Pseudotumor kao lokalno neželjeno dejstvo usled korozije implanta
Sažetak
Uvod. Termin neželjene lokalne reakcije tkiva (NLRT) odnosi se na patološke promene tkiva koje se javljaju nakon totalne zamene zgloba i uključuje osteolizu, nekrozu kosti, nekrozu mišića, cistične promene, prekomerno nakupljanje tečnosti oko zglobova, pojavu mekotkivnih pseudotumora, reakciju preosetljivosti na metal, metaloze tkiva i hronične inflamacijske lezije. U literaturi su retko opisivane NLRT nastale nakon pucanja keramičkih komponenti endoproteze kuka. Prikaz bolesnika. Prikazujemo slučaj bolesnika sa masivnim tečnim kolekcijama ispunjenim metalnim i tkivnim detritusom i znacima sistemske intoksikacije jonima kobalta (cobalt – Co) i hroma (chromium – Cr). Simptomi su se razvili nakon revizije acetabularne komponente uz primenu metal-na polietilen oslanjajućeg para. Prethodno je učinjeno više revizija zbog pucanja keramičkih komponenti endoproteze i nestabilnosti kuka. Nakon uklanjanja pseudotumorskih masa i revizije svih komponenti endoproteze sa implantacijom oslanjajućeg para između keramičke glave i polietilenskog inserta, došlo je do značajnog pada nivoa Co i Cr u serumu. Zaključak. Tokom revizionih procedura treba proceniti oštećenje truniona (trunnion) i ukoliko ono postoji, potrebno je zameniti obe protetske komponente, kako bi se sprečili efekti korozije metala, NLRT i sistemska intoksikacija jonima metala. Merenjem nivoa Co i Cr u serumu kod bolesnika posle totalne artroplastike, mogu se prepoznati oni bolesnici koji imaju rizik od nastanka NLRT.
Reference
1. Hjorth MH, Mechlenburg I, Soballe K, Roemer L, Jakobsen SS, Stilling M. Higher prevalence of mixed or solid pseudotumors in metal-on-polyethylene total hip arthroplasty compared with metal-on-metal total hip arthroplasty and resurfacing hip arthroplasty. J Arthroplasty 2018; 33(7): 2279‒86.
2. Williams DH, Greidanus NV, Masri BA, Duncan CP, Garbuz DS. Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg Am 2011; 93(23): 2164‒71.
3. Hsu AR, Gross CE, Levine BR. Pseudotumor from modular neck corrosion after ceramic-on-polyethylene total hip arthroplasty. Am J Orthop (Belle Mead NJ 2012; 41(9): 422‒6.
4. Istanbullu OB, Akdogan G. A Simulation Study of Galvanic Corrosion Potential on the Surface of Implantable Biometallic Couples. J Bio Tribo Corros 2021; 7: 25.
5. Svensson O, Mathiesen EB, Reinholt FP, Blomgren G. Formation of a fulminant soft-tissue pseudotumor after uncemented hip arthroplasty. A case report. J Bone Joint Surg Am 1988; 70(8): 1238‒42.
6. Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop 2009; 80(6): 653‒9.
7. Campbell PA, Kung MS, Hsu AR, Jacobs JJ. Do retrieval analysis and blood metal measurements contribute to our understanding of adverse local tissue reactions? Clin Orthop Relat Res 2014; 472(12): 3718‒27.
8. Bravo D, Wagner ER, Larson DR, Davis MP, Pagnano MW, Sierra RJ. No Increased Risk of Knee Arthroplasty Failure in Patients With Positive Skin Patch Testing for Metal Hypersensitivity: A Matched Cohort Study. J Arthroplasty 2016; 31(8): 1717‒21.
9. Plummer DR, Berger RA, Paprosky WG, Sporer SM, Jacobs JJ, Della Valle CJ. Diagnosis and Management of Adverse Local Tissue Reactions Secondary to Corrosion at the Head-Neck Junction in Patients With Metal on Polyethylene Bearings. J Arthroplasty 2016; 31(1): 264‒8.
10. Matharu GS, Pandit HG, Murray DW, Judge A. Adverse reactions to metal debris occur with all types of hip replacement not just metal-on-metal hips: a retrospective observational study of 3340 revisions for adverse reactions to metal debris from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. BMC Musculoskelet Disord 2016; 17(1): 495.
11. MHRA. Medical Device Alert: MDA/2017/018: All Metal-on-Metal (MoM) hip Replacements—Updated Advice for Follow-up of Patients. Available from: https://www.gov.uk/drug-device-alerts/all-metal-on-metal-mom-hip-replacements-updated-advice-for-follow-up-of-patients [accessed on 2022 June].
12. Nousiainen T, Palosaari S, Peräniemi S, Tervahauta A, Niinimäki J, Leppilahti J, et al. Retention of metals in periprosthetic tissues of patients with metal-on-metal total hip arthroplasty is reflected in the synovial fluid to blood cobalt transfer ratio in the presence of a pseudotumour. BMC Musculoskelet Disord 2020; 21(1): 610.
13. Xing D, Yang C, Li R, Hou Y, Kou B, Li H, et al. Severe Wear and multiple Pseudotumor formation due to revision for ceramic head breakage after ceramic-on-ceramic Total hip arthroplasty: a case report. BMC Musculoskelet Disord 2019; 20(1): 332.