Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Int Orthop. 2020 Apr;44(4):609-621. doi: 10.1007/s00264-019-04474-z. Epub 2020 Jan 4.
Multiple cases of dissociation of the head from the neck termed as gross trunnion failure (GTF) in total hip replacement have been described. Very little quantitative data is available for patient and implant factors associated and predisposing to this complication.
To systematically review and analyze all studies which have gross trunnion failure in case of metal on polyethylene (MoP) total hip replacement.
PubMed database was searched. We also performed a secondary search by pearling bibliography of all full text articles obtained. Predefined inclusion and exclusion criteria were used for abstract screening by two independent observers. A total 46 cases met our inclusion criteria. These were included in the final analysis and data was pooled.
Till date, 46 cases of GTF in MoP THR have been reported. The mean age at time of revision was 70.13 years (range 50 to 89 years). The mean time to revision surgery was 8.24 years (range 4.7 to 14 years). 91.4% cases were male. BMI was ≥ 25 in 38/41 cases and ≥ 30 in 21/41 cases. Pain (95.5%) and difficulty or inability to walk (97.7%) were the most common symptoms. A total of 19/44 cases described varying sounds like click, clunk, and pop before dislocation. Accolade TMZF/TMZF plus was the most common stem used in 34/46 cases. The stem neck angle was 127 degrees in 97% cases (32/33 cases). A positive neck offset of 4 mm or more was used in 91.1% cases (40/44 cases). The head size ≥ 36 mm in approximately 90% cases. The head material was cobalt chromium in all 45 cases, where data was available. Among the intra-operative findings, the most common findings were metallosis (41/44), black or brow coloured synovial fluid (21/44), pseudotumour (19/44), synovial hypertrophy (18/44), damage to the abductor musculature (17/44), proximal femoral osteolysis (5/44 cases), and heterotrophic ossification (2/44 cases). Histopathological analysis was available in 11 cases and was suggestive of fibrous tissue with chronic cellular infiltrate in all cases. The serum cobalt and chromium concentrations were raised above normal in 86.4% (19/22) and 21.7% cases (5/23) respectively.
Gross trunnion failure may not be as uncommon as was previously thought. A number potential associations and predisposing factors of this complication have been highlighted in this review. But due to small sample size and weak level of evidence, further studies are needed in this field.
已描述过多例总髋关节置换术中头部与颈部分离的情况，称为大头臼严重失败（GTF）。与这种并发症相关并导致其发生的患者和植入物因素的定量数据非常有限。
系统回顾和分析所有涉及金属对聚乙烯（MoP）全髋关节置换术中出现大头臼严重失败的研究。
检索 PubMed 数据库。我们还通过对所有获得的全文文章的参考文献进行二次搜索来进行二次搜索。两位独立观察者使用预设的纳入和排除标准对摘要进行筛选。共有 46 例符合我们的纳入标准。这些病例被纳入最终分析并进行数据汇总。
迄今为止，已报告了 46 例 MoP THR 中的 GTF。翻修时的平均年龄为 70.13 岁（50 至 89 岁）。平均翻修手术时间为 8.24 年（4.7 至 14 年）。91.4%的病例为男性。41 例中有 38 例 BMI≥25，41 例中有 21 例 BMI≥30。疼痛（95.5%）和行走困难或无法行走（97.7%）是最常见的症状。共有 19/44 例在脱位前描述了不同的声音，如咔哒声、咔嗒声和爆裂声。Accolade TMZF/TMZF plus 是 46 例中最常用的 34 个柄。97%的病例（32/33 例）的柄颈角为 127 度。91.1%的病例（40/44 例）使用了 4 毫米或更大的正颈偏移量。大约 90%的病例（45 例中 40 例）的头大小≥36 毫米。所有 45 例中头材料均为钴铬，其中有数据可查。在术中发现中，最常见的发现是金属沉着症（41/44）、黑色或棕色滑膜液（21/44）、假性肿瘤（19/44）、滑膜肥大（18/44）、臀肌损伤（17/44）、股骨近端溶骨（5/44 例）和异位骨化（2/44 例）。11 例进行了组织病理学分析，所有病例均显示纤维组织伴有慢性细胞浸润。86.4%（19/22）和 21.7%（5/23）的血清钴和铬浓度分别高于正常值。
大头臼严重失败可能并不像以前认为的那样罕见。在本综述中强调了这种并发症的一些潜在关联和易患因素。但由于样本量小，证据强度弱，因此该领域需要进一步研究。
