Hip & pelvis

  • 제21권4호
  • /
  • Pages.314-319
  • /
  • 2009
  • /
  • 2287-3260(pISSN)
  • /
  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지

AML (Anatomic Medullary Locking) 인공관절 삽입물을 이용한 고관절 전치환술의 임상 및 방사선학적 결과 - 최소 7년 이상 추시 -

The Clinical and Radiologic Results of Total Hip Arthroplasty with an AML Hip Prosthesis - Minimum 7 Years' Follow-up Study -

  • 신헌규 (성균관대학교 의과대학 강북삼성병원 정형외과학교실) ;
  • 최재열 (성균관대학교 의과대학 강북삼성병원 정형외과학교실) ;
  • 정화재 (성균관대학교 의과대학 강북삼성병원 정형외과학교실) ;
  • 임종준 (성균관대학교 의과대학 강북삼성병원 정형외과학교실)
  • Shin, Hun-Kyu (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University) ;
  • Choi, Jae-Yeol (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University) ;
  • Jeong, Haw-Jae (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University) ;
  • Lim, Jong-Joon (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University)
  • 발행 : 2009.12.31

⟨ 이전 논문 다음 논문 ⟩

초록

목적: 무시멘트 인공관절 치환술을 AML인공 삽입물을 이용하여 수술하고 7년 이상 장기 추시가 가능하였던 환자를 대상으로 다른 문헌상의 결과와 비교하고자 하였다. 대상 및 방법: 1995년 1월부터 2002년 7월까지 본원 정형외과에서 AML 인공관절 기기를 이용하여 고관절 전치환술을 시행한 환자 중 최소 7년 이상(최저 7.1년, 최고 14.6년, 평균 10.7년) 임상 및 방사선학적 추시가 가능하였던 51명 57예를 대상으로 하여 임상 및 방사선학적 결과에 대해 분석하였다. 결과: 임상 평가는 수술전 평균 Harris 고관절 점수는 52.4점 이었으며, 술 후 평균 Harris 고관절 점수는 최종 추시에서는 88.2점으로 향상되었다. 술 후 대퇴 주대의 초기 고정도 평가상 압박고정이 된 경우가 40예(70%)였으며 압박고정이 되지 않은 경우가 17예(30%)였다. 최종 압박고정된 40예 중 대퇴 주대의 최종 안정도 평가상 골내성장 고정이 29예(72.5%), 압박 고정이 되지 않은 17예 중 골내성장 고정이 7예(41.2%), 불안정성 고정이 6예(35.3%)였다. 최종 추시 방사선 사진상 골내성장이 이루어진 36예 중 28예(77.8%)에서 응력 차단을 확인 할 수 있었으며 대퇴골 주위의 골용해는 21예(36.8%)에서 관찰되었고 비구컵 주위 골용해는 6예(10.5%)에서 관찰되었다. 결론: AML 인공물을 이용한 무시멘트 고관절 전치환술을 시행하고 최소 7년 이상의 추시 관찰을 시행한 결과 우수한 결과를 나타내었으나 폴리에틸렌 마모와 골용해에 대해서는 지속적으로 추시 관찰이 필요할 것으로 사료된다.

Purpose: To evaluate the long-term results (minimum 7 Years'follow-up) of cementless total hip arthroplasty using an Anatomic Locking Medullary (AML) hip prosthesis. Materials and Methods: Fifty-one patients (57 hips) underwent total hip arthroplasty between January 1995 and July 2002. They were followed up for a minimum of seven years (7.1 to 14.6) after the initial operation. The mean age of the patients was 56.8 years. The radiographs were reviewed and the clinical results were evaluated. Results: The mean Harris hip score improved from 52.4 points preoperatively to 88.2 points postoperatively. Of the 40 hips showing a good press-fit, 29 hips (72.5%) exhibited bone ingrowth fixation. Of the remaining 17 hips with a poorer press-fit, 7 hips (35.3%) showed bone ingrowth fixation and 6 hips (35.3%) had unstable fixation. Of the 36 hips showing bone ingrowth fixation, 28 hips (77.8%) exhibited stress mediated bone resorption. On the last follow-up radiographic examination, osteolysis occurred around the femoral stem and acetabular cup in 21 (36.8%) and 6 (10.5%) hips, respectively. Conclusion: The results of cementless AML total hip arthroplasty were acceptable up to 7 years but polyethylene wear and osteolysis should be followed carefully over the long term.

