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.

Efficacy of Computed Tomography-Based Navigation for Cup Placement in Revision Total Hip Arthroplasty

Yuta Kubota,Nobuhiro Kaku,Tomonori Tabata,Hiroaki Tagomori,Hiroshi Tsumura 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.1

Background: Navigation systems are an effective tool to improve the installation accuracy of the cup in primary total hip arthroplasty. This study aimed to evaluate the efficacy of a computed tomography-based navigation system in achieving optimal installation accuracy of implants in revision total hip arthroplasty and to clarify the usefulness of the navigation system. Methods: We conducted a retrospective study of 23 hips in 23 patients who underwent revision total hip arthroplasty using a computed tomography-based navigation system; the control group comprised 33 hips in 33 patients who underwent revision total hip arthroplasty without a navigation system. Results: The average cup position with the navigation system was 40.0° ± 3.7° in radiographic abduction angle, 18.8° ± 4.8° in radiographic anteversion, and 41.2° ± 8.9° in combined anteversion; without the navigation system, the average cup position was 38.7° ± 6.1°, 19.0° ± 9.1°, and 33.6° ± 20.5°, respectively. The achievement rate of cup positioning within the Lewinnek safe zone was not significantly different between the navigation group (82.6%) and control group (63.6%). In contrast, the achievement rate of cup positioning within the Widmer combined anteversion guidelines was significantly greater in the navigation group (78.3%) than in the control group (48.0%, p = 0.029). Furthermore, outlier cases in the navigation group had a smaller variance of deviation from the optimal cup position than those in the control group did. Conclusions: The results show that the use of navigation for revision total hip arthroplasty improved cup positioning and reduced the range of outliers. Improvement of cup placement accuracy influenced the installation of the stem and also improved the achievement rate of combined anteversion. Thus, a computed tomography-based navigation system is very useful for surgeons when placing the cup within the target angle in revision total hip arthroplasty.

지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 이용한 고관절 재치환술

이경재 ( Kyung Jae Lee ),민병우 ( Byung Woo Min ),배기철 ( Ki Cheor Bae ),조철현 ( Chul Hyun Cho ),김동후 ( Dong Hu Kim ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.3

목적: 인공 고관절 재치환술 시 다량의 대퇴골 골결손 부위에 대해 지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 사용하고 그 결과를 알아보고자 하였다. 대상 및 방법: 1998년부터 2005년까지 재치환술 시 근위 대퇴골 골결손으로 지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 사용하고 2년 이상 추시관찰이 가능하였던 12예를 대상으로 하였다. 추시 기간은 평균 4.6년이었다. 재치환술의 원인은 광범위한 골용해 및 이로 인한 대퇴 삽입물 주위 골절이 5예, 무균성 해리 7예였다. 결과: Harris 고관절 점수는 술전 평균 40.8점에서 최종 추시시 85.1점으로 향상되었으며 대퇴 삽입물의 고정도는 11예(92%)에서 골성 안정 소견을 보였으며 1예(8%)에서 섬유성 안정 소견을 보였다. 응력 방패 현상은 1예에서 중등도의 소견을 보였으나 최종 추시 시 진행되는 소견은 없었다. 최종 추시시 심한 마모나 골용해를 보인 예는 없었으며 심부감염 1예를 제외한 전 예에서 이식골의 유합을 확인할 수 있었다. 결론: 다량의 대퇴골 골결손이 동반된 환자에서 지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 이용한 재치환술은 만족할 만한 결과를 보였으나 응력방패 현상 및 이식골로 인한 합병증 등에 대해서는 장기간의 추시관찰이 필요할 것으로 사료된다. Purpose: We wanted to report on the outcomes of using a strut allograft and extensively porous-coated femoral stems in revision total hip arthroplasty that was performed due to extensive femoral bone loss. Materials and Methods: Between 1998 and 2005, we performed 167 consecutive revision total hip arthroplasties. Among them, twelve cementless femoral revision surgeries with a strut allograft and extensively porous-coated stems were retrospectively reviewed. The average follow up was 4.6 years. The average age at the time of the index revision was 55.9 years. The reasons for the revisions were periprosthetic fracture due to extensive osteolysis in 5 hips and aseptic loosening in 7 hips. Results: The Harris hip score improved from a mean of 40.8 points before revision surgery to a mean of 85.1 points at the latest follow up. Radiographic evidence of bony stable stems were present in 11 hips and a fibrous stable stem was present in 1 hip. Moderate stress-shielding was noticed in one hip. Nonunion of the allograft was observed in 1 hip due to deep infection. To date, no significant wear or osteolysis has been observed. Conclusion: Revision total hip arthroplasty with a strut allograft and an extensively porous-coated femoral stem for treating cases of extensive femoral bone loss seems to be a reasonable choice. However, the concerns related to stress shielding, the difficulties in re-revisions and the complications associated with an allograft will require longer term follow up.

