Hydroxyapatite 피복된 ABG I 삽입물을 이용한 무시멘트 인공 고관절 전치환술: 최소 10년 이상 추시 결과

김이석 ( Yee Suk Kim ),박동혁 ( Dong Hyuck Park ),황규태 ( Kyu Tae Hwang ),김영호 ( Young Ho Kim ),최일용 ( Il Yong Choi ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.3

목적: ABG I 삽입물을 이용한 무시멘트 인공 고관절 전치환술 후 최소 10년 이상 추시한 결과를 알아보고자 한다. 대상 및 방법: 최소 10년 이상 추시가 가능한 121예를 대상으로 임상적, 방사선학적 결과를 분석하고, Kaplan-Meier 생존 분석을 시행하였다. 결과: 최종 추시 Harris 고관절 점수는 평균 84점이었으며, 비구컵 주위의 골용해는 53예(43.8%), 비구컵 해리는 5예(4.1%)에서 관찰되었다. 대퇴 스템 주위 골용해는 11예(9.1%), 스템 해리는 2예(1.7%)에서 관찰되었다. 폴리에틸렌 마모율은 0.23 mm/yr로 측정되었고 재수술은 모두 44예(36.3%)에서 시행되었다. 원인 질환에 따른 결과의 차이는 발견할 수 없었다. 비구컵의 원인으로 재수술을 한 경우 16년 생존율 56.3%, 대퇴 스템이 원인인 경우 16년 생존율 98.1%로 관찰되었다. 결론: ABG I 인공 고관절 삽입물을 이용한 무시멘트 인공 고관절 전치환술의 최소 10년 추시상 높은 골용해 발생과 낮은 비구컵 생존율을 보이는 등 우려스러운 결과가 확인되었다. 따라서, ABG I 인공 고관절 삽입물을 사용하였던 환자들에 대한 면밀한 추시 관찰이 필요할 것으로 사료된다. Purpose: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) with an ABG I hip prosthesis after a minimum ten-year follow up. Materials and Methods: From January 1996 to March 2001, 121 hips in 104 patients, whi were followed up for a minimum of ten-years, were enrolled in this study. The clinical and radiographic outcomes were evaluated and Kaplan-Meier survival analysis was performed. Results: The mean Harris hip score at the last follow-up was 84 points. A radiolucent line around the cup, osteolysis, and cup loosening were observed in 5 hips(4.1%), 53 hips(43.8%), and 5 hips(4.1%), respectively. In the femoral side, osteolysis and stem loosening were observed in 11 hips(9.1%) and 2 hips(1.7%), respectively. The mean linear wear rate of the polyethylene liner was 0.23 mm/yr. Forty four revisions(36.3%) were performed. The outcomes were similar regardless of the cause of primary THA. The survival rate with the end point of revision due to cup loosening was 56.3%, and revision due to stem loosening was 98.1% after a 16 year follow-up. Conclusion: High polyethylene wear and the disappointing survival rate of the ABGI cup were observed after a minimum ten year follow-up. Therefore, close observation of patients who have received an ABG I prosthesis is necessary.

Wagner 재치환 대퇴스템을 이용한 인공 고관절 재치환술

김이석 ( Yee Suk Kim ),조창민 ( Chang Min Cho ),황규태 ( Kyu Tae Hwang ),김영호 ( Young Ho Kim ),최일용 ( Il Yong Choi ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.2

Purpose: We evaluated the results of revision total hip arthroplasty using a Wagner revision femoral stem. Materials and Methods: We enrolled 54 patients who underwent hip arthroplasty using a Wagner revision stem between 1996 and 2004. The mean age at revision surgery was 65.4 years and the mean follow up period was 7.2 years. There were 42 aseptic loosenings and 12 periprosthetic fractures. The pre-operative femoral defects were classified according to the Paprosky classification system. Clinical and radiological results were evaluated. Results: The mean Harris hip score improved from 43 preoperatively to 89 at the latest follow up. There were 2 cases with inguinal pain and 1 with thigh pain; in each case pain was reduced by medications. All cases showed endosteal bone formation around the stem. Five cases showed radiolucency in Gruen zones 1 and 7. Six cases had hips that showed subsidence (average=3.1 mm). There was 1 dislocation (1.8%) and 1 intraoperative periprosthetic fracture (1.8%). There were no re-revisions. Conclusion: Use of a Wagner revision femoral stem for revision total hip arthroplasty elicits satisfactory results including stable fixation of the stem, a low rate of subsidence, and a low rate of dislocation.

