세라믹-세라믹 관절면을 이용한 고관절 전치환술: 5년 중기 추시결과

임수재 ( Soo Jae Yim ),장문석 ( Mun Suk Jang ),윤준희 ( Joon Hee Yoon ),이상혁 ( Sang Hyok Lee ),강희경 ( Hee Kyung Kang ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4

목적: 세라믹에서 나타나는 강성 성질을 완화하여 세라믹-세라믹 관절면에서 나타나는 합병증을 시멘트형 대퇴 스템을 사용함으로써 감소 시킬 수 있을 것으로 생각하여 중기 추시의 효과를 알아보고자 하였다. 대상 및 방법: 2004년 1월부터 2005년 12월까지 시멘트형, 무 시멘트형 고관절 전치환술을 시행하고 5년 이상 추시 가능하였던 각각 30명 32예와 31명 33예를 대상으로 임상적 평가와 방사선학적 평가를 시행하였다. 결과: Harris 점수와 WOMAC 점수는 시멘트형 군과 무 시멘트형 군에서 수술 전 보다 최종 추시상 모두 향상되었다(P<0.05). 그러나 Harris 점수나 WOMAC 점수의 시멘트형과 무 시멘트형 간의 증가에 대한 특이한 차이는 없었다(P=0.304, P=0.769). 무 시멘트형 군에서만 보행 시 발생한 고관절부 불편감 3예, 대퇴부 통증 5예가 있었다. 양군에서 비구 컵의 골성 고정을 얻었고, 삽입물의 이동소견은 보이지 않았다. 시멘트형 군에서 대퇴 스템의 침강은 30예서 1 mm이내, 2예에서 2 mm 이내였으며, 무 시멘트형 군의 모든 예에서 대퇴 스템의 골성 고정을 얻었다. 결론: 세라믹-세라믹 관절면을 이용한 무 시멘트형과 시멘트형 고관절 전치환술의 중기 추시 결과는 통계학적으로 효과를 얻을 수 없었다. Purpose: We believe that cemented femoral stems will relieve the stiffness of ceramic-based bearings, resulting in reduced complication of ceramic-on-ceramic bearing total hip arthroplasty (THA). The purpose of this study was to evaluate the midterm effect of ceramic-on-ceramic bearing THA using cemented femoral stems. Materials and Methods: We studied 32cases (30 patients) of THA using ceramic-on-ceramic bearing cemented femoral stems and 33 cases (31 patients) of THA using ceramic-on-ceramic bearing cementless femoral stems. All total hip arthroplasties were performed between January 2004 and December 2005 and were followed up for more than 5 years. The clinical results and radiographic results were evaluated. Results: The mean HHS improved from points pre-operatively to points at the last follow-up in both the cemented and cementless stem groups (P<0.05). The mean WOMAC score also improved from points pre-operatively to points at the last follow-up in both the cemented and cementless stem groups (P<0.05). But no statistically significant difference was noted between the cemented and cementless stem groups in HHS and WOMAC scores (P=0.304, P=0.769). There were 3 patients with a sense of discomfort on ambulation and 5 patients with thigh pain in the cementless stem group and no cases in the cemented stem group. There was no instance of acetabular loosening in either group. Subsidenc of the cemented femoral stem was less than 1mm in 30 cases and less than 2 mm in 2 cases. All cementless femoral stems acquired firm bony union. Conclusion: Midterm results showed no statistical links between ceramicon-ceramic-bearing THA using cemented femoral stems or cementless femoral stems.

시멘트 광택 대퇴 금속주(Cemented Polished Femoral Stem)의 5년 이상 추시 연구

이주원 ( Ju Won Yi ),손원용 ( Won Yong Shon ),허창룡 ( Chang Yong Huh ),윤호현 ( Ho Hyun Yun ),허영재 ( Young Jae Huh ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.1

