시멘트와 무시멘트 고관절 전치환술 후의 골소실

황성관 ( Sung Kwan Hwang ),박기홍 ( Ki Hong Park ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.2

Osteolysis and aseptic loosening do occur not only in cemented total hip arthroplasties but also in cementless ones. Recently, osteolysis became the main concern in total hip arthroplasty. Numerous articles, proving particulate debris, such as, polyethylene, PMMA, and metal particles can induce osteolysis, have been published. We examined ten hips which had received either cemented or cementless hip arthroplasty. We examined osteolytic lesions radiographically and microscopically and tried to find out the differences in biopsy findings between osteolytic lesions after cemented and cementless arthroplasty. The results were as follows 1) Acetabular osteolysis occurred in 4 hips with cemented total hip arthroplasty, and two hips with cementless one. 2)Femoral ostelysis developed in 4 hips with cemented total hip arthroplasty, and three hips with cementless one. 3) A similar histopathologic findings of foreign body reactions in cemented and cementless arthmplasty were found. 4) A foreign body reaction is stronger in cemented arthroplasty than cementless arthroplasty. 5) The polyethylene was a main source of osteolysis in both cemented and cementless arthroplasty. 6) The foregin body reaction was found in all lesions of osteolysis after cemented and cementless arthroplasties, the inflammatory reaction was considered as cell-mediated immune reaction.

고관절 전치환술에서 신경손상의 빈도 및 예후

박명식 ( Myung Sik Park ),황병연 ( Byung Yun Hwang ),송경진 ( Kyung Jin Song ),장선웅 ( Sun Ung Jang ) 전북대학교 의과학연구소 2002 全北醫大論文集 Vol.26 No.1

연구목적: 고관절 전치환술 후에 발생하는 신경손상 빈도와 예후를 분석, 연구 하고자 하였다. 연구방법: 1990년에서 1995년까지 고간절 전치환술을 받은 650명의 환자를 대상으로 하여 후향성 조사 방법으로 연구하였다. 연구결과: 고관절 전치환술 후 6례에서 (0.9%) 신경손상이 확인되었고, 그중 1례는 좌골 신경이 손상되었고, 나머지 5례에서는 비골 신경이 손상되었다. 이차성 골성 관절염으로 수술한 환자중 5례에서 신경손상이 발생하였으며 수술 후에 하지의 연장이 있었던 경우에서는 4례에서 신경 손상이 발생하였다. 또 6례의 신경 손상 중 5례가 일차 수술 후 발생 하였고 나머지 1례는 재치환술 후에 발생하였다. 신경 손상의 회복은 3례에서는 완전히 회복되었고, 2례는 3개월 이내에 회복되었으며, 1례는 변화가 없었다. 결론: 본 연구에서 고관절 전치환술 후 0.9%에서 신경손상이 발생하였다. 이러한 신경손상의 대부분은 수술시 과도한 견인, 수술 후 하지의 길이증가, 수술 기구등과 관련이 있다고 하며 재치환술에서 높게 발생 한다고 한다. 그러나 본 연구에서는 6례의 신경 손상 중 5례가 일차 수술 후에 발생하였고, 6례의 신경 손상 중 4례에서는 하지의 길이 증가가 있었다. 그러므로 수술시 보다 많은 주의가 필요하며 또한 치밀한 수술 전 계획으로 신경손상을 줄여야 할 것이다. Objectives: The purpose of this study was to analysis frequency and prognosis of nerve injury after total hip arthroplasty. Method: We reviewed, by using retrospective study, 650 patients received total hip arthroplasty that has been performed from 1990 to 1995. Results: Six patients showed nerve lesion after total hip arthroplasty and sciatic nerve was affected in I case of them and the peroneal nerve was affected in 5 cases of them. Of patients who were performed total hip arthroplasty due to secondary osteoarthritis, 5 cases nerve injury occurred. Among six patients, five patients showed after primary total hip arthroplasty, but only one patient showed after revision total hip arthroplasty. In recovery of nerve injury a complete recovery of function was 3cases, the decreased nerve function was 2 cases and until last follow up, and unchanged function was I case. Conclusion: A lesion of a peripheral nerve followed total hip arthroplasty was rare. Generally nerve injury was related to retractor, intraoperative over traction, limb lengthening, and thermal injury from cement. Our studies showed 0.9%. But this lesion was related to the leg lengthening after primary total hip arthroplasty for Acetabular dysplasia Careful operative technique and preoperative planning reduce the incidence of postoperative nerve injury.