무시멘트형 비구컵을 이용한 비구 재치환술

김이석 ( Yee Suk Kim ),김영호 ( Young Ho Kim ),박기철 ( Kee Cheol Park ),이창훈 ( Chang Hoon Lee ),최일용 ( Il Yong Choi ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.1

목적: 골 결손이 동반된 비구컵 재치환술시 골 이식 및 무시멘트형 비구컵으로 치환한 후 임상적, 방사선학적 결과를 알아보고자 한다. 대상 및 방법: 1990년 6월부터 2006월 3월까지 무시멘트형 비구컵과 골이식을 이용한 재치환술을 시행하였던 124명 환자, 131개 고관절을 대상으로 하였으며, 평균 추시 기간은 5년 6개월이었다. 임상적 결과로 Harris 고관절 점수를, 방사선학적 결과로 이식골 유합시기, 이식골 흡수율, 비구컵 이동과 경사각 변화를 조사하였으며, 실패율과 생존율 분석을 하였다. 결과: Harris 고관절 점수는 술 전 51.8에서 술 후 82.5로 향상되었다. 이식골의 골유합시기는 평균 6.4개월이었으며, 방사선학적 이식골의 흡수는 10% 이하 흡수율이 가장 많았다. 최종 추시시 비구컵의 이동은 상방이동 평균 1.37mm, 내측이동 평균 1.20 mm, 비구컵의 경사각 변화는 평균 1.24도이었다. 5례에서 재수술이 시행되었다. 실패율은 3.8 %, 비구컵 해리기준 13년 생존율은 94.9%이었다. 결론: 비구골 결손이 동반된 경우 골이식을 함께한 무시멘트 비구컵을 이용한 재치환술은 빠른 이식골의 골결합과 안정적 비구컵을 얻을 수 있어 권장할 만한 술식으로 사료된다. Purpose: The purpose of this study is to evaluate the clinical and radiological results of revision total hip arthroplasty with using impacted bone grafts and uncemented acetabular cups on the acetabulum with bone defects. Materials and Methods: From June 1990 to March 2006, 131 revision total hip arthroplasties using an uncemented acetabular cup and impacted bone graft, were performed in 124 patients. The average follow-up period was 66 months. The clinical results were evaluated with the Harris hip score. The radiological results included the period of graft incorporation, the rate of resorption, the migration and the change of inclination of the cup. The failure rate and 13 year survival rate were analyzed. Results: The Harris hip scores were 51.8 preoperatively and 82.5 postoperatively. The period of incorporation was a mean of 6.38 month. Most cases showed a resorption rate below 10%. The mean migrations of the acetabular cup were 1.37 mm superiorly and 1.20 mm medially. The mean change of inclination was 1.24°. There were 5 re-revision surgeries. The failure rate was 3.8%. The survival rate of the revision that was done due to loosening was 94.9% at 13 years. Conclusion: Acetabular revision arthroplasty with bone grafts, and an uncemented cup is recommendable as it achieves favorable outcomes in terms of rapid incorporation of the grafted bone and stable fixation of the cup.

40세 미만의 환자에서 시행한 제3세대 알루미나-알루미나 관절면을 이용한 인공 고관절 전치환술

김이석(Yee-Suk Kim),김성재(Sung-Jae Kim),황규태(Kyu-Tae Hwang),최일용(Il-Yong Choi),김영호(Young-Ho Kim) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.6

목적: 40세 미만의 젊은 환자에서 시행한 제3세대 알루미나-알루미나 인공 고관절 전치환술의 최소 5년 이상 추시 결과를 알아보고자 하였다. 대상 및 방법: 2000년 4월부터 2006년 3월까지 수술 받은 환자 중 40세 미만으로 제3세대 알루미나-알루미나 관절면을 이용하여 무시 멘트 인공 고관절 전치환술을 시행받은 50명, 57예를 대상으로 하였다. 남자 24명, 여자 26명이었고 수술 당시 환자의 평균 연령은 30.3세(18-39세)였다. 평균 추시 기간은 8.0년(5-11년)으로서, 수술 전 진단명은 류마티스 관절염이 가장 많았다. 임상적 결과와 방사선학적 결과 및 합병증을 관찰하였다. 결과: Harris고관절 점수(Harris hip score)는 최종 추시 시 96점으로 향상되었으며, 서혜부 통증은 없었으나 대퇴부 통증은 2예에서 호소하였다. 관절내 잡음(squeaking)은 1예에서 관찰되었다. 모든 삽입물은 견고한 골성 안정 고정을 보였으며, 삽입물 해리와 골용해는 관찰되지 않았다. 합병증은 대전자 불유합 l예, 수술 후 조기 탈구 1예가 있었으며, 세라믹 파손, 감염, 재수술은 없었다. 결론: 40세 미만의 젊은 환자에서 시행한 제3세대 알루미나-알루미나 인공 고관절 전치환술에서 우수한 결과가 관찰되었다. 관절내 잡음에 대해서는 장기 추시 관찰이 필요할 것으로 생각된다. Purpose: We investigated the results of the third generation alumina on alumina bearing total hip arthroplasty in patients under the age of forty. Materials and Methods: Fifty patients (57 hips) under the age of forty, who had uncemented total hip arthroplasty using third generation alumina bearing, between April 2000 and March 2006 were observed. The group consisted of 24 men and 26 women The average age at the operation was 30.3 years (18-39 years). The average follow up period was 8.0 years (5-11 years). The most common cause for surgery was rheumatoid arthritis. We assessed the clinical and radiological results and postoperative complications. Results: The mean Harris hip score at the last follow-up was 96 points on average. There was no inguinal pain. However, there were two hips of which the patient was experiencing thigh pain. One hip with squeaking was observed. We could observe the stable bony fixation of implants in all hips There were no aseptic loosening and no osteolysis around the implants. Postoperative complications included one hip with nonunion of trochanteric osteotomy and one hip with dislocation. There were no ceramic fractures, no postoperative infections and no revisions. Conclusion: We observed the favorable clinical and radiographic outcomes of the third generation alumina on alumina total hip arthroplasty in patients under the age of forty. However, in the case of squeaking, a longer term follow-up is needed.