Purpose: Surface finishing of a cemented femoral stem is a subject of controversy even though the contemporary cementing techniques have improved results. Using the Versys Heritage femoral stem, we evaluated the outcome of using a polished surface. Materials and Methods: The subjects of this study were 95 hip arthroplasties in 82 patients and we used a cemented polished femoral stem with the 3rd generation cement technique and all the surgeries were done between October 2000 and August 2003. There were 58 male patients (64 hips) and 24 female patients (31 hips). The mean age at the time of the index arthroplasty was 52.3 years (26~74 years), and the average body mass index was 24.2±2.75 (19.1~29.8). The average follow up period was 80.7 months (64~109 months). All the hips were evaluated clinically by the Harris hip score and the thigh pain, and they were radiologically assessed by the cement grade and the presence of osteolysis around the femoral stem, as well as the presence of stress shielding of the proximal femur. Results: At the final follow up, the Harris hip score for all the patients had improved from preoperative 58.9 (17-83) to post operative 91.7 (72~100). The cement grade was measured using Barrack`s method. Of the 95 hips, 45 (47.3%) cases were grade A, 48 (50.5%) cases were grade B and 2 (2.1%) cases were grade C1 at the final follow up. There was 1 case of definite loosening. Stress shielding was noted in 65 (68.4%) cases of the zero grade and 19 (20.0%) cases of the 1st grade. Conclusion: In this study, the cemented polished femoral stem showed excellent results at the mid term with a minimum follow up of 5 years. But a longer-term follow-up study will be needed for further understanding the implications of cemented polished femoral stem.

Hybrid형 인공 고관절 전 치환술의 5-7년 추시 결과 (MS-30 대퇴 스템과 Omnifit 대퇴 스템의 비교)

이중명 ( Joong Myung Lee ),김선구 ( Seon Ku Kim ),조덕연 ( Duck Yun Cho ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

Forty patients(forty-six hips), who underwent hybrid total hip arthroplasties with a cemented femoral component and a non-cemented acetabular component between February, 1991 to September, 1993, were reviewed for a minimum follow-up of five years. Rerised case was excluded. The purpose of this study was to analyze the intermediate-term results and to compare clinically and radiographically between two groups of the patients: one group which used smooth-surfaced Omnifit femoral stem was 11 hips and the other group which used matte surfaced MS-30 femoral stem was 35 hips. The average age of these patients at the time of the operation was 57.4 years. The operation had been performed by a single surgeon(J-M Lee) except 1 hip using transgluteal approach. Clinically, the average Harris hip score was 94 points in the group used Omnifit femoral stem and 93 in the group used MS-30 femoral stem. In the group used Omnifit femoral stem, one hip was revised for a osteolysis, but no additional hip was definitely loosened in radiographic criteria. And in the group used MS-30 femoral stem, two hips were revised for one aseptic loosening and one infec- tion and three additional hips were definitely loosened in radiographic criteria. But on the acetabular side, one hip used Omnifit femoral stem showed severe wear, but in the group used MS-30 femoral stem didnt showed any definite loosening or severe wear. We supposed that the high rate of failure in the group used MS-30 femoral stem, which was contemporary designed, was due to a matte finished surface in tapered design. However, we need to compare polished stem with matte-surface stem for the true correct answer.

시멘트를 사용한 인공 고관절의 재치환술시 대퇴 Stem에 관한 연구 : Charnley 대퇴 스템과 Mu¨ller 대퇴 스템의 비교 Comparision Between Charnley Stem and Mu¨ller Stem

고한석,정우석,김진구,김병직,김영용 인제대학교 1996 仁濟醫學 Vol.17 No.2

1960년대 Charnley의 low friction arthroplasty의 개념에 입각한 인공 고관절 치환술의 도입은 이 분야에서의 눈부신 발전을 가져왔으나 장기 추시 결과 무균성 해리가 가장 큰 문제점으로 대두 되었다. 이의 원인과 예방책에 대한 여러가지 연구 및 가설이 존재하나 아직까지는 정확한 이론이 정립되지는 않은 상태이다. 저자는 인공 고관절 전치환술의 초기의 형태인 Charnley형과 Mu¨ller형의 무균성 해리로 인한 재대치술시 수술 소견과 조직 검사를 통하여 무균성 해리의 원인에 대한 고찰, 이의 방지를 위한 대퇴 스템의 형태에 대한 연구를 하고자 하였다. The present investigation was an attempt to compare observations on plain radiograph with those made during the exchange operation in a series of total hip arthroplasties revised for various reasons. In a series of patient cases who had admitted for revision at Seoul Paik Hospital from March 1992 to March 1994 with late loosening after cemented THRA were studies about the radiographic analysis and operative findings of Charnley stem and Muller stem. The Results as follows ; 1.The mean age at revision was 57 years old and the average time to revision was 14 years and of them Charnley stems were 28 cases and Mu¨ller stems were 5 cases. 2.Femoral radioluscent line (more than 2mm) was found 19 cases at Charnley 28 stem, 5 cases at Mu¨ller stem. The most common site was present in zone 7, and osteolysis was found at zone 1, zone 7 at Charnley stem in 9 cases, Mu¨ller stem in 3 cases. 3.In all cases at revision granuloma like materials were seen, which were proven to be polyethylene debris under the light and polarizing microscope. 4.The aseptic loosening was found one in Charnley femoral stem but in Muller femoral stem, aseptic loosening was found in 3 cases at revision surgery.

