연령에 따른 미세포말형 고관절 전치환술의 장기 추시 결과 비교

문경호,William J. Culpopper II,Christi Sychterz,Charles A. Engh (Kyoung Ho Moon) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.1

A total of 223 total hip arthroplasties(THAs) in 215 consecutive patients were operated using the Anatomic Medullary Locking hip system. In this study, we compared the incidences of reoperation, clinical results, and radiographic findings between young(<60 years old: 1 1 1 hips in 105 patients) and elderly patients((>-60 years old; 88 hips in 86 patients) at a minimum of five year follow-up. Twelve patients(1 young and 11 elderly) died before five year follow-up and twelve patients(8 hips in 7 young patients and 4 hips in 4 elderly patients) were lost to follow-up. The incidence of reoperation of the young group(15.3%) was significantly higher than that of the elderly group(3.4%). Excellent clinical results were obtained in both groups with 96% of the young group and 93% of the elderly group reporting they were satisfied with their hip arthroplasty. In radiological analysis, the incidences of osteolysis(acetabular and femoral) and acetabular mechanical failure in the young group(15.3%) were significantly higher than those in the elderly group(5.7%). These results suggest that porous-coated total hip arthroplasty is an effective treatment option for painful arthritic hips in elderly patients.

AML(Anatomical Medullary Locking) 대퇴 스탬을 이용한 무시멘트 고관절 치환술

문경호 ( Kyoung Ho Moon ),박승림 ( Seung Rim Park ),김형수 ( Hyoung Soo Kim ),강준순 ( Joon Soon Kang ),권순철 ( Soon Cheul Kwon ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1

The author tried to get result after clinical and radiological studies with 39 patients (50 hip Joints) who have been operated non-cemented bipolar hemiarthroplasty or total hip replacement arthroplasty with using AML(Courtesy Depuy, Warsaw, Ind. ) femoral stem and who could be followed for the period of more th two years(average 39 months) at the INHA University Hospital, Dept. Of Orthopaedic Surgery from the Feb, 1989 through the Feb, 1992. The results were as rollows 1. There were 41 cases of press-fit on the radiogram after operation, 9 cases of no press fit. 2. Pre-operative Harris hip score was average 37. 4, but it was raised to 82. 9 after operation, Amomg them, Harris hip score for the press fit group was 86. 1 ynd those of no press fit group was 79.6, it shows significant statistical differences (p<0. 05). 3. The vetical subsidence, calcar resorption and reactive white lines were relatively higher incidence at the case of no press fit femoral stem, but here were no significant statistical meanings compared with press fit group(p>0.05). 4. The formation of spot welds were shown higher frequency at the press fit group than no press fit group and had statistically significances(p<0.05). 5. The 39(78%) cases were assessed with bony remodeling by the stress shielding effect and press fit group was on the 3rd degree stress shield effect which was nuch higher in those of no press fit, it shows significant statistical meanngs(p<0.05) 6. The fication with bony ingrowth which was estimated through the final radiologic evaluations, were 25 cases (50%), stable fibrous ingrowth fication were 23 cases(46%), and unstable fication were 2 cases (4%). The higher incidences of bony ingrowth fication were shown ft the cases of press fit stem, and stable fibrous ingrewth fication for the no press fit of it. There were significant statistical meanings between the incidences(p<0.05). According to the conclusion of this retrospective study, the noncemented hip arthroplasty using AML femoral stem in initial press fit froup had much better clinical results than no press fit group.

Crowe IV 선천성 고관절 탈구 환자에서 전자하 단축 절골술과 동반하여 시행한 무시멘트 고관절 전치환술

문경호 ( Kyoung Ho Moon ),박현우 ( Hyun Woo Park ),이정윤 ( Jung Youn Lee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

Hip dysplasia in its end stage may require arthroplasty, and the pathological anatomy of chronically dislocated hips makes reconstruction far more difficult in them than in most cases. Total hip arthroplasty with subtrochanteric shortening osteotomy was performed on five Crowe VI developmental dysplasia of the hip in four women. The clinical and radiological results of this operative technique were excellent in short term follow-up. This operative technique is useful method in Crowe VI developmental dysplasia of the hip for correcting the leg length discrepancy without permanent neurologic deficit.

