인공 관절 시행 후 발생한 대퇴부 골용해의 진단과 치료

The Diagnosis and Treatment of Femoral Osteolysis Developed after the Hip Replacement

  • 조명래 (대구가톨릭대학교 의과대학 정형외과학교실)
  • Cho, Myung-Rae (Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University)
  • 발행 : 2010.06.30

초록

목적: 대퇴부 골용해의 진단 및 치료 방법을 알아보고자 한다. 내용: 골용해(osteolysis)는 마모입자에 의한 생물학적 반응으로 인공관절의 수명에 가장 큰 영향을 미치는 가장 흔하고 중요한 합병증이다. 그러나 심각한 골결손 및 이완이 발생하기 전까지 증세가 나타나지 않아 조기 진단과 치료에 어려움이 있다. 조기진단과 정확한 치료를 시행하기 위해 대퇴부 골용해시 나타날 수 있는 임상적 소견 및 방사선 소견 등을 살펴보고 필요한 약물치료 및 수술적 치료방법 등을 살펴보았다. 결론: 인공관절의 재질 및 디자인의 향상으로 마모 입자의 발생이 감소되어 골용해가 줄어들고 있으나 여전히 문제가 존재하는 상태로 골용해 방지를 위해 지속적인 노력이 필요할 것으로 사료된다.

Purpose: To evaluate the diagnosis and treatment of femoral osteolysis. Contents: Osteolysis developed from biologic interaction by wear debris, is one of the common and important complications, which is the most influencing factor of the durability of artificial joint. However, it is difficult to diagnose and treat femoral osteolysis early, because there are no symptoms until a serious bone loss occurs. For the accurate treatment and the early diagnosis of femoral osteolysis, we evaluated the clinical and radiological findings, and also evaluated the medical and surgical managements. Conclusion: From the improvement of the quality and design of artificial joint, femoral osteolysis is reducing these days. However, it still remains a problem, so consistent effort are required to reduce it.

키워드

참고문헌

  1. Harris WH, Schiller AL, Scholler JM, Freiberg RA, Scott R. Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am. 1976;58:612-8.
  2. Sinha RK, Shanbhag AS, Maloney WJ, Hasselman CT, Rubash HE. Osteolysis: cause and effect. Instr Course Lect. 1998;47:307-20.
  3. Heekin RD, Engh CA, Herzwurm PJ. Fractures through cystic lesions of the greater trochanter. A cause of late pain after cementless total hip arthroplasty. J Arthroplasty. 1996;11:757-60. https://doi.org/10.1016/S0883-5403(96)80017-9
  4. Pazzaglia U, Byers PD. Fractured femoral shaft through an osteolytic lesion resulting from the reaction to a prosthesis. A case report. J Bone Joint Surg Br. 1984;66:337-9.
  5. Engh CA Jr, Sychterz CJ, Young AM, Pollock DC, Toomey SD, Engh CA Sr. Interobserver and intraobserver variability in radiographic assessment of osteolysis. J Arthroplasty. 2002;17:752-9. https://doi.org/10.1054/arth.2002.33554
  6. Anthony PP, Gie GA, Howie CR, Ling RS. Localised endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties. J Bone Joint Surg Br. 1990;72:971-9.
  7. Zicat B, Engh CA, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am. 1995;77:432-9.
  8. Gruen TA, McNeice GM, Amstutz HC."Modes of failure"of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17-27.
  9. Harris WH, McCarthy JC Jr, O'Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg Am. 1982;64:1063-7.
  10. Kwong LM, Jasty M, Mulroy RD, Maloney WJ, Bragdon C, Harris WH. The histology of the radiolucent line. J Bone Joint Surg Br. 1992;74:67-73.
  11. Goetz DD, Smith EJ, Harris WH. The prevalence of femoral osteolysis associated with components inserted with or without cement in total hip replacements. A retrospective matched-pair series. J Bone Joint Surg Am. 1994;76:1121-9.
  12. Tanzer M, Maloney WJ, Jasty M, Harris WH. The progression of femoral cortical osteolysis in association with total hip arthroplasty without cement. J Bone Joint Surg Am. 1992;74:404-10.
  13. Maloney WJ, Woolson ST. Increasing incidence of femoral osteolysis in association with uncemented Harris- Galante total hip arthroplasty. A follow-up report. J Arthroplasty. 1996;11:130-4. https://doi.org/10.1016/S0883-5403(05)80005-1
  14. Engh CA, Hooten JP Jr, Zettl-Schaffer KF, et al. Porouscoated total hip replacement. Clin Orthop Relat Res. 1994;298:89-96.
  15. Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg Am. 1985;67:1074-85.
  16. Berger R, Fletcher F, Donaldson T, Wasielewski R, Peterson M, Rubash H. Dynamic test to diagnose loose uncemented femoral total hip components. Clin Orthop Relat Res. 1996;330:115-23. https://doi.org/10.1097/00003086-199609000-00014
  17. D'Antonio J, McCarthy JC, Bargar WL, et al. Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1993;296:133-9.
  18. Howell GE, Bourne RB. Osteolysis; etiology, prosthetic factor, and pathogenesis. Instr Course Lect. 2000;49:71-82.
  19. Goodman SB, Trindade M, Ma T, Genovese M, Smith RL. Pharmacologic modulation of periprosthetic osteolysis. Clin Orthop Relat Res. 2005;430:39-45.
  20. Im GI, Han JD. Suppressive effects of interleukin-4 and interleukin-10 on the production of proinflammatory cytokines induced by titanium-alloy particles. J Biomed Mater Res. 2001;58:531-6. https://doi.org/10.1002/jbm.1051
  21. Pollice PF, Silverton SF, Horowitz SM. Polymethylmethacrylatestimulated macrophages increase rat osteoclast precursor recruitment through their effect on osteoblasts in vitro. J Orthop Res. 1995;13:325-34. https://doi.org/10.1002/jor.1100130305
  22. Berry DJ. Liner and femoral head exchange for osteolysis. Orthopedics. 2003;26: 939-40.
  23. Meek RM, Greidanus NV, Garbuz DS, Masri BA, Duncan CP. Extended trochanteric osteotomy: planning, surgical technique, and pitfalls. Instr Course Lect. 2004;53:119-30.