The era of metal-on-metal(MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to descri...The era of metal-on-metal(MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to describe the tissue reactions. Sometimes the nomenclature can be confusing. We present a review of the concepts introduced by Willert and Semlitsch in 1977,along with further developments made in the understanding of periprosthetic tissue reactions to metallic debris. We propose that periprosthetic tissue reactions be thought of as(1) gross(metallosis, necrosis, cyst formation and pseudotumour);(2) histological(macrophage-dominated, lymphocyte-dominated or mixed);and(3) molecular(expression of inflammatory mediators and cytokines such as interleukin-6 and tumor necrosis factor-alpha). Taper corrosion and modularity are discussed, along with future research directions to elucidate the antigen-presenting pathways and materi-al-specific biomarkers which may allow early detection and intervention in a patient with adverse periprosthetic tissue reactions to metal wear debris.展开更多
The theoretical advantages of metal-on-metal(MOM)bearing couples in total hip arthroplasty(THA) have been recently balanced by concerns regarding adverse local and systemic effects. Higher than anticipated early revis...The theoretical advantages of metal-on-metal(MOM)bearing couples in total hip arthroplasty(THA) have been recently balanced by concerns regarding adverse local and systemic effects. Higher than anticipated early revision rates have been reported by several joint registries. Failed MOM hips present with a spectrum of symptoms and findings and traditional methods of failure must be considered in addition to the failure modes that appear to be unique to the MOM bearing couple. Metal hypersensitivity and soft tissue immune reactions remain incompletely understood and require careful ongoing study. The tools available to evaluate MOM THAs and the indications for revision surgery remain to be defined. Outcomes following revision of MOM hips appear to depend on appropriate evaluation, early identification, and appropriate surgical management.展开更多
Background: There is much interest regarding metal-on-metal implants in medical and general media. Much of this has been regarding failure of specific implant systems and metal ion toxicity. We present our early mid-t...Background: There is much interest regarding metal-on-metal implants in medical and general media. Much of this has been regarding failure of specific implant systems and metal ion toxicity. We present our early mid-term experience of the ADEPT metal-on-metal system which has both modular and non-modular hip options. Methods: Functional assessment, blood metal ion quantification, and radiographic analysis were performed for the modular and non-modular ADEPT variants. Fifty implants were implanted with a mean follow up time of 28 months. Unpaired t-tests were used to compare modular and resurfacing groups, standardised hip scores were used to compare function to conventional total hip arthroplasty. Results: Metal ion levels were significantly higher in modular prostheses compared to resurfacing implants, but not at “harmful” levels (as determined by a previous metal-on-metal implant recall). Functional outcomes were excellent and revision rates were lower than expected. Conclusions: At our institution we have good outcomes with the ADEPT hip prosthesis. Though patient selection and implant position are crucial, poor performance of metal-on-metal hip replacements is implant specific.展开更多
Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the e...Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients展开更多
BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)patients.AIM To determine the association of commonly used implant metals w...BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)patients.AIM To determine the association of commonly used implant metals with echocardiographic measures in TJA patients.METHODS The study comprised 110 TJA patients who had a recent history of high chromium,cobalt or titanium concentrations.Patients underwent two-dimensional,three-dimensional,Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal concentrations.Age and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations(exposure)with echocardiographic measures(outcome).RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume(estimate 5.09;95%CI:0.02-10.17)as well as left atrial and right ventricular dilation,particularly in men but no changes in cardiac function.Higher titanium concentrations were associated with a reduction in left ventricle global longitudinal strain(estimate 0.38;95%CI:0.70 to 0.06)and cardiac index(estimate 0.08;95%CI,-0.15 to-0.01).CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some patients.Longitudinal studies are warranted to better understand the systemic effects of metals in TJA patients.展开更多
BACKGROUND This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty(THA)construct.The constellation of patient symptoms and la...BACKGROUND This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty(THA)construct.The constellation of patient symptoms and laboratory findings contradict the expected elevated serum metal ion levels associated with the formation of pseudotumor.The presentation,lab trends,and imaging findings contribute to the growing base of knowledge surrounding the effects of corrosion in arthroplasty constructs with stem-neck modularity.CASE SUMMARY A 74-year-old man status post primary THA presented with left hip swelling and elevated serum metal ions five years after implantation of a modular stem-neck prosthesis.The swelling was diagnosed as pseudotumor based on laboratory trends and imaging findings and was treated with revision arthroplasty that completely resolved the initial hip swelling.The patient presented with recurrent hip swelling and recurrent pseudotumor findings on imaging in the same hip four months later.Non-operative management with ultrasound-guided hip aspiration resulted in symptom relief and resolution of the recurrent swelling.After one year of follow-up,the patient had no further recurrences of hip swelling.CONCLUSION This case of post-revision pseudotumor recurrence elucidates attributable patient,surgical,and implant factors with a discussion of diagnostics,management,and prognosis for patients with pseudotumor in non-metal-on-metal arthroplasty constructs.展开更多
