Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Revision Total Hip Arthroplasty Using Acetabular Reinforcement Ring - Midterm Follow-up Result -

비구 강화 환을 이용한 고관절 비구컵 재치환술의 중기 추시 결과

  • Kwak, Sang-Joon (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Chun, Young-Soo (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Rhyu, Kee-Hyung (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Huh, Dong-Bum (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Yoo, Myung-Chul (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Cho, Yoon-Je (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
  • 곽상준 (경희대학교 의과대학 정형외과학교실) ;
  • 전영수 (경희대학교 의과대학 정형외과학교실) ;
  • 유기형 (경희대학교 의과대학 정형외과학교실) ;
  • 허동범 (경희대학교 의과대학 정형외과학교실) ;
  • 유명철 (경희대학교 의과대학 정형외과학교실) ;
  • 조윤제 (경희대학교 의과대학 정형외과학교실)
  • Published : 2011.09.30
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Abstract

Purpose: To evaluate the clinical and radiographic outcomes of the revision total hip arthroplasty using the acetabular reinforcement ring. Materials and Methods: Thirty-six acetabular revisions were performed in 36 patients with use of the reinforcement ring and structural or morselized allograft, between 1997 and 2005, in thirty-six patients. According to the AAOS classification, thirty-four cases of acetabular defects were Ttype III, and two were Ttype IV. Mean follow-up period after surgery was 7.2 years. Results: The mean Harris hip score was 92.3, which was significantly increased compared with the preoperative score. (p<0.001). There were five failures: a case of aseptic loosening of Muller ring, two cases of infection (5.4%) and two cases of hip dislocation (5.4%). Graft incorporation and bone remodeling occurred successfully in all hips, but in the case of aseptic loosening in which the ring fixation had been inadequate at the time of surgery. The success rate was 91.7% with a mean follow-up of 7.2 years, if the cases of revision or loosening of the component were classified into failure cases. Conclusion: Patients treated with acetabular revision with three kinds of reinforcement ring had reconstitution of periacetabular bone stock as well as good clinical and radiographic results. For the good results, the secure implant fixation during the surgery should be confirmed and we should completely understand the characters of the each kinds of reinforcement rings.

목적: 비구 강화 환(reinforcement ring)을 사용하여 인공 고관절 재치환술을 시행한 후 임상적 및 방사선학적 결과를 분석하고자 하였다. 대상 및 방법: 1997년부터 2005년까지 36명의 환자 36예를 대상으로 비구 강화환과 동종 골이식을 이용하여 비구 재 치환술이 시행되었다. AAOS III형 골 결손이 34예, IV형이 2예였다. 수술 후 평균 추시 기간은 7.2년이었다. 결과: 술전에 비하여 Harris 고관절 점수는 92.3점으로 의미 있게 향상되었다(p<0.001). 1예에서 이식 골과 골반 골 사이의 유합이 되지 않아 비구 컵의 해리가 발생하였고, 감염이 2예(5.4%), 고관절 탈구 2예(5.4%) 발생하였다. 수술 중 비구 강화 환의 부적절한 고정이 이루어진 1예를 제외한 모든 예에서 골 이식은 잘 유합 되었다. 재 치환술이 필요했던 경우와 비구 컵의 해리가 발생한 경우를 재 치환술의 실패로 정의하였을 때 성공률은 91.7%였다. 결론: 비구 강화환을 이용하여 비구 재치환술을 시행받은 환자에서 비구 주위 골재건과, 훌륭한 임상적 및 방사선학적 결과를 보여주었다. 좋은 결과를 얻기 위해서는 수술 시 정확한 삽입물의 삽입이 필요하며, 각각의 비구 강화환의 종류에 따른 특성을 잘 이해하고 시행해야겠다.

