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.

인공 고관절 치환술 후 발생된 대퇴 스템 주위 골절

이중명(Joong-Myung Lee),황대우(Dae-Woo Hwang),최희준(Hee-Joon Choi),설용동(Yong-Dong Seol),이돈석(Don-Seok Lee) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.2

목적: 인공 고관절 치환술 이후에 발생한 대퇴 스템 주위 골절을 Vancouver 방식에 따라 분류하고 각각의 치료 결과를 분석하고자 한다. 대상 및 방법: 1991년 8월부터 2008년 2월까지, 인공 고관절 치환술 이후에 발생한 대퇴 스템 주위 골절, 총 44명 44예 중 최소 1년 이상 추시가 기능하였던 32예를 대상으로 하였으며, Beals와 Tower의 기준을 이용하여 치료결과를 판정하였다. 결과: 치료결과는 우수가 27예, 불량이 5예로, 불량한 결과를 보인 5예 중 불유합이 4예에서 발생되어 3예에서는 내고정술을 시행하였고, 나머지 1예는 보존적 치료를 시행하였다. 불량한 결과를 보인 나머지 1예는 시멘트형 스템 B1형 골절 치료 후 스템에서 이완이 발생되었으며, 추가로 중장기 추시에서 4예(시멘트형 스템 B1형 골절 3예, 시멘트형 스템 C형 골절 l예)에서 스템의 이완이 발생되어 총 5예에서 재치환술을 시행하였다. 결론: 무시멘트형 B1형 골절과 시멘트 시용 유무와 상관없이 B2, B3형 골절은 Vancouver 분류 및 이에 따른 치료원칙이 우수함을 확인할 수 있었다. 하지만, 시멘트형 스템 B1형 골질의 경우 치료 후, 불유합, 대퇴 스템의 이완 등이 초래되는 불량한 치료 결과를 보여 내고정시 골이식술을 포함한 견고한 고정이나 스템 재치환술이 필요하다. 골다공증이 있는C형 골절에서도 불량한 치료 결과를 보일 수 있어 세심한 주의를 요한다. Purpose: To determine results of treatment according to the guidelines of the Vancouver classification in periprosthetic femoral fractures after total hip arthroplasty. Materials and Methods: Among 44 cases of periproshtetic femoral fractures after hip arthroplasty treated between Aug. 1991 and Feb. 2008, thirty-two cases with minimum follow-up greater than one year were included. Outcomes were evaluated using the Beals and Tower's critieria. Results: Outcomes were excellent in 27 cases, and poor in 5 cases. Four of 5 cases with poor result were due to non-union. Three cases were treated with internal fixation and 1 case was treated with a conservative method. One case with a poor result was due to loosening of the cemented stem of a Vancouver type B1 fracture. Loosening of the stem after mid to long term follow up occurred in an additional 4 cases (3 cases with a cemented stem in a type B1 fracture, 1 case with a cemented stem of a type C fracture). Loosened stems were revised with a long revision stem. Conclusion: For type B1 peri prosthetic fractures around a cementless stem, and for type 82, type B3 peri prosthetic fractures, treatment according to the guidelines of the Vancouver classification showed excellent results. However, type B1 peri prosthetic fractures around a cemented stem showed poor results with non-union or stem loosening. Hence, more rigid fixation using a bone graft or revision of the stem is needed. In type C periprosthetic fractures in osteoporotic patients, closer attentions is needed to avoid complications.

Wagner Revision Femoral Stem을 이용한 인공 고관절 재 치환술

이중명 ( Joong Myung Lee ),한용호 ( Yong Ho Hahn ),조덕연 ( Duck Yun Cho ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.1

A retrospective follow-up study was performed on 37 revision total hip arthroplasties using Wagner revision stem in 34 patients due to the loosening of arthroplasty at the department of orthopaedic surgery, National Medical Center from March 1991 to March 1996. The average age at the surgery was 53 years old (range, 34 to 47 years). The follow-up period ranged from 2 years to 8 years. The acetabular side was revised with hemispherical cup and allograft, which was not reviewed in this study. According to the AAOS method, the bone defect of the femur was classified as cavitary type in 5 hips, combined type in 29 hips and discontinuity type in 3 hips. According to the Paprosky method, the bone defect was classified as type I in 5 hips, type IIA in 7 hips, type IIB in 8 hips and type III in 17 hips. The fresh-frozen femoral head allograft was used for filling the gap between proximal stem and cortex in recently operated 14 hips. Within this period, the loosening or failure developed in one case, but postoperative infection did not occur. Subsidence developed in three cases by less than 5 mm. The stress shielding was minimal(grade I or II according to Engh s criteria). Until the latest follow-up time, the results of this technique were excellent. We will continuously follow up these patients for the exact evaluation.

