Wagner 재치환 스템을 이용한 인공 고관절 대퇴 재치환술

한창동(Chang Dong Han),양익환(Ick Whan Yang),박진(Jin Park) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.2

목적: Wagner 재치환 스템을 이용한 인공 고관절 대퇴 재치환술 후 추시 결과를 평가하고자 한다. 대상 및 방법: 1992년부터 2001년까지 Wagner 대퇴 재치환 스템을 이용하여 재치환술을 시행 받은 55명, 56예를 대상으로 하였다. 평균 나이는 50세였고, 평균 추시 기간은 8.4년(5-12.5년)이었다. 재치환술의 원인은 무균성이완 52예, 세균성 이완 2예, 스템 주위 골절 2예였다. 재치환술 전 대퇴부 결손은 Paprosky분류법을 이용하였고, 임상평가 및 방사선적 평가를 시행하였다. 결과: Harris 고관절 점수는 수술 전 평균 47점에서 최종 추시 시 평균 87점으로 향상되었다. Paprosky 분류상 Ⅰ, Ⅱ, ⅢA, ⅢB가 각각 5, 20, 22, 9예였고, 52예(93%)에서 최근 방사선 사진상 안정된 스템 소견을 보였다. 수직 침강은 평균 6.2 ㎜ (0-21 ㎜)였으며, 이중 수직 침강이 심했던 3예와 감염 1예는 2차 재치환술을 시행하였다. 결론: 대퇴 근위부 골결손이 동반된 대퇴 재치환술 시, grit-blast처리된 원추형 대퇴 재치환 스템은 원위부 압박고정으로 만족할 만한 결과를 보여주며, 디자인 자체에 기인하는 수직 침강을 줄일 수 있다면 스템의 기계적 실패율을 더욱 낮출 수 있을 것으로 기대된다. Purpose: To evaluate the results of revision total hip arthroplasty using a Wagner SL revision stem. Materials and Methods: This study reviewed 56 revisions of the femoral component performed using a Wagner stem in 55 patients between 1992 and 2001. The mean age of the patients at the time of the revision was 50 years. The mean follow up duration was 8.4 years (range, 5 to 12.5 years). The indication for revision was aseptic loosening in fifty-two hips, septic loosening in two and peri prosthetic fractures in two. The pre-revisional femoral defects were classified according to the Paprosky classification system. A clinical evaluation and radiological assessment were performed. Results: The mean Harris hip score improved from 47 points preoperatively to 87 points at the latest follow-up. There were 5, 20, 22 and 9 hips of type Ⅰ, Ⅱ, ⅢA and ⅢB according to the Paprosky classification system. Fifty two hips (93%) showed stable stems at the latest follow-up radiographs. The mean vertical subsidence of the stem was 6.2 ㎜ (range, 0 to 21 ㎜). Severe progressive vertical subsidence in three hips and an infection in one occurred requiring repeat revision. Conclusion: For severe proximal femoral bone loss, the conical femoral revision stem with a fully grit-blasted surface produced satisfactory results with distal press-fit fixation. We can expect a decrease in the rate of mechanical failure rate of the stem by reducing the subsidence derived from the stem design itself.

Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty?

Kap-Soo Han,Seung-rok Kang,Sun-Jung Yoon 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.1

Background: Management of periprosthetic femoral fractures (PFFs) is reportedly challenging. Different patterns of PFFs would occur based on whether stem fixation was primarily cemented or cementless and whether these patterns would be associated with clinical outcomes, such as subsidence, fracture union, and complications, after stem revision. Methods: A retrospective comparative study was performed, involving 52 PFF patients treated with tapered fluted modular stems (TFMSs). In the 52 patients with Vancouver B2 or B3, including 21 cemented stems and 31 cementless stems, fracture patterns and bone stock were analyzed. Clinical outcomes after revision surgery using the TFMSs were compared between the two groups. Results: Transverse or short oblique type PFFs occurred around the cemented stem with loosening at the bone-cement interface. The Paprosky type III femoral deficiency and Vancouver type B3 fracture were observed more frequently in the cemented stem group. Otherwise, spiral fractures occurred more frequently in the cementless group (p < 0.001). Excessive subsidence of > 5 mm was observed more frequently in the cemented stem group (p < 0.001). The re-revision rates were higher in the cemented group than in the cementless group (p = 0.047). Conclusions: In our study, it was found that the patterns of transverse or oblique PFFs were more frequently produced with cemented stems, while long spiral fractures were more frequent with cementless stems. Stem subsidence and reoperation related to complications were more common in patients with PFFs around cemented stems than those with PFFs around cementless stems.