근위조립형 무시멘트 대퇴스템을 이용한 인공관절 재치환술

박명식 ( Myung Sik Park ),임영진 ( Yung Jin Lim ),이주홍 ( Ju Hong Lee ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.1

목적: 인공고관절 재치환술에 있어서 근위조립형 무시멘트 스템(Link MP hip reconstructive system)을 이용한 결과를 임상적 방사선학적 분석을 하고자 한다. 대상 및 방법: 1997년 1월부터 서 2002년 12월까지 인공관절 재치환술을 받은 환자 95명을 대상으로 하여 최소 24개월 최대 8년 4개월 이상 추시가 가능 하였던 57명 (57례)을 대상으로 하였다. 재치환술의 원인으로는 무균성이완이 45례, 감염성 이완으로 재-재치환경우가 5례, 대퇴스템과 관련된 골절이 6례, 재발성 탈구가 1례였다. 골결손의 정도는 Paprosky 분류에 의거하였으며 IIIA 이하가 46례, IIIB 이상이 11례였다. 결과: Harris hip score는 술 전 47에서 87.6으로 향상되었으며, 최종 추시상 환자의 만족도는 87.7%이며 원위 대퇴스템의 골형성에 의한 고정은 94.7%에서 관찰되었으며. 수술 중 합병증은 대전자부 골절 2례, 근위 대퇴골 골절이 2례였으며, 수술 후 합병증으로는 대퇴스템 침강이 5례(0-5 mm in 2hips, >20 mm in 3 hips), 심부 감염이 4례에서 관찰 되었으며, 대전자부 불유합과 동반된 아탈구 1례, 절골술 부위 불유합이1례, 고정나사의 이완이 1례에서 관찰 되었다. 근위-원위부품 모두 재치환은 20 mm이상 침강을 보인 3례중 2례에서 시행되었으며. 근위부품만을 교환한 경우는 3례로 불유합과 전자부 전위가 2례, 고정나사 이완1례였다. 최종추시상 대퇴스템 원위골절의 발생은 없었다. 결론: 인공관절 재치환술에서 근위 조립형 대퇴스템은 전염각 조정과 하지 길이의 조정이 편리하며, 감염 시 원위부 스템을 유지 한 채로 근위부만 단계적인 치환을 할 수 있었다. 조립형 재치환스템은 근위 대퇴골의 소실이 있는 증례에서 유용하게 사용 되었으며 보다 성공적인 결과를 얻기 위하여서는 섬세한 수술 수기와 합병증의 예방이 중요 할 것으로 사료 된다. Purpose: The goal of study was to evaluate the clinical and radiographic performance of the proximal modular cementless femoral stem for use in revision total hip arthroplasty. Material and method: Fifty seven patients (57 hips) were followed for longer than 24 months or up to 8.4 years after performing revision total hip arthroplasty with using the proximal modular cementless femoral stem between January 1997 and December 2002. The preoperative diagnosis included 45 cases of aseptic loosening, 5 cases of septic loosening (re-revision operation), 6 cases of periprosthetic fracture and 1 case of recurrent dislocation. The bone deficiencies were classified according to the Paprosky classification: there were 27 cases of Type I and II, 19 cases of Type IIIA, 9 cases of Type IIIB and 2 cases of Type IV. Results: The average Harris hip score improved from 47 to 87.6. Clinically satisfactory results were noted in 50 patients (87.7%). Radiographically, distal stable fixation was observed in 54 patients (94.7%). Intraoperative complications included two greater trochanteric fractures and two proximal femur fractures. Postoperative complications included 5 femoral stem subsidences (2hips< 5mm, 3 hips>20mm), 4 deep infections, 2 non-unions of the greater trochanter and the osteotomy site and set screw dissociation was noted in 1 case. 5 proximal component changes were done due to progressive subsidence in two cases, non-union at the osteotomy site and trochanteric displacement in two cases and set screw dissociation in one hip. For the infection cases, the proximal segment was removed and re-revised with a 2nd stage operation. (Ed note: check this.) The subsidence of the femoral stems was showed in 3 Paprosky grade IIIA cases and in 2 cases of grade IIIB or more. There was no postoperative periprosthetic fracture observed at the last follow-up. Conclusion: Revision total hip arthroplasty using the proximal modular cementless femoral stem showed good results in the face of the infection of the proximal component and deficient proximal bony support. This procedure appears to be convenient for the surgeon to correct anteversion of the femoral head and leg length discrepancy.

Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

( Gurvinder Singh ),( Ankit Khurana ),( Shailendra Gupta ) 대한고관절학회 2021 Hip and Pelvis Vol.33 No.3

The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (P<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level Ⅲ-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.

감염된 인공 고관절에서 항생제 골 시멘트 충전물을 이용한 2단계 재치환술의 장기 임상적 결과

강준순(Joon-Soon Kang),문경호(Kyoung Ho Moon),이동주(Tong-Joo Lee),김영태(Young-Tae Kim),류동진(Dong-Jin Ryu),최재황(Jae-Hwang Choi) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.5

목적: 인공 고관절 치환술 후 발생한 감염에서 항생제 골 시멘트 충전물 삽입 후 2단계 재치환술의 장기 결과를 분석하였다. 대상 및 방법: 항생제 골 시멘트 충전물 삽입 후 2단계 재치환술을 받은 환자 중 5년 이상 추시한 26명을 대상으로 하였다. 평균 추시 기간은 7.4년이었고, 대퇴 스템은 유지한 채 비구 부품만 재치환술을 시행한 경우가 11예(1군), 대퇴와 비구 부품 모두 재치환술을 시행한 경우가 15예(2군)였다. 실험실 검사 수치, Harris 고관절 점수, 재치환술 전, 후의 영상학적 변화 및 재감염 여부 등을 평가하였다. 결과: 대퇴 스템 유지 및 비구 부품만 재치환술을 시행한 1군의 Harris 고관절 점수는 수술 전 51.1점, 1년 추시 89.3점, 3년 추시 91.8점, 5년 추시 89.8점이었다. 모든 부품을 제거한 2군은 수술 전 49.8점, 1년 추시 83.7점, 3년 추시 90.3점, 5년 추시 88.7점이었다. 재치환술 시행 후 각 군에서 1예씩 감염이 재발하였다. 결론: 인공 고관절 치환술 후 감염에 대하여 항생제 골 시멘트 충전물을 이용한 2단계 재치환술을 통하여 92.3%의 치료 결과를 얻었다. 감염이 고관절 내에 국한되고 대퇴 스템이 안정적인 경우 스템은 유지한 채 비구컵만을 제거하고 항생제 골 시멘트 충전물을 삽입하여 만족할 만한 결과를 얻을 수 있었다. Purpose: We retrospectively analyzed long-term clinical results after two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for infected total hip arthroplasty. Materials and Methods: Twenty-six hips (group 1: cup exchanged, group 2: cup and stem exchanged) were enrolled in this study. The mean follow-up period was 7.4 years (5 to 11 years). We analyzed the laboratory findings, the time interval between antibiotic-impregnated cement spacer insertion and revision arthroplasty, Harris hip score, Oxford hip score, radiologic changes, and recurrence of infection. Results: Revision hip arthroplasty was performed at 7.5 weeks on average (group 1: 7.2 weeks, group 2: 7.7 weeks) after implant removal and cement spacer insertion. In group 1, Harris hip score was 51.1 points preoperatively, 84.4 points at six months, 89.3 points in at one year, 91.8 points at three years, and 89.8 points at five years. In group 2, the Harris hip score was 49.8 points preoperatively, 78.1 points at six months, 83.7 points at one year, 90.3 points at three years, and 88.7 points at five years. Recurrence of infection developed in one hip in each group. Conclusion: Ninety-two percent of infected hips were eradicated with two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for infected hip arthroplasty at minimum five-year follow-up. When the infection was limited to the hip joint and the stem was fixed well, two-stage revision with stem retained could be a good treatment option.

