시멘트와 무시멘트 고관절 전치환술 후의 골소실

황성관 ( Sung Kwan Hwang ),박기홍 ( Ki Hong Park ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.2

Osteolysis and aseptic loosening do occur not only in cemented total hip arthroplasties but also in cementless ones. Recently, osteolysis became the main concern in total hip arthroplasty. Numerous articles, proving particulate debris, such as, polyethylene, PMMA, and metal particles can induce osteolysis, have been published. We examined ten hips which had received either cemented or cementless hip arthroplasty. We examined osteolytic lesions radiographically and microscopically and tried to find out the differences in biopsy findings between osteolytic lesions after cemented and cementless arthroplasty. The results were as follows 1) Acetabular osteolysis occurred in 4 hips with cemented total hip arthroplasty, and two hips with cementless one. 2)Femoral ostelysis developed in 4 hips with cemented total hip arthroplasty, and three hips with cementless one. 3) A similar histopathologic findings of foreign body reactions in cemented and cementless arthmplasty were found. 4) A foreign body reaction is stronger in cemented arthroplasty than cementless arthroplasty. 5) The polyethylene was a main source of osteolysis in both cemented and cementless arthroplasty. 6) The foregin body reaction was found in all lesions of osteolysis after cemented and cementless arthroplasties, the inflammatory reaction was considered as cell-mediated immune reaction.

65세이상 환자에서 시행한 무시멘트 고관절 전치환술

황성관 ( Sung Kwan Hwang ),이우용 ( Woo Young Lee ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1

Aseptic loosening of the components has been the most significant and frequent long term problems in cemented total hip arthroplasty. Recently some surgeons, such as Harris", has improved the function of the cemented total hip prostheses by centrifuging of the cement and improvement of the techniques for cementing. Other surgeons, such as Engh," started to use cementless components to achieve direct bonding between the component and surrounding bone by biological ingrowth. In older age group (65 years of age or older), cemented total hip arthroplasty has been the gold standard and the results are excellent. However, during performing cemented total hip arthroplasty, a few serious medical complications, such as hypotension and rarely cardiac arrest, may occur. The anesthesia and operation time may be longer in cemented total hip arthroplasty than those of cementless ones. The purpose of this study was to find any differences in clinical and radiologic results between cementless femoral stom and cemented femoral stem. We performed total hip arthroplasties in 82 patients who were 65 years of age or older from May 1985 to December 1990. Thirty-five(39 hips) patients who could be followed more than 2 years were included for this study. Twenty-three patients(25 hips) had cementless total hip arthroplasty and 12 patients(14 hips) had hybrid total hip arthroplasty. We could not find any significant differences in results between hybrid and cementless total hip arthroplasty.

Cementless 인공관절 전치환술에서 수술중 발생하였던 대퇴거(Calcar Femorale)부위 골절

이창주 ( Chang Ju Lee ),장준동 ( Jun Dong Chang ),조원호 ( Won Ho Cho ),장호근 ( Ho Geun Chang ),이영호 ( Young Ho Lee ) 대한고관절학회 1995 Hip and Pelvis Vol.7 No.2

The purposes of this study are to document the effect of the undisplaced intra-operative fracture of the calcar area during primary cementless total hip arthroplasty and to compare the clinical result of primary cementless total hip arthroplasty in patients who sustained an intraoperative fracture of the calcar area with an unfractured control group. 7wenty-two patients of intraoperative undisplaced fracture of calcar area during cementless total hip arthroplasty matched by age, sex, diagnosis, type of the prosthesis, and length of follow-up were compared with 22 patients who had cemetless total hip arthroplasty without fracture. The fractutes were managed with the application of one or two cerclage wires with stability test. No statistically significant difference was found in clinical or radio- graphic results after cementless total hip arthroplasty between the calcar fracture group and control group. If initial stability of the implant is satisfactory, despite of intraoperaive fracture, good clinical results can be expected with cementless total hip arthroplasty. The subsidence of femoral stem and the unstable fixation/stability were noted in three hips of which the diagnosis was Stage IIIC or IV avascular necrosis of femoral head.

