Wakabayashi Hiroki, Hasegawa Masahiro, Naito Yohei, Tone Shine, Sudo Akihiro
Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan.
Antibiotics (Basel). 2025 Feb 6;14(2):161. doi: 10.3390/antibiotics14020161.
Complications associated with metal-on-metal (MOM) prostheses, such as adverse reactions to metal debris (ARMDs), include pseudotumor (PT) formation, metallosis, and soft tissue necrosis. High short-term failure rates have been reported for various MOM total hip arthroplasties (THAs) due to ARMDs. ARMDs in MOM THAs can potentially lead to secondary failure modes, such as dislocation or infection.
This study aims to examine the cumulative incidence of revisions due to ARMDs and periprosthetic joint infection (PJI) in primary MOM total hip arthroplasty and to compare the outcomes of ARMD and PJI cases.
Between 2006 and 2011, 247 primary MOM THAs were performed on 230 patients (39 men, 191 women) with a mean age of 64.1 years. The average follow-up duration was 10.5 years.
Thirty-eight hips were converted to metal-on-polyethylene articulation between 1.2 and 14.7 years postoperatively (mean: 7.2 years) due to pain, swelling, infection, and/or implant failure. Eight hips (3.2%) were complicated by infection, while 30 hips (12.1%) were diagnosed with ARMDs. Rheumatoid arthritis (RA) was significantly more prevalent in patients with PJI. Preoperative C-reactive protein (CRP) levels were significantly elevated in THAs diagnosed with PJI compared to ARMD cases. Additionally, the preoperative white blood cell (WBC) counts, neutrophil counts, and neutrophil-to-WBC ratios were significantly higher in THAs with PJI, while the lymphocyte-to-WBC ratios were significantly lower.
The incidence of postoperative infection in MOM THA cases was 3.2%, with a notable occurrence of late-onset infections. Differentiating ARMDs from PJI in MOM THA cases remains crucial.
金属对金属（MOM）假体相关并发症，如对金属碎屑的不良反应（ARMDs），包括假瘤（PT）形成、金属沉着症和软组织坏死。由于ARMDs，各种MOM全髋关节置换术（THAs）的短期失败率较高。MOM THAs中的ARMDs可能会导致继发性失败模式，如脱位或感染。
本研究旨在检查初次MOM全髋关节置换术中因ARMDs和假体周围关节感染（PJI）导致的翻修累积发生率，并比较ARMD和PJI病例的结果。
2006年至2011年期间，对230例患者（39例男性，191例女性）进行了247例初次MOM THAs，平均年龄为64.1岁。平均随访时间为10.5年。
术后1.2至14.7年（平均7.2年），38例髋关节因疼痛、肿胀、感染和/或植入物失败而转换为金属对聚乙烯关节。8例髋关节（3.2%）并发感染，30例髋关节（12.1%）被诊断为ARMDs。类风湿性关节炎（RA）在PJI患者中明显更常见。与ARMD病例相比，诊断为PJI的THAs术前C反应蛋白（CRP）水平显著升高。此外，PJI的THAs术前白细胞（WBC）计数、中性粒细胞计数和中性粒细胞与WBC比值显著更高，而淋巴细胞与WBC比值显著更低。
MOM THA病例术后感染发生率为3.2%，迟发性感染发生率较高。在MOM THA病例中区分ARMDs和PJI仍然至关重要。
