The Diagnostic Utility of Serum Metal Ion Markers for High-Grade Aseptic Lymphocyte-Dominated Vasculitis-Associated Lesions (ALVALs) in Revision Hip and Knee Arthroplasty: An International Multicenter Study.

Autor: Sheridan GA; Department of Orthopaedics, University of British Columbia, Vancouver, Canada., Neufeld ME; Department of Orthopaedics, University of British Columbia, Vancouver, Canada., Sidhu A; Department of Orthopaedics, University of British Columbia, Vancouver, Canada., Kurmis AP; Department of Orthopaedic Surgery, Lyell McEwin Hospital, Vale, Elizabeth, SA, Australia., Kelly M; Royal College of Surgeons in Ireland, Dublin, Ireland., O'Byrne JM; Royal College of Surgeons in Ireland, Dublin, Ireland., Howard LC; Department of Orthopaedics, University of British Columbia, Vancouver, Canada., Masri BA; Department of Orthopaedics, University of British Columbia, Vancouver, Canada., Garbuz DS; Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2024 Jan; Vol. 39 (1), pp. 206-210. Date of Electronic Publication: 2023 Jun 16.
DOI: 10.1016/j.arth.2023.06.024
Abstrakt: Background: Aseptic lymphocyte-dominated vasculitis-associated lesions (ALVALs) are typically described in the context of metal-on-metal (MoM) hip bearings. This study explores the diagnostic utility of preoperative serum cobalt and chromium ion levels in determining the histological grade of ALVAL in revision hip and knee arthroplasty.
Methods: This was a multicenter retrospective review of 26 hips and 13 knees assessing the correlation between preoperative ion levels (mg/L (ppb)) and the histological grade of ALVAL from intraoperative specimens. The diagnostic ability of preoperative serum cobalt and chromium levels to determine high-grade ALVAL was assessed using a receiver operating characteristic (ROC) curve.
Results: In the knee cohort, there was a higher serum cobalt level in high-grade ALVAL cases (10.2 mg/L (ppb) versus 3.1 mg/L (ppb)) (P = .0002). The Area Under the Curve (AUC) was 1.00 (95% confidence interval (CI) 1.00 to 1.00). There was a higher serum chromium level in high-grade ALVAL cases (12.25 mg/L (ppb) versus 7.77 mg/L (ppb)) (P = .0002). The AUC was 0.806 (95% CI 0.555 to 1.00). In the hip cohort, there was a higher serum cobalt level in high-grade ALVAL cases (333.5 mg/L (ppb) versus 119.9 mg/L (ppb)) (P = .0831). The AUC was 0.619 (95% CI 0.388 to 0.849). There was a higher serum chromium level in high-grade ALVAL cases (186.4 mg/L (ppb) versus 79.3 mg/L (ppb)) (P = .183). The AUC was 0.595 (95% CI 0.365 to 0.824).
Conclusions: Histologically, high-grade ALVAL has significantly higher preoperative serum cobalt and chromium ion levels in revision TKA. Preoperative serum ion levels have excellent diagnostic utility in revision TKA. Cobalt levels in revision THA have a fair diagnostic ability and chromium levels had a poor diagnostic ability.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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