무시멘트형 인공고관절 전치환술에서 내반 삽입된 대퇴 스템의 임상적 결과

김성곤(Sung Kon Kim),박종웅(Jong Woong Park),왕준호(Jun Ho Wang),한정우(Jeong Woo Han),송준엽(Jun Yeop Song) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.5

목적: 무시멘트 근위부 고정형 인공고관절전치환술 후 내반 고정된 스템이 치료결과에 미치는 영향을 평가하고자 하였다. 대상 및 방법: 무시멘트 근위부 고정형 인공고관절전치환술을 시행한 136명의 환자 144예 중 내반 고정된 21예를 대상으로 나머지 중립위로 고정된 123예와 임상적 및 방사선학적으로 비교 분석하였다. 임상적 평가는 대퇴부동통 및 Harris Hip Score에 의거하였으며, 방사선학적으로는 Gruen 구역에 따른 방사선 음영감소, pedestal formation, 대퇴골 비후 및 위축, 골내측 신생골 형성, 침강 등의 해리 및 골 용해 소견과 스템 골절 여부를 관찰하였다. 결과: 내반 고정된 경우 대퇴부동통 1예, Harris Hip Score 평균 96점이었으며 중립 고정된 경우 대퇴부 동통은 6예, Harris Hip Score 평균 97점이었다. 방사선학적으로 내반 고정된 경우 대퇴 스템의 해리나 스템 골절의 소견 없었으며, 국소적 골용해소견 1예, 대퇴골 골막비후 1예, 비진행성방사선음영감소 2예 관찰되었다. 중립위의 경우 대퇴 스템의 해리 나 스템 골절의 소견 없었고, 국소적 골용해소견 8예, 대퇴골 골막비후 9예, 비진행성 방사선음영감소 7예 관찰되었다. 결론: 무시멘트 근위부 고정형 인공고관절전치환술에서 내반 고정된 대퇴스템의 경우 중립위와 비교하여 임상적으로나 방사선학적으로 치료 결과에 차이가 없었다. Purpose: This study examined the effect of a varus positioned femoral stem after cementless proximal fitting total hip arthroplasty. Materials and Methods: A total of 144 hips in 136 patients who underwent cementless total hip arthroplasty, were followed-up. Twenty-one varus positioned hips were compared with 123 neutral positioned hips. The clinical results were analyzed according to the level of thigh pain and the Harris Hip score. The radiological outcome was assessed according to osteolysis, loosening and stem failure. Results: In the varus positioned hips, thigh pain was present in 1 hip, and the average Harris Hip Score was 96 points. None of the implants showed radiological evidence of loosening or impending failure. Localized osteolysis was identified in 1 hip, non-progressive radiolucencies in 2 hips, and cortical hypertrophy in 1 hip. In the neutral positioned hips, thigh pain was present in 6 hips, and the average Harris Hip Score was 97 points. Localized osteolysis was identified in 8 hips, non-progressive radiolucencies in 7 hips, cortical hypertrophy in 9 hips. Conclusion: Patients with varus alignment of the stem did not present poorer clinical outcomes than those with neutral alignment of the stem.

고관절 이형성증에서 시행한 무시멘트형 인공 고관절 전치환술

김대희 ( Dae Hee Kim ),임채현 ( Chae Hyun Lim ),안상호 ( Sang Ho Ahn ),김민욱 ( Min Wook Kim ),정영율 ( Young Yool Chung ) 대한고관절학회 2012 Hip and Pelvis Vol.24 No.1

