Detection and analysis of serum metal ions concentration level after metal-to-metal hip arthroplasty

doi:10.3969/j.issn.2095-4344.2016.53.001

Abstract

Abstract:

BACKGROUND: Metal-metal hip prosthesis is suitable for young patients with a large amount of activity, but the friction between the interface will lead to metal debris, and release metal ions into blood. Accurate determination and analysis will help to direct clinical operation.

OBJECTIVE: To determine serum cobalt (Co), chromium (Cr), and molybdenum (Mo) ion levels at various time points in patients resurfacing arthroplasty of the hip (RSAH) and metal-metal total hip arthroplasty (M-M THR) by inductively coupled plasma mass spectrometry (ICP-MS), and analyze the influential factors.

METHODS: We included 32 patients undergoing RSAH (40 hips) and 12 patients undergoing M-M THR (14 hips). Average metal ion value of six normal people was considered as normal reference value. Prosthesis position was measured by using X-ray and CT after replacement. ICP-MS could accurately determine serum metal ion levels in patients after hip arthroplasty.

RESULTS AND CONCLUSION: The concentrations of serum Co ion reached the peak at 1 year after operation, which was 7.7-fold relative to normal people. Cr ion reached its peak at 9 months after operation, which was 7.5-fold relative to normal people. Mo ion concentration kept the increased trend, reached 7.8-fold 5 years after replacement relative to normal people (P < 0.05). Five years after total hip arthroplasty, Co and Cr ions concentrations were 10.6-fold and 9.8-fold relative to normal people, respectively. ICP-MS could precisely measure serum metal ion levels after hip arthroplasty. Serum Co ions reached a peak at 1 year, and Cr ions reached a peak at 9 months, and stabilized after 5 years. Above ion levels were slightly higher than that of RSAH. These findings concluded that metal ion concentrations rose obviously compared to the normal level after metal-metal hip prosthesis, and had an obvious trend of increasing and stability. The concentrations had close relationship with the acetabulum prosthesis position, and affected by the joint function after surgery.

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: Tissue Engineering, Hip Joint, Acetabulum

CLC Number:

R318

Cui Peng, Jiang Wen-xue, Fan Meng, Wan Yan-lin. Detection and analysis of serum metal ions concentration level after metal-to-metal hip arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(53): 7909-7916.

Figures/Tables 3

2.1 受试者数量分析纳入髋关节表面置换者32例，全髋置换者12例，正常对照组6例，共计50例均进入结果分析，无中途退出者。 2.2 受试者基线分析见表1。 2.3 不同时间血清金属离子水平 6例正常人血清Co质量浓度平均为0.71 μg/L；Cr质量浓度平均为00.73 μg/L；Mo质量浓度平均为00.84 μg/L。作为3种金属离子水平的基础参照值。表面置换患者32例体内金属离子水平均较正常值显著升高，Co离子水平于置换后1年到达顶峰，平均为0 (5.46±0.31) μg/L，较正常值高7.7倍(P < 0.01)，后缓慢下降，至置换后4年较正常值高5.6倍(4.00± 0.26) μg/L情况下再次升高，置换后5年高6.3倍(4.60± 0.42) μg/L，接近置换后2年(4.19±0.29) μg/L水平。 Cr离子水平持续升高，于置换后9个月到达顶峰，平均(5.37±1.01) μg/L，为正常值7.5倍(P < 0.01)，后逐渐下降，置换后5年平均(1.00±0.04) μg/L，接近正常水平(P > 0.05)。 Mo离子水平稍有起伏，总体为上升趋势，置换后5年平均(6.54±0.54) μg/L，为正常7.8倍(P < 0.01)。较正常均呈现显著的高值(图1)。全髋置换后5年Co、Cr离子水平分别为平均(7.12±0.97) μg/L，(6.79±1.03) μg/L，分别为正常值9.8倍和8.2倍，明显高于正常值(P < 0.01)，但与表面置换后离子水平无明显统计学差异(P > 0.05)，Mo离子水平接近正常(P > 0.05)。 2.4 金属离子水平与髋臼假体位置的关系测量所有髋臼假体前倾角及外展角，与相应金属离子水平分组比较。髋臼发育不良患者髋臼及股骨侧术前可能存在比较大的畸形及股骨头的脱位，故术前髋臼大部分患者已存在较大形变，假体位置需做出相应调整，共计16例髋臼发育不良患者，髋臼假体外展角处于45°-50°时Co、Mo离子水平较< 45°或> 50°时显著降低(P < 0.05)，Cr未见明显变化，28例非髋臼发育不良患者Co离子水平于外展角处于40°-45°时较低前倾角处于10°-20°时各金属离子水平明显较低(P < 0.05)，不同前倾角间3种金属离子水平未见明显差异(表2-4)。 2.5 金属离子水平与股骨头假体直径的关系金属对金属界面假体均为大头假体，但假体设计不同，表面置换与全髋置换股骨头直径行按术式分组，行组内分段对比。表面置换假体股骨头直径最小40 mm，最大 52 mm，以2 mm为组距分组对比，相邻两组间未出现明显差异。股骨头直径大于48 mm时，Co离子平均(4.02±2.12) μg/L，低于股骨头直径小于48 mm时(5.73±2.34) μg/L的平均值(P=0.045)。Cr，Mo离子水平不同直径间未见明显差异。全髋假体股骨头直径最小 44 mm，最大54 mm，以2 mm为组距分组对比，并以48 mm为界，未出现明显统计学差异。 "

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