Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Analysis of Failure Cause of Acetabular Components Among Total Hip Replacement Arthroplasties Using RB Wagner Acetabular Cup

무시멘트 Wagner 비구 컵을 이용한 인공 고관절 치환술에서 비구컵 실패의 원인 분석

  • Kim, Young-Chang (Department of Orthopaedic Surgery, College of Medicine, Inje University, Haeundae Paik Hospital) ;
  • Kim, Young-Bok (Department of Orthopaedic Surgery, College of Medicine, Inje University, Haeundae Paik Hospital) ;
  • Park, Dae-Hyun (Department of Orthopaedic Surgery, College of Medicine, Inje University, Busan Paik Hospital) ;
  • Moon, Sang-Won (Department of Orthopaedic Surgery, College of Medicine, Inje University, Busan Paik Hospital)
  • 김영창 (인제대학교 해운대 백병원 정형외과학교실) ;
  • 김영복 (인제대학교 해운대 백병원 정형외과학교실) ;
  • 박대현 (인제대학교 부산 백병원 정형외과학교실) ;
  • 문상원 (인제대학교 부산 백병원 정형외과학교실)
  • Published : 2010.06.30
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Abstract

Purpose: The purpose of this study was to analyze the cause of failure of acetabular component cases after metal-onmetal primary total hip arthroplasty using RB Wagner acetabular cup. Materials and Methods: Between January 1993 and January 2005, we retrospectively studied failure cause of 27patients who underwent acetabular revision surgery among 468 consecutive cementless total hip arthroplasties using RB Wagner acetabular component. The duration of primary arthroplasty to revision ranged from 5.1 years to 11.5 years (mean 9.2 years). The clinical evaluation was performed using preoperative and last follow-up modified Harris hip scores. The radiological evaluation was performed in terms of the stability, such as inclination, anteversion, cup size, acetabular bone coverage, osteolysis, radiolucency and gap. Results: The average Harris hip scores was 49.6 preoperatively and 91.3 at the most recent follow-up. In revision cases, the score was 41.2 to 51.7. Among 468 cases, 27 patients underwent revision surgery (7%, 27/468) and there was no osseointegration in all cases. The radiological evaluation in revision cases revealed inclination ($46.04{\pm}5.328$, p=0.0031), anteversion ($14.14{\pm}2.95$, p=0.584), cup size ($54mm{\pm}2.5$, p=0.042) and acetabular bone coverage ($67.9%{\pm}4.77$, p=0.003). Focusing on the relation between disease entities, there was relatively high risk in patients with hip dysplasia (Fisher's exact test, p=0.0095). Conclusion: Although Wagner acetabular cup relatively showed as high survival rate as 93%, failure rate is significantly high in dysplastic hip patients.

목적: 무시멘트 Wagner 비구 컵을 이용한 금속 대 금속 인공 고관절 치환술 후 비구컵 실패의 원인에 대해서 연구해 보고자 한다. 대상 및 방법: 1993년 1월부터 2005년 1월까지 본원에서 무시멘트 Wagner cup을 이용하여 무시멘트형 인공 고관절 치환술을 시행한 468예 가운데 비구컵 재치환술을 시행한 27명의 비구컵재치환 원인을 분석하였다. 일차 인공 고관절 치환술 후 비구컵 재치환까지는 5.1년에서 11.5년(평균 9.2년) 사이에서 시행되었다. 임상적 평가는 술 전 및 최종 추시 시 시행한 modified Harris hip scores를 이용하였고, 방사선학적으로는 골반 경사, 전향각, 컵의 크기, 비구 골 피복(acetabular bone coverage), 골용해 등을 이용하여 안정성을 평가하였다. 결과: Harris hip scores는 술 전 49.6에서 최종 추시 시 91.3, 비구컵 재치환술을 시행한 군에서는 술 전 41.2에서 최종 추시 시 51.7로 관찰되었다. 468예 가운데 27명의 환자에서 비구컵 재치 환술이 시행되었으며 모든 예에서 골결합은 관찰되지 않았고, 방사선학적으로 골반 경사($46.04{\pm}5.328$, p=0.0031), 전향각($14.14{\pm}2.95$, p=0.584), 컵 크기($54mm{\pm}2.5$, p=0.042) 그리고 비구 골 피복($67.9%{\pm}4.77$, p=0.003) 으로 관찰되었다. 질환에 따른 상관 관계를 평가하였을 때, 고관절 이형성증에서 상대적으로 높은 비구컵 재치환술의 위험성이 발견되었다(Fisher's exact test, p=0.0095). 결론: 무시멘트 Wagner cup은 93%의 비교적 높은 생존율을 보이지만 고관절 이형성증에서는 통계적으로 유의한 실패율을 보였다.