Deep Vein Thrombosis after Cementless Total Hip Replacement Arthroplasty Using Doppler Ultrasound

Kyoung-Ho Moon(문경호),Won-Hong Kim(김원홍),Jung-Youn Lee(이정윤) 대한정형외과학회 1998 대한정형외과학회지 Vol.33 No.6

고관절 전치환술 후 비구 컵 해리와 동반된 장요 점액낭 팽대 -증례보고-

문경호 ( Kyoung Ho Moon ),양승욱 ( Seung Wook Yang ),홍기천 ( Kee Chun Hong ),이정윤 ( Jung Youn Lee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.1

A 65-year-old woman was seen with a pelvic mass and swelling of the right lower extremity. She had undergone totoal hip arthroplasty on the right side 13 years ago. The pelvic mass was removed through an abdominal approach. After 7 months, her loosened total hip arthroplasty was revised. The mass was diagnosed as an iliopsoas bursitis distended by the influx of the synovial fluid from the loosened total hip arthroplasty.

세라믹-세라믹 관절면의 광범위 세공 피복 AML(R)형 고관절 전치환술의 단기 추시 결과

문경호 ( Kyoung Ho Moon ),강준순 ( Joon Soon Kang ),조중모 ( Joong Mo Cho ) 대한고관절학회 2005 Hip and Pelvis Vol.17 No.4

목적: 본 연구는 세라믹-세라믹 관절면을 갖는 무시멘트 광범위 세공 피복 주대를 이용한 일차 인공 고관절 전치환술의 단기 추시 결과를 보고자 하였다. 대상 및 방법: 2001년 4월부터 2003년 1월까지 81명, 86고관절에 세라믹-세라믹 무시멘트성 인공 치환물을 이용한 인공 고관절 전치환술을 시행하였다. 이중 2년 이상 추시가 가능했던 79명, 84 고관절을 연구 대상으로 평가하였다. 수술 당시 평균 연령은 51세 (19~83)였다. 진단으로는 대퇴골두 무혈성 괴사가 44예, 일차성 퇴행성 관절염 8예, 외상성 관절염 7예, 발달성 비구 이형성증 7예, 화농성 고관절염 후유증 7예, 고관절 강직 4예, 대퇴 경부 골절 3예, 기타 4예였다. 결과: 최종 추시 방사선 소견 상 비구컵의 무균성 해리를 보인 경우는 없었으며, 1예에서 의미 있는 대퇴 삽입물의 무균성 해리가 있었고 2예에서 무균성 해리를 의심할 만할 소견을 보였다. 이외에는 전예에서 골침습성 고정을 얻었고 치환물 주위 골용해는 없었다. 합병증으로 수술 중 발생한 세라믹 라이너의 조각 골절이 2예 있었다. 수술 후 3주째에 발생한 후방 탈구가 1예 있었으며 수술 후 6주째에 세라믹 라이너의 해리를 동반한 전방 탈구가 1예 있었다. 결론: 세라믹-세라믹형 인공 고관절 전치환술의 단기 추시 결과는 비교적 만족스러웠으나 정확한 결과를 위하여 장기 추시가 필요할 것으로 사료된다. Purpose: To analyze the prognostic factors influencing clinical outcomes and to aid the surgeon`s decision making concerning conversion of ankylosed hip to total hip arthroplasty (THA). Materials & Methods: Forty-six patients (53 hips) with a mean follow-up duration of 3 years 4 months were studied. Prognostic factors including type of ankylosis, age at fusion, abductor development, fusion duration, preceding diseases, leg length discrepancy, implant type, and trochanteric osteotomy were analyzed. Clinical results were evaluated retrospectively using Harris hip score (HHS; pain, gait, activity), pain scale of adjacent joints, and range of motion. Results: Favorable prognosis factors were severe fibrous ankylosis, spontaneous ankylosis, and age at fusion over 15 years. Unfavorable factors were bony ankylosis, surgical ankylosis, and age at fusion under 15 years in HHS and pain scale of adjacent joints. Strong contraction of the abductor muscle was also an important prognosis factor in HHS, especially in gait. Conclusion: In conversion of ankylosed hip to THA, it is important to recognize the possible prognostic factors and to meet the patient`s various demands and needs.

