Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Cementless Total Hip Arthroplasty Using a Modular Femoral Component in Patients with Femoral Head Osteonecrosis : Comparison of Metal-on-Metal and Ceramic-on-Ceramic Articulation

대퇴골두 골괴사를 가진 환자에서의 조립식 대퇴주대를 이용한 무시멘트형 고관절 전치환술 - 금속 금속 관절면과 세라믹 세라믹 관절면의 비교 -

  • Kang, Bun-Jung (Department of Orthopaedic Surgery, SM Christianity Hospital) ;
  • Lee, Jue-Hee (Department of ImmunoMicrobiology, College of Pharmacy, Dongduk Women's University) ;
  • Jung, Young-Bok (Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University) ;
  • Kim, Jin-Hong (Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University) ;
  • Han, Yong-Moon (Department of ImmunoMicrobiology, College of Pharmacy, Dongduk Women's University) ;
  • Jang, Eui-Chan (Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University) ;
  • Kim, Kyoung-Woon (Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University)
  • 강번중 (포항 세명기독병원 정형외과) ;
  • 이주희 (동덕여자대학교 약학대학 면역미생물연구실) ;
  • 정영복 (중앙대학교 의과대학 정형외과학교실) ;
  • 김진홍 (중앙대학교 의과대학 정형외과학교실) ;
  • 한용문 (동덕여자대학교 약학대학 면역미생물연구실) ;
  • 장의찬 (중앙대학교 의과대학 정형외과학교실) ;
  • 김경운 (중앙대학교 의과대학 정형외과학교실)
  • Published : 2011.12.31
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to evaluate the clinical and radiological outcomes after total hip arthroplasty using the S-ROM modular system for osteonecrosis of the femoral head, and to compare the results between the groups using metal-on-metal articulation and ceramic-on-ceramic articulation. Materials and Methods: Sixty-six patients (78 hips) with osteonecrosis of the femoral head were evaluated after primary total hip arthroplasty between January 2001 and December 2004, using an S-ROM proximal modular femoral stem. The average follow-up was 77 months (range, 60 to 122 months) and all patients were followed for more than five years. Results: The average Harris hip score improved from 53 points to 88.5 points at the final follow-up. At the latest radiologic evaluation, sixty-seven stems had bony ingrowth stability, and 10 stems had stable fibrous ingrowth. However, one stem had diffuse extensive osteolysis and loosening, which was revised at 9 years. Postoperative complications included 4 cases of heterotrophic ossificiation, 1 case of linear fracture after insertion of the femoral stem, 1 case of dislocation, 2 cases of infection, and 1 case of extensive osteolysis and loosening. There were 3 cases of revision and Kaplan-Meier survivorship analysis with revision estimated at a 95.7% chance of survival for the femoral component during 122 months. Conclusion: Our study showed that total hip arthroplasty using the S-ROM modular system with metal-on-metal articulation or ceramic-on-ceramic articulation had favorable clinical and radiological mid- to long-term results.

목적: 진행된 대퇴골두 골괴사증 환자에서 무시멘트형 조립식 대퇴주대를 이용한 고관절 치환술의 임상적 및 방사선학적 결과를 평가하였으며, 금속-금속 관절면을 사용한 군과 세라믹-세라믹 관절면을 사용한 군 간, 결과에 차이가 있는지를 확인하고자 하였다. 대상 및 방법: 2001년 1월부터 2004년 12월 까지 대퇴골두 골괴사증으로 조립식 대퇴주대를 이용하여 무시멘트형 고관절 치환술을 시행 받았으며, 5년 이상 추시관찰이 가능하였던 66명(78예)을 대상으로 하였고, 술 후 평균 추시 기간은 평균 77개월(60~122개월) 이었다. 결과: 임상적 평가로 술 전 평균 Harris 고관절 점수는 53점에서 최종 추시 시 88.5점으로 향상되었다. 방사선학적 검사 결과에서 대퇴주대의 안정도는 68예에서 골성고정을 얻었으며, 9예에서 섬유성 안정고정, 1예에서 불안정고정을 나타내었다. 재치환술은 3예에서 시행하였으며, 122개월 간 대퇴 스템의 생존율은 95.7%인 것으로 조사되었다. 결론: 진행된 대퇴골두 골괴사증에서 시행한 조립식 대퇴주대를 이용한 무시멘트형 고관절 전치환술은 5년 이상 추시 결과 금속-금속 관절면을 사용한 군과 세라믹-세라믹 관절면을 사용한군, 모두 만족한 만한 임상적 및 방사선학적 결과를 얻었다.