대퇴골두 무혈성 괴사에서의 연골조직의 병리학적 소견 및 의의

이중명 ( Joong Myung Lee ),조덕연 ( Duck Yun Cho ),황재광 ( Jae Kwang Hwang ),김윤주 ( Yoon Ju Kim ) 대한고관절학회 1997 Hip and Pelvis Vol.9 No.1

This study was performed with the articular cartilage of the femoral head and acetabulum in 24 patients who had undergone uncemented total hip arthroplasty under the diagnosis of osteonecrosis of tbe femoral head at the department of orthopaedic surgery, National Medical Center. There were 15 patients (average age, 49.1 years) in Ficat and Arlet stage III and 9 patients (average age, 56 years) in stage W. The histopathological findings demonstrated that the collapse of the femoral head showed 0.9mm in stage III and 5.7mm in stage N, the extent of necrotic area of the femoral head 19.8% in stage III and 27.0% in stage IV. Degree of degenerative change of cartilage was analyzed according to histo- logical-histochemical grading system that suggested by Mankin in 1971. Cartilage change of the femoral head and acetabulum was well correlated with the degree of the collapse of the femoral head(P<0.01), but neither with the extent of necrotic area of the femoral head nor the duration of symptoms. And the extent of necrotic area of the femoral head was not correlated with the degree of collapse. Necrosis in the acetabular subchondral bone was found in 3cases in stage 1Y. Articular cartilage of the femoral head on the area without collapse showed no definite pathological change. These results of study suggest that for the treatment of late stage of osteonecrosis of the femoral head, total hip arthroplasty seems to be a better option than bipolar arthroplasty or rotational osteoto- my of the femoral head in terms of long-term use and pain free operation.

Hybrid형 인공 고관절 전치환 성형술의 3-5년 추시 결과

이중명 ( Joong Myung Lee ),조덕연 ( Duck Yun Cho ),나기호 ( Ki Ho Nah ) 대한고관절학회 1996 Hip and Pelvis Vol.8 No.1

Forty-three patients(forty-six hips), who underwent hybrid total hip arthroplasties with a cemented femoral component and a noncemented acetabular component between November 1991 to March 1993, were followed for a minimum of three years(mean, 44 months). The purpose of this retrospective follow-up study is to obtain the short-term results and to analyze and to compare the clinical and radiological findings in two groups of the patients: the one group has 25 hips with non-deformed femoral canals(male in 19 hips) and the other group has 21 hips with deformed femoral canals(male in 15 hips). The average age of the patients at operation was 61 years(52-78 years) in non-deformed femoral canal group and 51 years(31-72 years) in deformed femoral canal group. The operation had been performed by a single surgeon(J-M Lee) using transgluteal or transtrochanteric approach. Clinically, the average Harris hip score at the last follow-up was 98 points in non-deformed and 89 points in deformed femoral canal group. One hip failed because of the late infection and was revised with two-stage method, who is now walking well without any complaint of pain or the recurrence of infection. No patient had moderate to severe pain or limping. Radiologically, one hip had radiolucent line on the whole zones of Gruen because of the reactivation of quiescent tuberculosis of the hip joint, who had been treated by currettage of soft tissues without removal of the implants and longterm medication of the anti-tuberculous drugs. One hip of excessive polyethylene wear was observed in non-deformed femoral canal group. On the acetabular side, no case showed radiolucent line around the whold three zones of De Lee and Chanley. Although we obtained relatively good short-term results even in a young age group and in the patients with deformed femoral canals, the long term follow-up is mandatory for correct evaluation.

