Manfreda Francesco, Bufi Egzon, Florio Enrico Francesco, Ceccarini Paolo, Rinonapoli Giuseppe, Caraffa Auro, Antinolfi Pierluigi
Division of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia 06100, Italy.
Department of Orthopedics and Traumatology, University of Perugia, Perugia 06100, Italy.
World J Orthop. 2021 Oct 18;12(10):768-780. doi: 10.5312/wjo.v12.i10.768.
Among the various complications associated with total hip arthroplasty (THA) periprosthetic osteolysis and wear phenomena due to the release of metal particles, are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released particles that generally activate macrophagic osteolytic effects. Therein, new masses known as pseudotumors can appear in soft tissues around a prosthetic implant. To date, there is paucity of reliable data from studies investigating for any association between the above mentioned adverse events.
To investigate for the existence of any association between serum and urine concentrations of metal-ions released in THA and periprosthetic osteolysis for modular neck and monolithic implants.
Overall, 76 patients were divided into three groups according to the type of hip prosthesis implants: Monoblock, modular with metal head and modular with ceramic head. With an average f-up of 4 years, we conducted a radiological evaluation in order to detect any area of osteolysis around the prosthesis of both the femur and the acetabulum. Moreover, serum and urinary tests were performed to assess the values of Chromium and Cobalt released. Statistical analysis was performed to determine any association between the ion release and osteolysis.
For the 3 study groups, the monolithic, modular ceramic-headed and modular metal-headed implants had different incidences of osteolysis events, which were higher for the modular implants. Furthermore, the most serious of these (grade 3) were detected almost exclusively for the modular implants with metal heads. A mapping of the affected areas was performed revealing that the highest incidences of osteolysis were evidenced in the pertrochanteric region at the femur level, and in the supero-external region at the acetabular level. Regarding the evaluation of the release of metals-ions from wear processes, serum and urinary chromium and cobalt values were found to be higher in cases of modularity, and even more so for those with metal head. Statistical linear correlation test results suggested positive correlations between increasing metal concentrations and incidences areas of osteolysis. However, no cases of pseudo-tumor were detected.
Future studies are needed to identify risk factors that increase peri-prosthetic metal ion levels and whether these factors might be implicated in the triggering of local events, including osteolysis and aseptic loosening.
在全髋关节置换术（THA）相关的各种并发症中，假体周围骨溶解和因金属颗粒释放导致的磨损现象是最常见的两种，并且据报道它们之间存在关联，这是由于针对释放颗粒的炎症反应通常会激活巨噬细胞的溶骨作用。其中，在假体植入物周围的软组织中可能会出现称为假肿瘤的新肿块。迄今为止，关于上述不良事件之间是否存在关联的研究缺乏可靠数据。
研究THA中释放的金属离子的血清和尿液浓度与模块化颈和一体式植入物的假体周围骨溶解之间是否存在任何关联。
总体而言，76例患者根据髋关节假体植入物的类型分为三组：一体式、金属头模块化和陶瓷头模块化。平均随访4年，我们进行了放射学评估，以检测股骨和髋臼假体周围的任何骨溶解区域。此外，进行了血清和尿液检测以评估铬和钴的释放值。进行统计分析以确定离子释放与骨溶解之间的任何关联。
对于3个研究组，一体式、陶瓷头模块化和金属头模块化植入物的骨溶解事件发生率不同，模块化植入物的发生率更高。此外，其中最严重的（3级）几乎仅在金属头模块化植入物中检测到。对受影响区域进行了绘图，结果显示股骨转子周围区域和髋臼水平的上外侧区域骨溶解发生率最高。关于磨损过程中金属离子释放的评估，模块化情况下血清和尿液中的铬和钴值较高，金属头的情况更是如此。统计线性相关测试结果表明金属浓度增加与骨溶解发生率区域之间存在正相关。然而，未检测到假肿瘤病例。
未来需要开展研究，以确定增加假体周围金属离子水平的风险因素，以及这些因素是否可能与包括骨溶解和无菌性松动在内的局部事件的触发有关。