Keywords

References

  1. Ortiguera CJ, Pulliam IT, Cabanela ME. Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term follow-up. J Arthroplasty. 1999;14:21-8. https://doi.org/10.1016/S0883-5403(99)90197-3
  2. Ritter MA, Meding JB. A comparison of osteonecrosis and osteoarthritis patients following total hip arthroplasty. A long-term follow-up study. Clin Orthop Relat Res. 1986;206:139-46.
  3. Saito S, Saito M, Nishina T, Ohzono K, Ono K. Long-term results of total hip arthroplasty for osteonecrosis of the femoral head. A comparison with osteoarthritis. Clin Orthop Relat Res. 1989;244:198-207.
  4. Salvati EA, Cornell CN. Long-term follow-up of total hip replacement in patients with avascular necrosis. Instr Course Lect. 1988;37:67-73.
  5. Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with alumina-on-highly cross-linked polyethylene bearing in young patients with femoral head osteonecrosis. J Arthroplasty. 2011;26:218-23. https://doi.org/10.1016/j.arth.2010.03.010
  6. Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop. 2010;34:1123-7. https://doi.org/10.1007/s00264-009-0878-y
  7. Kim YH, Kim JS, Park JW, Joo JH. Contemporary total hip arthroplasty with and without cement in patients with ssteonecrosis of the femoral head: a concise follow-up, at an average of seventeen years, of a previous report. J Bone Joint Surg Am. 2011;93:1806-10. https://doi.org/10.2106/JBJS.J.01312
  8. Millar NL, Halai M, McKenna R, McGraw IW, Millar LL, Hadidi M. Uncemented ceramic-on-ceramic THA in adults with osteonecrosis of the femoral head. Orthopedics. 2010;33:795.
  9. Buly R. The S-ROM stem: versatility of stem/sleeve combinations and head options. Orthopedics. 2005;28: s1025-32.
  10. Goldstein WM, Branson JJ. Modular femoral component for conversion of previous hip surgery in total hip arthroplasty. Orthopedics. 2005;28:s1079-84.
  11. Spitzer AI. The S-ROM cementless femoral stem: history and literature review. Orthopedics. 2005;28:s1117-24.
  12. Christie MJ, DeBoer DK, Trick LW, et al. Primary total hip arthroplasty with use of the modular S-ROM prosthesis. Four to seven-year clinical and radiographic results. J Bone Joint Surg Am. 1999;81:1707-16.
  13. 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.
  14. Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22:815-21. https://doi.org/10.1016/j.orthres.2003.11.001
  15. Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty. 2002;17: 463-6. https://doi.org/10.1054/arth.2002.32171
  16. Martell JM, Pierson RH 3rd, Jacobs JJ, Rosenberg AG, Maley M, Galante JO. Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. J Bone Joint Surg Am. 1993;75:554-71.
  17. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;257: 107-28.
  18. Latimer HA, Lachiewicz PF. Porous-coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg Am. 1996;78:975-81.
  19. Engh CA, Hooten JP Jr, Zettl-Schaffer KF, et al. Porouscoated total hip replacement. Clin Orthop Relat Res. 1994;298:89-96.
  20. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20-32.
  21. 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.
  22. 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.
  23. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457-81. https://doi.org/10.1080/01621459.1958.10501452
  24. Brinker MR, Rosenberg AG, Kull L, Galante JO. Primary total hip arthroplasty using noncemented porous-coated femoral components in patients with osteonecrosis of the femoral head. J Arthroplasty. 1994;9:457-68. https://doi.org/10.1016/0883-5403(94)90091-4
  25. Cornell CN, Salvati EA, Pellicci PM. Long-term follow-up of total hip replacement in patients with osteonecrosis. Orthop Clin North Am. 1985;16:757-69.
  26. Haddad RJ, Cook SD, Brinker MR. A comparison of three varieties of noncemented porous-coated hip replacement. J Bone Joint Surg Br. 1990;72:2-8.
  27. Taylor AH, Shannon M, Whitehouse SL, Lee MB, Learmonth ID. Harris Galante cementless acetabular replacement in avascular necrosis. J Bone Joint Surg Br. 2001;83:177-82. https://doi.org/10.1302/0301-620X.83B2.11419
  28. Yoo MC, Cho YJ, Kim KI, et al. Long term follow up study of cementless total hip arthroplasty for osteonecrosis of the femoral head: minimum 10-year follow up study. J Korean Hip Soc. 2004;16:1-9.
  29. Han CD, Choi WS, Lee WS, Cho JH. Cementless total hip arthroplasty for osteonecrosis in patients forty-five years old and less:minimum 5-year follow-up result. J Korean Hip Soc. 1999;11:134-41.
  30. Willert HG, Buchhorn GH, Fayyazi A, et al. Metal-onmetal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 2005;87:28-36.
  31. Davies AP, Willert HG, Campbell PA, Learmonth ID, Case CP. An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am. 2005;87:18-27. https://doi.org/10.2106/JBJS.C.00949
  32. 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.
  33. Park YS, Moon YW, Lim SJ, Yang JM, Ahn G, Choi YL. Early osteolysis following second-generation metal-onmetal hip replacement. J Bone Joint Surg Am. 2005;87: 1515-21. https://doi.org/10.2106/JBJS.D.02641
  34. Bourne RB, Rorabeck CH, Ghazal ME, Lee MH. Pain in the thigh following total hip replacement with a porouscoated anatomic prosthesis for osteoarthrosis. A five-year follow-up study. J Bone Joint Surg Am. 1994;76:1464-70.