지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 이용한 고관절 재치환술

이경재 ( Kyung Jae Lee ),민병우 ( Byung Woo Min ),배기철 ( Ki Cheor Bae ),조철현 ( Chul Hyun Cho ),김동후 ( Dong Hu Kim ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.3

목적: 인공 고관절 재치환술 시 다량의 대퇴골 골결손 부위에 대해 지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 사용하고 그 결과를 알아보고자 하였다. 대상 및 방법: 1998년부터 2005년까지 재치환술 시 근위 대퇴골 골결손으로 지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 사용하고 2년 이상 추시관찰이 가능하였던 12예를 대상으로 하였다. 추시 기간은 평균 4.6년이었다. 재치환술의 원인은 광범위한 골용해 및 이로 인한 대퇴 삽입물 주위 골절이 5예, 무균성 해리 7예였다. 결과: Harris 고관절 점수는 술전 평균 40.8점에서 최종 추시시 85.1점으로 향상되었으며 대퇴 삽입물의 고정도는 11예(92%)에서 골성 안정 소견을 보였으며 1예(8%)에서 섬유성 안정 소견을 보였다. 응력 방패 현상은 1예에서 중등도의 소견을 보였으나 최종 추시 시 진행되는 소견은 없었다. 최종 추시시 심한 마모나 골용해를 보인 예는 없었으며 심부감염 1예를 제외한 전 예에서 이식골의 유합을 확인할 수 있었다. 결론: 다량의 대퇴골 골결손이 동반된 환자에서 지주 동종골 이식술 및 광범위 미세 피복 대퇴스템을 이용한 재치환술은 만족할 만한 결과를 보였으나 응력방패 현상 및 이식골로 인한 합병증 등에 대해서는 장기간의 추시관찰이 필요할 것으로 사료된다. Purpose: We wanted to report on the outcomes of using a strut allograft and extensively porous-coated femoral stems in revision total hip arthroplasty that was performed due to extensive femoral bone loss. Materials and Methods: Between 1998 and 2005, we performed 167 consecutive revision total hip arthroplasties. Among them, twelve cementless femoral revision surgeries with a strut allograft and extensively porous-coated stems were retrospectively reviewed. The average follow up was 4.6 years. The average age at the time of the index revision was 55.9 years. The reasons for the revisions were periprosthetic fracture due to extensive osteolysis in 5 hips and aseptic loosening in 7 hips. Results: The Harris hip score improved from a mean of 40.8 points before revision surgery to a mean of 85.1 points at the latest follow up. Radiographic evidence of bony stable stems were present in 11 hips and a fibrous stable stem was present in 1 hip. Moderate stress-shielding was noticed in one hip. Nonunion of the allograft was observed in 1 hip due to deep infection. To date, no significant wear or osteolysis has been observed. Conclusion: Revision total hip arthroplasty with a strut allograft and an extensively porous-coated femoral stem for treating cases of extensive femoral bone loss seems to be a reasonable choice. However, the concerns related to stress shielding, the difficulties in re-revisions and the complications associated with an allograft will require longer term follow up.

무시멘트 비구컵을 이용한 단독 비구 재치환술시 일체형과 조합형 대퇴스템의 비교

최일용 ( Il Yong Choi ),박기철 ( Kee Cheol Park ),민경보 ( Kyoung Bo Min ),이준환 ( Joon Hwan Lee ),김영호 ( Young Ho Kim ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.4

목적: 무시멘트 비구컵을 이용한 단독 비구 재치환술의 임상적, 방사선학적 결과를 조사하고, 일체형과 조합형 대퇴스템간의 결과의 차이가 있는지 알아보고자 한다. 대상 및 방법: 1991년 10월부터 2002년 6월까지 골 이식과 함께 무시멘트 비구컵을 이용하여 단독 비구 재치환술을 시행 받은 39례를 대상으로 하였다. 평균 추시 기간은 5년 3개월(2년 1개월~9년 8개월)이었으며, 수술시 평균 연령은 51세(26~75세)이었다. 일체형 대퇴스템이 19례, 조합형이 20례이었다. 일체형의 경우 수술 당시 육안적으로 대퇴 골두에 찰과 흔적이 없고, 대퇴스템이 안정된 경우 대퇴스템을 보존하였고, 조합형의 경우는 새로운 대퇴 골두로 모두 치환하였다. 결과: 임상적 평가로 술 전 Harris 고관절 점수는 57에서 87점으로 향상되었다. 방사선학적으로 모든 대퇴스템은 최종 추시까지 해리가 관찰되지 않았으며 골내성장을 보이는 안정된 대퇴스템을 유지하였다. 재재치환술을 시행한 경우는 총 5례로 과도한 폴리에틸렌 컵의 마모로 인한 골 용해와 비구컵 해리가 3례, 골용해 없이 비구컵의 기계적 해리에 의한 경우가 2례로 모두 대퇴 골두를 교환하지 못한 일체형 대퇴스템에서 발생하였다. 폴리에틸렌의 평균 마모율도 재재치환술을 시행한 일체형 대퇴스템의 경우 0.27 mm/year로서 조합형 대퇴스템의 마모율 0.11 mm/year보다 높게 나타났다. 결론: 일체형 대퇴스템의 경우 인공 골두가 육안적 찰과 흔적이 없더라도 추후 발생할 심한 폴리에틸렌 마모 등에 의한 실패를 방지하기 위해 비구컵 뿐 아니라 안정 고정된 일체형 대퇴스템도 재치환하는 것이 바람직할 것으로 사료된다. Purpose: The purpose of our study was to assess the clinical and radiological results of isolated acetabular revision and the differences in the results between monoblock and modular femoral stems. Materials and Methods: Between October 1991 and June 2002, 39 patients (39 hips) underwent isolated acetabular revisions with use of uncemented cups and bone grafts. The mean period of follow-up was 5 years 3 months (range, 2 years 1 month to 9 years 8 months). The mean age of the patients at the time of the surgery was 51 years old (range, 26 to 75 years old). The monoblock femoral stems were used in 19 hips and the modular femoral stems were used in 20 hips. The monoblock stems were retained without exchange provided that there was no gross scratch on the femoral head and the femoral stem was confirmed to be stable and fixed intraoperatively. In the modular stems, the femoral heads were always exchanged with new ones. Results: The mean Harris hip score improved from 57 to 87 points. Radiologically, all the stems retained at surgery remained well osseointegrated without osteolysis. Re-revisions of the acetabular components were performed in 5 hips using monoblock stems due to periacetabular osteolysis caused by excessive wear of polyethylene and subsequent loosening of the cups in 3 hips and mechanically unstable acetabular cups without osteolysis in 2 hips. The mean wear rate of polyethylene coupled with the monoblock stem was 0.27 mm/year which was greater than the 0.11 mm/year in the cases with modular stems. Conclusion: To prevent failure of acetabular cups that may occur later by excessive wear of polyethylene, we recommend revision of the well-fixed monoblock femoral stems even though there is no gross scratch on the femoral heads of the monoblock stems.