목적: 비구 이형성증 환자에서 무시멘트형 삽입물을 이용한 인공 고관절 전치환술을 시행하고 장기 추시하여 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 1990년 7월부터 2008년 5월까지 본원에서 비구 이형성증으로 인공 고관절 전치환술을 받은 환자 35명 39예 중 사망한 4명을 제외한 35예를 대상으로 하였다. 추시 기간은 평균 103.7개월 이었다. 여자가 24명 27예, 남자가 7명 8예 이었으며 평균 연령은 55.7세(29-80세)이었다. Crowe 1형이 26예, 2형이 8예, 4형이 1예이었다. 술 후 방사선 사진에서 눈물 방울 선을 기준하여 비구컵의 삽입 위치와 각도를 측정하였으며, 비구골과 비구컵의 접촉률을 구하였다. 임상적 결과는 해리스 고관절 점수를 이용하였다. 삽입물의 생존율은 재치환을 기준으로 구하였다. 결과: 술 전 해리스 고관절 점수는 평균 55.1점이었으며, 최종 추시에서 평균 86.1점 이었다. 재치환술은 12예(33.3%)에서 시행하였으며, 10예에서 비구컵을 재치환 하였으며 2예에서는 폴리에틸렌 라이너 만 교체하였다. 결론: 고관절 이형성증에서 시행한 인공관절 치환술은 수산화인회석 피복 비구컵을 제외한 무시멘트형 비구컵은 비구골과 70%이상의 접촉률을 얻으면 좋은 임상적 및 방사선학적 결과를 얻었다. Purpose: To evaluate the clinical and radiological results after cementless total hip arthroplasty in dysplastic hips. Materials and Methods: This study included 36 cases that underwent total hip arthroplasty using a cementless prosthesis in our hospital from July 1990 to May 2008. The average time of of follow-up was 103.7 months. In total, 27 cases about 24 patients were women, and 8 cases about 7 patients were men. The average age at the time of operation was 55.7 years (29-80 years). In total, 26 cases were Crowe type I and 8 cases were Crowe type II. One case was Crowe type IV. Acetabular cup angles and the contact ratio between the acetabular cup and the host bone were measured, and the grafting bone was observed for absorption in the follow-up radiographs. Revision of components was defined as a failure. Results: Harris hip score was improved from 55.1 points pre-operatively to 86.1 points in the last follow-up. Revision was done in 12 cases (33.3%). Altogether, 10 cases revised the acetabular cup for osteolysis and polyethylene wear and 2 cases exchanged a polyethylene liner for only liner wear. Conclusion: Total hip arthroplasty in the dysplastic hip using a cementless acetabular cup, not a hydroxyapatite-coated acetabular cup, showed good clinical and radiological results when the contact ratio between acetabular cup and bone was above 70%.

일차성 골관절염과 대퇴골두 무혈성 괴사에 시행한 무시멘트형 인공 고관절 전 치환술의 결과 비교

김주오 ( Ju Oh Kim ),박봉주 ( Bong Ju Park ),조홍만 ( Hong Man Cho ),김주한 ( Ju Han Kim ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.3

목적: 무시멘트형 인공 고관절 전치환술을 일차성 골관절염과 대퇴골두 무혈성 괴사에 시행한 후 비구컵 및 대퇴 스템의 임상적, 방사선학적 결과를 비교하고자 하였다. 대상 및 방법: 1992년 3월부터 2001년 5월까지 무시멘트형 인공 고관절 전치환술을 시행한 환자 중 일차성 골관절염과 대퇴골두 무혈성 괴사로 수술하여 최소 8년 이상 추시가 가능하였던 84예를 대상으로 하였다 환자를 골관절염군과 무혈성 괴사군으로 나누고 A, B군으로 분류하였다. A군은 38예, B군은 46예 였다. 임상적 평가는 Harris Hip Score를 기준으로 하였고, 방사선학적 평가로 골용해와 비구부 이완 등을 관찰하였으며 통계학적으로 분석하였다. 결과: Harris Hip Score는 최종 추시상 평균 92.1와 91.2 (p=0.483)였고, 비구부 골용해는 9예와 15예(p=0.671) 였으며, 비구컵의 수직이동이 1예와 3예 였다. 8예와 7예의 합병증(p=0.572)이 발생 하였고 이중 4예와 5예에서 재치환을 시행하였으며 두군의 생존률 분석에 유의한 차이는 없었다(p=0.969). 결론: 일차성 골관절염 군과 대퇴 골두 무혈성 괴사군에서 시행한 무시멘트 인공 고관절 전치환술에서 비구컵과 대퇴 스템의 임상 및 방사선학적 결과는 차이를 보이지 않았다. 그러나 폴리에틸렌 라이너의 마모와 골 용해등의 문제는 높은 발생율을 보여 향후 이에 대한 더 많은 연구가 필요할 것으로 생각된다. Purpose: Cementless total hip arthroplasty was performed to treat primary osteoarthritis of the hip and avascular necrosis of the femoral head. The clinical and radiological results of the acetabular cups and femoral stems were compared. Materials and Methods: The subjects were 84 cases who underwent primary cementless total hip arthroplasty from March 1992 to May 2001. The 84 cases were followed up for at least eight years. The patients were divided into the following two groups: group (A), 38 cases of degenerative osteoarthritis of the hip; and group (B), 46 cases of avascular necrosis of the hip. The clinical evaluation was conducted based on the Harris Hip Score (HHS). A radiological assessment was performed to determine if osteolysis or acetabular loosening had occurred. The results were analyzed statistically. Results: The postoperative HHS of groups A and B at the final follow-up were 92.1 and 91.2, respectively (p=0.483). The radiological results revealed 9 and 15 cases of acetabular osteolysis (p=0.671) and 1 and 3 cases of vertical migration of the acetabular cups in the group A and B, respectively. Eight and 7 complications (p=0.572) were encountered in group A and B, respectively. Among these, 4 and 5 cases of revisional total hip arthroplasty were performed in group A and B, respectively. The results of survival analysis were similar in the two groups (p=0.969). Conclusion: The clinical and radiological features of the acetabular cups and stems were similar in the two groups. Nevertheless, further studies will be needed due to the high rate of polyethylene liner wear and osteolysis around the acetabular cups or femoral stems.

