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이중명,Eduardo a. Salvati,Foster Betts,Edward F. DiCarlo,Stephen B. Doty,Peter G. Bullough (Joong Myung Lee) 대한고관절학회 1991 Hip and Pelvis Vol.3 No.2
Reports of different failure rates with total hip replacements depending on the metal from which the parts were manufactured have prompted us to measure the size of metallic and polyethylene particulate debris present in the periarticular tissues around failed cemented total hip prostheses. Two methods of specimen preparation were used: An isolations method, in which the tissue was remove leaving the metallic debris and a non-isolation method consisting of routine histologic preparation for light microscopy. For each methods, we used the femoral components from ten cases each of titanium alloy, cobalt-chrome alloy, stainless steel. Particles were measured on a computer-assisted image analyzer. In all cases the mean size of metallic particulate debris with the isolation method was 0.8-1.0microns in short dimension and 1.5-1.8microns in long dimension. From the nonisolation method, the mean size was significantly smaller at 0.3-0.4 microns in short dimension and 0.6-0.7 microns in long dimension. Howerver, when the same technique was used, the sizes of metallic particulate debris did not differ. The mean size of polyethylene debris was 2-4microns in short dimerision, 8-3microns in long dimension, and was larger in tissues retrieved from titanium alloy failures than in tissues from cobaltchrome and stainless steel implants. This study suggests that factors other than the size of metallic debris (e.g. constituents of the alloy, amount, and celerity of generation of ddbris) may be more important for the failure of total hip replacement.
Acetabular Cup Revision Arthroplasty Using Morselized Impaction Allograft
이중명,김태호 대한고관절학회 2018 Hip and Pelvis Vol.30 No.2
The rate of acetabular cup revision arthroplasty is gradually rising along with an increased risk of osteolysis and prosthesis loosening over time and an increase in life expectancy. The goals of revision total hip arthroplasty are: i) implant stability through reconstruction of large bone defects, ii) restoration of range of motion and biomechanics of the hip joint, and iii) normalization of uneven limb lengths. In acetabular cup revision arthroplasty, stable fixation of acetabular components is difficult in the presence of severe bone loss (e.g., evidence suggests that it is challenging to achieve satisfactory results in cases of Paprosky type 3 or higher bone defects using conventional techniques). The author of this study performed acetabular revision to manage patients with large areas of defective bones by filling in with morselized impaction allografts. These allografts were irradiated frozen-stored femoral heads acquired from a tissue bank, and were applied to areas of an acetabular bone defect followed by insertion of a cementless cup. When this procedure was insufficient to obtain primary fixation, a tri-cortical or structural allograft using a femoral head was carried out. Structural stability and bone incorporation were confirmed via long-term follow-up. This study aims to review conventional surgical techniques and verify the utility of surgical procedures by analyzing the author’s surgical methods and discussing case reports.