Biological effects of metal on metal hip prostheses
- VernacularTitle:金属对金属髋关节假体的生物学效应
- Author:
Gang CHEN
;
Weidong XU
- Publication Type:Journal Article
- From:
Chinese Journal of Tissue Engineering Research
2007;0(09):-
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND: Metal on metal (MoM) hip prosthesis has been used for more than 30 years. With the increasing number of young patients who used it, the metal ions cumulative in the body may cause the biological effects, such as cell toxicity, genetic toxicity, carcinogenicity and metal allergy, etc, which have received attention and concern. OBJECTIVE: To describe what influences the production of metal ions, and how metal ions distribute in human tissue after MoM hip prosthesis implantation. In particular the change of the metal ions serum level and the MoM hip prosthesis biological effects of the pathological manifestations were investigated. This paper also focused on the factors influencing metal ions serum level and the mechanism of metal ions biological effects. RETRIEVAL STRATEGY: A computer-based search of Pubmed database was undertaken to identify the articles between January 2004 and November 2007, with the key items of "metals, total hip replacement" and language was limited to English. Meanwhile the China Journal Full-text Database was retrieved for the related articles published from January 2000 to November 2007, with the words of "joint replacement, metal ions" in Chinese. Totally 267 articles were screened out, and checked primarily. Inclusion criteria: ①prosthesis interface described the articles for MoM;②procedure described in the articles for hip replacement;③ articles focused on biological effects of metal ions. Exclusion criteria: ①non-MoM interface of the prosthesis;②non-hip arthroplasty;③articles described the metallurgy;④reproducibility study. LITERATURE EVALUATION: Both titles and abstracts were screened preliminarily, excluding 194 articles of unrelated objectives, 58 articles of repeated contents and 0 Meta analysis. Finally 30 articles were taken into further analysis, including 6 reviews and other basic or clinical trials. DATA SYNTHESIS: MoM prosthesis releases metal ions in the body through electrochemical process (corrosion) and enhanced machinery plus electrochemical process (wear-corrosion). It spreads to various body tissues by body fluid, and raises a number of biological effects. Human body shows a reaction of metal ions in a dose-dependent manner, and metal ions serum level decides the biological effects. Generally we consider the serum concentration of metal ions is influenced by ①ion excretion factors. ② mechanical factors. ③individual factors. ④others. At present, the biological effects of metal ions include ①inflammatory response, ②oxidative damage, ③apoptosis, ④osteoporosis and extracellular matrix dissolution, ⑤carcinogenesis, ⑥host response. Its mechanism is related with corrosion, macrophage activation, reactive oxygen generation, osteoblast function inhibition, osteoclast activation, metal-protein complex formation, and so on. The consequence is a series of pathological changes: ①foreign body granuloma synovitis, ②draining lymph node lesions, ③chromium calmly disease, ④malignant lesions, ⑤metal allergy. CONCLUSION: There is no better product to replace MoM hip prosthesis. Through the study of their biological effects, people gradually concern about two issues. First: What is a safe wear rate? Second: What is harmful serum level of metal ions?
