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Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities

BACKGROUND: Among the various complications associated with total hip arthroplasty (THA) periprosthetic osteolysis and wear phenomena due to the release of metal particles, are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released...

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Autores principales: Manfreda, Francesco, Bufi, Egzon, Florio, Enrico Francesco, Ceccarini, Paolo, Rinonapoli, Giuseppe, Caraffa, Auro, Antinolfi, Pierluigi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554354/
https://www.ncbi.nlm.nih.gov/pubmed/34754833
http://dx.doi.org/10.5312/wjo.v12.i10.768
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author Manfreda, Francesco
Bufi, Egzon
Florio, Enrico Francesco
Ceccarini, Paolo
Rinonapoli, Giuseppe
Caraffa, Auro
Antinolfi, Pierluigi
author_facet Manfreda, Francesco
Bufi, Egzon
Florio, Enrico Francesco
Ceccarini, Paolo
Rinonapoli, Giuseppe
Caraffa, Auro
Antinolfi, Pierluigi
author_sort Manfreda, Francesco
collection PubMed
description BACKGROUND: Among the various complications associated with total hip arthroplasty (THA) periprosthetic osteolysis and wear phenomena due to the release of metal particles, are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released particles that generally activate macrophagic osteolytic effects. Therein, new masses known as pseudotumors can appear in soft tissues around a prosthetic implant. To date, there is paucity of reliable data from studies investigating for any association between the above mentioned adverse events. AIM: To investigate for the existence of any association between serum and urine concentrations of metal-ions released in THA and periprosthetic osteolysis for modular neck and monolithic implants. METHODS: Overall, 76 patients were divided into three groups according to the type of hip prosthesis implants: Monoblock, modular with metal head and modular with ceramic head. With an average f-up of 4 years, we conducted a radiological evaluation in order to detect any area of osteolysis around the prosthesis of both the femur and the acetabulum. Moreover, serum and urinary tests were performed to assess the values of Chromium and Cobalt released. Statistical analysis was performed to determine any association between the ion release and osteolysis. RESULTS: For the 3 study groups, the monolithic, modular ceramic-headed and modular metal-headed implants had different incidences of osteolysis events, which were higher for the modular implants. Furthermore, the most serious of these (grade 3) were detected almost exclusively for the modular implants with metal heads. A mapping of the affected areas was performed revealing that the highest incidences of osteolysis were evidenced in the pertrochanteric region at the femur level, and in the supero-external region at the acetabular level. Regarding the evaluation of the release of metals-ions from wear processes, serum and urinary chromium and cobalt values were found to be higher in cases of modularity, and even more so for those with metal head. Statistical linear correlation test results suggested positive correlations between increasing metal concentrations and incidences areas of osteolysis. However, no cases of pseudo-tumor were detected. CONCLUSION: Future studies are needed to identify risk factors that increase peri-prosthetic metal ion levels and whether these factors might be implicated in the triggering of local events, including osteolysis and aseptic loosening.
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spelling pubmed-85543542021-11-08 Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities Manfreda, Francesco Bufi, Egzon Florio, Enrico Francesco Ceccarini, Paolo Rinonapoli, Giuseppe Caraffa, Auro Antinolfi, Pierluigi World J Orthop Retrospective Study BACKGROUND: Among the various complications associated with total hip arthroplasty (THA) periprosthetic osteolysis and wear phenomena due to the release of metal particles, are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released particles that generally activate macrophagic osteolytic effects. Therein, new masses known as pseudotumors can appear in soft tissues around a prosthetic implant. To date, there is paucity of reliable data from studies investigating for any association between the above mentioned adverse events. AIM: To investigate for the existence of any association between serum and urine concentrations of metal-ions released in THA and periprosthetic osteolysis for modular neck and monolithic implants. METHODS: Overall, 76 patients were divided into three groups according to the type of hip prosthesis implants: Monoblock, modular with metal head and modular with ceramic head. With an average f-up of 4 years, we conducted a radiological evaluation in order to detect any area of osteolysis around the prosthesis of both the femur and the acetabulum. Moreover, serum and urinary tests were performed to assess the values of Chromium and Cobalt released. Statistical analysis was performed to determine any association between the ion release and osteolysis. RESULTS: For the 3 study groups, the monolithic, modular ceramic-headed and modular metal-headed implants had different incidences of osteolysis events, which were higher for the modular implants. Furthermore, the most serious of these (grade 3) were detected almost exclusively for the modular implants with metal heads. A mapping of the affected areas was performed revealing that the highest incidences of osteolysis were evidenced in the pertrochanteric region at the femur level, and in the supero-external region at the acetabular level. Regarding the evaluation of the release of metals-ions from wear processes, serum and urinary chromium and cobalt values were found to be higher in cases of modularity, and even more so for those with metal head. Statistical linear correlation test results suggested positive correlations between increasing metal concentrations and incidences areas of osteolysis. However, no cases of pseudo-tumor were detected. CONCLUSION: Future studies are needed to identify risk factors that increase peri-prosthetic metal ion levels and whether these factors might be implicated in the triggering of local events, including osteolysis and aseptic loosening. Baishideng Publishing Group Inc 2021-10-18 /pmc/articles/PMC8554354/ /pubmed/34754833 http://dx.doi.org/10.5312/wjo.v12.i10.768 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Retrospective Study
Manfreda, Francesco
Bufi, Egzon
Florio, Enrico Francesco
Ceccarini, Paolo
Rinonapoli, Giuseppe
Caraffa, Auro
Antinolfi, Pierluigi
Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities
title Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities
title_full Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities
title_fullStr Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities
title_full_unstemmed Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities
title_short Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities
title_sort osteolysis in total hip arthroplasty in relation to metal ion release: comparison between monolithic prostheses and different modularities
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554354/
https://www.ncbi.nlm.nih.gov/pubmed/34754833
http://dx.doi.org/10.5312/wjo.v12.i10.768
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