S-ROM modular system을 사용한 고관절 재치환술

김영민 ( Young Min Kim ),김희중 ( Hee Joong Kim ),장광 ( Kwang Chang ) 대한고관절학회 1997 Hip and Pelvis Vol.9 No.2

Revision total hip arthroplasty has complex problems. These include significant bone loss of the acetabulum and femur, distortion of the proximal femora) portion, the variability of the ratio of the metaphyseal-diaphyseal diameter of the femur, and the difficulty of implant or cement removaL Most cases of revision surgery require bone graft including autograft and allograft. And some cases need to be replaced with modular or custom-made prosthesis to overcome the loss of bone. The use of modularity in total hip arthroplasty has been of benefit in terms of allowing inventory reduction while providing surgeon versatility and thus optimal joint reeonstruction. Fifteen consecutive revision total hip arthroplasties were performed with S-ROM modular system from May 1995 to October 1995 at Seoul National University Hospital, and had been followed more than two years in this study. Eleven cases were revised in both acetabular and femoral sides, and four cases were revised only in the femoral side. The revision cases were fo)lowed for the period from 24 months to 29 months (mean 27 months). Diagnosis included 13 hips of aseptic loosening and 2 hips of stem failure. We evaluated clinically and radiologically. The clinical evaluation was done by Harris hip score and thigh pain. The radiological evaluation in the acetabular side was performed by osseous union, resorption of the graft, the amount of migration of the revised component, cup angle change, and radiolucency around the acetabular cup. The femoral side was evaluated by radiolucency and subsidence. Harris hip scores preoperatively averaged 48 points(range, 25-70 points) and postoperatively averaged 86 points(range, 40-97 points). Two patients had moderate pain. In acetabulum, 9 cases(82%) showed osseous union within 6 months and 7 cases(64%) showed the graft bone resorption less than 20% of the initial graft thickness. Two cases(18%) showed 2 mm migration toward superomedial direction with stable fixation. One case showed radiolucency around the cup more than 2 mm with vertical rotation and is pending revision of the acetabular cup. In revised stem, all stems showed stable fixation without radiolucency and subsidence. Complications included one intraoperative distal femur fracture and one sciatic nerve palsy with gradual improvement. Although the follow-up period is short, it is our impression that S-ROM modular system is relatively feasible and valuable component in revision total hip arthroplasty.

무시멘트형 대퇴골 삽입물을 이용한 고관절 재치환술

정영률 ( Young Yool Chung ),임채현 ( Chae Hyun Lim ),김충영 ( Chung Young Kim ),김정석 ( Jeong Seok Kim ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.4

