Gkiatas Ioannis, Sharma Abhinav K, Greenberg Alexander, Duncan Stephen T, Chalmers Brian P, Sculco Peter K
Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10021, USA.
Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, 10021, USA.
J Orthop. 2020 Aug 25;21:432-437. doi: 10.1016/j.jor.2020.08.019. eCollection 2020 Sep-Oct.
Dual mobility (DM) constructs effectively reduce the risk of dislocation in revision and high risk primary total hip arthroplasty. However, modular DM designs require the use of a cobalt-chrome liner against a titanium cup which may induce corrosion, metal ions release, and associated biologic response. The purpose of this systematic review study was to collect all reported cases of serum metal ions after DM in the literature and ask the following questions: 1) what is the overall rate of significantly elevated Cobalt and Chromium metal ions and how do these levels change over time? 2) Does femoral head material composition influence serum metal ion levels? and 3) were there any atypical lymphocytic associated lesions after modular DM that required revision surgery?
A systematic review was performed according to PRISMA guidelines. In addition to patient demographics, information specific to the performance of the DM implant were recorded including: cobalt and chromium serum ion levels and all reported timepoints, the material composition of the femoral head, all revision and reoperations and any failure related to corrosion of the DM bearing. A significant elevation in cobalt or chromium was defined as >1.0 or >1.6 mcg/L.
248 modular DM THAs were analyzed. The cumulative mean cobalt and chromium levels for all included studies was 0.47mcg/L and 0.53mcg/L, respectively. At final follow-up 13 patients (5.2%) had elevated cobalt ion levels and 4 patients (1.6%) had elevated chromium ion levels. Femoral head material composition trended towards but did not significantly increase serum ion levels. Ceramic heads had elevated cobalt and chromium ions in 4/135 (3%) of patients compared to metal heads which had elevated cobalt ions in 9/113 (8%) and elevated chromium ions in 0/113 (0%), (p = 0.09). There were no reoperations or revisions for metal related reactions at final follow-up (mean 27.4 months).
In this systematic review including 248 modular DM THAs, elevated serum cobalt ions were present in 5.2% of patients at a mean follow-up of 27.4 months. While a trend towards increased Cobalt serum ions with the use of cobalt chrome femoral heads, femoral head composition was not significantly associated with increased serum metal ion levels. At final follow-up, metal ion levels appear to decrease in the majority of patients between 1 and 2 years and no patient was revised for metal ion related complications. Continued serum metal ion surveillance is recommended to ensure the safety of DM constructs in THA with longer term follow-up.
双动（DM）假体有效降低了翻修和高风险初次全髋关节置换术中脱位的风险。然而，模块化DM设计需要使用钴铬内衬与钛杯配合，这可能会引发腐蚀、金属离子释放及相关生物学反应。本系统评价研究的目的是收集文献中所有报道的DM术后血清金属离子病例，并提出以下问题：1）钴和铬金属离子显著升高的总体发生率是多少，这些水平随时间如何变化？2）股骨头材料成分是否会影响血清金属离子水平？3）模块化DM术后是否存在需要翻修手术的非典型淋巴细胞相关病变？
根据PRISMA指南进行系统评价。除患者人口统计学信息外，还记录了与DM植入物性能相关的特定信息，包括：钴和铬血清离子水平及所有报告的时间点、股骨头的材料成分、所有翻修和再次手术以及任何与DM轴承腐蚀相关的故障。钴或铬的显著升高定义为>1.0或>1.6 mcg/L。
分析了248例模块化DM全髋关节置换术。所有纳入研究的钴和铬累积平均水平分别为0.47 mcg/L和0.53 mcg/L。在末次随访时，13例患者（5.2%）钴离子水平升高，4例患者（1.6%）铬离子水平升高。股骨头材料成分有升高血清离子水平的趋势，但未显著升高。陶瓷头组4/135例（3%）患者钴和铬离子升高，而金属头组9/113例（8%）患者钴离子升高，0/113例（0%）患者铬离子升高，（p = 0.09）。末次随访时（平均27.4个月）没有因金属相关反应进行再次手术或翻修。
在这项纳入248例模块化DM全髋关节置换术的系统评价中，平均随访27.4个月时，5.2%的患者血清钴离子升高。虽然使用钴铬股骨头有使钴血清离子升高的趋势，但股骨头成分与血清金属离子水平升高无显著相关性。在末次随访时，大多数患者在1至2年期间金属离子水平似乎下降，且没有患者因金属离子相关并发症进行翻修。建议持续进行血清金属离子监测，以确保长期随访的THA中DM假体的安全性。