시멘트형 Polished Versys HeritageⓇ 대퇴 스템의 2-5년 추시 결과

손원용,허창룡,문준규,한상환,양재혁,장기모 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.1

Purpose: Surface finishing of a cemented femoral stem is a subject of controversy even though contemporary cementing techniques have improved results. Versys Heritage femoral stem was used with a contemporary cementing technique to determine the outcome of using a polished surface. Materials and Methods: Between October 2000 and August 2003, 131 primary hybrid hip arthroplasty procedures were performed in 117 patients. The mean age at the time of the index arthroplasty was 52 years and 9 months (24-78 years). The average follow up period was 49 months (range, 24-71 months). All the hips were evaluated clinically by the Harris hip score and radiologically by the cement grade, osteolysis as well as stress shielding. Results: At the final follow up, the Harris hip score for all patients had improved from preoperative 59.1 (range, 17-91) to post operative 92.8 (range, 78-100). The cement grade was measured using Barrack's method. Of 131 hips, 75, 54 and 2 were grade A, grade B and grade C1 at the final follow up, respectively. None of the hips showed a C2 or D grade. There was no evidence of aseptic loosening or osteolysis on the femoral side during follow up. 45% of stems showed grade 1 and 2 stress shielding according to Engh's criteria. Conclusion: In this study, the Polished Versys Heritage femoral stemⓇ showed excellent results at the short to mid term follow up period. However, a longer-term follow-up study will be needed to clarify the implications of the femoral prosthesis surface finish or design.

Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem

( Jung-yun Choi ),( Yerl-bo Sung ),( Joo-hyung Kim ) 대한고관절학회 2016 Hip and Pelvis Vol.28 No.4

Purpose: To compare and analyze clinical and radiologic outcomes of cemented versus cementless bipolar hemiarthroplasty for treatment of femur neck fractures. Materials and Methods: A total of 180 patients aged 65 years and over older who underwent bipolar hemiarthroplasty for treatment of displaced femur neck fractures (Garden stage III, IV) from March 2009 to February 2014 were included in this study. Among the 180 patients, 115 were treated with cemented stems and 65 patients with cementless stems. Clinical outcomes assessed were: i) postoperative ambulatory status, ii) inguinal and thigh pain, and iii) complications. The radiologic outcome was femoral stem subsidence measured using postoperative simple X-ray. Results: The cemented group had significantly lower occurrence of complications (postoperative infection, P=0.04) compared to the cementless group. There was no significant difference in postoperative ambulatory status, inguinal and thigh pain, and femoral stem subsidence. Conclusion: For patients undergoing bipolar hemiarthroplasty, other than complications, there was no statistically significant difference in clinical or radiologic outcomes in our study. Selective use of cemented stem in bipolar hemiarthroplasty may be a desirable treatment method for patients with poor bone quality and higher risk of infections.

골시멘트를 사용한 Precoat 대퇴 스템

손원용 ( Won Yong Shon ),전승주 ( Seung Ju Jeon ),나경욱 ( Kyoung Wook Rha ),김학준 ( Hack Jun Kim ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.1

We now report the results of Harris Precoat femoral stem(Zimmer, Inc.,Warsaw,IN) of fourty hips in twenty-nine patients at a 5-7.5 year follow up.In this study, cemented precoat femoral stem was used in sixty-one, nonselected hip patients from October 1990 to May 1993 in our department. Twelve patients(13 hips) had been lost to follow up. At the final follow up, seven patients(7 hips) had died and one hips were too ill for detailed follow up. Radiographies were available for 36 hips of 26 patients who were alive for the entire follow up period. The average age at the time of the procedure was 54 years(range 27-76). There were twenty-three men(thirty-four hips) and six women(six hip). The femoral component had been revised for aseptic loosening in three hips(8%).One additional hip showed definite radiographic loosening. Hence, the prevalaence of radiographic failure was 11%(four hips). Three of them had suboptimal cement mantle(C1 or C2) Subsidence without radiolucency between cement interface occured in one hip. No femoral osteolysis was seen in stable component. These results show that cementation techinques is one of the most important factors for durability of cemented femoral stem, early debonding between stem-cement interface may develop even in this precoated femoral stem and also once debonding may produce premature failure of cemented femoral fixation.

