背景:全髋关节置换术(THA)中的模块化连接具有手术优势,但是由于头-杆界面的微动,可能会导致植入物微动和腐蚀。先前的研究暗示较低的抗弯刚度是THA腐蚀和微动的关键促成因素,但弯曲刚度与直接组织学评估或磁共振成像(MRI)结果无关。这项研究的目的是确定THA失败患者的植入物弯曲刚度与MRI成像指标和组织病理学结果的关系。
方法:需要翻修THA手术的患者术前接受了三维(3D)多光谱成像技术的MRI检查,以抑制金属伪影。MRI图像根据不良局部组织反应进行分级。对于每个臀部,从收回的股骨柄测量耳轴弯曲刚度,并使用半定量组织学检索和评估假体周围组织样本。使用广义线性模型和方差分析来评估弯曲刚度与MRI和组织学结果之间的关联。
结果:共检索到106个THA茎(46名女性和60名男性,年龄:68岁(范围,60至73岁)。植入长度(LOI)调整后,弯曲刚度与组织学无菌性淋巴细胞显性血管炎相关病变(ALVAL)严重程度呈负相关(β=-26.27,P=0.018),Fujishiro淋巴细胞分级(β=-13.4,P=0.039),血管周围淋巴细胞层(β=-17.8,P=0.022),组织分级(β=-22.5,P=0.009),弥漫性滑膜炎的存在(β=-66.5,P=0.003),和淋巴聚集体的存在(β=-75.9,P=0.022)。MRI指标与弯曲刚度之间未发现关联。
结论:在这些植入物中,耳轴硬度降低与宿主介导的不良软组织反应的组织学特征增加相关.
BACKGROUND: Modular connections in total hip arthroplasty (THA) offer surgical advantages, but can contribute to implant fretting and corrosion due to micromotion at the head-stem interface. Previous studies implicated lower flexural rigidity as a key contributing factor to THA corrosion and fretting, but none associated flexural rigidity with direct histological evaluation or magnetic resonance imaging (MRI) outcomes. The purpose of this study was to determine how implant flexural rigidity is associated with MRI imaging metrics and histopathological outcomes in patients who have a failed THA.
METHODS: Patients requiring revision THA surgery underwent preoperative MRIs with 3-dimensional multispectral imaging techniques to suppress metal artifacts. The MRI images were graded for adverse local tissue reactions. For each hip, trunnion flexural rigidity was measured from the retrieved femoral stem, and a periprosthetic tissue sample was retrieved and evaluated using semiquantitative histology. Generalized linear models and analyses of variance were used to assess associations between flexural rigidity and MRI and histology outcomes.
RESULTS: A total of 106 THA stems were retrieved (46 women and 60 men, age: 68 years (range, 60 to 73 years). After adjustment for length of implantation, flexural rigidity was negatively correlated with histologic aseptic lymphocyte-dominant vasculitis-associated lesion severity (β = -26.27, P = .018), Fujishiro lymphocyte grading (β = -13.4, P = .039), perivascular lymphocyte layers (β = -17.8, P = .022), the grade of tissue organization (β = -22.5, P = .009), the presence of diffuse synovitis (β = -66.5, P = .003), and the presence of lymphoid aggregates (β = -75.9, P = .022). No association was found between MRI metrics and flexural rigidity.
CONCLUSIONS: Among these implants, decreased trunnion stiffness was associated with increased histologic features of adverse host-mediated soft tissue reactions.