Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Revision Total Hip Arthroplasty Using a Wagner Revision Stem

Wagner 재치환 대퇴스템을 이용한 인공 고관절 재치환술

  • Kim, Yee-Suk (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Cho, Chang-Min (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Hwang, Kyu-Tae (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Kim, Young-Ho (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Choi, Il-Yong (Department of Orthopedic Surgery, College of Medicine, Hanyang University)
  • 김이석 (한양대학교 의과대학 정형외과학교실) ;
  • 조창민 (한양대학교 의과대학 정형외과학교실) ;
  • 황규태 (한양대학교 의과대학 정형외과학교실) ;
  • 김영호 (한양대학교 의과대학 정형외과학교실) ;
  • 최일용 (한양대학교 의과대학 정형외과학교실)
  • Published : 2010.06.30
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Abstract

Purpose: We evaluated the results of revision total hip arthroplasty using a Wagner revision femoral stem. Materials and Methods: We enrolled 54 patients who underwent hip arthroplasty using a Wagner revision stem between 1996 and 2004. The mean age at revision surgery was 65.4 years and the mean follow up period was 7.2 years. There were 42 aseptic loosenings and 12 periprosthetic fractures. The pre-operative femoral defects were classified according to the Paprosky classification system. Clinical and radiological results were evaluated. Results: The mean Harris hip score improved from 43 preoperatively to 89 at the latest follow up. There were 2 cases with inguinal pain and 1 with thigh pain; in each case pain was reduced by medications. All cases showed endosteal bone formation around the stem. Five cases showed radiolucency in Gruen zones 1 and 7. Six cases had hips that showed subsidence (average=3.1 mm). There was 1 dislocation (1.8%) and 1 intraoperative periprosthetic fracture (1.8%). There were no re-revisions. Conclusion: Use of a Wagner revision femoral stem for revision total hip arthroplasty elicits satisfactory results including stable fixation of the stem, a low rate of subsidence, and a low rate of dislocation.

목적: Wagner 재치환 대퇴 스템을 사용하여 인공 고관절 재치환술을 시행한 후 임상적 및 방사선학적 결과와 스템 침강, 탈구 등의 합병증을 알아보고자 하였다. 대상 및 방법: 1996년 1월부터 2004년 12월까지 Wagner 재치환 대퇴 스템을 이용하여 재치환술을 시행 받은 환자 중 52명, 54예를 대상으로 하였다. 평균 나이 65.4세, 평균 추시 기간은 7.2년이었다. 재치환술의 원인은 무균성 해리 42예, 스템 주위 골절 12예이었다. 대퇴골 결손은 Paprosky 방법으로 분류하고 임상적 및 방사선학적 결과 조사하였다. 결과: Harris 점수는 43점에서 89점으로 향상되었다. 서혜부 통증은 2예, 대퇴부 통증은 1예에서 관찰되었다. 전 예에서 대퇴 스템 원위부의 골내막골 형성이 관찰되었다. 방사선 투과 음영은 zone 1,7에서 5예 관찰되었다. 합병증으로는 수직 침강이 6례에서 관찰되었다. 다른 합병증으로는 탈구 1예, 수술 중 스템 주위 골절 1예 관찰되었고, 재수술을 시행한 예는 없었다. 결론: 심한 근위 대퇴부 골소실이 있거나 삽입물 주위 골절이 있는 재치환술에서 Wagner 재치환 대퇴 스템을 사용하여 스템의 안정고정과, 낮은 침강 정도, 낮은 탈구 발생을 관찰할 수 있었다.

Keywords

References

  1. Roberson JR. Proximal femoral bone loss after total hip arthroplasty. Orthop Clin North Am. 1992;23:291-302.
  2. Gie GA, Linder L, Ling RS, Simon JP, Slooff TJ, Timperley AJ. Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br. 1993;75:14-21.
  3. Gross AE, Allan DG, Lavoie GJ, Oakeshott RD. Revision arthroplasty of the proximal femur using allograft bone. Orthop Clin North Am. 1993;24:705-15.
  4. Paprosky WG, Greidanus NV, Antoniou J. Minimum 10- year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res. 1999;369:230-42. https://doi.org/10.1097/00003086-199912000-00024
  5. Wagner H. Revision prosthesis for the hip joint in severe bone loss. Orthopade. 1987;16:295-300.
  6. Franzen H, Mjoberg B, Onnerfalt R. Early loosening of femoral components after cemented revision. A roentgen stereophotogrammetric study. J Bone Joint Surg Br. 1992;74:721-4.
  7. Engelbrecht DJ, Weber FA, Sweet MB, Jakim I. Longterm results of revision total hip arthroplasty. J Bone Joint Surg Br. 1990;72:41-5.
  8. Kavanagh BF, Ilstrup DM, Fitzgerald RH Jr. Revision total hip arthroplasty. J Bone Joint Surg Am. 1985;67:517-26.
  9. Lee JR, Roh JY. Suh JM. 5-12 year results of femoral revision total hip arthroplasty using the Wagner revision stem. J Korean Orthop Assoc. 2006;41:785-92.
  10. Han CD, Yang IW, Park J. Femoral revision with the Wagner SL revision stem. J Korean Orthop Assoc. 2007;42:241-8. https://doi.org/10.4055/jkoa.2007.42.2.241
  11. Bohm P, Bischel O. Femoral revision with the Wagner SL revision stem : evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am. 2001;83-A:1023-31.
  12. Grunig R, Morscher E, Ochsner PE. Three-to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg. 1997;116:187-97. https://doi.org/10.1007/BF00393708
  13. Bourne RB, Mehin R. The dislocating hip: what to do, what to do. J Arthroplasty. 2004;19:111-4. https://doi.org/10.1016/j.arth.2004.02.016
  14. 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.
  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. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629-32.
  17. Valle CJ, Paprosky WG. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty. J Bone Joint Surg Am. 2003;85-A Suppl:1-6.
  18. Isacson J, Stark A, Wallensten R. The Wagner revision prosthesis consistently restores femoral bone structure. Int Orthop. 2000;24:139-42. https://doi.org/10.1007/s002640000130
  19. Kolstad K, Adalberth G, Mallmin H, Milbrink J, Sahlstedt B. The Wagner revision stem for severe osteolysis. 31 hips followed for 1.5-5 years. Acta Orthop Scand. 1996;67:541-4. https://doi.org/10.3109/17453679608997752
  20. Gutierrez Del Alamo J, Garcia-Cimbrelo E, Castellanos V, Gil-Garay E. Radiographic bone regeneration and clinical outcome with the Wagner SL revision stem: a 5-year to 12-year follow-up study. J Arthroplasty. 2007;22:515-24. https://doi.org/10.1016/j.arth.2006.04.029
  21. Padgett DE, Warashina H. The unstable total hip replacement. Clini Orthop Relat Res. 2004;420:72-9.
  22. Boucher HR, Lynch C, Young AM, Engh CA Jr, Engh C Sr. Dislocation after polyethylene liner exchange in total hip arthroplasty. J Arthroplasty. 2003;18:654-7. https://doi.org/10.1016/S0883-5403(03)00266-3
  23. Weber M, Hempfing A, Orler R, Ganz R. Femoral revision using the Wagner stem: results at 2-9 years. Int Orthop. 2002;26:36-9. https://doi.org/10.1007/s00264-001-0299-z
  24. Sporer SM, Paprosky WG. Femoral fixation in the face of considerable bone loss: the use of modular stems. Clin Orthop Relat Res. 2004;429:227-31. https://doi.org/10.1097/01.blo.0000150120.80409.0d