Miranda Ignacio, Chiappe Caterina, Valverde-Vázquez Rocío, Miranda Francisco J, Doménech Julio
Hospital Arnau de Vilanova, Valencia, Spain.
Universidad Católica de Valencia, Valencia, Spain.
Arch Orthop Trauma Surg. 2025 Sep 3;145(1):435. doi: 10.1007/s00402-025-06053-x.
There is concern in the scientific community that patients implanted years ago with metal-on-metal (M-M) bearings for total hip arthroplasty (THA) may still have persistent and potentially toxic levels of chromium (Cr) and cobalt (Co). Studies suggest that blood metal levels may be elevated in both ceramic-on-metal (C-M) and M-M bearings. The objective of this study was to establish whether patients with THA and C-M bearing surfaces require the same follow-up as those with M-M THA and to evaluate the long-term survival of THAs with M-M and C-M bearing surfaces, blood Cr and Co levels and complications (especially metallosis).
A retrospective, observational, analytical, descriptive cohort study was conducted on the patients who underwent THA at a single centre with the use of M-M (64) and C-M (76) bearings and a control group (44 THA: 23 ceramic-on-ceramic, 8 metal-on-polyethylene, 13 ceramic-on-polyethylene) between 2005 and 2009 (an additional 12 THAs performed with the same implants between 2010 and 2012 were also included). The median follow-up period was 14.41 (interquartile range 11.6-15.7) years. The primary outcomes were blood levels of Cr and Co, complications, implant survival and patient survival (Kaplan Meier analysis). Multivariate binary logistic regression was performed to examine the risk of metallosis, prosthesis replacement and death between groups, adjusting for potential confounders.
THA with M-M bearings produce more metallosis (47%, p < 0.001) than C-M bearings (16%). Thirty-one THA revisions were performed (17%), with significantly more revisions in the M-M group (33%) compared to both the C-M group (11%, p = 0.002) and the control group (4%, p = 0.003). There were no significant differences in 15-year patient survival between the groups.
Routine monitoring of C-M bearings should be recommended, similar to the protocols for M-M. In the long term, both metallosis and revision rates are unacceptably high for both types of bearings, with M-M bearings performing worse. Therefore, neither implant type is recommended for THA.
科学界担心，多年前接受金属对金属（M-M）轴承全髋关节置换术（THA）的患者体内可能仍存在持续且潜在有毒水平的铬（Cr）和钴（Co）。研究表明，陶瓷对金属（C-M）和M-M轴承的血液金属水平可能都会升高。本研究的目的是确定接受C-M轴承表面THA的患者是否需要与接受M-M THA的患者进行相同的随访，并评估使用M-M和C-M轴承表面的THA的长期生存率、血液Cr和Co水平以及并发症（尤其是金属沉着症）。
对2005年至2009年期间在单一中心接受THA的患者进行了一项回顾性、观察性、分析性、描述性队列研究，这些患者使用了M-M（64例）和C-M（76例）轴承，并设立了一个对照组（44例THA：23例陶瓷对陶瓷、8例金属对聚乙烯、13例陶瓷对聚乙烯）（还纳入了2010年至2012年期间使用相同植入物进行的另外12例THA）。中位随访期为14.41年（四分位间距11.6 - 15.7年）。主要结局指标为血液Cr和Co水平、并发症、植入物生存率和患者生存率（Kaplan Meier分析）。进行多变量二元逻辑回归以检验各组之间金属沉着症、假体置换和死亡的风险，并对潜在混杂因素进行校正。
与C-M轴承（16%）相比，M-M轴承的THA产生更多的金属沉着症（47%，p < 0.001）。共进行了31例THA翻修手术（17%），M-M组的翻修手术明显多于C-M组（11%，p = 0.002）和对照组（4%，p = 0.003）。各组之间15年患者生存率无显著差异。
应建议对C-M轴承进行常规监测，类似于对M-M轴承的监测方案。从长期来看，两种类型的轴承金属沉着症和翻修率都高得令人无法接受，M-M轴承表现更差。因此，两种植入物类型均不推荐用于THA。