Threaded Acetabular Cup은 과연 모두 문제가 있는가? -CLW threade cup의 5년 이상 추시 결과-

이중명 ( Joong Myung Lee ),조덕연 ( Duck Yun Cho ),나기호 ( Ki Ho Nah ),이중배 ( Joong Bae Lee ) 대한고관절학회 1995 Hip and Pelvis Vol.7 No.2

We reviewed 14 patients(22 hips) to whom had been performed total hip arthroplasty using CLW(CementLess weill, Protek, Switzerland)acetabular cup at the department of orthopaedic surgery, National Medical Center from February 1988 to August 1990. The purpose of this retrospective follow-up study was to analyze the radiological findings such as loosening or migration at the acetabular component and to assess the usefulness of the CLW cup. The CLW acetabular cup is made of self-tapping, double-threaded anchoring ring with deep pitch and low profile and it is made of pure titanium with rough corundum blasted surface. The average age of the patients at operation was 49 year(23-62 years) and all were male. The mean follow-up period was 6years and 3months(from Syears 2months to 7years 9months). The operation had been performed by a single surgeon(J-M Lee) using transgluteal approach. We analyzed the loosening and migration on the immediate postoperative and last follow-up plain X-ray film by Engh's criteria, which demonstrated no loosening and migration. While we need long term follow-up, we think that threaded cups which are well designed biomechanically and have good surface with bone on-growth capability should make different results compared to the poor results of other threaded cups.

인공 고관절 전치환술 후 잠재성 결핵의 재활성화 -2례보고-

이중명 ( Joong Myung Lee ),조덕연 ( Duck Yun Cho ),박수현 ( Soo Hyun Park ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1

Although the incidence of tuberculous arthritis of the hip has decreased with improvement of hygiene, preventive measures, and chemotherapy, there remain many patients having deformities and degenerative arthritis of the hip joints as the sequalae of it. Total hip arthroplasty has been used with good functional result, and most patients who were free of tuberculous symptoms for decades have be performed total hip arthroplasty without additional antituberculous medication preoperatively or postoperatively. We report two cases of reactivation of tuberculosis following THA, and discuss the antituberculous medication for these patients.

양측성 고관절 대퇴골두 무혈성 괴사에서 각각 나누어 시행한 HA-coated CLS stem과 non-coated CLS stem의 방사선학적 비교

이중명 ( Joong Myung Lee ),조덕연 ( Duck Yun Cho ),구본섭 ( Bon Seop Koo ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1

A prospective radiological follow-up study was performed on 40 total hip arthro- plasties for bilateral osteonecrosis: in all cases, 20 HA-coated CLS(Cementless Spotorno, Protek, Berne, Switzerland) femoral stems in Lt. sides and 20 non-coated CLS titanium-ally femoral stems in Rt. side. The average follow-up was 13 months (mim, 6 months, max. 20 months). The operation was performed by single senior surgeon(J-M Lee) using direct lateral transgluteal approach. In a same patient, same sized stems were used. The first operation was done in more painful hip joint, and the second operation was followed 1-2 weeks later in the other side. At postopertive 6 weeks, half partial weight bearing was allowed. Radiological analysis of last follow-up films demonstrated greater radioluceent line in HA-coated group' 6 cases, which was mainly seen around the uncoated distal part of the stem(p<0.01). The endosteal spot welds was greater in non-coated group,' 10 cases, which was mainly seen around distal part of the stem(p<0.01). Other radiological parameters such as stem subsidence, osteolysis, calcar response and heteotrophic ossification was not stastically significantly different between two kinds of stem. But long-term follow-up was demanding although the early radiological findings showed differences between two kinds of stem.

MS-30기기를 이용한 Cemented Total Hip arthroplasty 에서 Centralizer의 효과

이중명 ( Joong Myung Lee ),조덕연 ( Duck Yun Cho ),김재화 ( Jae Hwa Kim ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.2