인공 고관절 치환술에서 대퇴주대 주위의 시멘트 두께 측정

조명래(Myung Rae Cho),박위태(Wee Tae Park),박창민(Chang Min Park),이상욱(Sang Wook Lee),김신근(Shin Kun Kim),권굉우(Koing Woo Kwon) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.3

목적: 확강용 기구에 의해 만들어진 가상의 업체 공간 속에서 대퇴주대의 회전에 따른 시멘트의 두께 변화를 측정하였다. 대상 및 방법: C stem과 Versys stem을 사용하였고, 분석은 C250/400VZ (Steinbichler Co., Germany)와 S/W: Geomagic & CATLA V5를 이용하였다. 정중간에 대퇴주대를 정일치 시킨 후 확강용 기구를 이용하여 만들어진 가상의 입체 공간 내에서 실제 대퇴주대를 횡단면과 관상면을 기준으로 회전시켜 회전 변화에 따른 실제 주대의 바깥면과 확강용 기구의 바깥면 사이의 거리를 측정하였다. 결과: C stem은 대퇴주대가 3도 회전할 때에 1 ㎜ 미만으로 감소하였고 Versys stem의 경우는 5도에서 간격이 1 ㎜ 미만으로 감소하였다. 선회축 회전의 경우 C stem은 0.25도 내반된 상태에서 1 ㎜ 미만으로 감소하였고, 내반각이 0.8도에서 접촉하였으며, Versys stem의 경우는 1도에서 접촉하였다. 선회축 회전과 횡단면의 회전이 복합된 경우 전예에서 1 ㎜ 미만으로 나타났다. 결론: 적절한 시멘트 두께의 유지를 위하여 대퇴주대의 정확한 삽입을 위한 기구 개발, 또는 대퇴주대의 회전 변화에 견딜 수 있는 대퇴주대의 모형 변화가 필요할 수 있으리라 판단된다. Purpose: To measure the cement mantle thickness that developed from a rotation of the femoral stem in virtual space made by the broach. Materials and Methods: The C stem and Versys stem of the subjects enrolled in this study were examined. A C250/400VZ(Steinbichler Co. Germany) and S/W: Geomagic & CATIA V5 was used to examine the three-dimensional configurations. The axial images were acquired after neutral placement of the femoral stem, horizontal rotation, coronal tilting, and a combination of both. The thick-ness was measured from the distance between the outer surface of the femoral stem and the closest vertex in the outer contour of the broach in cross-sectional images. Results: The distance was < 1 ㎜ at the horizontal rotation of 3 degrees in the C stem, and at 5 degrees in the Versys stem. The distance was < 1 ㎜ at varus of 0.25 degrees in the C stem, and touched at 0.8 degrees. In the case of the Versys stem, the femoral stem touched at a varus of 1 degree. A combination of both horizontal and pivot rotation made the distance < 1 ㎜ at rotation of all angles. Conclusion: It might be necessary to develop a new instrument for the accurate insertion of the femoral stem along the broached space or to modify the stem design to stand against the change in the femoral stem position in the broached space.

Exeter stem을 이용한 고관절 전치환술

임수재 ( Soo Jae Yim ),우승한 ( Seung Han Woo ),김민영 ( Min Young Kim ),박철수 ( Chul Soo Park ),박종석 ( Jong Seok Park ),김응하 ( Eung Ha Kim ),서유성 ( You Sung Suh ),이병일 ( Byung Il Lee ) 대한고관절학회 2005 Hip and Pelvis Vol.17 No.4