목적: 무시멘트형 대퇴 삽입물을 이용하여 인공 고관절 재치환술을 시행한 후 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2010년 5월까지 본원에서 무시멘트형 대퇴 삽입물을 이용하여 인공 고관절 재치환술을 시행하고 2년 이상 추시가 가능하였던 26예를 대상으로 하였다. 재치환술 당시 나이는 평균 63.8세이었다. 추시 기간은 평균 45개월이었다. 재치환술의 원인은 무균성 해리 11예, 골절 6예, 골용해 6예, 감염 3예이었다. 방사선학적 결과는 삽입물의 침강, 해리, 응력 방패 현상을 관찰하였으며, 임상적 결과는 대퇴부 동통과 해리스 고관절 점수를 이용하여 평가하였다. 결과: 재치환술 전 해리스 고관절 점수는 평균 41.2점에서 최종 추시시 평균 85.8점이었으며 18예(69%)에서 양호 이상의 결과를 얻었다. 5예에서 대퇴부 동통을 호소하였다. 대퇴골 삽입물 침강은 3예에서 10 mm 이상 발생하였으며 평균 14 mm이었다. 2예에서 최종 추시시 해리 소견이 관찰되었다. 응력 방패 현상은 6예에서 관찰되었다. 지주 동종골 이식을 시행한 3예는 숙주골과 골유합 소견이 관찰되었다. 합병증은 2예에서 수술 중 발생한 대퇴 삽입물 주위 골절로 금속판과 강선을 이용하여 고정하였고, 3예에서 수술 후 탈구가 발생하여 정복 후 보조기를 착용시켰다. 결론: 무시멘트형 대퇴 삽입물을 이용한 인공 고관절 재치환술에서 임상적 및 방사선학적으로 만족할 만한 결과를 얻을 수 있었다. 그러나 직경이 너무 큰 삽입물을 사용한 경우에서 대퇴부 동통과 응력방패가 발생하였다. Purpose: To evaluate the clinical and radiographic results of patients who received revision total hip arthroplasty using cementless femoral stems. Materials and Methods: This study included 26 patients who underwent revision total hip arthroplasty using a cementless femoral stems in our hospital, between Jan 2000 and May 2010, and were able to be evaluated in the final follow-up. The mean age was 63.8 years at the time of the revision surgery, and the follow up period was an average of 45 months. The causes of revision were aseptic loosening in 11 cases, periprosthetic fracture in 6 cases, femoral osteolysis in 6 cases, and infection in 3 cases. The radiologic results were evaluated in term of subsidence, loosening, and the stress shielding. The clinical results were evaluated by the Harris hip score and thigh pain. Results: Harris hip score improved from 41.2 points preoperatively to 85.8 points at the final follow-up. There were 5 cases that complained of thigh pain at the last follow-up. Subsidence of femoral stem of more than 10 mm was observed in 3 cases. Stress shielding was noticed in 6 hips. The 3 grafted strut allografts were completely fused with the host bone. Complications included 2 cases of intraoperative periprosthetic fracture and 3 cases of dislocation. Conclusion: We obtained favorable clinical and radiologic outcomes in revision total hip arthroplasty using a cementless femoral stems. However, thigh pain and stress shielding resulted from the diameter of femoral stem being too large.

광범위 다공성 표면 처리된 대퇴 스템을 이용한 인공 고관절 재치환술 -최소 5년 이상의 추시 결과-

조윤제 ( Yoon Je Cho ),곽상준 ( Sang Joon Kwak ),전영수 ( Young Soo Chun ),유기형 ( Kee Hyung Rhyu ),고택수 ( Taeg Su Ko ),유명철 ( Myung Chul Yoo ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.3

목적: 광범위 다공성 표면 처리 스템을 이용한 재치환술의 중기 추시 결과를 분석하였다. 대상 및 방법: 광범위 다공성 표면 처리 스템을 이용한 재치환술 후 평균 5년 5개월 추적 관찰한 20예를 분석하였다. 재치환술 원인은 무균성 해리, 스템 주위 골절, 감염성 인공 관절이 있었다. 4종류의 광범위 다공성 표면 처리 스템을 사용하였고, 17예에서 골 이식을 함께 시행하였다. Harris 고관절 점수, 대퇴 동통 및 파행과 운동 범위를 평가하였으며, 수직 침강, 응력 차단, 골 용해 등 방사선 변화를 관찰하였다. 결과: Harris 고관절 점수는 56.5점에서 91.9점으로 향상되었고, 만족스런 관절 운동 범위를 보였다. 지주골 이식을 시행한 1예에서 대퇴 동통이 지속되었다. 의미 있는 스템 수직 침강 및 이완소견은 없었고, 재재치환술의 예도 없었다. 결론: 광범위 다공성 처리된 대퇴 스템의 안정성은 중기 추시에서도 잘 유지되었다. 본 술식은 간부에서 견고한 골 고정을 얻어, 골 결손이 심한 때에도 스템 안정성을 얻을 수 있고, 근위부 골 재건을 도모할 수 있으며, 다른 술식에 비하여 간편한 장점이 있다. 간부까지 골 결손이 심한 경우 적합하지 않으며, 대퇴골 균열, 응력 차단, 대퇴 통증이 발생할 수 있으므로 세심한 주의가 필요하다. Purpose: We wanted to evaluate the mid-term results of revision total hip arthroplasty using a fully porous-coated long stem. Materials and Methods: A retrospective series of 20 hips in 19 patients who underwent stem revision with a fully porous-coated long stem were evaluated at a mean follow-up of 64.6 months. The causes of revision were aseptic loosening, periprosthetic fracture and infected arthroplasty. Four kinds of implants had previously been used and an additional bone graft procedure had been done in 17 cases. The Harris hip scores, thigh pain, limping and ROM were reported. Radiological changes of the radiolucent signs, subsidence, loosening and the stress shielding signs were evaluated. Results: The Harris hip score improved from an average of 56.5 to 91.9 and the ROMs were satisfactory. The only case with persistent thigh pain showed stable bony ingrowth. No signs of subsidence or loosening of the stem was found in all the cases. There were 2 cases of periprosthetic fracture. None of the patients experienced re-revision surgery. Conclusion: The mid-term results of revision hip arthroplasty using a fully porous coated long stem have demonstrated that it provides a reliable initial fixation with a propensity for stable longevity. It is relatively easy for the techniques, and there is the opportunity to restore the bone stock by bone-grafting procedures with diaphyseal fixation and bypassing a bone defect. Yet alternative techniques may be required for the femur with extensive diaphyseal bone loss. There are some concerns about the technique and the possibility of making a crack in the femur during the operation, which will cause thigh pain at the follow-up. So, only by employing great caution when performing this technique can successful results be guaranteed.

