Gass Henry M, Goel Rahul K, Heo Kevin, Shah Jason, Wilson Jacob M, Premkumar Ajay
Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.
Duke Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina.
J Arthroplasty. 2025 Apr;40(4):1068-1073. doi: 10.1016/j.arth.2024.10.053. Epub 2024 Oct 18.
Mechanically assisted crevice corrosion is a complication that may occur in vivo at modular metal interfaces following metal-on-polyethylene total hip arthroplasty (THA). Metal ions released in vivo may be associated with adverse local tissue reactions (ALTRs). While there is no definitive value, high serum ion levels are implicated as contributors to ALTR, and various screening levels have been recommended. The purpose of this investigation was to evaluate the relationship between synovial fluid (SF) cobalt and chromium ion levels and the risk of developing ALTR.
This was a retrospective cohort study of 552 patients who underwent 621 metal-on-polyethylene primary THAs. A total of 69 patients underwent revision THA due to symptomatic primary failure with elevated serum metal ions levels. There were 28 who had preoperative serum and intraoperative SF chromium and cobalt samples. Patient demographics, surgical, and laboratory data were collected. Descriptive statistics, Mann-Whitney U, analysis of variance tests, and linear regression analyses were performed.
There were 40.6% of revisions that had preoperative serum and intraoperative SF samples. The mean time to revision was 5.7 (range, 3.8 to 7.6) years. Mean SF cobalt and chromium levels were 870.9mcg/L (range, 1.1 to 8,300.0) and 573.5mcg/L (range, 1.3 to 10,000.0). Mean serum and SF cobalt-chromium ratios were 4.0 (range, 0.9 to 7.1) and 6.4 (range, 0 to 15.1), respectively. Elevated serum cobalt levels were predictive of ALTR (P = 0.002), SF levels were not. Analysis of preoperative serum to SF cobalt-chromium ratios showed poor correlation (R = 0.05).
There was no correlation between SF ion levels and ALTR. Also, serum and intra-articular ion levels did not correlate. The SF levels did not provide additional value over serum levels for diagnosis or prognosis of mechanically assisted crevice corrosion. Further studies are needed to better understand the relationship between serum and SF ion levels and its relationship to ALTR.
机械辅助缝隙腐蚀是一种可能在金属对聚乙烯全髋关节置换术（THA）后体内模块化金属界面处发生的并发症。体内释放的金属离子可能与局部组织不良反应（ALTRs）有关。虽然没有确定的值，但高血清离子水平被认为是ALTR的促成因素，并且已经推荐了各种筛查水平。本研究的目的是评估滑液（SF）中钴和铬离子水平与发生ALTR风险之间的关系。
这是一项对552例行621次金属对聚乙烯初次THA患者的回顾性队列研究。共有69例患者因血清金属离子水平升高导致有症状的初次失败而接受了翻修THA。其中28例患者有术前血清以及术中SF铬和钴样本。收集了患者的人口统计学、手术和实验室数据。进行了描述性统计、Mann-Whitney U检验、方差分析和线性回归分析。
40.6%的翻修病例有术前血清和术中SF样本。翻修的平均时间为5.7年（范围3.8至7.6年）。SF钴和铬的平均水平分别为870.9mcg/L（范围1.1至8300.0）和573.5mcg/L（范围1.3至10000.0）。血清和SF钴铬比的平均值分别为4.0（范围0.9至7.1）和6.4（范围0至15.1）。血清钴水平升高可预测ALTR（P = 0.002），而SF水平则不能。术前血清与SF钴铬比的分析显示相关性较差（R = 0.05）。
SF离子水平与ALTR之间无相关性。此外，血清和关节内离子水平也不相关。SF水平在机械辅助缝隙腐蚀的诊断或预后方面并未提供超过血清水平的额外价值。需要进一步研究以更好地理解血清和SF离子水平之间的关系及其与ALTR的关系。
