{"title":"双锥度模块化茎：无菌淋巴细胞血管炎相关病变（ALVAL）：单一医院系列的修正率和结果","authors":"Pascal Kouyoumdjian, Jad Mansour, Francois Bauzou, Jeffrey Michaud, Remy Coulomb","doi":"10.1177/11207000251356413","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Dual-taper modular stems have been linked to implant failure due to aseptic lymphocytic vasculitis-associated lesions (ALVAL), yet data on revision outcomes remain limited. This study assessed the survival rate of modular stems revised for ALVAL and compared outcomes with a non-revised control group.</p><p><strong>Methods: </strong>A retrospective analysis of 233 total hip arthroplasties (THA) with ABGII dual-taper modular stems (2007-2011) was conducted, with follow-up until 2024. 39 THA (16.7%) underwent revision for ALVAL, confirmed by intraoperative histology. The control group included unrevised patients with ⩾1-year follow-up. Pre-revision assessments included Harris Hip Score (HHS), radiographs, MARS-MRI, and cobalt/chromium ion levels. Revision was indicated for disabling pain, cobalt >5 µg/L, or progressive effusion/pseudotumours. Outcomes included HHS, complications, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>Revisions for ALVAL (39 THA, 16.7%) were primarily due to groin pain (64.1%), MRI effusion (79.5%), and elevated cobalt levels (46.2%). The median time to revision was 4 years postoperatively, with a mean time to revision of 2.4 years. Of 21 unipolar revisions 10 hips (27.1%) had a had a dislocation, bipolar revisions (18 hips) had none (<i>p</i> <0.001).At 5, 10, and 15 years, overall revision-free survival was 88.8%, 80.3%, and 75.2%, respectively, while survival free from revision specifically due to ALVAL, confirmed by histological findings, was 91.4%, 83.7%, and 83.1%. 3 hips were re-revised for periprosthetic fractures. After ALVAL revision the HHS improved from 77.6 to 87.7 (<i>p</i> <0.001) but remained lower than in the non-revised controls (<i>p</i> = 0.002). 25.6% of the revised patients had persistent pain.</p><p><strong>Conclusions: </strong>ALVAL-related revisions led to improvement in the HHS but did not reach the levels of non-revied control. Revision with dual-mobility cups reduced the dislocation risk.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000251356413"},"PeriodicalIF":1.1000,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dual-taper modular stems: aseptic lymphocytic vasculitis-associated lesions (ALVAL): revision rates and outcome in a single hospital series.\",\"authors\":\"Pascal Kouyoumdjian, Jad Mansour, Francois Bauzou, Jeffrey Michaud, Remy Coulomb\",\"doi\":\"10.1177/11207000251356413\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Dual-taper modular stems have been linked to implant failure due to aseptic lymphocytic vasculitis-associated lesions (ALVAL), yet data on revision outcomes remain limited. This study assessed the survival rate of modular stems revised for ALVAL and compared outcomes with a non-revised control group.</p><p><strong>Methods: </strong>A retrospective analysis of 233 total hip arthroplasties (THA) with ABGII dual-taper modular stems (2007-2011) was conducted, with follow-up until 2024. 39 THA (16.7%) underwent revision for ALVAL, confirmed by intraoperative histology. The control group included unrevised patients with ⩾1-year follow-up. Pre-revision assessments included Harris Hip Score (HHS), radiographs, MARS-MRI, and cobalt/chromium ion levels. Revision was indicated for disabling pain, cobalt >5 µg/L, or progressive effusion/pseudotumours. Outcomes included HHS, complications, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>Revisions for ALVAL (39 THA, 16.7%) were primarily due to groin pain (64.1%), MRI effusion (79.5%), and elevated cobalt levels (46.2%). The median time to revision was 4 years postoperatively, with a mean time to revision of 2.4 years. Of 21 unipolar revisions 10 hips (27.1%) had a had a dislocation, bipolar revisions (18 hips) had none (<i>p</i> <0.001).At 5, 10, and 15 years, overall revision-free survival was 88.8%, 80.3%, and 75.2%, respectively, while survival free from revision specifically due to ALVAL, confirmed by histological findings, was 91.4%, 83.7%, and 83.1%. 