근위조립형 무시멘트 대퇴스템을 이용한 인공관절 재치환술

박명식 ( Myung Sik Park ),임영진 ( Yung Jin Lim ),이주홍 ( Ju Hong Lee ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.1

목적: 인공고관절 재치환술에 있어서 근위조립형 무시멘트 스템(Link MP hip reconstructive system)을 이용한 결과를 임상적 방사선학적 분석을 하고자 한다. 대상 및 방법: 1997년 1월부터 서 2002년 12월까지 인공관절 재치환술을 받은 환자 95명을 대상으로 하여 최소 24개월 최대 8년 4개월 이상 추시가 가능 하였던 57명 (57례)을 대상으로 하였다. 재치환술의 원인으로는 무균성이완이 45례, 감염성 이완으로 재-재치환경우가 5례, 대퇴스템과 관련된 골절이 6례, 재발성 탈구가 1례였다. 골결손의 정도는 Paprosky 분류에 의거하였으며 IIIA 이하가 46례, IIIB 이상이 11례였다. 결과: Harris hip score는 술 전 47에서 87.6으로 향상되었으며, 최종 추시상 환자의 만족도는 87.7%이며 원위 대퇴스템의 골형성에 의한 고정은 94.7%에서 관찰되었으며. 수술 중 합병증은 대전자부 골절 2례, 근위 대퇴골 골절이 2례였으며, 수술 후 합병증으로는 대퇴스템 침강이 5례(0-5 mm in 2hips, >20 mm in 3 hips), 심부 감염이 4례에서 관찰 되었으며, 대전자부 불유합과 동반된 아탈구 1례, 절골술 부위 불유합이1례, 고정나사의 이완이 1례에서 관찰 되었다. 근위-원위부품 모두 재치환은 20 mm이상 침강을 보인 3례중 2례에서 시행되었으며. 근위부품만을 교환한 경우는 3례로 불유합과 전자부 전위가 2례, 고정나사 이완1례였다. 최종추시상 대퇴스템 원위골절의 발생은 없었다. 결론: 인공관절 재치환술에서 근위 조립형 대퇴스템은 전염각 조정과 하지 길이의 조정이 편리하며, 감염 시 원위부 스템을 유지 한 채로 근위부만 단계적인 치환을 할 수 있었다. 조립형 재치환스템은 근위 대퇴골의 소실이 있는 증례에서 유용하게 사용 되었으며 보다 성공적인 결과를 얻기 위하여서는 섬세한 수술 수기와 합병증의 예방이 중요 할 것으로 사료 된다. Purpose: The goal of study was to evaluate the clinical and radiographic performance of the proximal modular cementless femoral stem for use in revision total hip arthroplasty. Material and method: Fifty seven patients (57 hips) were followed for longer than 24 months or up to 8.4 years after performing revision total hip arthroplasty with using the proximal modular cementless femoral stem between January 1997 and December 2002. The preoperative diagnosis included 45 cases of aseptic loosening, 5 cases of septic loosening (re-revision operation), 6 cases of periprosthetic fracture and 1 case of recurrent dislocation. The bone deficiencies were classified according to the Paprosky classification: there were 27 cases of Type I and II, 19 cases of Type IIIA, 9 cases of Type IIIB and 2 cases of Type IV. Results: The average Harris hip score improved from 47 to 87.6. Clinically satisfactory results were noted in 50 patients (87.7%). Radiographically, distal stable fixation was observed in 54 patients (94.7%). Intraoperative complications included two greater trochanteric fractures and two proximal femur fractures. Postoperative complications included 5 femoral stem subsidences (2hips< 5mm, 3 hips>20mm), 4 deep infections, 2 non-unions of the greater trochanter and the osteotomy site and set screw dissociation was noted in 1 case. 5 proximal component changes were done due to progressive subsidence in two cases, non-union at the osteotomy site and trochanteric displacement in two cases and set screw dissociation in one hip. For the infection cases, the proximal segment was removed and re-revised with a 2nd stage operation. (Ed note: check this.) The subsidence of the femoral stems was showed in 3 Paprosky grade IIIA cases and in 2 cases of grade IIIB or more. There was no postoperative periprosthetic fracture observed at the last follow-up. Conclusion: Revision total hip arthroplasty using the proximal modular cementless femoral stem showed good results in the face of the infection of the proximal component and deficient proximal bony support. This procedure appears to be convenient for the surgeon to correct anteversion of the femoral head and leg length discrepancy.

