Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Orthopedic Surgery, Washington University in St. Louis, 1 Barnes Jewish Hospital Plaza, 63110, St. Louis, MO, USA.
BMC Musculoskelet Disord. 2022 Aug 20;23(1):796. doi: 10.1186/s12891-022-05743-6.
Total hip arthroplasty(THA)is widely used to treat end-stage hip disorders. Ceramic-on-ceramic total hip prostheses are widely used because of their durability. Alumina matrix composite (AMC), known as the fourth-generation ceramics, reduces implant fracture and wear rate compared to their predecessors. However, ceramic acetabular liner dissociation is a complication that necessitates revision of the AMC prostheses. To date, only few cases of AMC liner dissociation have been reported and all of which have been treated with revision surgery. Therefore, the prognosis of non-operated AMC liner dissociation remains unknown so far.
A 57-year-old man with avascular necrosis of the femoral head was treated with THA, wherein a Pinnacle® (DePuy, J&J, Warsaw, IN) acetabular cup and AMC liner were implanted. Intraoperative examination confirmed proper seating of the liner, whereas the initial postoperative radiograph revealed liner dissociation. The patient refused surgical revision due to the absence of symptoms and was discharged and followed-up. The patient made an uneventful recovery, and radiographic follow-up at 6-month post-operation showed that the liner was re-seated to its right position. No clinical or radiographic anomaly was found at the 15-month of postoperative follow-up.
Here, we report an unprecedented case of AMC ceramic liner dissociation with spontaneous resolution. This case shows that ceramic liner dissociation could be asymptomatic, and careful postoperative examination of the patient is important. Spontaneous resolution is possible, but the underlying mechanism and the eligible patient to benefit from it must be investigated. Before clarifying these questions, revision surgery should be the first-line treatment.
全髋关节置换术（THA）被广泛用于治疗终末期髋关节疾病。由于其耐用性，陶瓷-陶瓷全髋关节假体被广泛使用。氧化铝基复合材料（AMC），被称为第四代陶瓷，与前代产品相比，降低了植入物的断裂和磨损率。然而，陶瓷髋臼内衬分离是一种需要对 AMC 假体进行翻修的并发症。迄今为止，仅报道了少数 AMC 衬垫分离病例，所有病例均采用翻修手术治疗。因此，迄今为止，未手术的 AMC 衬垫分离的预后尚不清楚。
一名 57 岁男性，患有股骨头缺血性坏死，接受了 THA 治疗，其中植入了 Pinnacle®（DePuy，J&J，Warsaw，IN）髋臼杯和 AMC 衬垫。术中检查确认衬垫位置正确，而初始术后 X 线片显示衬垫分离。由于无症状，患者拒绝手术翻修，并出院随访。患者恢复顺利，术后 6 个月的影像学随访显示衬垫重新置于正确位置。术后 15 个月随访时，未发现临床或影像学异常。
在此，我们报告了首例 AMC 陶瓷衬垫分离伴自发复位的病例。该病例表明陶瓷衬垫分离可能无症状，术后仔细检查患者很重要。自发复位是可能的，但必须研究其潜在机制和适合从中获益的患者。在澄清这些问题之前，翻修手术应是首选治疗方法。