Squeaking is a well-recognized complication for hardon-hard bearings.The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon.Patient,implant,and surgical factors p...Squeaking is a well-recognized complication for hardon-hard bearings.The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon.Patient,implant,and surgical factors play a role in squeaking.It is believed that mechanisms damaging the fluid film lubrication in which these bearings function optimally have a critical role.Such mechanisms include edge loading,stripe wear,impingement,third body particles and ceramic fracture.The resonance of metallic parts can produce noise in the human audible range hence the implant metallurgic composition and design may play a role.Implant positioning can facilitate impingement and edge loading enhancing the occurrence of squeaking.The recent introduction of large heads(> 36 mm) 4th generation ceramic-on-ceramic bearing may accentuate the conditions facilitating noise formation; however the current literature is insufficient.Clinically,squeaking may manifest in extreme hip positions or during normal gait cycle however it is rarely associated with pain.Evaluations of patients with squeaking include clinical and radiographic assessments.Computer tomography is recommended as it can better reveal ceramic breakage and implant malposition.The treatments for most squeaking patients include reassurance and activity modification.However for some,noise can be a problem,requiring further surgical intervention.In the occurrence of ceramic fracture,implant failure,extreme components malposition,instability and impingement,surgery should be advised.This review will aim to discuss the current literature regarding squeaking.展开更多
BACKGROUND Metal-on-metal(MoM)total hip arthroplasty(THA)has been associated with adverse reactions to metal debris,presenting clinically as pseudotumors.CASE SUMMARY This case report presents a female aged 73 year-ol...BACKGROUND Metal-on-metal(MoM)total hip arthroplasty(THA)has been associated with adverse reactions to metal debris,presenting clinically as pseudotumors.CASE SUMMARY This case report presents a female aged 73 year-old with MoM THA-related pseudotumor.After arthrotomy and bursectomy surgeries,histologic examinations of surgical specimens revealed a specific lymphocyte-dominant immunologic response,now known as aseptic lymphocyte-dominant vasculitisassociated lesion(ALVAL).Due to soft tissue persisting effusion after arthrotomy and bursectomy,revision surgery was then performed with ceramic-onpolyethylene THA.However,revision did not resolve the patient’s symptoms.Here we describe our application of tigecycline sclerotherapy to treat recurrent pseudotumor after revision THA and no recurrence after 24-mo follow-up.CONCLUSION Tigecycline sclerotherapy is safe and effective in the management of recurrent pseudotumor after revision non-MoM THA in ALVAL cases.展开更多
Dialkyldithiocarbamate （R<sub>2</sub>NCS<sup>-</sup><sub>2</sub>） acting as either bridging or terminal ligand plays an important role in modern coordination chemistry. The molecu...Dialkyldithiocarbamate （R<sub>2</sub>NCS<sup>-</sup><sub>2</sub>） acting as either bridging or terminal ligand plays an important role in modern coordination chemistry. The molecules of the univalent coinage metals （Cu, Ag, and Au） with dialkyldithiocarbamate ligands form a class of compounds in which the sterical restriction influences strongly the crystal structures, and several types of polymerizates were found. However, only a few structures in linear form展开更多
文摘The era of metal-on-metal(MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to describe the tissue reactions. Sometimes the nomenclature can be confusing. We present a review of the concepts introduced by Willert and Semlitsch in 1977,along with further developments made in the understanding of periprosthetic tissue reactions to metallic debris. We propose that periprosthetic tissue reactions be thought of as(1) gross(metallosis, necrosis, cyst formation and pseudotumour);(2) histological(macrophage-dominated, lymphocyte-dominated or mixed);and(3) molecular(expression of inflammatory mediators and cytokines such as interleukin-6 and tumor necrosis factor-alpha). Taper corrosion and modularity are discussed, along with future research directions to elucidate the antigen-presenting pathways and materi-al-specific biomarkers which may allow early detection and intervention in a patient with adverse periprosthetic tissue reactions to metal wear debris.
文摘The theoretical advantages of metal-on-metal(MOM)bearing couples in total hip arthroplasty(THA) have been recently balanced by concerns regarding adverse local and systemic effects. Higher than anticipated early revision rates have been reported by several joint registries. Failed MOM hips present with a spectrum of symptoms and findings and traditional methods of failure must be considered in addition to the failure modes that appear to be unique to the MOM bearing couple. Metal hypersensitivity and soft tissue immune reactions remain incompletely understood and require careful ongoing study. The tools available to evaluate MOM THAs and the indications for revision surgery remain to be defined. Outcomes following revision of MOM hips appear to depend on appropriate evaluation, early identification, and appropriate surgical management.
文摘Background: There is much interest regarding metal-on-metal implants in medical and general media. Much of this has been regarding failure of specific implant systems and metal ion toxicity. We present our early mid-term experience of the ADEPT metal-on-metal system which has both modular and non-modular hip options. Methods: Functional assessment, blood metal ion quantification, and radiographic analysis were performed for the modular and non-modular ADEPT variants. Fifty implants were implanted with a mean follow up time of 28 months. Unpaired t-tests were used to compare modular and resurfacing groups, standardised hip scores were used to compare function to conventional total hip arthroplasty. Results: Metal ion levels were significantly higher in modular prostheses compared to resurfacing implants, but not at “harmful” levels (as determined by a previous metal-on-metal implant recall). Functional outcomes were excellent and revision rates were lower than expected. Conclusions: At our institution we have good outcomes with the ADEPT hip prosthesis. Though patient selection and implant position are crucial, poor performance of metal-on-metal hip replacements is implant specific.
