일차성 골관절염과 대퇴골두 무혈성 괴사에 시행한 무시멘트형 인공 고관절 전 치환술의 결과 비교
The Results of Cementless Total Hip Arthroplasty for Primary Osteoarthritis Compared with Avascular Necrosis of the Femoral Head
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목적: 무시멘트형 인공 고관절 전치환술을 일차성 골관절염과 대퇴골두 무혈성 괴사에 시행한 후비구컵 및 대퇴 스템의 임상적, 방사선학적 결과를 비교하고자 하였다. 대상 및 방법: 1992년 3월부터 2001년 5월까지 무시멘트형 인공 고관절 전치환술을 시행한 환자중 일차성 골관절염과 대퇴골두 무혈성 괴사로 수술하여 최소 8년 이상 추시가 가능하였던 84예를 대상으로 하였다 환자를 골관절염군과 무혈성 괴사군으로 나누고 A, B군으로 분류하였다. A 군은 38예, B군은 46예 였다. 임상적 평가는 Harris Hip Score를 기준으로 하였고, 방사선학적평가로 골용해와 비구부 이완 등을 관찰하였으며 통계학적으로 분석하였다. 결과: Harris Hip Score는 최종 추시상 평균 92.1와 91.2 (p=0.483)였고, 비구부 골용해는 9예와 15예(p=0.671) 였으며, 비구컵의 수직이동이 1예와 3예 였다. 8예와 7예의 합병증(p=0.572)이 발생 하였고 이중 4예와 5예에서 재치환을 시행하였으며 두군의 생존률 분석에 유의한 차이는 없었다(p=0.969). 결론: 일차성 골관절염 군과 대퇴 골두 무혈성 괴사군에서 시행한 무시멘트 인공 고관절 전치환술에서 비구컵과 대퇴 스템의 임상 및 방사선학적 결과는 차이를 보이지 않았다. 그러나 폴리에틸렌 라이너의 마모와 골 용해등의 문제는 높은 발생율을 보여 향후 이에 대한 더 많은 연구가 필요할 것으로 생각된다.
Abstract
Purpose: Cementless total hip arthroplasty was performed to treat primary osteoarthritis of the hip and avascular necrosis of the femoral head. The clinical and radiological results of the acetabular cups and femoral stems were compared. Materials and Methods: The subjects were 84 cases who underwent primary cementless total hip arthroplasty from March 1992 to May 2001. The 84 cases were followed up for at least eight years. The patients were divided into the following two groups: group (A), 38 cases of degenerative osteoarthritis of the hip; and group (B), 46 cases of avascular necrosis of the hip. The clinical evaluation was conducted based on the Harris Hip Score (HHS). A radiological assessment was performed to determine if osteolysis or acetabular loosening had occurred. The results were analyzed statistically. Results: The postoperative HHS of groups A and B at the final follow-up were 92.1 and 91.2, respectively (p=0.483). The radiological results revealed 9 and 15 cases of acetabular osteolysis (p=0.671) and 1 and 3 cases of vertical migration of the acetabular cups in the group A and B, respectively. Eight and 7 complications (p=0.572) were encountered in group A and B, respectively. Among these, 4 and 5 cases of revisional total hip arthroplasty were performed in group A and B, respectively. The results of survival analysis were similar in the two groups (p=0.969). Conclusion: The clinical and radiological features of the acetabular cups and stems were similar in the two groups. Nevertheless, further studies will be needed due to the high rate of polyethylene liner wear and osteolysis around the acetabular cups or femoral stems.
