무시멘트 고관절 전치환술에서 수산화 인회석이 피복된 평탄한 반구형 비구컵의 역할
Role of Hydroxyapatite-Coated smooth-surfaced Hemi-Spherieal Acetabular Component in Cementless Total Hip Arthroplasty
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 수산화인회석이 피복된 평탄한 반구형 비구컵을 이용한 무시멘트성 고관절 전치환술의 최소 7년 결과를 보고하고자 한다. 대상 및 방법: 1993년 3월부터 1995년 2월까지 수산화인회석이 피복된 평탄한 반구형 비구컵을 이용하여 무시멘트 고관 절 전치환술을 시행하였던 87명 114례 중 임상적 및 방사선학적 추시가 가능하였던 54명 65례를 대상으로 하였다. 추 시 기간은 평균 102개월, 평균 54세였다. 임상적으로 Harris hip score를 이용하여 평가하였고, 방사선학적으로는 비 구컵 주위의 골용해, 폴리에칠렌의 마모율과 비구컵 주위의 골용해 등을 관찰하였다. 결과: Harris hip score는 술 전 평균 54.2 점에서 술 후 1년에 92.7점으로 크게 향상되었으나, 최종 추시시 평균 81.9점으로 감소되었다. 골용해는 16례(24.6%)에서 관찰되었으며 폴리에칠렌 마모율은 평균 0.28 mm/year 이었다. 4례(6.2%)에서 비구컵의 이동을 포함한 불안정성이 관찰되었다. 8례(12.3%)에서 비구컵과 주위의 심한 골용해와 비구 컵의 해리로 재치환술을 실시하였다. 재치환술까지의 평균 기간은 102.4개월이었다. 결론: 수산화인회석 피복된 평탄한 반구형 비구컵을 이용한 고관절 전치환술의 중단기 추시결과, 폴리에칠렌 마모에 의한 비구컵 주위의 높은 골용해 빈도, 비구컵의 골 내성장의 실패, 높은 폴리에칠렌 마모율이 관찰되었으며, 결과적으로 높은 빈도의 재치환술을 경험하였다.
Abstract
Purpose: To report the 7 year outcome of a cementless total hip arthroplasty using a HA coated smooth surfaced hemi-spherical acetabular cup component. Materials and Methods: A total hip arthroplasty using a hydroxyapatite coated smooth-surfaced hemi-spherical acetabular cup was performed on 114 hips(87patients) between March 1993 and February 1995. Among them, 65 hips(54 patients) were followed-up clinically and radiologically. The patients were followed-up for an average of 102 months. The mean age at the time of the arthroplasty was 54 years old. The clinical results were evaluated using the Harris hip score. The radiological results were evaluated for osteolysis around the acetabular cup and the polyethylene wear rate. R e s u l t s: The mean preoperatively Harris hip score of 54.2 was improved to 92.9 1 year after surgery, then decreased to 81.9 at the final follow-up. Pelvic osteolysis was observed at 16 cases (24.6%) and the mean polyethylene wear rate was 0.28 mm/year. Four hips(6.2%) of the acetabular component were unstable and detachable. Eight hips(12.3%) with severe osteolysis around the acetabular cup and were revised due to a dissociation of acetabular cup. The mean follow-up period to the revision was 102.4 months Conclusion: The mid-term follow-up results of the total hip arthroplasties using HA coated smooth-surfaced hemispherical acetabular cup component showed a high rate of polyethylene wear and osteolysis around the acetabular cup due to polyethylene wear and a failure of bony ingowth into the acetabular cup. This resulted in a high rate of revision surgery.
참고문헌 (25)
- Bauer TW, "Hydroxyapatite-coated femoral stems:histological analysis of components retrieved at autopsy", 73-a, pp.1439~1452 (1991)
- Capello WN, "Hydroxyapatite in total hip arthroplasty:clinicalresults and critical issues", 355, pp.200~211 (1998)
- Cook SD, "Hydroxyapatitecoating of porous implants improves bone ingrowth andinterface attachment strength", 26, pp.989~1001 (1992)
- D’Antonio JA, "Hydroxyapatite coated implants.Total hiparthroplasty in the young patients and patients withavascular necrosis", 344, pp.124~138 (1997)
- David A,, "Mechanical andhistological evaluation of hydroxyapatite-coated,titanium-coated and grit-blasted surfaces under weightbearingconditions.", 114, pp.112~118 (1995)
- Geesink RGT, "Bonding ofbone to apatite-coated implants", 70-b, pp.17~22 (1988)
- Geesink RGT, "Osteoconductive coatings for total jointarthroplasty", 395, pp.53~65 (2002)
- Hardy DCR, "Bonding ofhydroxyapatite-coated femoral prostheses:histopathologyof specimens from four cases", 73-b, pp.732~740 (1991)
- Havelin LI, "Revision foraseptic loosening of uncemented cups in 4352 primarytotal hip prostheses:a report from the Norwegianarthroplasty register", 66, pp.494~500 (1995)
- Jaffe WL, "Current concepts review:totalhip arthroplasty with hydroxyapatite-coated prostheses", 78, pp.1918~1934 (1996)
- Lai KA,, "Failure of hydroxyapatite-coated acetabularcups.", 84, pp.641~646 (2002)
- Lintner F, "Histologyof tissue adjacent to an HAC-coated femoral prostheses:acase report", 76-b, pp.824~830 (1994)
- Manley MT,, "Fixation of acetabular cups withoutcement in total hip arthroplasty a comparison of threedifference implant surfaces at a minimun duration offollow-up of five years", 80, pp.1175~1185 (1998)
- McNally SA, "The results at nine to twelve years of the use of ahydroxyapatite-coated femoral stem", 82, pp.378~382 (2000)
- Moilanen T, "Hydroxyapatite coating of an acetabular prosthesis:effecton stability", 78, pp.200~205 (1996)
- Morscher EW, "Severe osteolysis afterthird-body wear due to hydroxyapatite particles fromacetabular cup coating", 80, pp.267~272 (1998)
- Onsten I, "Migration and wear of a hydroxyapatite-coated hipprosthesis:a controlled roentgen stereophotogrammetricstudy", 78, pp.85~91 (1996)
- Oosterbos CJM, "Hydroxyapatite coated hip prosthesis follow up for 5years", 310, pp.98~102 (1995)
- "P o l y e t h y l e n ewear, osteolysis and acetabular loosening with an HAcoatedhip prosthesis: a follow up of 94 consecutivearthroplasties.", 81, pp.582~589 (1999)
- Shen WJ, "Mechanical failure of hydroxyapatite- and polysulfonecoatedand titanium rods in a weight-bearing caninemodel", 7, pp.43~49 (1992)
- Søballe K, "Gap healing enhanced by hydroxyapatite coating indogs", 272, pp.300~307 (1991)
- Thanner J, "Porous cups with and without hydroxylapatite-tricalciumphosphate coating:23 matched pairs evaluated withradiostereometry", 14, pp.266~271 (1999)
- Tonino AJ, "T h ehydroxyapatite-ABG hip system.5-to 7 year results froman international study", 312, pp.2111~2125 (1995)
- Wang BC, "Ahistomorphometric study on osteoconduction andosseointegration of titanium alloy with and withoutplasma-sprayed hydroxyapatite coating using backscatteredelectron images", 4, pp.394~403 (1993)
- Wang BC, "The shearstrength and the failure mode of plasma-sprayedhydroxyapatite coating to bone the effect of coatingthickness", pp.1315 1315~1327 1327