Metallabrieb bei Hüfttotalendoprothesen und Hüftoberflächenersatz

Zusammenfassung

In den letzten Jahren mehren sich die Berichte in den globalen Medien und in der internationalen Fachpresse über Komplikationen nach Implantation von Hüfttotalendoprothesen mit Metall-Metall-Gleitpaarung. Neben negativen Reaktionen auf metallische Fremdkörper und Abrieb (ARMD) treten Korrosion am Implantat, aseptische Lockerungen sowie periprothetische Osteolysen mit lokaler Immunantwort im Gelenkgewebe auf. Auf systemischer Ebene wurden erhöhte Serum- und Urinkonzentrationen von Kobalt und Chrom beschrieben. Des Weiteren können bei bereits bestehenden Metallallergien Überempfindlichkeitsreaktionen gegenüber Implantaten auftreten bzw. kann sich eine spezifische Sensibilisierung von Lymphozyten gegen Legierungskomponenten neu ausbilden. In letzter Zeit häufen sich hierzu Berichte über allergische Reaktionen auf Abriebpartikel von Metall-Metall-Gleitpaarungen. Bis zum heutigen Tag ist auch das karzinogene Potenzial von Metall-Metall-Gleitpaarungen nicht abschließend geklärt. Deshalb hat eine internationale Konsensus-Konferenz zur Thematik der „Metall-Metall-Gleitpaarungen“ mit Experten unterschiedlicher Fachrichtungen und Gremien eine Empfehlung zur fachübergreifenden Handhabung mit diesen Implantaten sowie zum Umgang mit betroffenen Patienten erarbeitet.

Summary

In recent years the global media and international press reported complications after implantation of total hip replacements with metal-metal bearings. Adverse reactions to metallic debris (ARMD) due to corrosion of the implant, periprosthetic osteolysis and aseptic loosening induce a local immune response in joint tissues. At the systemic level, increased serum and urine concentrations of cobalt and chromium have been described. Furthermore, hypersensitivity reactions occur to implants or develop new specific sensitization of lymphocytes against alloy components in existing metal allergies. Recently, these reports suggest allergic reactions to wear particles from metal-on-metal bearings. To this day, even carcinogenic potential of metal-on-metal bearings is not fully understood. Therefore, an international consensus conference about the topic of “metal-onmetal bearings” with experts from different fields has prepared a recommendation on the multidisciplinary management with these implants as well as dealing with affected patients.

Schlüsselwörter

Metallabrieb - Hüfttotalendoprothesen - Metall-Metall-Gleitpaarung - Konsensus

Keywords

Metal debris - total hip replacements - metalon-metal bearings - consensus statement

• Literatur

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