Abstract：
Despite the initial promise of metal-on-metal (MoM) implants as the ideal bearing surface for hip replacements and resurfacings, high short term failure rates due to an adverse reaction to metal debris (ARMD) have led to a dramatic reduction in the number of MoM implants used in the modern era. With over one million patients worldwide having undergone hip operations utilizing a MoM bearing surface, the long term outcomes for such patients remains unknown, and there is much debate as to the most effective management of these patients. Although several regulatory bodies have released guidelines on the management of patients with MoM hips, these recommendations remain open to interpretation, and the most effective management for these patients remains unclear. The aim of this review is to compare the current guidelines for managing patients with MoM hips and also to discuss established ARMD risk factors, evidence regarding the optimum management for patients with MoM hips, and the indications for revision surgery. Furthermore, although specialized laboratory tests and imaging can be used to facilitate clinical decision making, over-reliance on any single tool should be avoided in the decision making process, and surgeons should carefully consider all findings when determining the most appropriate course of action.
摘要：
尽管金属对金属（MoM）植入物最初有望成为髋关节置换和修复的理想支承面，由于对金属碎片（ARMD）的不良反应而导致的高短期故障率导致了现代使用的MoM植入物数量的急剧减少。全球有超过一百万的患者使用MoM轴承表面进行了髋关节手术，这些患者的长期结果仍然未知，关于这些患者的最有效管理还有很多争论。尽管一些监管机构已经发布了有关MoM臀部患者管理的指南，这些建议仍然可以解释，对这些患者最有效的治疗仍不清楚.本综述的目的是比较当前的MoM髋关节患者管理指南，并讨论已确定的ARMD风险因素，关于MoM臀部患者最佳管理的证据，以及翻修手术的适应症。此外，尽管可以使用专门的实验室检查和成像来促进临床决策，在决策过程中应避免过度依赖任何单一工具，在确定最合适的行动方案时，外科医生应仔细考虑所有发现。
