Alpaugh Kyle, Mishu Mithun, Westrich Geoffrey
Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, NY, USA.
Division of Hip & Knee Replacement, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Arthroplast Today. 2022 Aug 30;17:132-135. doi: 10.1016/j.artd.2022.07.019. eCollection 2022 Oct.
Modular junctions of mixed metals have been associated with fretting and corrosion, and in extreme circumstances, adverse local tissue reactions. Since modular dual mobility (MDM) hip constructs involve a titanium shell with a modular cobalt-chromium liner, the aim of this study was to evaluate serum metal ions at minimum 1 year following total hip arthroplasty (THA) in a cohort of patients with these types of implants.
A single surgeon enrolled 30 patients in a prospective study in which all patients were evaluated preoperatively with serum cobalt, chromium, and titanium metal ion levels. Patients underwent primary THA with an additively manufactured titanium acetabular shell, MDM cobalt-chromium liner, titanium cementless stem, and ceramic head. A "Four Quadrant Test" was used to ensure proper liner seating intraoperatively. At minimum 1 year following surgery, clinical and radiographic evaluation was conducted, and repeat metal ion levels were collected. Patient-reported outcome measures were collected preoperatively and postoperatively.
Twenty-five patients completed 1-year follow-up. All patients had normal metal ion levels for cobalt (<1 μg/L), chromium (<5 μg/L), and titanium (sensitivity test) preoperatively and postoperatively. Patient-reported outcome measures improved significantly after primary THA: Veterans RAND-12 Physical Component Score (31.05 to 45.02, < .001), Visual Analogue Scale Pain score (70.68 to 7.77, < .001), Hip Disability and Osteoarthritis Outcomes Score, Joint Replacement (51.99 to 86.97, < .001).
No significant elevation was detected in serum metal ion levels 16 months following THA using an additively manufactured titanium acetabular shell, a cobalt-chromium MDM liner, and titanium stem with a ceramic head.
混合金属的模块化连接与微动磨损和腐蚀有关，在极端情况下，还会引发局部组织不良反应。由于模块化双动（MDM）髋关节假体包含一个钛金属外壳和一个模块化钴铬内衬，本研究的目的是评估接受此类假体全髋关节置换术（THA）的患者队列在术后至少1年时的血清金属离子水平。
一位外科医生招募了30名患者进行前瞻性研究，所有患者术前均接受血清钴、铬和钛金属离子水平评估。患者接受了使用增材制造钛髋臼杯、MDM钴铬内衬、钛非骨水泥股骨柄和陶瓷股骨头的初次THA手术。术中使用“四象限测试”确保内衬正确就位。术后至少1年时，进行临床和影像学评估，并采集重复的金属离子水平数据。术前和术后收集患者报告的结局指标。
25名患者完成了1年随访。所有患者术前和术后钴（<1μg/L）、铬（<5μg/L）和钛（敏感性测试）的金属离子水平均正常。初次THA术后患者报告的结局指标显著改善：退伍军人兰德12项身体成分评分（从31.05提高到45.02，P<.001）、视觉模拟量表疼痛评分（从70.68降至7.77，P<.001）、髋关节功能障碍和骨关节炎结局评分，关节置换部分（从51.99提高到86.97，P<.001）。
使用增材制造钛髋臼杯、钴铬MDM内衬和带陶瓷头的钛股骨柄进行THA术后16个月，未检测到血清金属离子水平有显著升高。
