Mininvasive and Computer-Assisted Orthopaedic Surgery, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Orthopaedics, Catholic University of Rome-Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito,1, 00168, Rome, Italy.
BMC Musculoskelet Disord. 2022 Feb 22;22(Suppl 2):1065. doi: 10.1186/s12891-022-05077-3.
Hip prosthetic replacement surgery is the gold standard for patients affected by symptomatic osteoarthritis. The ceramic-on-metal hybrid hard-on-hard bearing was initially launched on the market with the purpose of reducing adhesive and corrosion wear, loss of metal debris and ions and risk of fracture and squeaking. However, this bearing was withdrawn from the market, in the apprehension of local and systemic toxicity. The aim of this study is to evaluate the reliability and safety of ceramic-on-metal bearing at long term follow-up.
From 2 cohorts of patients suffering of hip osteoarthritis who underwent total hip arthroplasty using ceramic-on-metal bearing with two different short stems, 19 of the GROUP A and 25 of the GROUP B were suitable for this study. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12P/M), and radiographically. Blood samples were collected in order to evaluate chromium and cobalt ions level. The two groups were compared in terms of metal ions blood levels, and finally all the implanted prostheses were compared with a healthy control group.
All the implanted stems were well-positioned and osseointegrated at a mean follow-up of 114 months. Improvements were observed for all clinical scores comparing preoperative and postoperative values in both groups. Radiographic evaluation showed a good ability to restore proper articular geometry. Chromium and cobalt ion analysis revealed values below the safety threshold except for 1 case in GROUP A (cup malposition) and 2 cases in GROUP B (6.1%). No revision occurred.
Ceramic-on-metal bearing is safe and reliable at long term follow-up in association to short stems arthroplasty, if the implant is correctly positioned. Chromium and cobalt metal ions blood levels evaluation should be performed annually.
髋关节假体置换术是治疗症状性骨关节炎患者的金标准。陶瓷-金属混合硬对硬轴承最初投放市场的目的是减少粘着和腐蚀磨损、金属碎片和离子的损失以及骨折和嘎吱声的风险。然而，由于担心局部和全身毒性，这种轴承已被撤出市场。本研究旨在评估陶瓷-金属轴承在长期随访中的可靠性和安全性。
从接受陶瓷-金属轴承全髋关节置换术的两组髋关节骨关节炎患者中，2 组 A 中有 19 例和 2 组 B 中有 25 例符合本研究要求。所有患者均采用 Harris 髋关节评分（HHS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、视觉模拟评分（VAS）、12 项简明健康调查量表（SF12P/M）进行临床比较，并进行影像学检查。采集血样以评估铬和钴离子水平。比较两组患者的金属离子血水平，最后将所有植入假体与健康对照组进行比较。
所有植入的假体均在平均 114 个月的随访中位置良好且与骨整合。两组患者的所有临床评分均较术前有所改善。影像学评估显示，在正确定位假体的情况下，该假体具有良好的恢复关节正常几何形状的能力。铬和钴离子分析显示，除 1 例 A 组（杯错位）和 2 例 B 组（6.1%）外，所有病例的离子值均低于安全阈值。无翻修手术。
陶瓷-金属轴承与短柄关节置换术结合使用时，在长期随访中是安全可靠的，如果假体正确定位。应每年进行铬和钴金属离子血水平评估。
