Wang Qiong, Eltit Felipe, Garbuz Donald, Duncan Clive, Masri Bassam, Greidanus Nelson, Wang Rizhi
Department of Materials Engineering, University of British Columbia, Vancouver, British Columbia, Canada.
School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.
J Biomed Mater Res B Appl Biomater. 2020 May;108(4):1213-1228. doi: 10.1002/jbm.b.34470. Epub 2019 Aug 19.
Increasing cases of adverse local tissue reactions (ALTRs) associated with metal release have been observed in patients with metal-on-highly crosslinked polyethylene (MoP) hip implants, the most common design in total hip replacements. Studies have demonstrated the metal release from fretting corrosion at the head-neck junction, but rarely investigated tribocorrosion associated metal release at articulating surfaces in MoP hip implants. The objective of this study is to investigate both tribocorrosion at the articulating surfaces and fretting corrosion at the head-neck junction in CoCrMo femoral heads, as well as their association with metal species released in periprosthetic tissues and body fluids in MoP hip systems. Twenty-three patients with ALTRs associated with MoP implants were included. Systematic analyses were performed on the wear damage in articulation, corrosion at the head-neck junction and their correlation with degradation products observed in synovial fluid, periprosthetic tissues, and serum. Results showed that tribocorrosion at the articulating surfaces contributed to the elevated concentration of both Co and Cr ions in serum, while fretting corrosion at the head-neck junction mainly released Co ions to serum. Both tribocorrosion at the articulating surfaces and fretting corrosion at the head-neck junction released particles rich in chromium and phosphate, the dominant particles found in synovial fluids and tissues. This study provides strong evidence that tribocorrosion at the articulating surfaces in MoP hip implants could result in significant metal release. This information should be taken into account when studying the mechanisms of ALTRs and developing strategies of preventing metal release in total hip replacements.
在使用金属对高交联聚乙烯（MoP）髋关节植入物的患者中，观察到与金属释放相关的局部组织不良反应（ALTR）病例不断增加，这种植入物是全髋关节置换中最常见的设计。研究已经证明了头颈交界处微动腐蚀导致的金属释放，但很少研究MoP髋关节植入物关节表面的摩擦腐蚀相关金属释放。本研究的目的是调查CoCrMo股骨头关节表面的摩擦腐蚀和头颈交界处的微动腐蚀，以及它们与MoP髋关节系统假体周围组织和体液中释放的金属种类之间的关系。纳入了23例与MoP植入物相关的ALTR患者。对关节磨损损伤、头颈交界处的腐蚀及其与滑液、假体周围组织和血清中观察到的降解产物的相关性进行了系统分析。结果表明，关节表面的摩擦腐蚀导致血清中Co和Cr离子浓度升高，而头颈交界处的微动腐蚀主要向血清中释放Co离子。关节表面的摩擦腐蚀和头颈交界处的微动腐蚀都释放了富含铬和磷酸盐的颗粒，这些颗粒是滑液和组织中发现的主要颗粒。本研究提供了有力证据，表明MoP髋关节植入物关节表面的摩擦腐蚀可能导致大量金属释放。在研究ALTR的机制和制定全髋关节置换中防止金属释放的策略时，应考虑到这些信息。