文摘Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients
基金Supported by The National Institutes of Health,No.R01HL147155 and No.R01AG060920.
文摘BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)patients.AIM To determine the association of commonly used implant metals with echocardiographic measures in TJA patients.METHODS The study comprised 110 TJA patients who had a recent history of high chromium,cobalt or titanium concentrations.Patients underwent two-dimensional,three-dimensional,Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal concentrations.Age and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations(exposure)with echocardiographic measures(outcome).RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume(estimate 5.09;95%CI:0.02-10.17)as well as left atrial and right ventricular dilation,particularly in men but no changes in cardiac function.Higher titanium concentrations were associated with a reduction in left ventricle global longitudinal strain(estimate 0.38;95%CI:0.70 to 0.06)and cardiac index(estimate 0.08;95%CI,-0.15 to-0.01).CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some patients.Longitudinal studies are warranted to better understand the systemic effects of metals in TJA patients.
文摘BACKGROUND This unique presentation of hip swelling is only the seventh reported case of pseudotumor recurrence in a non-metal-on-metal total hip arthroplasty(THA)construct.The constellation of patient symptoms and laboratory findings contradict the expected elevated serum metal ion levels associated with the formation of pseudotumor.The presentation,lab trends,and imaging findings contribute to the growing base of knowledge surrounding the effects of corrosion in arthroplasty constructs with stem-neck modularity.CASE SUMMARY A 74-year-old man status post primary THA presented with left hip swelling and elevated serum metal ions five years after implantation of a modular stem-neck prosthesis.The swelling was diagnosed as pseudotumor based on laboratory trends and imaging findings and was treated with revision arthroplasty that completely resolved the initial hip swelling.The patient presented with recurrent hip swelling and recurrent pseudotumor findings on imaging in the same hip four months later.Non-operative management with ultrasound-guided hip aspiration resulted in symptom relief and resolution of the recurrent swelling.After one year of follow-up,the patient had no further recurrences of hip swelling.CONCLUSION This case of post-revision pseudotumor recurrence elucidates attributable patient,surgical,and implant factors with a discussion of diagnostics,management,and prognosis for patients with pseudotumor in non-metal-on-metal arthroplasty constructs.
文摘Squeaking is a well-recognized complication for hardon-hard bearings.The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon.Patient,implant,and surgical factors play a role in squeaking.It is believed that mechanisms damaging the fluid film lubrication in which these bearings function optimally have a critical role.Such mechanisms include edge loading,stripe wear,impingement,third body particles and ceramic fracture.The resonance of metallic parts can produce noise in the human audible range hence the implant metallurgic composition and design may play a role.Implant positioning can facilitate impingement and edge loading enhancing the occurrence of squeaking.The recent introduction of large heads(> 36 mm) 4th generation ceramic-on-ceramic bearing may accentuate the conditions facilitating noise formation; however the current literature is insufficient.Clinically,squeaking may manifest in extreme hip positions or during normal gait cycle however it is rarely associated with pain.Evaluations of patients with squeaking include clinical and radiographic assessments.Computer tomography is recommended as it can better reveal ceramic breakage and implant malposition.The treatments for most squeaking patients include reassurance and activity modification.However for some,noise can be a problem,requiring further surgical intervention.In the occurrence of ceramic fracture,implant failure,extreme components malposition,instability and impingement,surgery should be advised.This review will aim to discuss the current literature regarding squeaking.
文摘BACKGROUND Metal-on-metal(MoM)total hip arthroplasty(THA)has been associated with adverse reactions to metal debris,presenting clinically as pseudotumors.CASE SUMMARY This case report presents a female aged 73 year-old with MoM THA-related pseudotumor.After arthrotomy and bursectomy surgeries,histologic examinations of surgical specimens revealed a specific lymphocyte-dominant immunologic response,now known as aseptic lymphocyte-dominant vasculitisassociated lesion(ALVAL).Due to soft tissue persisting effusion after arthrotomy and bursectomy,revision surgery was then performed with ceramic-onpolyethylene THA.However,revision did not resolve the patient’s symptoms.Here we describe our application of tigecycline sclerotherapy to treat recurrent pseudotumor after revision THA and no recurrence after 24-mo follow-up.CONCLUSION Tigecycline sclerotherapy is safe and effective in the management of recurrent pseudotumor after revision non-MoM THA in ALVAL cases.
基金Project supported by the National Natural Science Foundation of China.
文摘Dialkyldithiocarbamate （R<sub>2</sub>NCS<sup>-</sup><sub>2</sub>） acting as either bridging or terminal ligand plays an important role in modern coordination chemistry. The molecules of the univalent coinage metals （Cu, Ag, and Au） with dialkyldithiocarbamate ligands form a class of compounds in which the sterical restriction influences strongly the crystal structures, and several types of polymerizates were found. However, only a few structures in linear form