참고문헌 (27)
- Kim YH, "Cementless total hip arthroplasty in patients with osteonecrosis of the femoral head", Clin Orthop Relat Res, 320, pp.73~84 (1995)
- Cornell CN, "Long-term follow-up of total hip replacement in patients with osteonecrosis", Orthop Clin North Am, 16, pp.757~769 (1985)
- Xenakis TA, "Total hip arthroplasty for avascular necrosis and degenerative osteoarthritis of the hip", Clin Orthop Relat Res, 341, pp.62~68 (1997)
- Harris WH, "Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation", J Bone Joint Surg Am, 51, pp.737~755 (1969)
- DeLee JG, "Radiological demarcation of cemented sockets in total hip replacement", Clin Orthop Relat Res, 121, pp.20~32 (1976)
- Livermore J, "Effect of femoral head size on wear of the polyethylene acetabular component", J Bone Joint Surg Am, 72, pp.518~528 (1990)
- Massin P, "Evaluation of cementless acetabular component migration. An experimental study", J Arthroplasty, 4, pp.245~251 (1989)
- Gruen TA, "Modes of failure of cemented stem type femoral components: a radiographic analysis of loosening", Clin Orthop Relat Res, 141, pp.17~27 (1979)
- Engh CA, "Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results", J Bone Joint Surg Br, 69, pp.45~55 (1987)
- Kaplan EL, "Nonparametric estimation from incomplete observations", J Am Stat Assoc, 53, pp.457~481 (1958)
- Brooker AF, "Ectopic ossification following total hip replacement. Incidence and a method of classification", J Bone Joint Surg Am, 55, pp.1629~1632 (1973)
- Burkatt BC, "Thigh pain in cementless total hip arthroplasty. A comparison of two systems at 2 years’ follow up", Orthop Clin North Am, 24, pp.645~653 (1993)
- Engh CA, "Roentgenographic assessment of biologic fixation of porous-surfaced femoral components", Clin Orthop Relat Res, 257, pp.107~128 (1990)
- Ranawat CS, "Conventional total hip arthroplasty for degenerative joint disease in patients between the ages of forty and sixty years", J Bone Joint Surg Am, 66, pp.745~752 (1984)
- Cornell CN, "Long-term follow-up of total hip replacement in patients with osteonecrosis", Orthop Clin North Am, 16, pp.757~769 (1985)
- Salvati EA, "Long-term follow-up of total hip replacement in patients with avascular necrosis", Instr Course Lect, 37, pp.67~73 (1988)
- Saito S, "Long-term results of total hip arthroplasty for osteonecrosis of the femoral head. A comparison with osteoarthritis", Clin Orthop Relat Res, 244, pp.198~207 (1989)
- Ritter MA, "A comparison of osteonecrosis and osteoarthritis patients following total hip arthroplasty.A long-term follow-up study", Clin Orthop Relat Res, 206, pp.139~146 (1986)
- Piston RW, "Osteonecrosis of the femoral head treated with total hip arthroplasty without cement", J Bone Joint Surg Am, 76, pp.202~214 (1994)
- 박상원, "무시멘트형 비구컵 주위에 발생한 골용해", Hip and Pelvis, 16(4), pp.423~427 (2004), 대한고관절학회
- Mont MA, "Uncemented total hip arthroplasty in young adults with osteonecrosis of the femoral head: a comparative study", J Bone Joint Surg Am, 88, pp.104~109 (2006)
- Kim YH, "A comparison of total hip arthroplasty between osteonecrosis and osteoarthritis of the hip- retrospective matched pair studyminimum 5 years of follow up", J Korean Hip Soc, 12, pp.1~8 (2000)
- Chiang PP, "Osteolysis of the pelvis: evaluation and treatment", Clin Orthop Relat Res, 417, pp.164~174 (2003)
- Friedman RJ, "Current concepts in orthopaedic biomaterials and implant fixation", Instr Course Lect, 43, pp.233~255 (1994)
- 손원용, "혼합형 인공고관절 전치환술에서의 비구컵 골용해 (5~11.5년 추시결과)", Hip and Pelvis, 16(3), pp.324~331 (2004), 대한고관절학회
- Claus AM, "Pattern of osteolysis around two different cementless metal-backed cups: retrospective, radiographic analysis at minimum 10-year follow-up", J Arthroplasty, 16, pp.177~182 (2001)
- Stulberg SD, "Monitoring pelvic osteolysis following total hip replacement surgery:an algorithm for surveillance", J Bone Joint Surg Am, 84, pp.116~122 (2002)