키워드

참고문헌

  1. Berend KR, Lombardi AV, Mallory TH, Dodds KL, Adams JB. Cementless double-tapered total hip arthroplasty in patients 75 years of age and older. J Arthroplasty, 19: 288-295, 2004. https://doi.org/10.1016/j.arth.2003.11.002
  2. Bourne RB, Rorabeck CH, Patterson JJ, Guerin J. Tapered titanium cementless total hip replacements: a 10- to 13- year followup study. Clinical Orthop Relat Res, 393: 112- 120, 2001. https://doi.org/10.1097/00003086-200112000-00013
  3. Bozie KJ, Salch KJ, Rosenberg AG, Rubash HE. Economic evaluation in total hip arthroplasty: analysis and review of the literature. J Arthroplasty, 19: 180-189, 2004 https://doi.org/10.1016/S0883-5403(03)00456-X
  4. Brander VA, Malhotra S, Jet J, Heinemann AW, Stulberg DS. Outcome of hip and knee arthoplasty in persons aged 80 years and older, Clinical Orthop Relat Res, 345: 67-78, 1997.
  5. Callaghan JJ, Dysart SH, Savory CG. The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg, 70-A: 337-346, 1988.
  6. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clinical Orthop Relat Res, 121: 20-32, 1976.
  7. Engesaeter LB, Espehaug B, Lie SA, Furnes O, Havelin LI. Does cement increase the risk of infection in primary total hip arthroplasty? Revision rates in 56,275 cemented and uncemented primary THAs followed for 0-16 years in the Norwegian Arthroplasty Register. Acta Orthop, 77: 351-358, 2006. https://doi.org/10.1080/17453670610046253
  8. Engh CA, Boybn JD. Biologic fixation in total hip arthroplasty. New Jersey, SLACK: 3-16, 1985.
  9. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clinical Orthop Relat Res, 231: 7-28, 1988.
  10. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg, 69-B: 45-55, 1987.
  11. Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of the use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Join Surg, 79- A: 177-184, 1997
  12. Engh CA, Glassman AH, Suthers KE. The case for porous-coated hip implants: The femoral side. Clin Orthop, 261: 63-81, 1990.
  13. EnghCA, Massini P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clinical Orthop Relat Res, 257: 107- 128, 1990.
  14. Gruen TA, McNeice GM, Amstutz HC.“Modes of failure”of cemented stem-type femoral components: a radiographic analysis of loosening. Clinical Orthop Relat Res, 141: 17-27, 1979.
  15. Hwang SK, Son YK. The clinical and radiographic results of primary cementless AML (anatomic medullary locking) total hip arthroplasties. Minimum 10 years' follow-up study. J Korean Hip Soc, 11: 142-149. 1999.
  16. Keisu KS, Orozco F, Sharkey PF, Hozack WJ, Rothman RH, McGuigan FX. Primary cementless total hip arthroplasty in octogenarians. Two to eleven-year followup. J Bone Joint Surg, 83-A: 359-363, 2001.
  17. Kim YH, Kim VE. Cementless porous-coated anatomic medullary locking total hip prostheses. J arthroplasty, 9: 243-252, 1994. https://doi.org/10.1016/0883-5403(94)90078-7
  18. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg, 72-A: 518-528, 1990.
  19. Maloney WJ, Smith RL. Periprosthetic osteolysis in total hip arthroplasty: the role of particulate wear debris. Instr Course Lect: 45: 171-182, 1996.
  20. McAuley JP, Moore KD, Culpepper WJ 2nd, Engh CA. Total hip arthroplasty with porous-coated prostheses fixed without cement in patients who are sixty-five years of age or older. J Bone Joint Surg, 80-A: 1648-1655, 1998.
  21. Pieringer H, Labek G, Auersperg V, Bo¨hler N. Cementless total hip arthroplasty in patients older than 80 years of age. J Bone Joint Surg, 85-B: 641-645, 2003.