동시에 시행한 양측성 무시멘트 고관절 전치환술 최소 17년 추시 - 편측성 무시멘트 고관절 전치환술과 비교연구 -
Simultaneous Bilateral Cementless Total Hip Arthroplasty: a Minimum 17-year Follow-up Study - Comparison Study with Unilateral Cementless Total Hip Arthroplasty -
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목적: 양측성 무시멘트 고관절 전치환술을 동시에 시행한 환자와 편측성 고관절 전치환술을 시행한 환자를 대상으로 장기 추시 결과를 비교한다. 대상 및 방법: 양측성 인공 고관절 전치환술을 동시에 시행한 환자 중 17년 이상 추시 가능한 48예, 편측성 환자 49예를 대상으로 하였다. 평균 연령은 69.1세, 66.7세이었고 평균 추시 기간은 21.5년, 22.4년이었다. Harris 고관절 점수와 전후면 및 측면 방사선 사진을 촬영하여 분석하였다. 결과: 양측성군에서 평균 Harris 고관절 점수는 술 전 44.3점(표준편차 3.78) 최종 추시 시 81.2점(10.75), 편측성군에서는 46.5점(3.27), 80.1점(12.05)이었다. 비구컵의 안정도와 대퇴주대의 고정도는 두군 모두 최종 추시 시 안정적 위치를 보였다. 비구컵 주위의 골용해는 26.3%, 31.4%에서 발생하였고, 대퇴주대 주위의 골용해는 16.6%, 17.1%, 폴리에틸렌 연평균 마모율은 0.17 mm/yr, 0.16mm/yr으로 계측되었고 비구컵 및 대퇴주대의 17년 생존율은 양측성군 78%, 89%이고 편측성군은78%, 86%이었다. 결론: 동시에 시행한 양측성 고관절 전치환술은 편측성과 비교할 때 17년 이상 장기 추시 시에도 임상적 방사선학적으로 유의한 차이가 없었다.
Abstract
Purpose: Long-term follow-up results of concurrent bilateral or unilateral cementless hip arthroplasty were compared. Materials and Methods: Forty eight and 49 patients with concurrent bilateral and unilateral hip artrhoplasties who had more than a 17-year follow-up time were selected. At final follow-up, mean ages were 69.1 and 66.7 years old in the bilateral and unilateral groups, respectively. Mean follow-up times were 21.5 and 22.4 years in the bilateral and unilateral groups, respectively. Clinical results were attained using Harris hip score and standardized anteroposterior and lateral view X-rays. Results: The bilateral group had mean Harris scores of 44.3(standard deviation 3.78) preoperatively, and 81.2(10.75) at final follow-up. For the unilateral group, the mean scores were 46.5(3.27) preoperatively, and 80.1(12.05) at final follow-up. At final follow-up, an acetabular cup was securely located in 78.9% and 82.8% of the bilateral and unilateral groups, respectively, and all cases showed firm fixation of the femoral stem in both groups. Osteolysis around the cup and stem were found in 26.3% and 31.4% of the bilateral group and 16.6% and 17.1% of the unilateral group, respectively. Polyethylene wear rate was 0.17 mm/yr and 0.16 mm/yr in the unilateral and bilateral groups, respectively. Using the Kaplan-Meier method, 17-year survival rates for cup and stem were 78% and 89% in the bilateral group, respectively, and 78% and 86% in the unilateral group, respectively. Conclusion: In 17-year long-term follow-up, concurrent bilateral hip arthroplasty was insignificantly different clinically and radiologically from the result of unilateral hip arthroplasty.
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