La Budde J K, Orosz J F, Bonfiglio T A, Pellegrini V D
Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, New York.
J Arthroplasty. 1994 Jun;9(3):291-304. doi: 10.1016/0883-5403(94)90084-1.
Histologic examination of synovial tissue from the revisions of six cobalt-chrome and six titanium alloy total knee arthroplasties was made. Aseptic polyethylene wear-through had resulted in metal-on-metal contact of bearing surfaces and was the primary indication for revision surgery in all knees. The cobalt-chrome alloy prostheses failed at the femorotibial articulation at a mean of 92 months, while the titanium prostheses experienced patellofemoral failure at a mean of 39 months after implantation. Neither alloy was associated with any meaningful inflammatory infiltrate, and cement debris was comparable in both groups. Titanium alloy knees generated significantly more metallic debris than the cobalt-chrome alloy knees (P < .001). Cobalt-chrome alloy knees had more polyethylene debris (P < .01) and a greater number of histiocytes (P < .005). Titanium and polyethylene debris were associated with a prominent giant cell reaction. Titanium exhibited greater abrasive wear and elicited a different cellular response than cobalt-chrome under conditions of polyethylene failure allowing metal-on-metal contact. The variability of this foreign body reaction may be due to important differences in particle size and number, as well as in the material properties of the two alloys.
对六个钴铬合金和六个钛合金全膝关节置换翻修术中的滑膜组织进行了组织学检查。无菌性聚乙烯磨损导致承重面金属对金属接触，这是所有膝关节翻修手术的主要指征。钴铬合金假体在股骨胫骨关节处平均92个月失效，而钛合金假体在植入后平均39个月出现髌股关节失效。两种合金均未伴有任何有意义的炎性浸润，且两组中的骨水泥碎屑情况相当。钛合金膝关节产生的金属碎屑明显多于钴铬合金膝关节（P < 0.001）。钴铬合金膝关节有更多的聚乙烯碎屑（P < 0.01）和更多的组织细胞（P < 0.005）。钛碎屑和聚乙烯碎屑与显著的巨细胞反应有关。在聚乙烯失效允许金属对金属接触的情况下，钛比钴铬表现出更大的磨料磨损并引发不同的细胞反应。这种异物反应的变异性可能是由于两种合金在颗粒大小和数量以及材料特性方面存在重要差异。
