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Partikelfreisetzung bei Metall-Metall-Gleitpaarungen

Eine Risikoanalyse

Particle release in metal-on-metal bearings

A risk analysis

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Zusammenfassung

Moderne Metall-Metall-Gleitpaarungen zeichnen sich durch einen sehr geringen Verschleiß der Gelenkpartner aus. Sie setzen jedoch durch die Reibung an den artikulierenden Oberflächen Partikel und Ionen frei, die sich im Gelenk und im gesamten Organismus verteilen. Insbesondere in der Einlaufphase werden vermehrt Metallpartikel produziert. Die freigesetzten Ionen führen potentiell zu zytotoxischen, kanzerogenen und allergischen Reaktionen, die sich dann lokal oder systemisch auf die Patientengesundheit auswirken können. Vor allem die Hypersensitivität auf die in der Legierung enthaltenen Metallionen wird von vielen Operateuren als bedenklich angesehen. Die Inzidenz dieser implantatbezogenen Komplikationen wird zum jetzigen Zeitpunkt als sehr gering eingeschätzt, jedoch kann es im schlimmsten Fall zu einem frühzeitigen Versagen des Implantats kommen. Weil auch die alternativ einsetzbaren Gleitpaarungen (Keramik-Polyethylen, Keramik-Keramik) mit z. T. nicht unerheblichen Komplikationen einhergehen können, ist bis heute keine abschließende Beurteilung zur Risikoeinschätzung möglich.

Abstract

Modern metal-on-metal bearings show very low wear rates but release particles and ions from the articulating surfaces into the joint and the whole organism. Especially during the run-in period an increased number of particles is produced. The released metal ions potentially trigger cytotoxic, cancerogenic and allergic reactions, which can impair the patient’s health locally or systemically. Many surgeons fear a hypersensitivity reaction to the metal ions of the CoCr alloy in their patients. Today it is assumed that the incidence of these implant-related complications is very low but in some cases it will lead to early failure of the implant. Because the available alternative bearing combinations (ceramic-on-polyethylene and ceramic-on-ceramic) also bear the risk of severe complications, a final statement on the best and safest bearing choice for the patient cannot be made based on the currently existing data.

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Authors and Affiliations

  1. Labor für Biomechanik und Implantatforschung, Orthopädische Universitätsklinik, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    C. Heisel, E. Jakubowitz & J.P. Kretzer

  2. Fachbereich Orthopädie, DRK-Klinik, Baden-Baden, Deutschland

    M. Thomsen

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  1. C. Heisel
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  2. M. Thomsen
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  3. E. Jakubowitz
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  4. J.P. Kretzer
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Correspondence to C. Heisel.

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Heisel, C., Thomsen, M., Jakubowitz, E. et al. Partikelfreisetzung bei Metall-Metall-Gleitpaarungen. Orthopäde 37, 644–649 (2008). https://doi.org/10.1007/s00132-008-1297-2

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  • DOI: https://doi.org/10.1007/s00132-008-1297-2

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