지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 이용한 고관절 재치환술
Revision Total Hip Arthroplasty with a Strut Allograft and an Extensively Porous-Coated Femoral Stem
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목적: 인공 고관절 재치환술 시 다량의 대퇴골 골결손 부위에 대해 지주 동종골 이식술 및 광범위미세 피복 대퇴스템을 사용하고 그 결과를 알아보고자 하였다. 대상 및 방법: 1998년부터 2005년까지 재치환술 시 근위 대퇴골 골결손으로 지주 동종골 이식술및 광범위 미세 피복 대퇴스템을 사용하고 2년 이상 추시관찰이 가능하였던 12예를 대상으로 하였다. 추시 기간은 평균 4.6년이었다. 재치환술의 원인은 광범위한 골용해 및 이로 인한 대퇴 삽입물 주위 골절이 5예, 무균성 해리 7예였다. 결과: Harris 고관절 점수는 술전 평균 40.8점에서 최종 추시시 85.1점으로 향상되었으며 대퇴삽입물의 고정도는 11예(92%)에서 골성 안정 소견을 보였으며 1예(8%)에서 섬유성 안정 소견을보였다. 응력 방패 현상은 1예에서 중등도의 소견을 보였으나 최종 추시 시 진행되는 소견은 없었다. 최종 추시시 심한 마모나 골용해를 보인 예는 없었으며 심부감염 1예를 제외한 전 예에서 이식골의 유합을 확인할 수 있었다. 결론: 다량의 대퇴골 골결손이 동반된 환자에서 지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 이용한 재치환술은 만족할 만한 결과를 보였으나 응력방패 현상 및 이식골로 인한 합병증 등에 대해서는 장기간의 추시관찰이 필요할 것으로 사료된다.
Abstract
Purpose: We wanted to report on the outcomes of using a strut allograft and extensively porous-coated femoral stems in revision total hip arthroplasty that was performed due to extensive femoral bone loss. Materials and Methods: Between 1998 and 2005, we performed 167 consecutive revision total hip arthroplasties. Among them, twelve cementless femoral revision surgeries with a strut allograft and extensively porous-coated stems were retrospectively reviewed. The average follow up was 4.6 years. The average age at the time of the index revision was 55.9 years. The reasons for the revisions were periprosthetic fracture due to extensive osteolysis in 5hips and aseptic loosening in 7 hips. Results: The Harris hip score improved from a mean of 40.8 points before revision surgery to a mean of 85.1 points at the latest follow up. Radiographic evidence of bony stable stems were present in 11 hips and a fibrous stable stem was present in 1 hip. Moderate stress-shielding was noticed in one hip. Nonunion of the allograft was observed in 1hip due to deep infection. To date, no significant wear or osteolysis has been observed. Conclusion: Revision total hip arthroplasty with a strut allograft and an extensively porous-coated femoral stem for treating cases of extensive femoral bone loss seems to be a reasonable choice. However, the concerns related to stress shielding, the difficulties in re-revisions and the complications associated with an allograft will require longer term follow up.
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