LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New York, New York.
Surg Technol Int. 2024 Jul 15;44:305-310. doi: 10.52198/24.STI.44.OS1767.
While dual mobility systems in total hip replacements have demonstrated reduced dislocation and revision occurrences, concerns persist about the potential elevation of metal ions in the bloodstream, leading to negative tissue reactions. Notably, there's a scarcity of research spanning over five years post-surgery that examines cobalt and chromium levels after such implants. This study aimed to delve into these metal ion concentrations after a five-year period, building on previous metal-ion findings. We focused on: (1) cobalt concentrations in blood and urine; (2) chromium concentrations in blood and urine; (3) cobalt variations based on follow-up duration and specific implant metrics (e.g., offset, cup dimension, stem, and neck inclination); and (4) chromium variations based on the same parameters.
We tracked 57 individuals who received THA using modular dual mobility systems from January 1, 2011, to December 31, 2016, for an average span of six years (ranging from five to 10 years). At the final check-up, we measured cobalt and chromium levels in serum, plasma, blood, and urine. We also evaluated parameters like head composition and dimension, stem offset, cup dimension, and stem-neck inclination.
Cobalt concentrations remained minimal, with average blood and urine values being 0.8+0.6mcg/L (standard <1.8mcg/L) and 1.2+1.0mcg/L (standard <2.8mcg/L), respectively. Two individuals exhibited a slight increase in blood cobalt concentration by 0.1 and 0.2mcg/L. Chromium averages in blood and urine were also minimal, with readings of 0.9+0.2mcg/L (standard <1.2mcg/L) and 1.3 + 0.5mcg/L (standard <2mcg/L), respectively. One individual had a marginally increased blood chromium concentration of 1.3mcg/L. Evaluations considering ceramic or cobalt-chrome heads, up to a decade of follow up, or varying implant metrics showed negligible variations in metal ion concentrations.
The findings reveal that over a minimum of five years (average = six years; span, five to 10 years), cobalt and chromium concentrations in patients' systems remained within normal limits and were clinically insignificant, irrespective of the follow-up duration, head material, or implant specifications. This underscores the efficacy of dual mobility systems in ensuring minimal metal ion presence.
虽然全髋关节置换中的双动系统已证明可降低脱位和翻修发生率，但人们仍对血流中金属离子升高的潜在风险表示担忧，这可能导致组织产生不良反应。值得注意的是，目前缺乏针对此类植入物术后五年以上的研究，以检查钴和铬水平。本研究旨在深入研究这些金属离子浓度，在此基础上进一步分析先前的金属离子研究结果。我们重点关注以下几个方面：（1）血液和尿液中的钴浓度；（2）血液和尿液中的铬浓度；（3）根据随访时间和特定植入物指标（如偏心距、杯尺寸、柄和颈倾斜度）变化的钴浓度；（4）基于相同参数的铬浓度变化。
我们跟踪了 57 名于 2011 年 1 月 1 日至 2016 年 12 月 31 日期间接受模块化双动系统全髋关节置换术的患者，平均随访时间为六年（范围为 5 年至 10 年）。在最后一次检查时，我们测量了血清、血浆、血液和尿液中的钴和铬水平。我们还评估了头的组成和尺寸、柄的偏心距、杯的尺寸以及柄颈倾斜度等参数。
钴浓度保持在较低水平，血液和尿液中的平均浓度分别为 0.8+0.6mcg/L（标准值<1.8mcg/L）和 1.2+1.0mcg/L（标准值<2.8mcg/L）。有两名患者的血液钴浓度略有增加，分别增加了 0.1 和 0.2mcg/L。血液和尿液中的铬平均值也较低，分别为 0.9+0.2mcg/L（标准值<1.2mcg/L）和 1.3+0.5mcg/L（标准值<2mcg/L）。有一名患者的血液铬浓度略有增加，为 1.3mcg/L。考虑到陶瓷或钴铬头、长达十年的随访期或不同的植入物指标，金属离子浓度的变化可以忽略不计。
研究结果表明，在至少五年（平均=六年；范围，五年至十年）的时间内，患者系统中的钴和铬浓度保持在正常范围内，且具有临床意义，与随访时间、头材料或植入物规格无关。这突显了双动系统在确保最小金属离子存在方面的有效性。