Keywords

References

  1. Wiles PW. The surgery of the osteoarthritic hip. Br J Surg. 1958;45:488-97. https://doi.org/10.1002/bjs.18004519315
  2. Chan FW, Bobyn JD, Medley JB, Krygier JJ, Yue S, Tanzer M. Engineering issue and wear performance of metal on metal hip implants. Clin Orthop Relat Res. 1996;333:96-107.
  3. Renawat CS, Deshmukh RG, Peters LE, Umlas ME. Prediction of the long-term durability of all-polyethylene cemented sockets. Clin Orthop Relat Res. 1995;317:89-105.
  4. Dowdy PA, Rorabeck CH, Bourne RB. Uncemented total hip arthroplasty in patients 50 years of age or younger. J Arthroplasty. 1997;12: 853-62. https://doi.org/10.1016/S0883-5403(97)90154-6
  5. Fye MA, Huo MH, Zatorski LE, Keggi KJ. Total hip arthroplasty performed without cement in patients with femoral head osteonecrosis who are less than 50 years old. J Arthroplasty. 1998;13:876-81. https://doi.org/10.1016/S0883-5403(98)90193-0
  6. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737-55.
  7. Schmalzried TP, Harris WH. The Harris-Galante porouscoated acetabular comoponent with screw fixation. Radiographic analysis of eighty-three primary hip replacements at a minimum of five years. J Bone Joint Surg Am. 1992;74:1130-9.
  8. Kim SY, Kyung HS, Ihn JC, Cho MR, Koo KH, Kim CY. Cementless Metasul metal-on-metal total hip arthroplasty in patients less than fifty years old. J Bone Joint Surg Am. 2004;86-A:2475-81.
  9. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20-32.
  10. 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.
  11. Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res. 1970;72:7-21.
  12. Morscher E, Schmassmann A. Failures of total hip arthroplasty and probable incidence of revision surgery in the future. Calculations according to a mathematical model based on a ten years'experience in total hip arthroplasty. Arch Orthop Trauma Surg. 1983;101:137-43. https://doi.org/10.1007/BF00433274
  13. Bra-nemark PI, Zarb GA, Albrektsson T, Rosen HM. Tissue-integrated prostheses. Osseointegration in clinical dentistry. Plastic and Reconstructive Surgery. 1986;77:496-97. https://doi.org/10.1097/00006534-198603000-00037
  14. Albrestsson T, Albrestsson B. Osseointegration of bone implants. A review of an alternative mode of fixation. Acta Orthop Scand. 1987;58:567-77. https://doi.org/10.3109/17453678709146401
  15. Uhthoff HK. Mechanical factors influencing the holding power of screws in compact bone. J Bone Joint Surg Br. 1973;55:633-9.
  16. Schatzker J, Horne JG, Sumner-Smith G. The effect of movement on the holding power of screws in bone. Clin Orthop Relat Res. 1975;111:257-62. https://doi.org/10.1097/00003086-197509000-00032
  17. Bruijin JD, Seelen JL, Feenstra RM, Hansen BE, Bernoski FP. Failure of the Mecring screw-ring acetabular component in total hip arthroplasty. A three to seven-year follow-up study. J Bone Joint Surg Am. 1995;77:760-6.
  18. Linder L, Carlsson A, Marsal L, Bjursten LM, Branemark PI. Clinical aspects of osseointegration in joint replacement. A histological study of titanium implants. J Bone Joint Surg Br. 1988;70:550-5.
  19. Anderson MJ, Harris WH. Total hip arthroplasty with insertion of the acetabular component without cement in hips with total congenital dislocation or marked congenital dysplasia. J Bone Joint Surg Am. 1999;81:347-54.
  20. Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am. 2004;86-A:242-50.
  21. Jasty M, Anderson MJ, Harris WH. Total hip replacement for developmental dysplasia of the hip. Clin Orthop Relat Res. 1995;311:40-5.
  22. Merican AM, Randle R. Early clinical and radiographic analysis of the Fitmore cup. J Arthroplasty. 2006;21:846-51. https://doi.org/10.1016/j.arth.2005.09.011
  23. Demmelmeyer U, Schraml A, Honle W, Schuh A. Longterm results of the standard Wagner cup. Int Orthop. 2010;34:33-7. https://doi.org/10.1007/s00264-009-0766-5