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Mallory-Head Hip System을 사용한 무시멘트 고관절 전치환술 (HA Coating v.s. Non-HA Coating)
황성관 ( Sung Kwan Hwang ),이한규 ( Han Kyu Lee ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1
The use of total hip arthroplasty is steadily increasing. The development of bone cement as a filler between bone and hip prosthesis was a revolutionary step in orthopedics in the 1960s since the short-term results were excellent with consistent relief of pain and disability. However, long-term results revealed an increased rate of mechanical loosening in younger, active patients whereas the revision rate in older patients is significant lower. Improvement in cementation techniques have reduced the incidence of mechanical loosening. The process of biologic ingrowth into porous metal surfaces has evolved as a possible solution for high-risk, younger, and heavier patients. Under ideal cirumstances, where good bone quality exists and rigid initial implant stability is achieved, bone ingrowth will occur. However, failure to achieve solid bony fixation may be a source of thigh pain in cementless femoral stems and the clinical result of cementless prosthesis was not better than that of cemented ones. Synthetic hydroxyapatite is highly biocompatible and has chemical and crystalline structure same as the major mineral component of biologic apatite. Numerus experimental studies and several clinical datas tell us that bone has an affinity for hydrox- yaptite, resulting in rapid and early bone bonding. The clinical and radiologic observation during short-term period revealed there was no significant difference between two groups. However, during early postop. period, clinical results of HA-coating group were superior than those of NON-HA coating group. HA coating may be effective on early bone ingrowth, resulting early weight bearing and less thigh pain.
황성관 ( Sung Kwan Hwang ),박융 ( Yung Park ) 대한고관절학회 1997 Hip and Pelvis Vol.9 No.1
One hundred twenty eight patients underwent 128 primary unilateral total hip arthroplasties from January 1992 to December 1995. Patients were divided into two groups based on the type of anesthesia utilized for their procedure. Group I consisted of 56 patients (35 women and 21 men; average age 56 years) who had general endotracheal anesthesia. Group II consisted of 72 patients (40 women and 32 men; average age 58 years) who had spinal anesthesia. Data were analyzed by anesthesia group to compare a variety of clinically relevant factors. No statistically significant differences in each groups were noted regarding average age at the time of surgery, the underlying diseases, the number of preexisting medical conditions, surgical time, length of hospitalization, deep venous thrombosis, deep infections, death and intraoperative blood transfusion. Significant differences were observed for two factors: 1) estimated intraoperative blood loss was higher in Group I (p <0.05), and 2) postoperative hemovac output was also greater in Group I (p <0.05). In conclusion, spinal anesthesia appears to be a safer modality for patients, especially with pulmonary problems undergoing primary unilareral total hip replacement.
Hydroxyapatite Coating 과 Porous Coating 된 비구컵의 방사선학적 변화 비교
황성관 ( Sung Kwan Hwang ),박융 ( Yung Park ) 대한고관절학회 1996 Hip and Pelvis Vol.8 No.2
The purpose of this study was to compare the radiological changes of Hydroxyapatite-coated cups with those of porous-coated cups. From January 1992 to December 1994, we carried out 125 total hip arthroplasties in 101 patients; 61 hips in 49 patients had H-A coated acetabular implants of Omnifit' system and 64 hips in 52 patients with porous coated acetabular implants of Mallory-Head' Hip system. And the average follow up period was 32 months (1S to 56 months). Radiologic evaluation of both acetabular components reveals that bone condensation begins to occur in over 40% of cases by one year with both H-A and porous-coated cups, but by five years, condensation with HA cups was seen in 93% of cases in zone 1 and 5796 in zone 3, compared with 89% in zone 1 and 44% in zone 3 with porous cups. Reactive line formation was found in only 2% of the HA-coated cups, whereas with porous-coated cups it was seen in 3% of cases. Prosthetic migra- tion was noted with two HA- and four porous-coated cups. Comparing the use of HA-and porous-coated acetabular cups, the radiological results over threeto-five years appear similiar. Continued follow-up of this patient population is desirable to establish the durability of these three-to-five year results.
동시에 시행한 양측성 고관절 무시멘트 전치환술에 관한 임상적 고찰
황성관 ( Sung Kwan Hwang ),김호성 ( Ho Sung Kim ) 대한고관절학회 1992 Hip and Pelvis Vol.4 No.1
We compared the clinical results of 27 one-stage bilateral cementless total hip replacements. with the results of 20 two-stage bilateral cementless total hip replacements. The hospital time for patient in the one-stage group averaged 1 week shorter than the twostage group. The cost in patients of one-stage group was saved as much as 12.8% of that in two stage group. The anesthesia time, blood loss and ineideace of local and systemic complications were similar for two groups. We think one-stage bilateral cementless total hip replacements can be done in patients who have bilateral hip lesions and have no serious systemic medical problems.