Metal-Backed 비구컵 내의 Polyethylene 마모의 측정 -새 이차원적 방법-

문경호 ( Kyoung Ho Moon ),오승재 ( Sung Je Oh ),이정윤 ( Jung Youn Lee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

We measured the wear of polyethylene liners in a group of 34 hips(27 patients) in which a metal-backed acetabular cup had been implanted. Each patients was evaluated radiographically and clinically at a minimum of four different postoperative intervals. The initial evaluation was performed just postoperatively, and the last evaluation was performed at a mean of 5.9 years(range, three to eight years) postoperatively. Two-dimensional wear that is, penetration by the femoral head into the ultra-high molecular weight polyethylene liner was determined from anteroposterior radiographs of the pelvis with a computer analysis system that calculated the change in the position of the center of the head relative to the center of the cup. The results were as follows: There was a large difference (mean, 0.46 millimeters) between the center of the head and that of the cup as measured on the initial postoperative radiographs. The difference underscores the need for researchers to consider the initial displacement of the head when measuring and reporting polyethylene wear. The wear rate was mean 0.17 millimeters per year. The wear rate of male group was higher than that of female group. There were no statistically significant difference in each groups regarding age, body weight, cup inclination, head size and the production company. This new computer assisted 2-dimensional method could be a good method for clinical evaluation of the polyethylene wear in metal-backed acetabular cups.

고관절 반치환술 후 비구 연골의 퇴화

문경호(Kyoung Ho Moon),강준순(Jun Soon Kang),조규정(Kyu Jung Cho),이동주(Tong Joo Lee),권대규(Dae Gyu Kwon) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.3

목적: 기간에 따른 인공 금속 골두가 비구 관절 연골을 퇴화시키는 정도를 알아보고, 어떤 임상적 인자들이 비구 관절 연골의 퇴화에 영향을 미치는지 알아보고자 하였다. 대상 및 방법: 1996년 8월부터 2002년 8월까지 고관절 반치환술을 시행 받은 192명(226 고관절) 중 최소 2년이상 추시가 가능하고, 탈구, 감염 및 기능상의 문제를 보이지 않은 61명(65 고관절)을 대상으로 하였다. Computer assisted vector wear analysis program을 변형하여 비구 관절 연골의 퇴화 정도를 측정하였으며 퇴화의 정도가 평균값보다 많은 군과 적은 군으로 나누어 퇴화에 영향을 미치리라 생각되는 인자들을 통계학적으로 분석하였다. 결과: 고관절 반치환술 후 측정된 비구 관절 연골의 선상 퇴화 변화는 평균 0.23±0.107 ㎜/yr, 부피 퇴화 변화는 평균 114±47.2㎣/yr로 측정되었다. 평균 이상 및 이하의 군으로 나누어 비교 분석한 결과 활동력 및 Harris hip score(HHS)는 통계학적으로 의미 있는 차이를 보였다. 퇴화에 미치는 기여도에 있어서는 선상 및 부피 퇴화 변화에 대해 HHS가 역상관관계각 있었고 활동력은 상관관계에 있었다. 결론: 비구 관절 연골의 퇴화는 환자의 활동이 활발할수록 빠르며, HHS가 높을수록 느렸다. 고관절 치환술시 환자의 여명 및 활동력에 따라 반치환술 혹은 전치환술의 선택을 선별하여 시행하는 것이 좋으리라 생각된다. Purpose: This study examined the rate of degeneration of the acetabular cartilage by the bipolar head according to time, and which clinical factors are related to the degeneration of the acetabular cartilage. Materials and Methods: Among 192 patients (226 hip joint) who were received bipolar hemi-arthroplasty from August 1996 to August 2002, 61 patients (65 hip joint), who were followed up for more than 2 years and showed no signs of dislocation, infection and functional problems, were enrolled in this study. A modified form of a computer assisted vector wear analysis program was used to measure the rate of degeneration of the acetabular cartilage. The subjects were divided into two groups, those whose amount of degeneration of the acetabular cartilage was less than average and those whose amount of degeneration was more than average. The factors that appeared to affect the level of acetabular degeneration in the two groups were evaluated. Results: After a bipolar hemiarthroplasty, the average linear degenerative change in the acetabular cartilage and the volumetric degenerative change was 0.23±0.107 ㎣/yr and 114±47.2 ㎣/yr, respectively. The result showed significant differences with activity and the HHS between the two groups. The HHS showed a reverse relationship with the linear degeneration and volumetric degeneration, the activity showed a correlation with the linear and volumetric degeneration. Conclusion: The acetabular cartilage degenerates faster as the patient's activity increases, and slower with a higher HHS. When surgeons perform hip joint arthroplasty, it is strongly recommended that the life expectancy and the level of activity be considered when deciding between a hemiarthroplasty or total hip arthroplasty.

