Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, place de Verdun, 59037 Lille, France.
Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, place de Verdun, 59037 Lille, France.
Orthop Traumatol Surg Res. 2019 Sep;105(5):943-948. doi: 10.1016/j.otsr.2019.04.006. Epub 2019 Jun 11.
Short-term results in total hip arthroplasty (THA) with large-diameter metal-on-metal (MoM) bearings were encouraging, but high failure rates have been reported in the long term, notably implicating corrosion due to modularity. Several studies compared resurfacing (to which modularity does not apply) versus large-diameter MoM THA; but, to our knowledge, none compared the same bearing in the two situations with more than 10 years' follow-up. We therefore conducted a retrospective case-control study, using a single cup model (Durom™, Zimmer, Warsaw, USA) for both resurfacing (R) and large-diameter THA, to determine the role of modularity in failure of large-diameter MoM bearings. The study compared (1) metallic ion levels, and (2) survival, functional scores and complications rates between R and THA.
Large-diameter MoM bearing failure implicates not bearing wear but head-neck junction modularity in larger-diameter MoM THA.
Eighty-three THAs and 90 Rs were included between February 2004 and March 2006. All patients had clinical and radiologic follow-up with chromium (Cr) and cobalt (Co) ion blood assay.
In the THA group, 24 of the 83 patients (28.9%) underwent revision for adverse reaction to metal debris (ARMD), versus none in the R group. Ten-year all-cause survival was significantly better in R (97.7%; 95% CI, 96.2-99.2) than THA (67.1%; 95% CI, 60.9-73.3). Median blood ion level was higher in THA (with a difference between Co and Cr: 5.75μg/L (range, 3.82-19.2) versus 1.75μg/L (range, 1.34-2.94) respectively) than in R (no difference: 0.89μg/L (range, 0.67-2.89) and 1.07μg/L (range, 0.67-1.65) respectively). In the THA group, there were positive correlations between Co and Cr elevation and implant revision (both p<0.0001). Co/Cr ratio was significantly higher in THA (2.57) than R (0.88) (p<0.0001), and higher again in the 24 cases of THA revision (4.67). There was no significant difference in mean PMA score (THA: 17.08±1.82 (range, 7-18); R: 17.50±0.74 (range, 15-18)), whereas mean Oxford score was better in R (14.32±2.5 (range, 12-24)) than THA (18.17±8.05 (range, 12-42)) (p=0.02).
The present study confirmed the incontrovertible implication of modularity in failure of large-diameter MoM THA, by analyzing the same bearing in THA and in resurfacing. Trunnionosis was observed in the 24 cases of revision, with the THA adaptation ring inducing serious metallic ion release (with dissociated Co/Cr ratio), accounting for the high rate of revision.
III, case-control study.
在使用大直径金属对金属（MoM）关节轴承的全髋关节置换术（THA）中，短期结果令人鼓舞，但长期来看，失败率很高，特别是由于模块化而导致的腐蚀问题。有几项研究比较了表面置换（模块化不适用）与大直径 MoM THA；但据我们所知，没有一项研究在超过 10 年的随访中比较了同一种关节在两种情况下的情况。因此，我们进行了一项回顾性病例对照研究，使用单一的杯模型（Zimmer 的 Durom™，华沙，美国）进行表面置换（R）和大直径 THA，以确定模块化在大直径 MoM 关节轴承失效中的作用。该研究比较了（1）金属离子水平，以及（2）R 和 THA 之间的生存率、功能评分和并发症发生率。
大直径 MoM 关节轴承失效不仅涉及到关节的磨损，还涉及到大直径 MoM THA 中头颈交界处的模块化。
2004 年 2 月至 2006 年 3 月期间，共纳入 83 例 THA 和 90 例 R。所有患者均接受了临床和放射学随访，并进行了铬（Cr）和钴（Co）离子血液检测。
在 THA 组中，24 例患者（28.9%）因金属屑反应（ARMD）接受了翻修，而 R 组中无一例。R 的 10 年全因生存率明显优于 THA（97.7%；95%CI，96.2-99.2）（67.1%；95%CI，60.9-73.3）。THA 组的血液离子水平中位数较高（Co 与 Cr 之间的差异：5.75μg/L（范围，3.82-19.2）与 1.75μg/L（范围，1.34-2.94））（R 组无差异：0.89μg/L（范围，0.67-2.89）和 1.07μg/L（范围，0.67-1.65））。在 THA 组中，Co 和 Cr 升高与植入物翻修之间存在正相关（均 p<0.0001）。THA 组的 Co/Cr 比值明显高于 R（2.57 与 0.88）（p<0.0001），在 24 例 THA 翻修病例中，比值更高（4.67）。PMA 评分的平均值在 R（17.08±1.82（范围，7-18））和 THA（17.50±0.74（范围，15-18））之间没有显著差异，而 Oxford 评分的平均值在 R（14.32±2.5（范围，12-24））更好，THA（18.17±8.05（范围，12-42））（p=0.02）。
本研究通过分析 THA 和表面置换中的同一种关节，证实了模块化在大直径 MoM THA 失效中的不可否认的作用。在 24 例翻修病例中观察到转臼问题，THA 适配环导致严重的金属离子释放（伴有分离的 Co/Cr 比值），这也是翻修率高的原因。
III，病例对照研究。
