Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Arthroplasty. 2022 Aug;37(8):1483-1487. doi: 10.1016/j.arth.2022.01.063. Epub 2022 Jan 31.
The consensus systematic risk stratification algorithm from the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society summarizes clinical challenges in evaluation and treatment of metal-on-polyethylene total hip arthroplasty (THA) patients with adverse local tissue reaction (ALTR) due to mechanically assisted crevice corrosion (MACC), reviews up-to-date evidence, and identifies the areas for future research in order to provide a useful resource for orthopedic surgeons providing care to these patients. A painful THA has various intrinsic and extrinsic causes. ALTR is one of the intrinsic causes in patients with painful THA. The occurrence of ALTR due to MACC at modular junctions is likely to be multifactorial, including implant, surgical, and patient factors. Therefore, a systematic evaluation needs to involve a focused clinical history, detailed physical examination, laboratory tests, and imaging in order to identify potential differential diagnoses. There should be a low threshold to perform a systematic evaluation of patients with painful non-metal-on-metal THA, including patients with metal-on-polyethylene THA, and modular dual-mobility THA with the CoCr metal acetabular insert, as early recognition and diagnosis of ALTR due to MACC will facilitate initiation of appropriate treatment prior to significant adverse biological reactions. Specialized tests such as blood metal analysis and metal artifact reduction sequence magnetic resonance imaging are important modalities in evaluation and management of ALTR in patients with painful THA.
美国髋关节和膝关节外科医师协会、美国矫形外科医师学会和髋关节协会的共识系统风险分层算法总结了由于机械辅助缝隙腐蚀（MACC）导致不良局部组织反应（ALTR）的金属对聚乙烯全髋关节置换术（THA）患者评估和治疗的临床挑战，回顾了最新的证据，并确定了未来研究的领域，以便为这些患者提供护理的骨科医生提供有用的资源。疼痛的 THA 有各种内在和外在的原因。ALTR 是疼痛性 THA 患者的内在原因之一。由于在模块连接处的 MACC 发生的 ALTR 可能是多因素的，包括植入物、手术和患者因素。因此，系统评估需要涉及有针对性的临床病史、详细的体格检查、实验室检查和影像学检查，以确定潜在的鉴别诊断。对于疼痛的非金属对金属 THA 患者，包括金属对聚乙烯 THA 患者和带有 CoCr 金属髋臼插入物的模块化双动式 THA 患者，应进行系统评估，阈值应较低，因为早期识别和诊断由于 MACC 引起的 ALTR 将有助于在发生重大不良生物反应之前开始进行适当的治疗。对于疼痛性 THA 患者，血液金属分析和金属伪影减少序列磁共振成像等特殊检查是评估和管理 ALTR 的重要方式。
