Careful patient selection together with optimal implant positioning may reduce but does not eliminate the risk of elevated serum cobalt and chrome levels following metal-on-metal hip resurfacing

被引:1
作者
Oxblom, Alexander [1 ,2 ]
Hedlund, Hakan [1 ,3 ]
Itayem, Raed [4 ]
Fellander-Tsai, Li [1 ,5 ]
Vidgren, Mathias [1 ]
Rolfson, Ola [4 ]
Brismar, Harald [1 ,5 ]
机构
[1] Karolinska Inst, Div Orthopaed & Biotechnol, CLINTEC, H9,K54, S-17177 Stockholm, Sweden
[2] Sodertalje Hosp, Dept Orthopaed, VO KOU, Sodertalje, Sweden
[3] Visby Hosp, Dept Orthopaed, Visby, Sweden
[4] Univ Gothenburg, Inst Clin Sci, Dept Orthopaed, Sahlgrenska Acad, Gothenburg, Sweden
[5] Karolinska Univ Hosp, Dept Reconstruct Orthopaed, Stockholm, Sweden
关键词
Hip arthroplasty; hip resurfacing; metal ions; metal-on-metal; ARTICULAR SURFACE REPLACEMENT; ION LEVELS; ADVERSE-REACTIONS; CONTACT PATCH; WEAR ANALYSIS; ARTHROPLASTY; DISLOCATIONS; ORIENTATION; FAILURE; VERSION;
D O I
10.1177/11207000221124302
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Elevated serum chrome (sCr) and cobalt (sCo) concentrations are associated with local tissue adverse reactions to metal debris following metal-on-metal hip resurfacing (MoM-HR). Serum metal ions 5 mu g/l. Patients and methods: This is a retrospective, single-institution cohort study of 410 consecutive patients operated on with a Birmingham Hip Resurfacing (BHR) implant between 2001 and 2014. 288 of these had a unilateral MoM-HR, pelvic and true lateral radiographs, and a related sCo and sCr sample, and were included in the final analysis. They were allocated to either a presumed "optimal group" consisting of only men aged <60 years old, with femoral head component >48 mm diameter, and with a cup positioned within Lewinnek's safe zones, or a "suboptimal group" consisting of the remaining patients. Fisher ' s exact test and multiple logistic regression analyses were performed. Results: In the optimal group 48% (47/97) had serum metal ions >2 mu g/l and 8% (8/97) >5 mu g/l compared to 61% (116/191) and 18% (34/191) in the suboptimal group, p = 0.059 and p = 0.034 respectively. Acetabular cups with an anteversion <5 degrees had the highest odds ratio, 6.5 (95% CI, 3.0-14.3), of having sCo and sCr concentrations exceeding 5 mu g/l. Conclusions: A well oriented BHR acetabular component in a presumably "optimal" patient reduces the risk of having elevated serum metal ions but does not eliminate it. Insufficient cup anteversion seems to be the strongest associated factor of elevated serum metals.
引用
收藏
页码:872 / 879
页数:8
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