in total hip arthroplasty (THA) are associated with increased whole blood levels of chromium (Cr) and cobalt (Co), adverse reactions to metal debris (ARMD) and poor survival rates. The prevalence of high metals concentrations, ARMD and the risk of revision surgery may vary significantly among different prostheses and long-term studies are few. This single-center study reports the long-term results of the 38-mm MoM bearing system.
Between 2003 and 2009, 80 patients received primary cementless THA using the large head metal-on-metal articulating surface MA-38 cup (Biomet, Inc., Warsaw, IN, USA) at a single institution. Forty-five patients (53 hips) were retrospectively reviewed for a mean follow-up of 127 months.
Two cups were revised. The cumulative implant survival rate was 98% at 10 years and 74% at 13 years. In the whole sample, the median Co and Cr concentrations were 4.8 µg/L (IQR 1.2-4.9 µg/L) and 2.5 µg/L (IQR 0.6-3.0 µg/L), respectively. The incidence of Co or Cr levels > 7 μg/L was 15.5% and the incidence of ARMD was 3.8%. Co and Cr levels showed no correlation with cup inclination, Harris Hip Score, or total Hip Disability and Osteoarthritis Outcome score.
Our results confirm that the problems of release of metal ions with the possible increase of metal circulating levels and of adverse reactions may also occur in the long term with this brand of MoM large head, and that a structured follow-up program is mandatory.
Level 4.
全髋关节置换术（THA）中使用的大直径金属对金属（MoM）股骨头轴承与全血中铬（Cr）和钴（Co）水平升高、金属碎屑不良反应（ARMD）及低生存率相关。不同假体中高金属浓度、ARMD的发生率及翻修手术风险可能差异显著，且长期研究较少。本单中心研究报告了38毫米MoM轴承系统的长期结果。
2003年至2009年期间，80例患者在单一机构接受了使用大头金属对金属关节表面MA - 38杯（美国印第安纳州华沙市的Biomet公司）的初次非骨水泥型THA。对45例患者（53髋）进行回顾性分析，平均随访127个月。
2个髋臼杯进行了翻修。10年时累积植入物生存率为98%，13年时为74%。在整个样本中，Co和Cr浓度中位数分别为4.8μg/L（四分位间距1.2 - 4.9μg/L）和2.5μg/L（四分位间距0.6 - 3.0μg/L）。Co或Cr水平>7μg/L的发生率为15.5%，ARMD的发生率为3.8%。Co和Cr水平与髋臼杯倾斜度、Harris髋关节评分或全髋关节功能障碍与骨关节炎结果评分均无相关性。
我们的结果证实，使用该品牌的MoM大头假体，长期也可能出现金属离子释放问题，可能导致金属循环水平升高及不良反应，因此必须制定结构化的随访计划。
4级。