65세이상 환자에서 시행한 무시멘트 고관절 전치환술

황성관 ( Sung Kwan Hwang ),이우용 ( Woo Young Lee ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1

Aseptic loosening of the components has been the most significant and frequent long term problems in cemented total hip arthroplasty. Recently some surgeons, such as Harris", has improved the function of the cemented total hip prostheses by centrifuging of the cement and improvement of the techniques for cementing. Other surgeons, such as Engh," started to use cementless components to achieve direct bonding between the component and surrounding bone by biological ingrowth. In older age group (65 years of age or older), cemented total hip arthroplasty has been the gold standard and the results are excellent. However, during performing cemented total hip arthroplasty, a few serious medical complications, such as hypotension and rarely cardiac arrest, may occur. The anesthesia and operation time may be longer in cemented total hip arthroplasty than those of cementless ones. The purpose of this study was to find any differences in clinical and radiologic results between cementless femoral stom and cemented femoral stem. We performed total hip arthroplasties in 82 patients who were 65 years of age or older from May 1985 to December 1990. Thirty-five(39 hips) patients who could be followed more than 2 years were included for this study. Twenty-three patients(25 hips) had cementless total hip arthroplasty and 12 patients(14 hips) had hybrid total hip arthroplasty. We could not find any significant differences in results between hybrid and cementless total hip arthroplasty.

대퇴골두 무혈성 괴사시 Bipolar 형 골두 치환술과 고관절 전치환술의 비교연구

김영호 ( YH Kim ),김선재 ( SJ Kim ),최창옥 ( CU Choi ) 대한고관절학회 1992 Hip and Pelvis Vol.4 No.2

Authors reviewed 45 cases of bipolar hip arthroplasty and 70 cases of total hip arthroplasty which were performed as the management of avascular necrosis of femoral head with Ficat-Arlet stage III and IV from October, 1985 to October, 1991 to compare the results in both groups. And we also tried to identify the risk factors correlated with remarkable disadvantages in bipolar hip arthroplasty. The results were as followings: 1) As compared with the results of total hip arthroplasty, those of bipolar hip arthroplasty were markedly disadvantageous in terms of the incidence of acetabular erosion and proximal migration, and relatively disadvantageous to some extent in terms of incidence of groin or buttock pain, chronologic changes in hip function, and somewhat disadvantageous in terms of motion of external rotation which is necessary for cross leg position. 2) As compared with the results of total hip arthroplasty, those of bipolar. hip arthroplasty were markedly advantageous in terms of intraoperative blood loss and operation time, and slightly advantageous in the incidence of deep vein thrombosis. And with respect to another variables such as loosening rate of stem, incidence of thigh pain, the results were similar in both groups. 3) Heavy worker was a significantly meaningful risk factor and heavy weight more than 60Kg seemed to be another relatively meaningful risk factor to cause proximal migration of the bipolar cup. 4) In overall view, the results of bipolar hip arthroplasty were rather inferior to those of total hip arthroplasty especiaal in terms of acetabular procimal migration and groin of buttock pain.

The Result of Revision Total Hip Arthroplasty in Patients with Metallosis Following a Catastrophic Failure of a Polyethylene Liner

곽홍석,유정준,이영균,구경회,윤강섭,김희중 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.1

Background: Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops,the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affectedafter revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wearparticles and infiltration of the metal particles in this catastrophic condition. Methods: Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplastiesperformed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in thesepatients were evaluated. Results: The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the finalfollow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cuploosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and looseningas the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. Conclusions: The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PEliner was low.

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study

Won Sik Choy,김갑중,이상기,Kyoung Wan Bae,Yoon-Sub Hwang,Chang Kyu Park 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.3

Background: This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard towear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. Methods: We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that hadbeen performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). Themean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%),degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septichip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groinor thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. Results: The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoralstems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), andaround the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around thecup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes ofacetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. Conclusions: The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with nodetectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option ofprimary total hip arthroplasty for variable indications.

Hip&Pelvis : ORIGINAL ARTICLE : The Effect of Hydroxyapatite Coating on Long-term Results of Total Hip Arthroplasty with Hydroxyapatite-coated Anatomic Femoral Stem

( Young Yool Chung ),( Chae Hyun Im ),( Dae Hee Kim ),( Ju Yeong Heo ),( Young Jae Jang ) 대한고관절학회 2014 Hip and Pelvis Vol.26 No.3

Purpose: To evaluate the clinical and radiological results, as well as the survival rate, associated with total hip arthroplasty using a hydroxyapatite (HA)-coated anatomical femoral stem at a follow-up of ≥12 years. Materials and Methods: From April 1992 to May 1997, 86 patients (102 hips) underwent total hip arthroplasty with a HA-coated ABG I (Anatomical Benoist Giraud; Howmedica) hip prosthesis. The average age at the time of surgery was 53.4 years and the mean duration of follow-up was 17.1 years (range, 12.1-21.0 years). The Harris hip score (HHS) and radiographic assessments of thigh pain were used to evaluate the clinical results. We observed osteointegration, cortical hypertrophy, reactive line, calcar resorption and osteolysis around the femoral stems. The survival rate of the femoral stems was evaluated by using the span of time to a revision operation for any reasons was defined as the end point. Results: The mean HHS was 50.5 preoperatively and 84.2 at the time of last follow-up. Osteolysis only around the HA-coated proximal portion of the femoral stem was observed in 72 hips, cortical hypertrophy all around the distal portion of the femoral stem was observed in 38 hips, and calcar resorption was observed in 44 hips. A reactive line was observed in 13 hips, but was unrelated to component loosening. Stem revision operations were performed in 24 (23%) hips due to osteolysis (14 hips), fracture (5 hips) and infection (5 hips). The femoral stem survival rate was 75% over the mean duration of follow-up. Conclusion: Total hip arthroplasty using a HA-coated anatomical femoral stem showed necessitated a high rate of revision operations due to osteolysis around the femoral stem in this long term follow-up study.

