Department of Orthopaedic Surgery, Atlanta, GA.
J Arthroplasty. 2021 Dec;36(12):3966-3972. doi: 10.1016/j.arth.2021.08.010. Epub 2021 Aug 18.
Mechanically assisted crevice corrosion (MACC) is a described complication following metal-on-polyethylene (MoP) total hip arthroplasty (THA). The literature regarding outcomes following revision for MACC suggests that complication rates are high. The purpose of this investigation is to add to this literature with the largest reported series to date.
This is a retrospective cohort study of 552 consecutive patients who underwent 621 MoP primary THAs. We identified patients who subsequently underwent revision THA for a diagnosis of MACC. All patients were implanted with the same implant combination (Accolade I stem/cobalt-chromium low friction ion treatment femoral head). Patient demographic, surgical, and laboratory data were collected. Follow-up was calculated from the revision surgery and Hip Disability and Osteoarthritis Outcome Score Joint Replacement and hip subjective values (HSV) were examined at final follow-up. Descriptive statistics were performed.
The revision rate for MACC was 11.6% and mean time to revision was 6.6 (±2.4) years. Revised patients (n = 69) had a mean preoperative serum cobalt-chromium ratio of 3.5 (±2.4). There were 8 cases of gross trunnion failure. At mean 3.2 (±1.9) years following revision, the overall major complication rate was 11.6% with a 5.8% reoperation rate. At final follow-up, mean Hip Disability and Osteoarthritis Outcome Score Joint Replacement scores were 83.2 (±15.6) and mean hip subjective value was 77.6 (±17.4). Revision resulted in significant increases in both parameters (P < .001).
The incidence of MACC in MoP THA is likely higher than previously reported, particularly for certain implant combinations. Revision surgery for MACC can achieve good outcomes but a high clinical suspicion with early detection and revision is likely key to success.
机械辅助缝隙腐蚀（MACC）是金属对聚乙烯（MoP）全髋关节置换术（THA）后描述的一种并发症。关于 MACC 翻修后结果的文献表明，并发症发生率很高。本研究的目的是在迄今为止报告的最大系列中对此文献进行补充。
这是一项回顾性队列研究，纳入了 552 例连续接受 621 例 MoP 初次 THA 的患者。我们确定了随后因 MACC 诊断而行翻修 THA 的患者。所有患者均植入相同的植入物组合（Accolade I 柄/钴铬低摩擦离子处理股骨头）。收集患者的人口统计学、手术和实验室数据。随访时间从翻修手术开始计算，最后随访时评估髋关节残疾和骨关节炎结果评分关节置换和髋关节主观评分（HSV）。进行描述性统计分析。
MACC 的翻修率为 11.6%，平均翻修时间为 6.6（±2.4）年。翻修患者（n=69）术前血清钴铬比值平均为 3.5（±2.4）。有 8 例严重臼杯失败。翻修后平均 3.2（±1.9）年，总体重大并发症发生率为 11.6%，再次手术率为 5.8%。最后随访时，髋关节残疾和骨关节炎结果评分关节置换的平均评分分别为 83.2（±15.6）和 77.6（±17.4）。翻修后这两个参数均显著增加（P<.001）。
MoP THA 中 MACC 的发生率可能高于先前报道，特别是对于某些植入物组合。MACC 的翻修手术可以获得良好的结果，但高度怀疑、早期发现和翻修可能是成功的关键。
