Orthopaedics, George Eliot Hospital NHS Trust, Nuneaton, UK.
Trauma and Orthopaedics, Health Education North East, Newcastle Upon Tyne, UK.
Hip Int. 2024 Mar;34(2):215-220. doi: 10.1177/11207000231190738. Epub 2023 Aug 7.
Metal-on-metal (MoM) total hip arthroplasty (THA) may cause adverse reactions to metal debris (ARMD). ARMD causing femoral vessel compression with serious complications has been described in case reports, but the rate of compression by ARMD is not known. This study aims to investigate the rate, and quantify the severity, of femoral vessel compression in MoM hips with ARMD lesions.
Patients under surveillance for MoM THA investigated with MRI were studied. In patients with confirmed ARMD, femoral artery (FA) and vein (FV) diameters were measured at the point of maximal compression and compared to contralateral vessels. The primary outcome measure was presence or absence of compression. Cases were then classified by compression ratios. Secondary outcome measures were rates of deep vein thrombosis, revision surgery and time to ARMD from index procedure.
MRI scans for 436 patients with MoM THA were screened. Of these, 211/436 (48.4%) showed evidence of ARMD. Measurements were obtained on 133/211 (63.0%) patients. The FV was compressed in 102/133 (76.7%) and FA in 58/133 (43.6%), while 31/133 (23.3%) patients had no compression. In FVs, 42 demonstrated mild compression, 39 moderate and 21 severe. In FAs, none were severely compressed, 6 were moderate and 52 showed mild compression. There were 3 DVT cases, 2 in patients with moderate FV compression and 1 in patients without FV compression. Revision rates were highest in patients with severe FV compression (14/21, 66.7%). The mean time for MRI-diagnosed ARMD from index procedure was 8 years and 1 month (range 11 months-14.5 years).
Extra-luminal compression of the femoral vessels was found in >75% of patients with ARMD. Although it is not clear whether revision for femoral vessel compression is required, quantification of FV compression may be useful for surgeons and radiologists considering revision for ARMD.
金属对金属（MoM）全髋关节置换术（THA）可能会引起金属碎屑的不良反应（ARMD）。已有病例报告描述了 ARMD 导致股血管受压并伴有严重并发症，但 ARMD 导致股血管受压的发生率尚不清楚。本研究旨在调查 MoM 髋关节 ARMD 病变患者股血管受压的发生率，并量化受压严重程度。
研究了接受 MoM THA 监测的 MRI 检查的患者。在确诊为 ARMD 的患者中，测量了最大受压点处股动脉（FA）和股静脉（FV）的直径，并与对侧血管进行比较。主要观察指标为有无受压。然后根据受压比对病例进行分类。次要观察指标为深静脉血栓形成、翻修手术以及从初次手术到 ARMD 的时间。
对 436 例 MoM THA 患者的 MRI 扫描进行了筛选。其中，211/436（48.4%）例显示有 ARMD 证据。对 133/211（63.0%）例患者进行了测量。133 例患者中，102/133（76.7%）例 FV 受压，58/133（43.6%）例 FA 受压，31/133（23.3%）例患者无受压。在 FVs 中，42 例为轻度受压，39 例为中度受压，21 例为重度受压。在 FAs 中，无严重受压者，6 例为中度受压，52 例为轻度受压。有 3 例深静脉血栓形成（DVT），2 例见于中度 FV 受压患者，1 例见于无 FV 受压患者。FV 严重受压患者的翻修率最高（21 例，66.7%）。从初次手术到 MRI 诊断 ARMD 的平均时间为 8 年 1 个月（11 个月至 14.5 年）。
在有 ARMD 的患者中，超过 75%的患者存在股血管管腔外受压。虽然尚不清楚是否需要对股血管受压进行翻修，但股静脉受压的量化可能对考虑因 ARMD 进行翻修的外科医生和放射科医生有用。
