Influencing factors for the prognosis of the patients undergoing reversion metal-on-metal hip arthroplasty for inflammatory pseudotumor

doi:10.3969/j.issn.2095-4344.2017.15.001

Abstract

Abstract:

BACKGROUND: Reversion total hip arthroplasty for inflammatory pseudotumor is little reported.

OBJECTIVE: To investigate the prognosis of the reversion total hip arthroplasty for inflammatory pseudotumor and the related factors.

METHODS: Eighty-one patients failed metal-on-metal hip arthroplasty were recruited, the medical history, baseline data and information of primary arthroplasty were collected, and all preoperative examinations were completed prior to reversion. The postoperative joint function was evaluated by Hospital for Special Surgery score, and the morphology of prosthesis was observed by radiology. Additionally, the serum levels of cobalt and chromium ions were detected, as well as the incidence of complications and the related factors were analyzed.

RESULTS AND CONCLUSION: (1) There was a significant increase in Hospital for Special Surgery hip score and significant decrease in serum levels of cobalt and chromium ions after reversion (P=0.000). (2) The postoperative incidence of complications and secondary reversion rate was 16% and 6%, respectively. (3) Preoperative prosthesis loosening (P=0.012), tissue cirrhosis revealed on MRI (P=0.000) and the injury degree of tissue (P=0.049) were found to be related to the incidence of complications. (4) Kaplan-Meier curve showed that the survival rate of prosthesis was 88% at 30 months postoperatively. (5) These results suggest that the prognosis of reversion total hip arthroplasty is poor, which is related to the preoperative aseptic loosening, tissue cirrhosis surrounding the joint and intraoperative tissue injury, thus providing guidance for surgeons to make an appropriate operative scheme.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Hip, Hip Prosthesis, Risk Factors, Tissue Engineering

CLC Number:

R318

Wang Heng, Wang Yue. Influencing factors for the prognosis of the patients undergoing reversion metal-on-metal hip arthroplasty for inflammatory pseudotumor [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(15): 2297-2302.

Figures/Tables 2

2.1 参与者数量分析纳入患者81例，按意向性处理分析，全部进入结果分析。 2.2 髋关节置换翻修术中情况髋关节置换翻修术中按照组织分级评估假体周围损伤情况，其中1级52例，2级23例，3级6例。股骨头表面置换组中有3例存在组织硬化，3例患者存在不同类型髋臼假体松动，全髋关节置换组中5例存在髋臼假体松动。所有研究对象随访期股骨假体固定均良好。对于股骨头表面置换患者，使用生物型髋臼及股骨假体翻修。对于全髋置换患者，其中35例髋臼假体固定良好，保留髋臼假体，对于出现或者疑似出现骨溶解及假体移位的患者，予以翻修髋臼假体，该组所有患者予以生物性股骨假体翻修。在髋臼翻修病例中，使用钽金属髋臼及聚乙烯衬垫，钴铬合金股骨柄及陶瓷头。翻修股骨假体参数：表面置换组28 mm 2例，30 mm 1例，36 mm 16例，40 mm 6例；全髋关节置换为28 mm 3例，32 mm 4例，36 mm 28例，40 mm 19例，44 mm 2例。 2.3 临床评分及影像学评估结果翻修术后所有研究对象平均关节功能评分较术前显著上升，术前平均髋关节功能评分为(43.2±11.6)分，术后6周平均髋关节评分功能为(76.3±9.5)分，经t 检验，差异有显著性意义(t=18.007，P=0.000)，提示术后HHS评分高于术前。术后6周13例患者平均髋关节功能评分高于90，40例患者HHS评分高于80，28例患者HHS评分小于79分。术后3个月平均髋关节评分为(82.7±10.4)分，术后12个月平均髋关节功能评分为(88.3±12.6)分。术后影像学评估提示3例患者在术后6周内出现假体脱位，2例出现不同程度无菌性松动，余研究对象假体位置良好。 2.4 血清金属离子浓度实验室检查提示术前血清钴离子浓度为(8.2±3.4) mg/L，术后12个月下降至(1.2± 0.6) mg/L，经t 检验，差异有显著性意义(t=18.246，P=0.000)，提示术后血清钴离子浓度下降显著。术前血清铬离子浓度为(5.3±2.4)mg/L，术后12个月下降至 (1.6±0.4)mg/L，经t 检验，差异有显著性意义(t=9.645，P=0.000)，提示术后血清铬离子浓度下降显著。钴铬离子下降至术前水平的50%，半衰期分别为3.2个月和7个月，见图1。在术后1个月内，血清钴离子下降率为0.7%/d，在术后6个月内，为0.2%/d。在术后1个月内，血清铬离子下降率为0.32%/d，在术后6个月内，为1.8%/d，术后1年内下降为0.1%，见图2。术前血清钴离子浓度、铬离子浓度以及钴/铬离子浓度比例均与术后并发症的发生率无关(P1=0.561，P2=0.632，P3=0.448)。"

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