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소아에서 발생한 고관절 질환 후유증 환자에서 Conical 대퇴 스템을 이용한 무시멘트형 고관절 치환술 -최소 2년 이상의 단기 추시보고-
황득수 ( Deuk Soo Hwang ),윤승오 ( Seung Ho Yune ),이광진 ( Kwang Jin Rhee ),김상범 ( Sang Bum Kim ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2
Total hip arthroplasty in patients with pediatric hip sequelae is technically demanding and associated with special difficulties due to severe alternations in the proximal femur. For example, femurs in patients with dysplastic hip have straighter and moderate anteversion of the femoral neck. Also the canal of femur is greater in the anterior to posterior dimension than the medial to lateral dimension which turns the rectangular prosthesis stem to an undesired anteversion. So this proximal femoral shapes require a special prosthesis, overreaming, undersizing and cementing, or an osteotomy. The use of conical prothesis(Protek AG, Berne, Switzerland) in cemetless femoral fixation for proximal femoral deformity has been a benefit to matches as closely as possible the anatomical shape of femur. The conical fixation ensures excellent primary stability and the stump longitudinal ribs along the prosthesis stem that cut into the bone provided strong rotational stability. The coarse-blasted surface of the titanium implant encourages osteointegration, gradually leading to permanent fixation. Twenty-three primary total hip arthroplasties had been performed patients between June 1993 and June 1996 at Chungnam National University Hospital, and had been followed for the period from 24 months to 60 months(mean 39 months). The average age at surgery was 40 years(range, 24 to 53 years). The mean Harris hip score increased from 45.7 to 85 points and revealed mild thigh pain in ten cases(43.5%). The mean leg length discrepancy decreased from 3.1cm to 1.1 cm. The radiographic evaluation demonstrated endosteal bone formation in 19 cases(82.6%), calcar atrophy in two cases(8.7%), and average 2.86 mm vertical subsidence. During operation, there were four cases of linear fractures that were treated by circumferential wiring. After operation, there was one incomplete sciatic nerve injury. There was one heterotropic ossification but no osteolysis. Revision was performed for septic loosening in one case. Conical prosthesis is one of the alternatives for total hip arthroplasties in pediatric hip sequelae patients who have secondary arthritis with pain.
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