Abdelaal Mohammad S, Zachwieja Eric, Sharkey Peter F
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Arthroplast Today. 2021 Mar 3;8:78-83. doi: 10.1016/j.artd.2021.01.011. eCollection 2021 Apr.
There has been a significant increase in the use of modular dual mobility (MDM) acetabular cups for primary and revision total hip arthroplasty (THA) secondary to decreased dislocation rate and increased impingement-free range of motion. Mating of dissimilar metals in THA can result in mechanically assisted crevice corrosion, with increased serum metal ion levels and potentially adverse local tissue reaction that can lead to revision surgery. In this case report, we present a patient who had THA using MDM components, and his follow-up laboratory testing showed asymptomatic elevated serum cobalt level. The patient subsequently developed an intraprosthetic dislocation that required revision surgery. At the time of revision, significant corrosion was noted on the backside of the modular acetabular liner and the inner surface of the titanium shell. Serum cobalt levels returned to normal after revision surgery. This case suggests that mechanically assisted crevice corrosion at the modular surface of MDM components does occur. In addition, we believe surgeons should judiciously use MDM technology only for patients at significantly increased risk of dislocation after THA.
由于脱位率降低和无撞击活动范围增加，模块化双动（MDM）髋臼杯在初次和翻修全髋关节置换术（THA）中的使用显著增加。THA中不同金属的配对可导致机械辅助缝隙腐蚀，血清金属离子水平升高，并可能引发局部组织不良反应，进而导致翻修手术。在本病例报告中，我们介绍了一名使用MDM组件进行THA的患者，其随访实验室检查显示血清钴水平无症状升高。该患者随后发生了假体脱位，需要进行翻修手术。翻修时，在模块化髋臼衬垫背面和钛壳内表面发现了严重腐蚀。翻修手术后血清钴水平恢复正常。该病例表明，MDM组件的模块化表面确实会发生机械辅助缝隙腐蚀。此外，我们认为外科医生应仅对THA后脱位风险显著增加的患者谨慎使用MDM技术。