실패한 무시멘트형 양극성 고관절 반 치환술 및 고관절 전 치환술 주위조직으로부터 추출한 폴리에틸렌 마모세편의 비교 분석

황득수 ( Deuk Soo Hwang ),정제택 ( Je Taek Jeong ),이광진 ( Kwang Jin Rhee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

Many researchers have been reported wear mechanism of bipolar hip endoprostheses. i.e. Persistent cyclic impingement of the stem neck on the rim of the polyethylene liner has been widely accepted main mechanism. Also some authors have been described larger amounts and sizes of polyethylene wear debris in the bipolar hemiarthroplasty than total hip arthroplasty. But the relative roles of particle shape, size and number and wear mechanisms remain unclear. The purpose of present study is to isolate and characterize polyethylene wear debris around periprosthetic tissues in both cementless bipolar and total hip arthroplasty and compare polyethylene particles(size, number and shape). From 1994 to 1997, revision of eleven hips performed and isolated polyethylene particles retrieved from periprosthetic tissues. Five hips of revised hips had underwent cementless bipolar hemiarthroplasty and six hips cementless total hip arthroplasty before revision surgery. Polyethylene particles were isolated by digestive enzymes(Papain buffer) and KOH and subsequentiy examined by scanning electron microscopy(SEM). The results were followings: 1) Total hip arthroplasty group showed larger amounts and sizes of the polyethylene particles than bipolar group, but not different in shapes. 2) All the revised hips showed more substantial wear of the bearing surface of the polyethylene liner than circumferential wear of the polyethylene insert rims. Indeed, bearing surface wear could be play an another important role in aseptic loosening as well as impingement in bipolar hemiarthroplasty. Therefore we should be consider implants design and other factors producing polyethylene wear debris.

Ceramic-ceramic 관절면을 이용한 무시멘트 고관절 전치환술의 단기 추시

최원식 ( Won Sik Choi ),안재훈 ( Jae Hoon Ahn ),나규현 ( Kyu Hyun Na ),김승권 ( Seung Kwon Kim ) 대한고관절학회 2007 Hip and Pelvis Vol.19 No.1