Keywords

References

  1. Haentjens P, Handelberg F, Casteleyn PP, Opdecam P. The Müller acetabular support ring. A preliminary review of indications and clinical results. Int Orthop. 1986;10: 223-30. https://doi.org/10.1007/BF00454401
  2. Gill TJ, Sledge JB, Müller ME. The Bürch-Schneider antiprotrusio cage in revision total hip arthroplasty: indications, principles and long-term results. J Bone Joint Surg Br. 1998;80:946-53. https://doi.org/10.1302/0301-620X.80B6.8658
  3. Berry DJ, Müller ME. Revision arthroplasty using an antiprotrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br. 1992;74:711-5.
  4. Schlegel UJ, Bitsch RG, Pritsch M, Clauss M, Mau H, Breusch SJ. Mueller reinforcement rings in acetabular revision: outcome in 164 hips followed for 2-17 years. Acta Orthop. 2006;77:234-41. https://doi.org/10.1080/17453670610045966
  5. Gill TJ, Siebenrock K, Oberholzer R, Ganz R. Acetabular reconstruction in developmental dysplasia of the hip: results of the acetabular reinforcement ring with hook. J Arthroplasty. 1999;14:131-7. https://doi.org/10.1016/S0883-5403(99)90115-8
  6. Gerber A, Pisan M, Zurakowski D, Isler B. Ganz reinforcement ring for reconstruction of acetabular defects in revision total hip arthroplasty. J Bone Joint Surg Am. 2003;85-A:2358-64.
  7. Schatzker J, Wong MK. Acetabular revision. The role of rings and cages. Clin Orthop Relat Res. 1999;369:187-97.
  8. Winter E, Piert M, Volkmann R, et al. Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am. 2001;83-A:862-7.
  9. Schlegel UJ, Bitsch RG, Pritsch M, Clauss M, Mau H, Breusch SJ. Mueller reinforcement rings in acetabular revision: outcome in 164 hips followed for 2-17 years. Acta Orthop. 2006;77:234-41. https://doi.org/10.1080/17453670610045966
  10. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9:33-44. https://doi.org/10.1016/0883-5403(94)90135-X
  11. Winter E, Piert M, Volkmann R, et al. Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am. 2001;83-A:862-7.
  12. Zehntner MK, Ganz R. Midterm results (5.5-10 years) of acetabular allograft reconstruction with the acetabular reinforcement ring during total hip revision. J Arthroplasty. 1994;9:469-79. https://doi.org/10.1016/0883-5403(94)90092-2
  13. Peters CL, Curtain M, Samuelson KM. Acetabular revision with the Burch-Schnieder antiprotrusio cage and cancellous allograft bone. J Arthroplasty. 1995;10:307-12. https://doi.org/10.1016/S0883-5403(05)80179-2
  14. Bierbaum BE: Acetabular revision arthroplasty. In: Turner RH, Scheller AD Jr, ed. Revision total hip arthroplasty, New York: Grune & Stratton; 1982. 42-79.
  15. Korovessis P, Stamatakis M, Baikousis A, Katonis P, Petsinis G. Mueller roof reinforcement rings. Mediumterm results. Clin Orthop Relat Res. 1999;362:125-37.
  16. Oh I, Harris WH. Design concepts, indications, and surgical technique for use of the protrusio shell. Clin Orthop Relat Res. 1982;162:175-84.
  17. Eggli S, Muller C, Ganz R. Revision surgery in pelvic discontinuity: an analysis of seven patients. Clin Orthop Relat Res. 2002;398:136-45.
  18. Paprosky WG, Magnus RE. Principles of bone grafting in revision total hip arthroplasty. Acetabular technique. Clin Orthop Relat Res. 1994;298:147-55.
  19. Gross AE, Allan DG, Catre M, Garbuz DS, Stockley I. Bone grafts in hip replacement surgery. The pelvic side. Orthop Clin North Am. 1993;24:679-95.
  20. Gross AE, Duncan CP, Garbuz D, Mohamed EM. Revision arthroplasty of the acetabulum in association with loss of bone stock. Instr Course Lect. 1999;48:57-66.
  21. Korovessis P, Stamatakis M, Baikousis A, Katonis P, Petsinis G. Mueller roof reinforcement rings. Mediumterm results. Clin Orthop Relat Res. 1999;362:125-37.
  22. Haentjens P, de Boeck H, Handelberg F, Casteleyn PP, Opdecam P. Cemented acetabular reconstruction with the Müller support ring. A minimum five-year clinical and roentgenographic follow-up study. Clin Orthop Relat Res. 1993;290:225-35.
  23. Siebenrock KA, Trochsler M, Sadri H, Ganz R. Hooked roof cup in revision of difficult loose hip prosthesis cups. Results after a minimum of 10 years. Orthopade. 2001;30:273-9. https://doi.org/10.1007/s001320050608