목적: 고관절 전치환술에서 시멘트형의 Exeter 대퇴 스템 사용 후 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 1998년 1월부터 2001년 6월까지 본원에서 동일 술자에 의해 고관절 전치환술을 시행 받은 64명의 환자 84예를 대상으로 하였다. 평균 추시 기간은 3.8년(3~5.5년)이었다. 임상적 기능 평가는 수술 전후의 Harris hip score와 대퇴부 동통 유무를 기준으로 하였으며, 방사선학적 평가는 수술 전과 수술 후 2주, 3개월, 6개월, 그 후 매년 고관절의 전후면사진과 측면사진을 촬영하여 확인하였다. 결과: 임상적 결과상 Harris hip score가 수술 전 56점에서 수술 후 95점으로 향상되었으며 대부분의 환자에서 대퇴부동통 감소를 확인할 수 있었다. 방사선학적으로 대퇴 스템의 시멘트 등급은 수술직후 A등급이 34예, B등급이 45예였으며, C등급이 5예에서 관찰되었으며, D등급은 관찰되지 않았다. 최종 추시 상 대퇴 스템의 해리 소견은 관찰되지 않았고 1예에서 Zone I, VII에서 국소적인 골 용해 소견이 관찰되었다. 대퇴 스템의 침강은 82예에서 1 mm미만으로 나타났고, 나머지 2예에서 각각 1 mm, 1.9 mm로 나타났다. 대퇴 경부 내측의 높이 감소가 6예에서만 1 mm미만의 감소를 보일 뿐 나머지는 높이 감소가 관찰되지 않았다. 합병증으로는 시멘트 골절이 2예에서 발생하였다. 결론: 비교적 단기 추시 결과이지만 시멘트형의 Exeter 대퇴 스템을 이용한 인공 고관절 전치환술에서 임상적, 방사선학적으로 우수한 결과를 얻을 수 있었으나 좀 더 정확한 결과를 위해 장기간의 추시와 연구가 필요할 것으로 사료된다. Purpose: This study was conducted to evaluate the clinical and radiographic outcomes of total hip arthroplasty (THA) using cemented Exeter femoral stem. Materials and Methods: We reviewed the clinical records and serial radiographs of 64 patients (84 hips) who underwent THA using a cemented Exeter femoral stem by one surgeon from January 1998 to June 2001. The mean follow-up period was 3.8 years (3 to 5.5 years). The clinical results were evaluated with Harris hip score (HSS) and the thigh pain and radiographic results were assessed with serial radiographs. The patients "were examined at two weeks, three months and six months", during the first postoperative year, "and every year after that". Results: Mean HSS improved from 56 points preoperatively to 95 points at the time of the last postoperative follow-up. The thigh pain of most patients decreased. Postoperative cement grade was A in 34 cases, B in 45, C in 5 and D in none. Aseptic loosening was not found while focal radiolucency in Zone I, VII was found in one case during the follow-up period. Subsidence of the femoral stem was less than 1 mm in 82 cases and was 1 and 1.9 mm in the other 2 cases. No loss of the height of the medial femoral neck occurred in 76 cases while the loss in the other 6 cases was less than 1 mm. There were two cases of complication of cement mantle fracture. Conclusion: This study showed the good clinical and radiographic results of THA with a cemented Exeter femoral stem at the intermediate-term follow-up. However, a long-term follow-up study will be needed to evaluate the more precise clinical and radiographic outcomes.

Long-term Outcome of Polished Stems in Total Hip Arthroplasty

( Jin Young Park ),( Hong Joon Han ),( Seok Jong Baik ),( Suc Hyun Kweon ) 대한고관절학회 2015 Hip and Pelvis Vol.27 No.2

Purpose: The purpose of this study was to evaluate the clinical outcomes and radiologic findings of primary total hip arthroplasty (THA) using cemented polished femoral stems. Materials and Methods: We retrospectively reviewed 91 hips (91 patients) that had undergone primary THA with cemented polished femoral stems who were followed for at least 10 years. The mean age at surgery was 57 years (47-75 years). Mean follow up period was 12.8 years (10.1-14.0 years). Harris Hip Score (HHS) was used for clinical evaluation. Radiologic evaluation was focused on cementing+I14 technique including subsidence within the cement mantle, radiolucent lines at the cement-bone or cement-stem interface, cortical hypertrophy, and calcar resorption. Results: The average HHS was 55.2 points before the surgery that improved to an average of 93.2 points at the final follow-up. According to Barrack classification, there were 50, 32, and 9 cases in A, B, and C grades, respectively. Subsidence of femoral stem was less than 2 mm except in one patient. There were no progressing radiolucent line or loosening of the femoral stem. Conclusion: In this study, THA using cemented polished femoral stems was found to have favorable outcomes in long term follow-up.