목적: 세라믹-세라믹 관절면을 가진 고관절 전치환술을 시행하고 그 단기 결과를 분석하고자 하였다. 대상 및 방법: 세라믹-세라믹 관절면을 가진 무시멘트 고관절 전치환술을 시행하였던 환자 중 2년 이상 추시 가능하였던 142례를 대상으로 하였다. 평균 연령은 58.3세, 평균 추시 기간은 3.0년이었다. 평가는 Harris hip score와 서혜부 및 대퇴 통증 및 방사선학적인 각종 지표를 이용하여 분석하였다. 결과: 평균 Harris hip score는 수술 전 58.1점에서 최종 추시 시 93.2점으로 상승하였고, 최종 추시 시 임상적으로 유의한 통증은 4례(2.8%)에서 있었다. 추시 방사선 사진상 대퇴 삽입물은 전례에서 안정성을 유지하였다. 비구컵의 안정성은 2례(1.4%)에서 경사도가 유의하게 변화하여 해리로 진단되었다. 방사선 투과선은 대퇴측에서 9례(6.3%), 비구측에서 3례(2.1%)에서 보였으며, 골내막 신생골 형성은 대퇴측에서 50례(35%), 비구측에서 55례(38.5%)에서 각각 관찰되었다. 골용해는 대퇴측과 비구측에서 모두 발생하지 않았다. 결론: 세라믹-세라믹 관절면을 이용한 무시멘트 고관절 전치환술의 단기 추시상에서 골용해 없이 우수한 결과를 얻을 수 있었다. Purpose: This study evaluated the short-term results of ceramic articulation total hip arthroplasty in cementless total hip arthroplasty. Materials and Methods: 142 hips were followed-up for more than 2 years after cementless total hip arthroplasty using ceramic-on-ceramic articulation. The mean age and follow-up period was 58.3 years and 3.0 years, respectively. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using various radiological indices. Results: At the last follow-up, the Harris hip score improved from 58.1 points preoperatively to 93.2 points postoperatively. There were 4 cases (2.8%) of significant hip pain. Radiologically, all the stems demonstrated stable fixation. The inclination of the acetabular cup was changed significantly in 2 cases (1.4%), which were diagnosed as being loosened. A radiolucent line was observed around the stem in 9 cases (6.3%), and around the cup in 3 (2.1%). Endosteal new bone formation was observed around the stem in 50 cases (35%), and around the cup in 55 (38.5%). No osteolysis was observed around the stem and the cup. Conclusion: The short-term results of ceramic on ceramic articulation hip arthroplasty were excellent without osteolysis.

36 mm 골두를 사용한 Ceramic - Ceramic 무시멘트 인공 고관절 전치환술 -3년 이상 추시 결과-

주석규 ( Suk Kyu Choo ),오형근 ( Hyoung Keun Oh ),유시훈 ( Si Hoon Yoo ),남지호 ( Ji Ho Nam ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.2

목적: 36 mm 대퇴골두를 사용한 무시멘트 세라믹-세라믹 관절면 고관절 전치환술을 시행하고 임상적 및 방사선학적 결과를 분석 하였다. 대상 및 방법: 36 mm 대퇴 골두를 사용한 무시멘트 세라믹-세라믹 관절면 고관절 전치환술을 시행 받은 40명, 43예를 대상으로 하였다. 평균 연령은 56세(28-82세)였으며 평균 추시 기간은 5.3년(3-7.5년)이었다. 임상적 추시로서 Harris 고관절 점수와 통증의 정도, 운동범위를 수술 후 3년에 확인 하였고, 방사선학적 추시 및 합병증을 확인하였다. 결과: Harris 고관절 점수는 수술 전 43.4점(21-57점)에서 수술 후 3년에 88.1점(81-95점)으로 상승하였다. 고관절 운동범위는 평균 굴곡 113°, 외전 30°, 내전 24°, 외회전 36°, 내회전 12°였다. 주관적 통증은 전례에서 없거나 미미한 정도였다. 합병증으로 낙상으로 인한 탈구가 발생된 경우는 1예가 있었으며 비관혈적 정복술을 시행하였다. 이외 세라믹의 골절은 없었으며 1예에서 감염이 발생하였다. 결론: 36 mm 대퇴골두를 사용한 무시멘트 세라믹-세라믹 관절면 고관절 전치환술은 최소 3년 추시에서는 임상적, 방사선학적으로 만족한 결과를 보였으며 장기적인 경과관찰이 필요할 것으로 판단된다. Purpose: The purpose of this study was to analyze the results for clinical outcome and radiologic assessment of ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head. Materials and Methods: This study included a group of 40 patients of 43 cases who underwent ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head. The age range of this group was 28 to 82(mean 56); we monitored them over a period of 5.3 years(3-7.5 years). This clinical evaluation process included monitoring the degree of pain, range of motion, and the Harris hip score after three years since the surgery was performed. Radiographic evaluation and complication were confirmed as well. Results: The preoperative Harris hip score increased from 43.4(21-57) to 88.1(81-95) after the surgery. The average motion range of hip was 113° flexion, 30° abduction, 24° adduction, 36° external rotation, and 12° internal rotation. Subjective pain was zero or minimal in all cases. Among the complications, dislocation occurred in only one case by a fall from a height and was reduced by closed reduction. There was no occurrence of ceramic fracture, even though infection occurred in one hip. Conclusion: The clinical outcome and radiologic assessment of the ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head showed a satisfactory result at three-year follow-up. Longerterm follow up is needed for further assessment.