Un manchon interposé de titane réduit-il la fréquence des pseudo-tumeurs après arthrosplatie totale de hanche métal-métal au recul de 5–7 ans - 27/10/16

Does a titanium sleeve reduce the frequency of pseudotumors in metal-on-metal total hip arthroplasty at 5–7 years follow-up?

Doi : 10.1016/j.rcot.2016.09.030

M.H. Hjorth ^a,^⁎,^{^{1
www.orthoresearch.dk/.}} , N. Egund ^b, I. Mechlenburg ^a,^c, J. Gelineck ^b, S.S. Jakobsen ^a, K. Soballe ^a,^d, M. Stilling ^a,^e
^a Department of orthopaedics, Aarhus university hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Danemark
^b Department of radiology, Aarhus university hospital, Nørrebrogade 44, 8000 Aarhus C, Danemark
^c Centre of research in rehabilitation (CORIR), department of clinical medicine, Aarhus university, 8000 Aarhus C, Danemark
^d Orthopaedic research unit, Aarhus university hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
^e Department of clinical medicine, Aarhus university, 8000 Aarhus C, Danemark

^⁎Auteur correspondant.

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Abstract

Introduction

Little is known about pseudotumor frequency and risk factors for pseudotumor formation among different types of metal-on-metal (MoM) hip arthroplasties. A lower release of chromium and cobalt have been reported in MoM hip arthroplasties with a titanium sleeve compared to MoM designs without a titanium sleeve, but yet it is unknown whether a titanium sleeve reduces the pseudotumor frequence. We conducted a cross-sectional study to investigate: (1) pseudotumor frequency; (2) risk factors of pseudotumor formation; (3) and correlations between pseudotumors, serum metal-ions, implant position, and clinical symptoms.

Hypothesis

We expected a lower pseudotumor frequency in MoM hip articulation with a titanium sleeve than reported in MoM hip articulation designs using chromium-cobalt sleeve.

Materials and method

A consecutive series of 41 patients/49 hips (31 males), mean age 52 (28–68) years, participated in a 5.5±0.5 (4–6.5) year follow-up study of their M2a_Magnum hip articulation (Biomet Inc., Warsaw, Indiana, USA). Patients were evaluated with magnetic resonance imaging (MRI), measurements of serum metal-ions, plain radiographs, and clinical outcome measures of Harris Hip Score (HHS) and Oxford Hip Score (OHS).

Results

Eighteen of 47 hips (38%) had MRI-verified pseudotumors, all cystic, with a mean dimension of 10.6×25.6×41mm. Digital measurements on plain radiographs revealed a higher cup anteversion in patients with a pseudotumor of mean 28.4°±5.05° compared to mean 23.5°±6.5° in patients without a pseudotumor (P=0.009). Serum metal-ion concentrations, acetabular cup inclination and measures of HHS and OHS were similar between patients with and without a pseudotumor (P>0.46).

Conclusion

At 5.5±0.5 years after surgery, MRI-verified cystic pseudotumors were frequently observed in M2a_Magnum hip articulations despite the use of titanium sleeves. The pseudotumors were related to high cup anteversion angles but not related to high serum metal-ions or clinical symptoms.

Level of evidence

IV: cross-sectional study.

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Keywords : Titanium sleeve, Metal-on-metal total hip arthroplasty, Magnetic resonance imaging, Pseudotumor, Serum metal-ion levels, Clinical outcome measures

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (www.sciencedirect.com/) en utilisant le DOI ci-dessus.