We studied 80 patients(83 hips) who underwent cemented Total Hip Arthroplasty using MS-30 k distal centralizer(Protek, Switzerland) at the Dept. of Orthopaedic surgery, National Medical Center from January 1992 to May 1994. The purpose of this study was to evaluate the effect of centralizer on cement mantle. These cases were divided into three groups according to femoral geometry and use of the centralizer. Groupl had a normal femoral geometry using centralizer, group2 had a deformed femoral geometry using centralizer and group3 had a deformed femoral geometry not using centralizer. We assessed centralizing effect, demarcation line, cement mantle thickness, canal fit ratio, axis alignment, bubble formation and plugging failure on the immediately postoperative x-ray film (anteroposterial, lateral) after standardization with head template. Groupl 8c group2 showed well centrally aligned in both ant-posterial 8c lateral view, when compared to group3 (P<0.01). Demarcation line in three groups showed no differences and it observed mainly in distal zone, however, none of grade3(more than 2mm) were observed in antemposterial view. Mantle thickness more than 3mm in distal zones(desirable thickness) were achieved more in groupl k group2 than group3(P<0.01). Canal fit ratio showed about 65% proximally, 809o in the middle, and 40% distally. Perfect neutral aligment were achieved 46% in groupl, 47% in group2, however 25%, in gorup3. Bubbles in cement was observed mainly in zone4 and more in group3(55%) than group1(39%). Cement plugging failure were observed in groupl & group2.

대퇴부 인공고관절 재치환술 시 사용된 Wagner<SUP>®</SUP> 재치환용 스템의 5-12년 추시결과

이중명(Joong-Myung Lee),노재영(Jae-Young Roh),서정민(Jung-Min Suh) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.5

목적: 대퇴부 인공고관절 재치환술 시 사용된 Wagner 스템의 5-12년(평균 7년 5개월) 추시결과를 분석하였다. 재료 및 방법: 1991년 3월부터 2000년 1월까지 본원에서 무균성 해리로 Wagner 스템을 사용한 인공고관절 재치환술 79예 중 최소 5년 이상 추시가 가능했던 64명(남자 44명, 여자 20명)의 69 고관절을 대상으로 술 후 합병증 및 임상적, 방사선학적 결과를 분석하였다. 결과: Harris hip score는 술 전 평균 48.6에서 술 후 평균 91.2로 향상되었다. 3예에선 대퇴 스템 고정 실패 및 무균성 해리로 재수술하였다. Wagner 스템의 제거를 생존실패(failure)로 정의할 경우 Kaplan-Meier 12년 생존율은 97.1%였다. Wagner 스템이 제거된 예를 제외한 66예 중 대퇴부 통통은 없었고 심한 파행은 1예가 있었다. 방사선학적으로 수직 침강 5예(7.5%, 모두 10 mm 이하), 대퇴거 위축 4예(6.0%), 응력 방패 현상 4예(6.0%) 및 이소성 골형성 5예(7.5%)가 보였다. 술 후 합병된 2예의 비골(좌골)신경 마비는 6개월 뒤 특별한 치료 없이 회복되었다. 결론: Wagner 스템을 이용한 대퇴부 재치환술은 5-12년 추시에서 비교적 안정적인 고정과 만족할 만한 임상적 결과를 보였다. Purpose: To analyze the results of a 5-12 year (mean, 7 years, 5 months) follow-up of femoral revision THA using the Wagner<SUP>®</SUP> stem. Materials and Methods: Of 79 revision THA patients enrolled in the study between March 1991 and January 2000, there were 64 cases of aseptic loosening (69 hips, 44 males and 20 females) during a minimum 5-year follow-up. In addition, postoperative complications and clinical and radiographic results were evaluated. Results: The Harris hip score improved from 48.6 to 91.2 points, postoperatively. There were 3 revisions due to failed stem fixation and aseptic loosening. The Kaplan-Meier survivorship analysis, with failure defined as a removal of the Wagner<SUP>®</SUP> stem, revealed a 97.1% survival at a 12-year follow-up. Besides the revisions, there were 66 hips that were hip-related symptom-free. However, there was claudication in 1 case. Radiographic findings included subsidence of the implant (5 cases, 7.5%, all less than 10 mm), calcar femorale atrophy (4 cases, 6.0%), stress shielding (4 cases, 6.0%), and heterotopic ossification (5 cases, 7.5%). Postoperative peroneal nerve palsy (2 cases) resolved completely within the following 6 months. Conclusion: We obtained a stable fixation and satisfactory results in the cases we studied using the Wagner<SUP>®</SUP> revision stem.