Department of Bioengineering, Clemson University, Clemson, South Carolina, USA.
The Clemson University-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA.
J Biomed Mater Res B Appl Biomater. 2024 Dec;112(12):e35504. doi: 10.1002/jbm.b.35504.
Despite high total knee arthroplasty (TKA) survivorship after 10 years (92%-99%), a gap persists where patient satisfaction lags clinical success. Additionally, while cobalt chrome molybdenum (CoCrMo) use decreases in primary total hip arthroplasty, the alloy continues to be widely used in TKA femoral components. In vivo, CoCrMo degradation may be associated with adverse local tissue reactions (ALTR) and compared with the hip, the damage mechanisms that may release metal in the knee and the potential biological effects remain poorly understood. In this study, we characterized the damage on 50 retrieved CoCrMo femoral knee implants paired with 19 titanium alloy and 31 CoCrMo tibial baseplates. We asked (1) what damage modes can release CoCrMo debris in vivo from femoral components and (2) how frequently does the damage occur? First, we developed a semiquantitative scoring system for abrasive wear. Then, we characterized damage modes on CoCrMo femoral implants using digital optical microscopy (DOM), scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS). We found that wear, electrocautery damage, and Ti-6Al-4V material transfer were ubiquitous. Of the 50 CoCrMo femoral implants we investigated, we documented wear on 100% (n = 50/50), electrocautery damage on 98% (n = 49/50), and Ti-6Al-4V material transfer to the posterior condyles on 95% (n = 18/19). Our results suggest that these damage modes may be more prevalent than previously thought and may act as metal release mechanisms in vivo.
尽管 10 年后全膝关节置换术（TKA）的总体存活率很高（92%-99%），但患者满意度仍然落后于临床成功率。此外，虽然在初次全髋关节置换术中钴铬钼（CoCrMo）的使用减少，但该合金仍广泛用于 TKA 股骨部件。在体内，CoCrMo 的降解可能与局部不良反应（ALTR）有关，与髋关节相比，可能导致膝关节释放金属的损伤机制以及潜在的生物学效应仍知之甚少。在这项研究中，我们对 50 个回收的 CoCrMo 股骨膝关节植入物与 19 个钛合金和 31 个 CoCrMo 胫骨基板进行了配对研究。我们提出了以下两个问题：（1）体内从股骨部件释放 CoCrMo 碎屑的损伤模式有哪些；（2）损伤发生的频率是多少？首先，我们开发了一种用于磨蚀磨损的半定量评分系统。然后，我们使用数字光学显微镜（DOM）、扫描电子显微镜（SEM）和能量色散 X 射线光谱（EDS）对 CoCrMo 股骨植入物的损伤模式进行了特征描述。我们发现磨损、电灼损伤和 Ti-6Al-4V 材料转移是普遍存在的。在我们研究的 50 个 CoCrMo 股骨植入物中，我们记录了 100%（n=50/50）的磨损、98%（n=49/50）的电灼损伤和 95%（n=18/19）的 Ti-6Al-4V 材料转移到后髁。我们的研究结果表明，这些损伤模式可能比以前认为的更为普遍，并且可能是体内金属释放的机制。