P-M(Pathofer-Mouch)형 고관절 전치환술

문경호 ( Kyoung Ho Moon ),박승림 ( Seung Rim Park ),김형수 ( Hyoug Soo Kim ),강준순 ( Joon Soon Kang ),김명호 ( Myung Ho Kim ),최현 ( Hyoun Choi ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1

We reviewed the results of the 71 cases of total hip replacements that had been done with the P-M type cementless total hip prosthesis for 60 patients. This type of prosthesis consist of threaded acetabular component and anatomically adapted femoral stem. The following check-up for more than two year to 5 years(average 40 months) at the Department of Orthopedic Surgery, Inha General hospital, Inha med- ical school, during the period of Jan. 1987 to Dec. 1992. The result were followings; 1. Modified Harris hip score wps 39.4 before operation but it raised to average 86 after 4 years of operation and it become decreased after on. 2. The pain in the thigh were shown on 15 patients(21%) of the patients after 2 years of surgery as more than the slight pain, then in increased aftertime. 3. The fixation of femoral stem consisted with 27(38.0%) of excellent fixation, 30(42.3%) of good fixation, and 14 cases(20.7%) of poor fixation. 4. The 12 cases(16.9%) showed more than 2mm of radiolucent zone around the femoral stem. 5. The 13 cases(18.3%) showed more than 5mm of vertical subsidence, and the ver- tical subsidence frequently occured with poor fixation of the femoral stem on the radiographic image(P<0.05), and function of the hip joint was decreased thereafter (P=0. 0199).

양측으로 대퇴골두 골절을 동반한 외상성 양측 고관절 전후방 탈구

문경호(Kyoung-Ho Moon),이동주(Tong-ju Lee),박영하(Young-Ha Park) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.3

고관절 탈구는 전체 관절 탈구의 2-5% 정도를 차지하며 외상에 의해 양측 고관절이 동시에 발생된 달구는 매우 드물게 보고되어, 그 발생 빈도는 모든 관절 탈구의 0.025에서 0.050%이다. 양측성 고관절 탈구가 한쪽은 전방으로 한쪽은 후방으로 발생한 경우는 더욱 드문 것으로 알려져 있다. 본 증례는 교통사고로 양측 고관절에 동시에 탈구가 발생한 23세의 여자환자로 우측 고관절은 전방 탈구, 좌측 고관절은 후방탈구되어 있었으며 양측 모두 대퇴골두 골절이 발생되었다. 환자의 우측 고관절 탈구 방향은 우측 비구의 전하방이었고, 좌측 고관절 탈구는 후상방이었으며, 양측 대퇴골두 골절이 골두 중심와 상방에 동반되었다. 치료로 즉각적인 비관혈적 도수정복 후 피부견인을 하였다. 6주 침상 안정 후에 부분적으로 체중부하를 시작하였고, 10주째에 완전한 체중부하를 하였다. 추시 중 대퇴골두 무혈성 괴사 및 외상 후 관절염 등의 합병증은 없었다. Hip dislocation represents 2 to 5% of all joint dislocation whereas bilateral hip dislocation occurring as a result of trauma is rarely reported, accounting for 0.025 to 0.050% of hip dislocation cases. It is known that the simultaneous occurrence of traumatic dislocation with one anterior and the other posterior is even rarer. The case described showed a bilateral hip dislocation which occurred anteriorly at the right hip and posteriorly at the left with both femoral heads fractured as a result of a traffic accident. The right hip of the patient was dislocated in the anteroinferior direction of the right acetabulum, and the left hip in the posterosuperior direction of the left acetabulum. Both hip fractures were accompanied by fragments above the fovea centralis. The patient was treated by immediate reduction followed by skin traction. Partial weight bearing was performed after 6 weeks of bed rest and full weight bearing began on the 10th week. No complications such as avascular femoral head necrosis or traumatic arthritis occured.