Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
Department of Health Sciences, University of Eastern Piedmont (UPO) Orthopaedics and Traumatology Unit, "Maggiore della Carità" Hospital, Novara, Italy.
Acta Biomed. 2020 Dec 30;91(14-S):e2020014. doi: 10.23750/abm.v91i14-S.10955.
Adverse reaction to metal debris is the major cause of the high revision rates of metal on metal hip implants with femoral head size ≥ 36mm. Health authorities recommend regular surveillance even for asymptomatic individuals. The main investigations used are Co+ and Cr+ serum levels, x-rays and, eventually, ultrasound and MARS-MRI. Clinic is also assessed. The aim of this study is to identify if there is a relation between ion levels and the clinical scores in order to evaluate the outcome and plan the correct management after this type of implant.
383 subjects were included and divided in 3 groups (serum ion levels >, < and >60 µg/L). Co+, Cr+, HHS and OHS results of 1 2017 were analysed in order to show a correlation between ion levels and clinical scores .
Clinical scores were similar in group 1 and 2. Differences were observed comparing the group 1 and 2 with group 3 for both variables.
Surveillance algorithms have been introduced by health authorities. Nevertheless, the indication to revision surgery is not simple especially in those cases in which a discrepancy between clinic and investigations is present. In this study clinical scores seem to be less important than ion levels in the evaluation of outcomes and in order to plan the correct management in the majority of cases. Larger studies are needed to highlight the real importance of clinical scores in the decision making after these type of implants.
金属颗粒导致的不良反应是 36mm 以上金属对金属髋关节植入物高返修率的主要原因。健康机构建议对无症状人群进行定期监测。主要检查手段包括 Co+ 和 Cr+ 血清水平、X 射线，以及最终的超声和 MARS-MRI。同时也会进行临床评估。本研究旨在确定离子水平与临床评分之间是否存在关联，以便评估结果并为这类植入物的后续管理制定正确的方案。
共纳入 383 名受试者，并分为 3 组（血清离子水平>、<和>60μg/L）。分析了 2017 年 1 月的 Co+、Cr+、HHS 和 OHS 结果，以显示离子水平与临床评分之间的相关性。
组 1 和组 2 的临床评分相似。与组 3 相比，组 1 和组 2 的两个变量均存在差异。
健康机构已经引入了监测算法。然而，对于需要进行翻修手术的病例，特别是在临床和检查结果不一致的情况下，手术指征并不简单。在本研究中，在评估结果和制定大多数病例的正确管理方案方面，临床评分似乎不如离子水平重要。需要进行更大规模的研究，以突出临床评分在这类植入物决策中的实际重要性。
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