심한 변형을 보이는 감염성 고관절에 시행한 인공 고관절 전치환술

이중명(Joong Myung Lee),조덕연(Duk Yun Cho),김선구(Seon Ku Kim) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.1

A retrospective study was performed on the clinical and radiographic results of total hip arthroplasty in fifty-six patients(fifty-seven hips) who had had severely deformed hips due to the sequela of infectious arthritis from December 1987 till March 1997. The primary diagnosis was tuberculous sequela for 44 hips and pyogenic for 13 hips. We performed total hip arthroplasty with diffuse soft tissue release for the maximum correction of severely deformed hip. Leg length shortening was improved from an average 3.8cm(range, 1.5-8.5cm) to 0.4cm(range, 0-2cm) compared with the contralateral side. According to modified Merle dAubigne and Postel scoring, pain was improved from an average 2.2 to 5.2. The movement of hip was improved from an average 1.8 to 5.2. The ability to walk was improved from an average 2;4 to 5.4. Tuberculosis was reactivated after surgery in 2 hips. Femoral nerve palsy occurred in 3 hips, but recovered completely after a postoperative 3 to 6 months. In 1 hip of tuberculous arthritis, which had a circulation disturbance preoperatively, below knee amputation was performed due to the aggravation disturbance of the circulation after surgery. Radiographically, no hip showed definite loosening, and 1 hip was revised for a huge focal osteolysis in the femoral side and severe wear in the acetabular one. We believe that total hip arthroplasty in combination with diffuse soft tissue release and good rehabilitation program for sequela of infectious arthritis can satisfactorily improve the patients pain and function.

Ceramic-ceramic 관절면을 이용한 무시멘트 고관절 전치환술의 단기 추시

최원식 ( Won Sik Choi ),안재훈 ( Jae Hoon Ahn ),나규현 ( Kyu Hyun Na ),김승권 ( Seung Kwon Kim ) 대한고관절학회 2007 Hip and Pelvis Vol.19 No.1

목적: 세라믹-세라믹 관절면을 가진 고관절 전치환술을 시행하고 그 단기 결과를 분석하고자 하였다. 대상 및 방법: 세라믹-세라믹 관절면을 가진 무시멘트 고관절 전치환술을 시행하였던 환자 중 2년 이상 추시 가능하였던 142례를 대상으로 하였다. 평균 연령은 58.3세, 평균 추시 기간은 3.0년이었다. 평가는 Harris hip score와 서혜부 및 대퇴 통증 및 방사선학적인 각종 지표를 이용하여 분석하였다. 결과: 평균 Harris hip score는 수술 전 58.1점에서 최종 추시 시 93.2점으로 상승하였고, 최종 추시 시 임상적으로 유의한 통증은 4례(2.8%)에서 있었다. 추시 방사선 사진상 대퇴 삽입물은 전례에서 안정성을 유지하였다. 비구컵의 안정성은 2례(1.4%)에서 경사도가 유의하게 변화하여 해리로 진단되었다. 방사선 투과선은 대퇴측에서 9례(6.3%), 비구측에서 3례(2.1%)에서 보였으며, 골내막 신생골 형성은 대퇴측에서 50례(35%), 비구측에서 55례(38.5%)에서 각각 관찰되었다. 골용해는 대퇴측과 비구측에서 모두 발생하지 않았다. 결론: 세라믹-세라믹 관절면을 이용한 무시멘트 고관절 전치환술의 단기 추시상에서 골용해 없이 우수한 결과를 얻을 수 있었다. Purpose: This study evaluated the short-term results of ceramic articulation total hip arthroplasty in cementless total hip arthroplasty. Materials and Methods: 142 hips were followed-up for more than 2 years after cementless total hip arthroplasty using ceramic-on-ceramic articulation. The mean age and follow-up period was 58.3 years and 3.0 years, respectively. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using various radiological indices. Results: At the last follow-up, the Harris hip score improved from 58.1 points preoperatively to 93.2 points postoperatively. There were 4 cases (2.8%) of significant hip pain. Radiologically, all the stems demonstrated stable fixation. The inclination of the acetabular cup was changed significantly in 2 cases (1.4%), which were diagnosed as being loosened. A radiolucent line was observed around the stem in 9 cases (6.3%), and around the cup in 3 (2.1%). Endosteal new bone formation was observed around the stem in 50 cases (35%), and around the cup in 55 (38.5%). No osteolysis was observed around the stem and the cup. Conclusion: The short-term results of ceramic on ceramic articulation hip arthroplasty were excellent without osteolysis.

일차성 인공 고관절 전치환술 후 고관절 탈구 발생의 위험 요인

김영호,박기철,정재홍,최일용 대한고관절학회 2004 Hip and Pelvis Vol.16 No.1