Rajamäki Anni, Lehtovirta Lari, Niemeläinen Mika, Reito Aleksi, Parkkinen Jyrki, Peräniemi Sirpa, Vepsäläinen Jouko, Eskelinen Antti
Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Fimlab Laboratories, Tampere, Finland.
Bone Joint Res. 2024 Apr 4;13(4):149-156. doi: 10.1302/2046-3758.134.BJR-2023-0255.R1.
Metal particles detached from metal-on-metal hip prostheses (MoM-THA) have been shown to cause inflammation and destruction of tissues. To further explore this, we investigated the histopathology (aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) score) and metal concentrations of the periprosthetic tissues obtained from patients who underwent revision knee arthroplasty. We also aimed to investigate whether accumulated metal debris was associated with ALVAL-type reactions in the synovium.
Periprosthetic metal concentrations in the synovia and histopathological samples were analyzed from 230 patients from our institution from October 2016 to December 2019. An ordinal regression model was calculated to investigate the effect of the accumulated metals on the histopathological reaction of the synovia.
Median metal concentrations were as follows: cobalt: 0.69 μg/g (interquartile range (IQR) 0.10 to 6.10); chromium: 1.1 μg/g (IQR 0.27 to 4.10); and titanium: 1.6 μg/g (IQR 0.90 to 4.07). Moderate ALVAL scores were found in 30% (n = 39) of the revised knees. There were ten patients with an ALVAL score of 6 or more who were revised for suspected periprosthetic joint infection (PJI), aseptic loosening, or osteolysis. R2 varied between 0.269 and 0.369 for the ordinal regression models. The most important variables were model type, indication for revision, and cobalt and chromium in the ordinal regression models.
We found that metal particles released from the knee prosthesis can accumulate in the periprosthetic tissues. Several patients revised for suspected culture-negative PJI had features of an ALVAL reaction, which is a novel finding. Therefore, ALVAL-type reactions can also be found around knee prostheses, but they are mostly mild and less common than those found around metal-on-metal prostheses.
已证实金属对金属髋关节假体（MoM-THA）脱落的金属颗粒会引发组织炎症和破坏。为进一步探究这一现象，我们对接受膝关节置换翻修术患者的假体周围组织进行了组织病理学检查（无菌性淋巴细胞为主的血管炎相关病变（ALVAL）评分）及金属浓度检测。我们还旨在研究累积的金属碎屑是否与滑膜中的ALVAL型反应相关。
对2016年10月至2019年12月期间我院230例患者的滑膜和组织病理学样本中的假体周围金属浓度进行分析。计算有序回归模型以研究累积金属对滑膜组织病理学反应的影响。
金属浓度中位数如下：钴：0.69μg/g（四分位间距（IQR）0.10至6.10）；铬：1.1μg/g（IQR 0.27至4.10）；钛：1.6μg/g（IQR 0.90至4.07）。30%（n = 39）的翻修膝关节出现中度ALVAL评分。有10例ALVAL评分为6或更高的患者因疑似假体周围关节感染（PJI）、无菌性松动或骨溶解而接受翻修。有序回归模型的R2在0.269至0.369之间变化。有序回归模型中最重要的变量是模型类型、翻修指征以及钴和铬。
我们发现膝关节假体释放的金属颗粒可在假体周围组织中累积。几名因疑似培养阴性PJI接受翻修的患者具有ALVAL反应特征，这是一项新发现。因此，ALVAL型反应也可在膝关节假体周围发现，但大多较为轻微，且比金属对金属假体周围的反应少见。