부 주상골의 진구성 연골결합 손상과 동반된 편평족 변형 - 1예 보고 -

성일훈,김이석,Sung, Il-Hoon,Kim, Yee-Suk 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.2

We report a case, showing adult acquired flatfoot, associated with old synchodral diastasis of accessory navicular which was treated with surgical reconstruction.

증례 : 류마티스 ; 류마티스관절염 환자에서 발생한 비정형 대퇴골 골절의 1예

김담 ( Dam Kim ),정소담 ( So Dam Jung ),손창남 ( Chang Nam Son ),최지영 ( Ji Young Choi ),이승훈 ( Seung Hun Lee ),김이석 ( Yee Suk Kim ),성윤경 ( Yoon Kyoung Sung ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2

류마티스관절염 환자에서 질환 자체의 활성도나 질환으로 인한 비스포스포네이트의 장기간 사용 및 PPI, 스테로이드의 사용으로 비정형 대퇴골 골절의 위험도가 높아질 수있으므로 비정형 대퇴골 골절에 대한 많은 연구가 필요하다고 생각하며 대퇴부 통증이 있는 경우 비정형 대퇴골 골절을 염두에 두고 면밀한 진찰과 영상진단을 해야 한다. Atypical femoral fractures are characterized by a subtrochanteric or diaphyseal location. Recent studies have suggested that long-term treatment with bisphosphonates might be associated with the occurrence of atypical femoral fractures. The present report describes a case involving a 60-year-old woman with left buttock pain that was unassociated with trauma. Her hip pain was initially considered to be a symptom of her underlying rheumatoid arthritis, but a plain radiography, bone scintigraphy, and magnetic resonance imaging revealed an insufficiency fracture in the lateral shaft of the left proximal femur. She had been treated with a bisphosphonate for 4.5 years because of a previous vertebral fracture. Her chronic, long-term rheumatoid arthritis and history of bisphosphonate administration were considered to be associated with the development of her atypical femoral fracture. (Korean J Med 2014;87:240-244)

혈액 투석 환자의 고관절 골절에서 시행한 무시멘트 인공 고관절 반치환술

이준환 ( Joon Hwan Lee ),김이석 ( Yee Suk Kim ),황규태 ( Kyu Tae Hwang ),김영호 ( Young Ho Kim ) 대한고관절학회 2012 Hip and Pelvis Vol.24 No.3

경전자 도달법을 이용한 일차성 인공 고관절 전치환술 후 고관절 탈구 발생의 위험 요인

황규태 ( Kyu Tae Hwang ),김영호 ( Young Ho Kim ),김이석 ( Yee Suk Kim ),봉현종 ( Hyun Jong Bong ),최일용 ( Il Yong Choi ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.1

Purpose: We wanted to evaluate the risk factors that predispose a patient to dislocation after undergoing primary total hip arthroplasty with the transtrochanteric approach. Materials and Methods: Between July 1995 and May 2007, 593 consecutive total hip arthroplasties using the trantrochanteric approach were performed. A matched comparative study was performed for the dislocated group(18 hips) and the non-dislocated control group(18 hips). The patient-related factors and mechanical factors were retrospectively reviewed to evaluate the risk factors for dislocation. Results: Dislocation occurred in 18 hips(3.04%). The mean age was 57.1 years in the dislocated group and 55.2 years for all of the patients (p>0.05). Statistical analyses of the BMI, inclination and anteversion of the cup, lowering of the hip center, a leg length discrepancy, the size of the femoral head and nonunion of the greater trochanter revealed no significant differences between the two groups. Nonunion of the greater trochanter was observed in 16 hips(2.84%). The risk of dislocation was 8.5 times higher in the patients with excessive alcohol intake (p<0.05). The combination of more than 3 risk factors significantly affected the incidence of dislocation after total hip arthroplasty (p<0.05). Conclusion: After primary total hip arthroplasty with the transtrochanteric approach, in the cohort of this study, excessive alcohol intake was the main risk factor for dislocation and a combination of risk factors contributed to dislocation.

