Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Cementless Total Hip Arthroplasty for Osteonecrosis of the Femoral Head- A Follow-up Study for 10+ Years -

대퇴골두 골괴사증에서 시행한 인공 고관절 전치환술 -최소 10년 이상 추시-

  • Chung, Jong-Won (Department of Orthopedic Surgery, College of Medicine, Korea University) ;
  • Park, Sang-Won (Department of Orthopedic Surgery, College of Medicine, Korea University) ;
  • Han, Seung-Beom (Department of Orthopedic Surgery, College of Medicine, Korea University) ;
  • Park, Jong-Hoon (Department of Orthopedic Surgery, College of Medicine, Korea University) ;
  • Kim, Ho-Jung (Department of Orthopedic Surgery, College of Medicine, Korea University) ;
  • Lee, Won-Suck (Department of Orthopedic Surgery, College of Medicine, Korea University)
  • 정종원 (고려대학교 의과대학 정형외과학교실) ;
  • 박상원 (고려대학교 의과대학 정형외과학교실) ;
  • 한승범 (고려대학교 의과대학 정형외과학교실) ;
  • 박종훈 (고려대학교 의과대학 정형외과학교실) ;
  • 김호중 (고려대학교 의과대학 정형외과학교실) ;
  • 이원석 (고려대학교 의과대학 정형외과학교실)
  • Published : 2010.06.30
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Abstract

Purpose: The aim of this study was to assess the outcome of cementless total hip arthroplasty (THA) in cases of osteonecrosis of the femoral head. Materials and Methods: We studied long-term outcomes for 54 patients (72 hips). Mean duration of follow-up was 13.5 years. Clinical outcomes were evaluated by the Harris Hip Score. Radiographic evaluation from the preoperative and follow-up periods included assessment of the fixation of the femoral and acetabular components, polyethylene wear, osteolysis, and radiolucent line. Results: The mean Harris Hip Score improved from a preoperative value of 51.9 points to 89.4 at final follow-up. Regarding the femoral components, there was radiographic evidence of stable bony ingrowth in 69 hips, stable fibrous ingrowth in 2 hips and unstable fixation in 1 hip. There was a radiolucent line of less than 1 mm in 7 hips, and femoral osteolysis in 27 hips. Regarding the acetabular components, there was radiographic evidence of stable fixation in 68 hips, unstable fixation in 4 hips, and osteolysis in 39 hips. There was a significant correlation between (i) failure of components and (ii) femoral osteolysis, acetabular osteolysis, polyethylene thickness, linear wear rate per year, or total linear wear. Conclusion: The findings of this study show favorable long term results, both clinical and radiographic, using cementless total hip replacement arthroplasties. However, the revision rates for the Harris-Galante acetabular components were high. Wear of the load? weight? bearing surface continues to limit the long-term success rate of THA, and improved design of the acetabular components should be considered.

목적: 진행된 대퇴골두 골괴사증에 무시멘트형 고관절 전치환술을 시행 후 임상적 및 방사선학적 결과와 재치환술에 영항을 미치는 요소들을 분석하였다. 대상 및 방법: 10년 이상 추시관찰이 가능하였던 54명(72예)를 대상으로 하였다. 임상적 결과는 Harris 고관절 점수를 측정하였고 방사선학적 분석은 대퇴스템 주위 방사선 투과선, 골용해 및 대퇴스템 안정도와 비구컵 주위의 골용해 및 비구컵 안정도, 폴리에틸렌 마모 등을 분석하였다. 결과: Harris 고관절 점수는 술 전 평균 51.9점에서 최종 추시 시 89.4점이었다. 대퇴스템 주위방사선 투과선 7예, 골용해 27예였으며 대퇴스템은 69예에서 골성고정, 2예에서 섬유성 안정고정, 1예에서 불안정 고정을 나타냈다. 비구컵은 68예에서 안정고정, 4예에서 불안정성 고정을 나타냈고 골용해는 39예에서 관찰되었다. 재치환술에 영향을 미치는 인자는 대퇴스템 및 비구컵 주위의 골용해, 폴리에틸렌 라이너의 두께, 연간마모율 및 전체 마모율이었다. 결론: 무시멘트형 고관절 전치환술은 최소 10년 이상 추시 시 대퇴스템에 대해서는 만족할 만한 결과를 얻었다. Harris-Galante형 무시멘트 비구컵은 재치환술 빈도가 높았으며 잠금기전이 강화된 Trilogy 비구컵에서는 재치환이 없었다. 따라서 잠금기전의 보완 및 개선된 인공삽입물과 관절면을 사용시 인공고관절의 수명을 증가 시킬 수 있을 것으로 사료된다.

Keywords

References

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