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.

COREN Hip System을 이용한 무시멘트 고관절 전치환술

박윤수 ( Youn Soo Park ),김용식 ( Yong Sik Kim ),이중명 ( Joong Myung Lee ),선두훈 ( Doo Hoon Sun ),문영완 ( Young Wan Moon ),임승재 ( Seung Jae Lim ) 대한고관절학회 2007 Hip and Pelvis Vol.19 No.4

Purpose: To report the results of a minimum three-year follow-up of cementless total hip arthroplasty using the COREN Hip System(R) (Corentec, Seoul, Korea), which is the first total hip prosthesis developed in Korea. Materials & Methods: A total of 57 patients (68 hips) who had undergone cementless total hip arthroplasty using the COREN Hip System(R) between July 2003 and March 2004 were analyzed clinically and radiographically after a minimum follow-up of three years after the index arthroplasty. Results: The mean Harris hip score improved from 46 points preoperatively to 95 points at the one-year follow-up and to 99 points at the three-year follow-up. All the patients reported a good or excellent satisfaction with the results of surgery. All prostheses showed radiographic evidence of stable bony fixation, and no hips showed evidence of osteolysis or prosthesis loosening. During the follow-up period, there were no complications such as a deep infection, dislocation or ceramic fracture in any hip, and no revision surgery was required. Conclusion: The clinical and radiographic evaluations of Cementless total hip arthroplasty using the COREN Hip System(R) showed excellent outcomes after a minimum follow-up duration of three years.

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.

고도 고관절 이형성증에서 전자하 단축 절골술과 동반하여 시행한 무시멘트 고관절 전치환술의 단기 추시 결과

이수호 ( Soo Ho Lee ),김병관 ( Byung Kwan Kim ),안지용 ( Ji Yong Ahn ),황지효 ( Ji Hyo Hwang ),이대희 ( Dae Hee Lee ) 대한고관절학회 2007 Hip and Pelvis Vol.19 No.3

Purpose: This study examined the clinical, functional and radiological results of total hip arthroplasty with subtrochanteric shortening osteotomy in severe dysplasia of hip. Materials and Methods: Seventeen cases of severe dysplasia of the hip, which were treated with total hip arthroplasty with subtrochanteric shortening osteotomy from August 1997 to September 2004, were evaluated. The mean follow-up duration was 52.9 months (range: 26~106). Harris hip score (HHS), leg length discrepancy (LLD) and complication were assessed clinically. Gait analysis (7 cases) and Cybex study (8 cases) for the abductor muscle power were assessed functionally. Bony union and stability around the osteotomy site of the femoral and acetabular components was assessed radiologically. Results: The mean HHS improved from 65.1 (range: 23~87) points preoperatively to 88.2 (range: 72~100) points at the last follow-up. The mean LLD improved from 3.7 (range: 1~7) cm preoperatively to 1.6 (range: 0.5~3.3) cm postoperatively. All cases showed complete bony union of the allograft in the acetabulum and osteotomy site at a mean time of 6 months postoperatively. Gait analysis improved in all cases but there was some limping gait remaining. On the Cybex study, 6 out of 8 cases showed improved abductor muscle peak toque, postoperatively. Conclusion: A cementless total hip arthroplasty with subtrochanteric shortening osteotomy is believed to be a useful treatment for severe dysplasia of hip. Despite the improving HHS, the abductor power can be decreased. In these points, gait analysis and the Cybex study are helpful on the follow-up.

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

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

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.

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

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.

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

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%.

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

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.