Bünemann Peter Caspar, Luck Stefan, Ohlmeier Malte, Gehrke Thorsten, Ballhause Tobias Malte
Department of Orthopedic Surgery, ENDO-Clinic Hamburg, Holstenstr. 2, 22767 Hamburg, Germany.
Case Rep Orthop. 2021 Nov 10;2021:6151679. doi: 10.1155/2021/6151679. eCollection 2021.
Osteoarthritis of the hip joint (coxarthrosis) is the most common hip disease in adults. Since the 1960s, total hip arthroplasty (THA) has made great progress and is nowadays one of the most frequently used procedures in orthopedic surgery. Different bearing concepts exist in various implant designs. A metal-on-metal bearing can create metal debris and lead to metallosis. We present a unique case of a 78-year old woman, who received hip resurfacing with a McMinn-like prosthesis 15 years ago. Over the cause of time, metallosis developed and created a bone cyst in the Os ilium, and osteolysis led to a dislocation of the femoral implant. A minor stumble fall led to a fracture of the Os ilium. We present our treatment method with implantation of a cemented THA and refill of the bone cyst with bone from allogene femoral heads. The surgery led to a reconstruction of the physiological center of rotation in the hip. Consequently, to the inpatient stay, the patient took part in a follow-up treatment with intensive physiotherapy. Taken together, the results after total hip arthroplasty are more superior to other hip surface replacements in terms of longevity and patient satisfaction. Especially, metal-on-metal bearing couples carry a great risk of metallosis, which goes a long with pseudotumors, osteolysis, and the elevated metal ions in the blood. Since this case is unique in the literature, no guidelines are noted for surgical treatment. In our opinion, a periprosthetic fracture of this type should be performed in a hospital using extensive endoprosthetic expertise.
髋关节骨关节炎（髋关节炎）是成人中最常见的髋关节疾病。自20世纪60年代以来，全髋关节置换术（THA）取得了巨大进展，如今是骨科手术中最常用的手术之一。各种植入物设计中存在不同的轴承概念。金属对金属轴承会产生金属碎屑并导致金属沉着病。我们报告了一例独特的病例，一名78岁女性，15年前接受了类似McMinn假体的髋关节表面置换术。随着时间的推移，发生了金属沉着病，在髂骨形成了一个骨囊肿，骨溶解导致股骨植入物脱位。一次轻微的绊倒导致髂骨骨折。我们介绍了我们的治疗方法，即植入骨水泥型全髋关节置换术并用异体股骨头的骨填充骨囊肿。手术重建了髋关节的生理旋转中心。因此，在住院期间，患者接受了强化物理治疗的后续治疗。总体而言，全髋关节置换术后的结果在寿命和患者满意度方面比其他髋关节表面置换术更优越。特别是，金属对金属轴承配对存在很大的金属沉着病风险，这与假肿瘤、骨溶解和血液中金属离子升高有关。由于该病例在文献中是独特的，因此没有关于手术治疗的指南。我们认为，这种类型的假体周围骨折应在具备广泛假体植入专业知识的医院进行治疗。
