샌드위치 타입의 세라믹-세라믹 관절면을 이용한 일차성 무시멘트 고관절 전치환술 (최소 10년 추시 결과) = Primary Cementless Total Hip Arthroplasty with a Sandwich Type in Ceramic-Ceramic Articulation (Minimum 10-Year Follow up Results)

국문 초록 (Abstract)

목적: 세라믹 라이너에 폴리에틸렌을 부착한 샌드위치형 라이너를 이용한 일차성 고관절 전치환술의 최소 10년 이상 추시 결과를 평가하였다. 대상 및 방법: 1998년 11월부터 2000년 12월까지 샌드위치형 라이너를 이용한 고관절 전치환술을 시행하고 최소 10년 이상 추시 가능하였던 34명(40예)을 대상으로 하였다. 평균 추시 기간은 134개월(120~145개월), 수술 시 평균 연령은 47.1세(24~65세)이었다. 임상적 평가는 Harris hip score, 대퇴부통증 등을 조사하였으며, 방사선학적 평가는 골내막 신생골, 방사선 투과성선, 삽입물의 이동 등을 관찰하였다. 결과: Harris hip score는 최종 추시에서 평균 90.9점으로 향상되었다. 전례에서 골성 고정을 얻었으며 삽입물의 이동이나 해리는 관찰되지 않았다. 합병증으로 수술 시 대퇴골의 비전위 골절이 2예(5%), 후방 탈구가 1예(2.5%), 세라믹 라이너 파손이 1예(2.5%)가 있었다. 결론: 샌드위치형 라이너를 이용한 고관절 전치환술의 최소 10년 이상 추시 생존율은 양호한 결과를 보였으나, 세라믹의 골절은 여전히 중요한 문제점으로 판단되며 비구컵의 정확한 고정과 지속적인 세라믹 부품의 재질 개선이 필요할 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the minimum 10-year follow up results of primary total hip arthroplasty (THA) performed using a sandwich-type (alumina-polyethylene-titanium) ceramic bearing. Materials and Methods: Thirty four patients (40 hips) who underwent a THA with sandwich typed liners from November 1998 to December 2000 were analyzed. Among the 34 patients, 25 were men and nine were women. Mean follow-up was 134 months (range, 120~145 months) and mean patient age at the time of THA was 47.1 years (range, 24~65 years). The clinical results were evaluated using the Harris hip score and level of thigh pain with a limping gait. The radiographic evaluation was done in terms of the endosteal new bone formation, radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. Results: The mean preoperative Harris hip score of 50.2 points (range, 31~87 points) was improved to 90.9 points (range, 75~99 points) at the final follow-up and thigh pain with limping gait in one case. All cases had fixation by bony ingrowth. No radiographically detectable loosening was observed in any hip. Fracture of ceramic liner in one case required change of the polyethylene liner. Conclusion: At the minimum 10-year follow up, survival rate as the end-point was favorable. However, fracture of the ceramic is still a major problem. Satisfactory results can be obtained by more precise surgical technique for acerabular inclincation and anteversion, and by improving the quality of the ceramic.

참고문헌 (Reference)

1 Berry DJ, "Unstable total hip arthroplasty: detailed overview" 50 : 265-274, 2001

2 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" 51 : 737-755, 1969

3 Hannouche D, "Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty" 35 : 207-213, 2011

4 Callaghan JJ, "The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series" 70 : 337-346, 1988

5 Heekin RD, "The porous-coated anatomic total hip prosthesis, inserted without cement. Results after five to seven years in a prospective study" 75 : 77-91, 1993

6 Kawamura H, "The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty" 83 : 1333-1338, 2001

7 Nizard RS, "Ten-year survivorship of cemented ceramicceramic total hip prosthesis" 282 : 53-63, 1992

8 Park YS, "Ten-year results after cementless THA with a sandwich-type alumina ceramic bearing" 33 : 796-, 2010

9 Dalla PP, "Stiffness of the acetabular cups: a comparative study using the finite element method" 136-138, 1997

10 Engh CA, "Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components" 257 : 107-128, 1990

11 Bader R, "Range of motion vs position and design" Stuttgard, New York: Thieme Verlag 66-74, 2000

12 DeLee JG, "Radiological demarcation of cemented sockets in total hip replacement" 121 : 20-32, 1976

13 Bizot P, "Pressfit metal-backed alumina sockets: a minimum 5-year followup study" 379 : 134-142, 2000

14 Engh CA, "Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results" 69 : 45-55, 1987

15 Garbuz DS, "Periprosthetic fractures of the femur: principles of prevention and management" 47 : 237-242, 1998

16 D’Antonio J, "New experience with alumina-on-alumina ceramic bearings for total hip arthroplasty" 17 : 390-397, 2002

17 Gruen TA, "Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening" 141 : 17-27, 1979

18 Garcia-Cimbrelo E, "Mittelmeier ceramic-ceramic prosthesis after 10 years" 11 : 773-781, 1996

19 Nishii T, "Influence of component positions on dislocation: computed tomographic evaluations in a consecutive series of total hip arthroplasty" 19 : 162-166, 2004

20 Duncan CP, "Fractures of the femur after hip replacement" 44 : 293-304, 1995

21 Hwang SK, "Fracture-dissociation of ceramic liner" 31 : 804-, 2008

22 Suzuki K, "Fracture of a ceramic acetabular insert after ceramicon-ceramic THA--a case report" 74 : 101-103, 2003

23 Ravasi F, "Five-year follow-up with a ceramic sandwich cup in total hip replacement" 122 : 350-353, 2002

24 Livermore J, "Effect of femoral head size on wear of the polyethylene acetabular component" 72 : 518-528, 1990

25 Woo RY, "Dislocations after total hip arthroplasty" 64 : 1295-1306, 1982

26 Bader R, "Computer-based motion simulation of total hip prostheses with ceramic-on-ceramic wear couple. Analysis of implant design andorientation as influence parameters" 140 : 310-316, 2002

27 Ha YC, "Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty" 458 : 106-110, 2007

28 Park YS, "Ceramic failure after total hip arthroplasty with an alumina-on-alumina bearing" JOURNAL BONE JOINT SURGERY INC 88 : 780-787, 2006

29 Hasegawa M, "Ceramic acetabular liner fracture in total hip arthroplasty with a ceramic sandwich cup" 18 : 658-661, 2003

30 Santavirta S, "Biocompatibility of polyethylene and host response to loosening of cementless total hip replacement" 297 : 100-110, 1993

31 Nizard R, "Alumina-on-alumina hip arthroplasty in patients younger than 30 years old" 466 : 317-323, 2008

32 Lee YK, "Alumina-on-Alumina Total Hip Arthroplasty A Concise Follow-up, at a Minimum of Ten Years, of a Previous Report" JOURNAL BONE JOINT SURGERY INC 92A (92A): 1715-1719, 201007

33 Boutin P, "Alumina and its use in surgery of the hip. (Experimental study)" 79 : 639-640, 1971

34 Widmer KH, "A simplified method to determine acetabular cup anteversion from plain radiographs" 19 : 387-390, 2004