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대퇴골두 골괴사를 가진 환자에서의 조립식 대퇴주대를 이용한 무시멘트형 고관절 전치환술 - 금속 금속 관절면과 세라믹 세라믹 관절면의 비교 -

Cementless Total Hip Arthroplasty Using a Modular Femoral Component in Patients with Femoral Head Osteonecrosis : Comparison of Metal-on-Metal and Ceramic-on-Ceramic Articulation

이주희|김경운|정영복|김진홍|장의찬|강번중|한용문
대한고관절학회 (The Korean Hip Society)|2011.12|Hip and Pelvis|제23권 제4호|pp. 275-281

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참고문헌

키워드

Osteonecrosis고관절 치환술Femoral headCementless modular femoral stem대퇴골두무혈성 괴사무시멘트형 조립식 대퇴주대Primary THRA

초록

목적: 진행된 대퇴골두 골괴사증 환자에서 무시멘트형 조립식 대퇴주대를 이용한 고관절 치환술의 임상적 및 방사선학적 결과를 평가하였으며, 금속-금속 관절면을 사용한 군과 세라믹-세라믹 관절면을 사용한 군 간, 결과에 차이가 있는지를 확인하고자 하였다. 대상 및 방법: 2001년 1월부터 2004년 12월 까지 대퇴골두 골괴사증으로 조립식 대퇴주대를 이용하여 무시멘트형 고관절 치환술을 시행 받았으며, 5년 이상 추시관찰이 가능하였던 66명(78예)을 대상으로 하였고, 술 후 평균 추시 기간은 평균 77개월(60~122개월) 이었다. 결과: 임상적 평가로 술 전 평균 Harris 고관절 점수는 53점에서 최종 추시 시 88.5점으로 향상되었다. 방사선학적 검사 결과에서 대퇴주대의 안정도는 68예에서 골성고정을 얻었으며, 9예에서 섬유성 안정고정, 1예에서 불안정고정을 나타내었다. 재치환술은 3예에서 시행하였으며, 122개월 간 대퇴 스템의 생존율은 95.7%인 것으로 조사되었다. 결론: 진행된 대퇴골두 골괴사증에서 시행한 조립식 대퇴주대를 이용한 무시멘트형 고관절 전치환술은 5년 이상 추시 결과 금속-금속 관절면을 사용한 군과 세라믹-세라믹 관절면을 사용한 군, 모두 만족한 만한 임상적 및 방사선학적 결과를 얻었다.

Abstract

Purpose: The purpose of this study was to evaluate the clinical and radiological outcomes after total hip arthroplasty using the S-ROM modular system for osteonecrosis of the femoral head, and to compare the results between the groups using metal-on-metal articulation and ceramic-on-ceramic articulation. Materials and Methods: Sixty-six patients (78 hips) with osteonecrosis of the femoral head were evaluated after primary total hip arthroplasty between January 2001 and December 2004, using an S-ROM proximal modular femoral stem. The average follow-up was 77 months (range, 60 to 122 months) and all patients were followed for more than five years. Results: The average Harris hip score improved from 53 points to 88.5 points at the final follow-up. At the latest radiologic evaluation, sixty-seven stems had bony ingrowth stability, and 10 stems had stable fibrous ingrowth. However, one stem had diffuse extensive osteolysis and loosening, which was revised at 9 years. Postoperative complications included 4 cases of heterotrophic ossificiation, 1 case of linear fracture after insertion of the femoral stem, 1 case of dislocation, 2 cases of infection, and 1 case of extensive osteolysis and loosening. There were 3 cases of revision and Kaplan-Meier survivorship analysis with revision estimated at a 95.7% chance of survival for the femoral component during 122 months. Conclusion: Our study showed that total hip arthroplasty using the S-ROM modular system with metal-on-metal articulation or ceramic-on-ceramic articulation had favorable clinical and radiological mid- to long-term results.

참고문헌 (34)

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