무시멘트 인공 고관절 재치환술의 중, 장기 추시 결과

김영민 ( Young Min Kim ),김희중 ( Hee Joong Kim ),김상림 ( Sang Rim Kim ),장광 ( Kwang Chang ),김성태 ( Sung Tae Kim ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.1

Thirty-one cementless revision total hip arthroplasties were performed on thirty-one patients who had symptomatic aseptic loosening of the acetabular or the femoral component. All cases were revised in both acetabular and femoral components. We revised the acetabular component using a hemispherical, porous-coated cup fixed with screws and the femoral component with proximally- coated or fully-coated stem. Most cases required bone graft and we used morcellized autograft and allograft. These cases were followed for a mean of 64 months (range, 40 to 125 months). The diagnosis at the time of the initial arthroplasty was avascular necrosis in eighteen hips, old infection in nine, post-traumatic osteoarthritis in two, congenital acetabular dysplasia in one, and idiopathic chondrolysis in one. All patients were evaluated clinically and radiographically. The Harris hip score was used for clinical evaluation. The radiographical evaluation on the acetabular side included the assessment of incor- poration of the graft, the amount of graft resorption, radiolucency adjacent to the acetabular cup and the amount of migration of the revised component. The radiolucency adjacent to the femoral stem and subsidence were evaluated on the femoral side. Harris hip scores preoperatively averaged 48 points(range, 12 to 68 points) and improved to a mean of 84 points(range, 68 to 97 points) at the latest follow-up examination. 1) In thirty-one cases, all acetabular bone graft showed osseous incorporation within 1 year. 2) At the latest follow-up, more than 90 percent of the initial thickness was maintained in nineteen cases and 85 to 90 percent in eight cases. 3) Four cases showed stable fixaton of the acetabular cup without migration. The 26 cases showed 2.75 millimeters of medial migration and 3 millimeters of superior migration without surrounding radiolucency at three months postoperatively and showed no more migration at further fol- low-up. One cases showed radiolucency all adjacent to the cup more than 2 mm with vertical rotation and was re-revised on the acetabular side. 4) In revised stems twenty eight stems showed stable fixa- tions without progressive radiolucency and subsidence. Two cases showed the subsidence of the stem more than 2 mm with stable fixations. One case showed 2mm radiolucency all adjacent to the stem without subsidence. Other complications included four intraoperative femoral cracks or fractures, three trochanteric nonunions, one myositis ossificans, one trochanteric bursitis, and one sciatic nerve palsy, which recovered completely at 1 year follow-up. Although long-term results are not yet available, these midterm results of cementless revision total hip arthroplasty are encouraging compared with those of cemented revision.