인공 고관절 전치환술 후 관절 주위 연부 조직에 주입한 Bupivacaine과 Morphine이 수술 후 통증에 미치는 영향: 전향적 연구

황규태 ( Kyu Tae Hwang ),조창민 ( Chang Min Cho ),김이석 ( Yee Suk Kim ),심재항 ( Jae Hang Shim ),김영호 ( Young Ho Kim ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.4

Purpose: We wanted to assess the benefits and safety of periarticular soft tissue injection of bupivacaine and morphine in total hip arthroplasty by conducting a prospective randomized trial. Materials and Methods: Between February 2008 and January 2010, a prospective, randomized study was performed on fifty patients with an American Society of Anesthesiology stage of I or II. All the patients were administered COX-2 inhibitor and we used PCEA (Patient Controlled Epidural Analgesia) for 24 hours postoperatively. All the patients underwent their operation under general anesthesia. Fifty randomly selected patients were divided into two groups. After reduction of the hip joint, 50 ml of normal saline was intraoperatively injected into 25 patients (Group A) and 50 ml of locally injected analgesia that included 0.5 ml 5 mg of morphine HCL, 40 ml of 0.5% 50 mg chirocaine (Levo-bupivacaine) and 9.5 ml of normal saline was injected into the capsule and the soft tissue and muscle around the hip joint in 25 patients (Group B). The analgesic efficacy was evaluated by the visual analogue scale (VAS) at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and during a passive exercise (30˚) state. The consumption of PCEA and additional analgesic drugs was also evaluated postoperatively. Results: Significant differences were found between the 2 groups (P<0.05) with regard to the VAS at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and a passive exercise state. During 24 hours postoperatively, in the mixed analgesia injected group, the consumption of PCEA was significantly lower than that in the normal saline injected group (P<0.05). No significant differences were found for the consumption of additional analgesic drugs between the 2 groups (P>0.05). Conclusion: Intraoperative periarticular soft tissue injection of bupivacaine and morphine can significantly reduce pain and it can reduce the requirement for patient-controlled analgesia, with no apparent risks, following total hip arthroplasty.

고관절 주위 골절 환자에서 알렌드로네이트 투여 후 복용 지속성 및 골밀도의 변화

황규태 ( Kyu Tae Hwang ),유병욱 ( Byeong Wook Yoo ),김이석 ( Yee Suk Kim ),최일용 ( Il Yong Choi ),김영호 ( Young Ho Kim ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.4

Purpose: The purpose of this study was to evaluate the effects of alendronate on bone mineral density (BMD) and to determine the persistency and side effects of alendronate treatment after hip fractures. Materials and Methods: 452 patients who underwent surgery for hip fractures from March 2000 to February 2007 were retrospectively included. The hip fractures consisted of 218 cases of femur neck fractures and 234 cases of intertrochanteric fractures. There were 254 women and 198 men with a mean age of 73.4 years (range: 60~95 years) at the time of surgery. The BMD was assessed in 398 patients and 348 were diagnosed with osteoporosis, while 102 received alendronate for treatment. The persistency with alendronate treatment and change of the BMD were evaluated annually. We also evaluated the side effects and reasons for discontinuation. Results: The prescription rate of alendronate was 29.3% and the persistency rate over 1 year was 33%. The annual BMD of the lumbar spine showed a 9.11% increase the first year, a 4.5% increase the second year and a 3.5% increase the third year, while negative changes were noted in the proximal femur as a 1.89% decrease the first year, a 1.38% decrease the second year and a 0.97% decrease the third year. The BMD changes were 11%(L: Lumbar spine) and 1.1%(F: Femur) for the T-scores <-4.0, 6.3%(L) and 0.9%(F) for the T-scores -3.0~-4.0, and 3.8%(L) and -3.5%(F) for the T-scores >-3.0, respectively. The BMD changes in the patients with femur neck fractures and who were treated with hemiarthroplasty were 15.6%(L) and -3.9%(F). The BMD changes in the patients with intertrochanteric hip fractures and who were treated with compression hip screws or hemiarthroplasty were 18.7%(L), 0.77%(F), 24.2%(L) and 1.19%(F), respectively. Gastrointestinal problems(19.1%) were the most common cause for discontinuation of alendronate. Conclusion: It is important for doctors to approach osteoporosis more carefully and educate patients to follow the prescriptions in order to improve the low prescription and persistency rates for the management of osteoporotic hip fractures. Administration of alendronate may have a positive influence on the BMD of the proximal femur by lowering the rate of decreased BMD more than would be expected.