인공 고관절 재치환술에서 조립형 무시멘트 대퇴스템 사용 후 실패요인 분석
Risk Factors Related to Modular Femoral Stem Failures in Revision Hip Arthroplasty
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목적: 인공 고관절 재치환술에서, 무시멘트형 조립형 대퇴스템으로 치료한 결과, 실패의 원인인자를 알아보고자 하였다. 대상 및 방법: 2년 이상 추시관찰이 가능하였던, 총 93명(100예)를 대상으로 하였다. 관찰대상은 남자 49명, 여자 44명 이었으며, 평균 연령은 62세(32-84세)였다. 임상적 결과는 Harris Hip Score로 평가하였으며, 재-재치환술의 실패의 변수로 수술의 회 수, 일차 스템의 시멘트 사용 여부, 골 결손과의 관계를 비교 하였다. 골 결손의 정도는 Paprosky 분류를 이용 하였으며, I과 II가 24예, IIIa가 45예, IIIb 가28예, IV가 3예였다. 결과: 임상결과는 수술 전 Harris Hip Score가 42점에서 술 후 평균 81.5점으로 증가하였다. 실패의 초기 원인으로는 대퇴스템 침강이 4예, 후기는 감염이 3예였다. 실패요인에 인자에 대한 분석으로 골결손(P=0.727), 시멘트 스템(P=0.087), 재수술의 횟 수(P=0.024)를 변수로 분석하였다. 비교분석에서 재치환 수술의 횟수가 많을수록 실패율이 높았다(P=0.024). 결론: 인공 고관절 재치환술에서 조립형 스템은 만족할 만한 결과를 보였으나, 재수술 횟수가 많을수록 실패가 높았다.
Abstract
Purpose: The purpose of this study was to analyze failure rates and causes of hip arthroplasty revisions associated with the use of cementless modular femoral stems. Materials and Methods: This study comprised 93 patients(100 hips) that were followed up for more than two years after revision involving modular femoral stem arthroplasty. The clinical results were evaluated using the Harris Hip Score and the radiologic results were evaluated using leg length discrepancy, subsidence and bone formation assessments. We analyzed the relationship between the number of hip surgeries performed and the bone deficiencies and failures observed. Preoperative femoral bone deficiencies were described by Paprosky Grade; Grade I or II were identified in 24 hips, IIIa in 4 hips, IIIb in 28 hips and IV in 3 hips. Results: We observed 80 hips with aseptic loosening, 10 hips with infection after previous revision, 8 hips with periprosthetic fractures and 2 hips with dislocations. Clinical results improved from a preoperative score of 42(HHS) to a postoperative mean score of 81.5. The cause of early failure in 4 hips was identified as femoral stem subsidence, and the cause of late failure in 3 hips was due to infection. According to the comparison analysis,there was no statistical significance between femoral bone deficiency (P=0.727) and application of cement (P=0.087), but hips with previous revision surgery showed a higher rate of failure (P=0.024). Conclusion: Cementless modular stems produced satisfactory results. The main cause of failure was subsidence. A significant risk factor for failure was hips which had undergone previous revision surgery.
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