대퇴골두 골괴사증에서 시행한 인공 고관절 전치환술 -최소 10년 이상 추시-
Cementless Total Hip Arthroplasty for Osteonecrosis of the Femoral Head - A Follow-up Study for 10+ Years -
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 진행된 대퇴골두 골괴사증에 무시멘트형 고관절 전치환술을 시행 후 임상적 및 방사선학적결과와 재치환술에 영항을 미치는 요소들을 분석하였다. 대상 및 방법: 10년 이상 추시관찰이 가능하였던 54명(72예)를 대상으로 하였다. 임상적 결과는Harris 고관절 점수를 측정하였고 방사선학적 분석은 대퇴스템 주위 방사선 투과선, 골용해 및 대퇴스템 안정도와 비구컵 주위의 골용해 및 비구컵 안정도, 폴리에틸렌 마모 등을 분석하였다. 결과: Harris 고관절 점수는 술 전 평균 51.9점에서 최종 추시 시 89.4점이었다. 대퇴스템 주위방사선 투과선 7예, 골용해 27예였으며 대퇴스템은 69예에서 골성고정, 2예에서 섬유성 안정고정, 1예에서 불안정 고정을 나타냈다. 비구컵은 68예에서 안정고정, 4예에서 불안정성 고정을 나타냈고 골용해는 39예에서 관찰되었다. 재치환술에 영향을 미치는 인자는 대퇴스템 및 비구컵 주위의 골용해, 폴리에틸렌 라이너의 두께, 연간마모율 및 전체 마모율이었다. 결론: 무시멘트형 고관절 전치환술은 최소 10년 이상 추시 시 대퇴스템에 대해서는 만족할 만한결과를 얻었다. Harris-Galante형 무시멘트 비구컵은 재치환술 빈도가 높았으며 잠금기전이 강화된 Trilogy 비구컵에서는 재치환이 없었다. 따라서 잠금기전의 보완 및 개선된 인공삽입물과 관절면을 사용시 인공고관절의 수명을 증가 시킬 수 있을 것으로 사료된다.
Abstract
Purpose: The aim of this study was to assess the outcome of cementless total hip arthroplasty (THA) in cases of osteonecrosis of the femoral head. Materials and Methods: We studied long-term outcomes for 54 patients (72 hips). Mean duration of follow-up was 13.5 years. Clinical outcomes were evaluated by the Harris Hip Score. Radiographic evaluation from the preoperative and follow-up periods included assessment of the fixation of the femoral and acetabular components, polyethylene wear, osteolysis, and radiolucent line. Results: The mean Harris Hip Score improved from a preoperative value of 51.9 points to 89.4 at final follow-up. Regarding the femoral components, there was radiographic evidence of stable bony ingrowth in 69 hips, stable fibrous ingrowth in 2 hips and unstable fixation in 1 hip. There was a radiolucent line of less than 1 mm in 7 hips, and femoral osteolysis in 27 hips. Regarding the acetabular components, there was radiographic evidence of stable fixation in 68 hips, unstable fixation in 4 hips, and osteolysis in 39 hips. There was a significant correlation between (i) failure of components and (ii) femoral osteolysis, acetabular osteolysis, polyethylene thickness, linear wear rate per year, or total linear wear. Conclusion: The findings of this study show favorable long term results, both clinical and radiographic, using cementless total hip replacement arthroplasties. However, the revision rates for the Harris-Galante acetabular components were high. Wear of the load? weight? bearing surface continues to limit the long-term success rate of THA, and improved design of the acetabular components should be considered.
참고문헌 (32)
- Ortiguera CJ, "Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term follow-up", J Arthroplasty, 14, pp.21~28 (1999)
- 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)
- 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)
- Salvati EA, "Long-term follow-up of total hip replacement in patients with avascular necrosis", Instr Course Lect, 37, pp.67~73 (1988)
- Madey SM, "Charnley total hip arthroplasty with use of improved techniques of cementing. The results after a minimum of fifteen years of follow-up", J Bone Joint Surg Am, 79, pp.53~64 (1997)
- Mulroy RD Jr, "The effect of improved cementing techniques on component loosening in total hip replacement", J Bone Joint Surg Br, 72, pp.757~760 (1990)
- Mulroy WF, "Total hip arthroplasty with use of so-called second-generation cementing techniques. A fifteen-year-average follow-up study", J Bone Joint Surg Am, 77, pp.1845~1852 (1995)
- Piston RW, "Osteonecrosis of the femoral head treated with total hip arthroplasty without cement", J Bone Joint Surg Am, 76, pp.202~214 (1994)
- Xenakis TA, "Cementless hip arthroplasty in the treatment of patients with femoral head necrosis", Clin Orthop Relat Res, 386, pp.93~99 (2001)
- 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)
- 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)
- Engh CA, "Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components", Clin Orthop Relat Res, 257, pp.107~128 (1990)
- Sakalkale DP, "Minimum 10-year results of a tapered cementless hip replacement", Clin Orthop Relat Res, 362, pp.138~144 (1999)
- Martell JM, "Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement", J Bone Joint Surg Am, 75, pp.554~571 (1993)
- 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)
- 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)
- Capello WN, "Fit the patient to the prosthesis. An argument against the routine use of custom hip implants", Clin Orthop Relat Res, 249, pp.56~59 (1989)
- Taylor AH, "Harris Galante cementless acetabular replacement in avascular necrosis", J Bone Joint Surg Br, 83, pp.177~182 (2001)
- Chiu KH, "Osteonecrosis of the femoral head treated with cementless total hip arthroplasty. A comparison with other diagnoses", J Arthroplasty, 12, pp.683~688 (1997)
- Berger RA, "Primary cementless acetabular reconstruction in patients younger than 50 years old. 7- to 11-year results", Clin Orthop Relat Res, 344, pp.216~226 (1997)
- Hartley WT, "Osteonecrosis of the femoral head treated with cementless total hip arthroplasty", J Bone Joint Surg Am, 82, pp.1408~1413 (2000)
- 백종륜,박상원,오광준,정종원,조형준, "비외상성 대퇴골두 골괴사증에 Multilock 대퇴스템을 이용한 일차적 인공고관절 치환술-50세 미만과 50세 이상의 비교-", 대한고관절학회지, 17(2), pp.106~112 (2005), 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)
- Stulberg BN, "Uncemented total hip arthroplasty in osteonecrosis: a 2- to 10-year evaluation", Clin Orthop Relat Res, 334, pp.116~123 (1997)
- Kim YH, "Cementless total hip arthroplasty in patients with osteonecrosis of the femoral head", Clin Orthop Relat Res, 320, pp.73~84 (1995)
- 유명철, "대퇴골두 무혈성 괴사에서 시행한 무시멘트형 인공고관절 전치환술- 10년이상 장기추시 결과 -", 대한고관절학회지, 16(1), pp.1~9 (2004), 대한고관절학회
- Sochart DH, "The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis", J Bone Joint Surg Am, 79, pp.1599~1617 (1997)
- Schmalzried TP, "Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space", J Bone Joint Surg Am, 74, pp.849~863 (1992)
- Maloney WJ, "Severe osteolysis of the pelvic in association with acetabular replacement without cement", J Bone Joint Surg Am, 75, pp.1627~1635 (1993)
- Kim YH, "Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series", J Bone Joint Surg Br, 75, pp.6~13 (1993)
- Han CD, "Cementless total hip arthroplasty for osteonecrosis in patients forty-five years old and less:minimum 5-year follow-up result", J Korean Hip Soc, 11, pp.134~141 (1999)