PDF(Pubmed)
Abstract：
Soft tissue inflammatory responses to metal debris from prostheses, categorised as adverse reactions to metal debris (ARMD), are frequent complications of total hip arthroplasty (THA) and often result in implant failure. Introducing modular implant designs in modern orthopaedics has brought benefits to total hip replacements but has also increased patients\' susceptibility to corrosion-related risks. ARMD can develop from various metal articulating surfaces, including ceramic-on-polyethylene (CoP), ceramic-on-ceramic (CoC), metal-on-metal (MoM), and metal-on-polyethylene (MoP) configurations. In this case study, a 68-year-old male who underwent a MoP implant for osteoarthritis of the right hip 16 years ago presented with pain and difficulty walking, exacerbated over the past three months. Clinical examination revealed tenderness around the implant and a limited range of motion. Imaging studies, including X-rays and ultrasound-guided aspiration, coupled with normal serum and urinary cobalt (Co) and chromium (Cr) levels, confirmed the diagnosis of ARMD. Given the severity of symptoms and radiographic findings, surgical intervention was warranted, leading to a two-stage revision with implant augmentation using a Burch-Schneider cage. Three months post operation, the patient experienced significant improvements in pain levels, range of motion (ROM), and hip function. This case underscores the importance of vigilant surveillance for ARMD in patients undergoing non-MoM THA, even years post surgery. Prompt recognition and management of ARMD are crucial to mitigate the risk of long-term complications and optimise patient outcomes. Further research is needed to understand the risk factors and mechanisms underlying ARMD in MoP THA, aiding in developing preventive strategies and refined treatment protocols.
摘要：
软组织对假体金属碎片的炎症反应，归类为金属碎片不良反应(ARMD)，是全髋关节置换术（THA）的常见并发症，通常会导致植入物失败。在现代骨科中引入模块化植入物设计为全髋关节置换术带来了好处，但也增加了患者对腐蚀相关风险的敏感性。ARMD可以从各种金属铰接表面发展，包括聚乙烯上陶瓷(CoP)，陶瓷对陶瓷(CoC)，金属对金属(MoM)，和金属对聚乙烯(MoP)配置。在这个案例研究中,一名68岁的男性在16年前接受了MoP植入治疗右髋关节骨关节炎，表现出疼痛和行走困难，在过去的三个月中加剧了。临床检查显示植入物周围有压痛，运动范围有限。影像学检查,包括X射线和超声引导的抽吸，再加上正常的血清和尿中钴（Co）和铬（Cr）水平，确诊为ARMD。鉴于症状的严重程度和影像学检查结果，手术干预是必要的，使用Burch-Schneider笼子进行两阶段的植入物增强翻修。手术后三个月，患者的疼痛水平得到了显着改善，运动范围（ROM），和髋关节功能。此病例强调了对接受非MoMTHA的患者进行ARMD警惕监测的重要性，甚至手术后几年。及时识别和管理ARMD对于减轻长期并发症的风险和优化患者预后至关重要。需要进一步的研究来了解MOPTHA中ARMD的风险因素和机制，协助制定预防策略和完善的治疗方案。