3 hips were re-revised for periprosthetic fractures. After ALVAL revision the HHS improved from 77.6 to 87.7 (<i>p</i> <0.001) but remained lower than in the non-revised controls (<i>p</i> = 0.002). 25.6% of the revised patients had persistent pain.</p><p><strong>Conclusions: </strong>ALVAL-related revisions led to improvement in the HHS but did not reach the levels of non-revied control. Revision with dual-mobility cups reduced the dislocation risk.</p>\",\"PeriodicalId\":12911,\"journal\":{\"name\":\"HIP International\",\"volume\":\" \",\"pages\":\"11207000251356413\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-07-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"HIP International\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/11207000251356413\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"HIP International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/11207000251356413","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：由于无菌淋巴细胞血管炎相关病变（ALVAL），双锥度模块化茎与植入失败有关，但关于翻修结果的数据仍然有限。本研究评估了为ALVAL修改的模块化支架的存活率，并将结果与未修改的对照组进行了比较。方法：回顾性分析2007-2011年233例采用ABGII双锥度模块柄的全髋关节置换术（THA），随访至2024年。39例THA（16.7%）行ALVAL翻修，术中组织学证实。对照组包括随访1年的未修改患者。预修评估包括Harris髋关节评分（HHS）、x线片、MARS-MRI和钴/铬离子水平。对致残性疼痛、钴bbb50µg/L或进行性积液/假性肿瘤进行复查。结果包括HHS、并发症和Kaplan-Meier生存分析。结果：ALVAL （39 THA, 16.7%）的修订主要是由于腹股沟疼痛（64.1%），MRI积液（79.5%）和钴水平升高（46.2%）。术后翻修的中位时间为4年，平均翻修时间为2.4年。在21例单极矫正中，10例髋关节（27.1%）有脱位，双极矫正（18例）无脱位（p p p = 0.002）。25.6%的患者存在持续性疼痛。结论：与alval相关的修订导致了HHS的改善，但未达到未修订对照的水平。使用双活动杯进行翻修降低了脱位的风险。
Dual-taper modular stems: aseptic lymphocytic vasculitis-associated lesions (ALVAL): revision rates and outcome in a single hospital series.
Background: Dual-taper modular stems have been linked to implant failure due to aseptic lymphocytic vasculitis-associated lesions (ALVAL), yet data on revision outcomes remain limited. This study assessed the survival rate of modular stems revised for ALVAL and compared outcomes with a non-revised control group.
Methods: A retrospective analysis of 233 total hip arthroplasties (THA) with ABGII dual-taper modular stems (2007-2011) was conducted, with follow-up until 2024. 39 THA (16.7%) underwent revision for ALVAL, confirmed by intraoperative histology. The control group included unrevised patients with ⩾1-year follow-up. Pre-revision assessments included Harris Hip Score (HHS), radiographs, MARS-MRI, and cobalt/chromium ion levels. Revision was indicated for disabling pain, cobalt >5 µg/L, or progressive effusion/pseudotumours. Outcomes included HHS, complications, and Kaplan-Meier survival analysis.
Results: Revisions for ALVAL (39 THA, 16.7%) were primarily due to groin pain (64.1%), MRI effusion (79.5%), and elevated cobalt levels (46.2%). The median time to revision was 4 years postoperatively, with a mean time to revision of 2.4 years. Of 21 unipolar revisions 10 hips (27.1%) had a had a dislocation, bipolar revisions (18 hips) had none (p <0.001).At 5, 10, and 15 years, overall revision-free survival was 88.8%, 80.3%, and 75.2%, respectively, while survival free from revision specifically due to ALVAL, confirmed by histological findings, was 91.4%, 83.7%, and 83.1%. 3 hips were re-revised for periprosthetic fractures. After ALVAL revision the HHS improved from 77.6 to 87.7 (p <0.001) but remained lower than in the non-revised controls (p = 0.002). 25.6% of the revised patients had persistent pain.
Conclusions: ALVAL-related revisions led to improvement in the HHS but did not reach the levels of non-revied control. Revision with dual-mobility cups reduced the dislocation risk.
期刊介绍：
HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice.
The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit.
HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are:
• Biomaterials
• Biomechanics
• Conservative Hip Surgery
• Paediatrics
• Primary and Revision Hip Arthroplasty
• Traumatology
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