인공고관절 치환술에서 대퇴주대 회전에 따른 시멘트막 두께 변화

Change of the Cement Mantle Thickness According to the Movement of the Femoral Stem in THRA

  • 박용국 (대구가톨릭대학교 기계자동차공학부) ;
  • 김진곤 (대구가톨릭대학교 기계자동차공학부)
  • 발행 : 2007.02.01

초록

THRA(Total Hip Replacement Arthroplasty) has been widely used for several decades as a viable treatment of otherwise-unsolved hip problems. In THRA surgery, cement mantle thickness is critical to long-term implant survival of femoral stem fixed with cement. Numerous studies reported thin or incomplete cement mantle causes osteolysis, loosening, and the failure of implant. To analyze the effect of femoral stem rotation on cement thickness, in this study, we select two most popular stems used in THRA. Using CAD models obtained from a 3D scanner, we measure the cement mantle thickness developed by the rotation of a femoral stem in the virtual space created by broaching. The study shows that as the femoral stem deviates from the target coordinates, the minimum thickness of cement decreases. Therefore, we recommend development of a new methodology for accurate insertion of a femoral stem along the broached space. Also, modification of the stem design robust to the unintentional movement of a femoral stem in the broached space, can alleviate the problem.

키워드

참고문헌

  1. Choi, K. W., 'Joint Prostheses and Engineering Technology,' J. of KSPE, Vol. 17, No. 11, pp. 17-24, 2000
  2. Choueka, J., Koval, K. J. and Zuckerman, J. D., 'Cement augmentation of intertrochanteric fracture fixation; a cadaver comparison of 2 techniques,' Acta. Orthop. Scand., Vol. 67, No. 2, pp. 153-157, 1996 https://doi.org/10.3109/17453679608994661
  3. Ling, R. S., 'The use of a collar and precoating on cemented femoral stems is unnecessary and detrimental,' Clin. Orthop., Vol. 285, pp. 73-83, 1992
  4. Harris, W. H., 'Is it advantage to strengthen the cement-metal interface and use a collar for cemented femoral components of total hip replacement?,' Clin. Orthop., Vol. 285, pp. 67-71, 1992
  5. Cowin, S. C., 'Bone remodeling of diaphyseal surface by torsional laods; Theoretical predictions,' J. of Biomechanics, Vol. 20, pp. 1111-1120, 1987 https://doi.org/10.1016/0021-9290(87)90028-5
  6. Crowninshield, R. D. and Tolbert, J. R., 'Cement strain measurement surrounding loose and well-fixed femoral component explanation,' J. Biomed. Mater. Res., Vol. 17, pp. 819-828, 1983 https://doi.org/10.1002/jbm.820170509
  7. Garellick, G., Malchau, H. and Regner, H., 'The Charnley versus the Spectron hip prosthesis: Radiographic evaluation of a randomized, prospective study of 2 different hip implants,' J. Arthroplasty, Vol. 14, pp. 414-425, 1999 https://doi.org/10.1016/S0883-5403(99)90096-7
  8. Lim, J. W. and Ha, S. K., 'Behavior Analysis of the Treated Femur and Design of Composite Hip Prosthesis,' J. Biomed. Eng. Res., Vol. 23, No. 2, pp. 119-130, 2002
  9. Moore, D. C., Frankenburg, E., Goulet, J. A. and Goldstein, S. A., 'Hip screw augmentation with an in situ-setting calcium phosphate cement: an in vitro biomechanical analysis,' J. Orthop. Trauma, Vol. 14, No. 8, pp. 577-583, 1997
  10. Elder, S., Frankenburg, E. and Goulet, J. A., 'Biomechanical evaluation of calcium phophate cement-augmented fixation of unstable intertrochanteric fractures,' J. Orthop. Trauma, Vol. 18, No. 6, pp. 386-393, 2000
  11. Reading, A. D., McCaskie, A. W. and Gregg, P. J., 'The inadequacy of standard radiographs in detecting flaws in the cement mantle,' J. Bone Joint Surg., Vol.81-B, pp. 167-170, 1999 https://doi.org/10.1302/0301-620X.81B1.0810167
  12. Valdivia, G. G., Dunbar, M. J., Parker, D. A., Woolfrey, M. R., MacDonald, S. J. and McCalden R. W., 'Three-dimensional analysis of the cement mantle in total hip arthroplasty,' Clin. Orthop., Vol. 393, pp. 38-51, 2001 https://doi.org/10.1097/00003086-200112000-00005