Markel David, Bou-Akl Theresa, Rossi Maria, Pizzimenti Natalie M, Wu Bin, Ren Wei-Ping
The CORE Institute, Novi, MI.
Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.
Hip Int. 2025 Jul;35(4):353-359. doi: 10.1177/1120700019865530. Epub 2019 Jul 21.
The purpose of this study was to retrospectively evaluate blood metal ion levels and leukocyte profiles in patients with modular dual-mobility hip implant (MDM) during a postoperative follow-up up to 2 years.
We recruited 49 patients in a retrospective cohort study and had postoperative follow-up up to 2 years. Blood concentrations of chromium (Cr), cobalt (Co) and serum cytokines were measured. Flow cytometry was used to quantify the subpopulations of leukocytes, including CD14 and CD16 monocytes, CD3 T lymphocytes, CD19 B lymphocytes, CD4 Helper T-cells and CD45RA memory vs. naïve T-cells.
Clinical performances of implants were good during 2 years of follow-up. Cr levels were normal in all patients and only detectable in 1 patient (1.4µg/L, ref < 5.0µg/L). Co levels were mildly elevated in 4 patients at 1 year (mean 1.375µg/L, range 1.2-1.7µg/L, ref < 1.0µg/L) and in 2 patients at 2-year follow-up (both 1.2µg/L). Interestingly, Co level observed in 3 patients at 1 year converted to undetectable at their 2-year follow-up. Percentages of B cells, T cells and their subpopulations were within normal levels. There was no increase of CD16 inflammatory monocytes.
With the recent introduction of MDM systems there is potential for metal ion release from the interface between the acetabular shell and CoCr liner. Clinical results have been good and metal levels undetectable or within acceptable ranges at 1-2 years. There was no evidence of activated immune response, as manifested by constant circulating leukocyte profiles and no increase of CD16 inflammatory monocytes.
本研究的目的是回顾性评估接受模块化双动髋关节植入物（MDM）的患者在术后长达2年的随访期间的血液金属离子水平和白细胞谱。
我们在一项回顾性队列研究中招募了49名患者，并进行了长达2年的术后随访。测量了血液中铬（Cr）、钴（Co）的浓度以及血清细胞因子。采用流式细胞术对白细胞亚群进行定量分析，包括CD14和CD16单核细胞、CD3 T淋巴细胞、CD19 B淋巴细胞、CD4辅助性T细胞以及CD45RA记忆性T细胞与初始T细胞。
在2年的随访期间，植入物的临床性能良好。所有患者的Cr水平均正常，仅1例患者可检测到（1.4μg/L，参考值<5.0μg/L）。4例患者在1年时Co水平轻度升高（平均1.375μg/L，范围1.2 - 1.7μg/L，参考值<1.0μg/L），2例患者在2年随访时Co水平升高（均为1.2μg/L）。有趣的是，3例患者在1年时观察到的Co水平在2年随访时转为不可检测。B细胞、T细胞及其亚群的百分比均在正常水平范围内。CD16炎性单核细胞没有增加。
随着MDM系统的近期引入，髋臼杯与钴铬内衬之间的界面存在金属离子释放的可能性。临床结果良好，1 - 2年时金属水平不可检测或在可接受范围内。没有证据表明存在激活的免疫反应，表现为循环白细胞谱恒定且CD16炎性单核细胞没有增加。
