Metallionenfreisetzung nach Hüft- und Kniegelenkendoprothetik – Mechanismen, biologische Wirkungen und notwendige Diagnostik

Zusammenfassung

Bei allen metallischen Implantaten findet eine Freisetzung von Metallionen statt. Diese sind nicht per se schädlich und stellen für die allermeisten Patienten keine Gefährdung dar. Wenn die Metallionen im Körper jedoch eine kritische Konzentration überschreiten, kann dies zu lokalen oder sehr selten auch systemischen Problemen führen. Dieser Artikel soll deshalb die Grundlagen der Metallionenfreisetzung und deren klinische Konsequenzen zusammenfassen. Verschiedene Situationen können klinisch zu einer erhöhten Metallionenfreisetzung führen: Metall-Metall-Gleitpaarungen mit vermehrtem Abrieb, zu große Relativbewegungen an Konusverbindungen, direkter Kontakt metallischer Komponenten/Gleitflächen (Inlay-Verschleiß, Impingement), falscher Einsatz von Metallköpfen bei Revisionen nach Keramikkopfbruch. Wenn es zu klinischen Problemen kommt, betreffen diese meist die lokale Umgebung des jeweiligen Gelenkes. Des Weiteren gibt es Berichte über toxische Organschäden, vor allem bei massivem Abrieb nach fälschlicher Verwendung von Metallköpfen im Rahmen der Revision von Keramikkopfbrüchen. Für eine potenziell mögliche Karzinogenität oder Teratogenität gibt es derzeit keine überzeugenden Hinweise, allerdings ist die Datenlage dazu noch nicht ausreichend, um das abschließend zu bewerten. Bei Verdacht auf eine erhöhte Metallionenbelastung sollten Kobalt und Chrom im Blut (am günstigsten im Vollblut) bestimmt werden. Dabei sind nach heutigem Kenntnisstand Werte < 2 µg/l unbedenklich, Werte von 2 – 7 µg/l liegen in einem Grenzbereich mit noch unklaren Schwellenwerten bzw. biologischen Konsequenzen und Werte > 7 µg/l weisen i. d. R. auf ein lokales Problem hin, das abklärungsbedürftig ist. Grundsätzlich sollten Metallionenbestimmungen nicht für sich isoliert betrachtet, sondern immer im Zusammenhang mit klinischen Beschwerden und bildgebender Diagnostik gewertet werden.

Schlüsselwörter

Metallionen - Hüftendoprothetik - Knieendoprothetik - Komplikationen

Publication History

Article published online:
09 December 2019

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