Daher Jimmy, Desai Bhumit, Nammour Michael, Warren Michael, Chimento George
Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA.
Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA.
Arthroplast Today. 2023 Jul 23;22:101163. doi: 10.1016/j.artd.2023.101163. eCollection 2023 Aug.
In 2010, a recall was issued for a specific monoblock large head metal-on-metal (MoM) hip prosthesis due to short-term revision rates of 12%-13% (articular surface replacement, DePuy Orthopaedics, Inc., Warsaw, IN). High complication, infection, and rerevision rates for revised MoM implants have been reported. The purpose of the study is to report long-term outcomes and trend metal ion levels of this recalled MoM prosthesis from a single surgeon series.
Retrospective chart review was performed on all patients that underwent revision of large MoM hip replacements between 2010 and 2015. Pre- and post-revision Harris Hip Score (HHS), cup abduction angles, anteversion angles, and cup sizes were compared. Survivorship and HHS were the primary outcomes measured; serum cobalt and chromium levels were secondary outcomes. Multivariate linear regression was used to examine the correlation between prerevision serum metal ion levels and HHS.
A total of 24 hips (21 patients) met inclusion criteria. Mean time to revision was 4.12 years ± 1.1. Mean follow-up was 10.0 years (7-11.9 years). Mean HHS increased significantly after revision from 48.5 to 89.5 ( < .001). Higher prerevision cobalt levels were correlated with lower prerevision HHS (cobalt = 0.25; chromium = 0.3160). There was no correlation with prerevision cobalt ( = .2671) or chromium ( = .3160) with postrevision HHS. Most recent metal ion testing revealed a significant decrease in both cobalt ( = .0084) and chromium ( = .0115). Survival rate is 100%.
Our study showed excellent survivorship and outcomes at 10 years. There were no failures for any reason including infection. This differs from previous studies and confirms excellent long-term results are possible with revision of this recalled MoM implant.
2010年，由于特定的整体式大头金属对金属（MoM）髋关节假体短期翻修率达12%-13%（关节面置换，DePuy Orthopaedics公司，印第安纳州华沙），该假体被召回。据报道，翻修后的MoM植入物并发症、感染和再次翻修率较高。本研究的目的是报告来自单一外科医生系列的这种被召回的MoM假体的长期结果和金属离子水平趋势。
对2010年至2015年间接受大型MoM髋关节置换翻修的所有患者进行回顾性病历审查。比较翻修前后的Harris髋关节评分（HHS）、髋臼外展角、前倾角和髋臼尺寸。生存率和HHS是主要测量结果；血清钴和铬水平是次要结果。采用多元线性回归分析翻修前血清金属离子水平与HHS之间的相关性。
共有24例髋关节（21例患者）符合纳入标准。平均翻修时间为4.12年±1.1年。平均随访时间为10.0年（7-11.9年）。翻修后平均HHS从48.5显著提高到89.5（P<0.001）。翻修前较高的钴水平与较低的翻修前HHS相关（钴：r=0.25；铬：r=0.3160）。翻修前的钴（r=0.2671）或铬（r=0.3160）与翻修后的HHS无相关性。最近的金属离子检测显示钴（P=0.0084）和铬（P=0.0115）均显著降低。生存率为100%。
我们的研究显示10年时具有出色的生存率和结果。没有因任何原因包括感染导致的失败。这与先前的研究不同，并证实翻修这种被召回的MoM植入物可能获得出色的长期结果。
