폴리에틸렌 삽입물을 교체한 인공 고관절 재치환술
Isolated Polyethylene Liner Exchange in a Revision Total Hip Arthroplasty
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목적: 골성 고정된 Harris-Galante (HG) 비구컵을 제거하지 않고 폴리에틸렌 삽입물 만을 교체한 재치환술의 중기 추시 결과를 분석하고자 하였다. 대상 및 방법: 재치환술 시 골성 고정된 무시멘트 비구컵을 제거하지 않고, 폴리에틸렌 삽입물을 교체한 후, 5년 이상(평균 92개월) 추시 가능했던 33예를 대상하였다. Harris 고관절 점수, 골용해 크기 변화 및 폴리에틸렌 삽입물의 선형 마모율을 비교하였고, 이식골의 결합 정도와 새로운 골용해 병변 발생 여부를 관찰하였다. 결과: Harris 고관절 점수는 평균 89.3점으로 호전되었다. 골 이식을 시행한 군에서 골용해 크기가 감소하였고, 골 이식을 시행하지 않은 군에서 새로운 골용해의 발생은 없었다. 합병증으로 폴리에틸렌 삽입물의 해리와 치환물 주변 골절이 각 1예 있었다. 동일 관찰 시점의 비구 관절면 선형 마모율은 재치환술 전에 비하여 유의하게 감소하였다. 결론: 폴리에틸렌 삽입물 만을 교체하는 재치환술은 안전하고 효과적인 재치환술 방법으로 사료된다. 다만 잠김 기전이 약한 HG 비구컵의 특성상 조기에 잠금 장치의 손상이 발생할 위험이 높은 경우에는 비구컵 재치환술 또는 폴리에틸렌 삽입물 시멘트 고정 방법을 고려하는 것이 바람직할 것으로 사료된다.
Abstract
Purpose: To analyze the results of isolated exchange of polyethylene (PE) liners for treatment of wear and osteolysis around a well-fixed Harris-Galante (HG) cementless acetabular cup. Materials and Methods: Thirty-three PE liner changes were performed without the removal of stably ingrown implants (33 hips of 32 patients). They were able to be followed for a mean period of 92 months. Clinically, the Harris hip score (HHS), pain evaluation, and complications were evaluated. Radiologically, the annual wear rate and the size of the osteolytic lesions were measured before the operation and the latest follow-up. The bone graft incorporation scale and the development of new osleolytic lesions were checked during the final follow-up. Results: HHS improved to 89.3 at last follow-up. The size of the osteolysis was significantly reduced postoperatively. Bone graft incorporation scales were Grade I in 9 and Grade II in 14 cases. New osteolytic lesions have not developed at latest follow-up. As a complication, one case of dissociation of a liner and a periprosthetic fracture were noted. Annual wear rates during the same period were significantly reduced. There was no sign of alteration in stability of the PE liner. Conclusion: Exchange of a PE liner without removal of stable implants can be a good option for the treatment of wear and osteolysis around a stable cementless THA implant, even if the system has a weak locking mechanism, such as the HG cup. In these cases, under certain states with a higher risk of early failure in the locking mechanism, it would be better to select other revision procedures such as cup revision or cemented polyethylene liner fixation.
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