무시멘트형 대퇴골 삽입물을 이용한 고관절 재치환술

정영률 ( Young Yool Chung ),임채현 ( Chae Hyun Lim ),김충영 ( Chung Young Kim ),김정석 ( Jeong Seok Kim ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.4

목적: 무시멘트형 대퇴 삽입물을 이용하여 인공 고관절 재치환술을 시행한 후 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2010년 5월까지 본원에서 무시멘트형 대퇴 삽입물을 이용하여 인공 고관절 재치환술을 시행하고 2년 이상 추시가 가능하였던 26예를 대상으로 하였다. 재치환술 당시 나이는 평균 63.8세이었다. 추시 기간은 평균 45개월이었다. 재치환술의 원인은 무균성 해리 11예, 골절 6예, 골용해 6예, 감염 3예이었다. 방사선학적 결과는 삽입물의 침강, 해리, 응력 방패 현상을 관찰하였으며, 임상적 결과는 대퇴부 동통과 해리스 고관절 점수를 이용하여 평가하였다. 결과: 재치환술 전 해리스 고관절 점수는 평균 41.2점에서 최종 추시시 평균 85.8점이었으며 18예(69%)에서 양호 이상의 결과를 얻었다. 5예에서 대퇴부 동통을 호소하였다. 대퇴골 삽입물 침강은 3예에서 10 mm 이상 발생하였으며 평균 14 mm이었다. 2예에서 최종 추시시 해리 소견이 관찰되었다. 응력 방패 현상은 6예에서 관찰되었다. 지주 동종골 이식을 시행한 3예는 숙주골과 골유합 소견이 관찰되었다. 합병증은 2예에서 수술 중 발생한 대퇴 삽입물 주위 골절로 금속판과 강선을 이용하여 고정하였고, 3예에서 수술 후 탈구가 발생하여 정복 후 보조기를 착용시켰다. 결론: 무시멘트형 대퇴 삽입물을 이용한 인공 고관절 재치환술에서 임상적 및 방사선학적으로 만족할 만한 결과를 얻을 수 있었다. 그러나 직경이 너무 큰 삽입물을 사용한 경우에서 대퇴부 동통과 응력방패가 발생하였다. Purpose: To evaluate the clinical and radiographic results of patients who received revision total hip arthroplasty using cementless femoral stems. Materials and Methods: This study included 26 patients who underwent revision total hip arthroplasty using a cementless femoral stems in our hospital, between Jan 2000 and May 2010, and were able to be evaluated in the final follow-up. The mean age was 63.8 years at the time of the revision surgery, and the follow up period was an average of 45 months. The causes of revision were aseptic loosening in 11 cases, periprosthetic fracture in 6 cases, femoral osteolysis in 6 cases, and infection in 3 cases. The radiologic results were evaluated in term of subsidence, loosening, and the stress shielding. The clinical results were evaluated by the Harris hip score and thigh pain. Results: Harris hip score improved from 41.2 points preoperatively to 85.8 points at the final follow-up. There were 5 cases that complained of thigh pain at the last follow-up. Subsidence of femoral stem of more than 10 mm was observed in 3 cases. Stress shielding was noticed in 6 hips. The 3 grafted strut allografts were completely fused with the host bone. Complications included 2 cases of intraoperative periprosthetic fracture and 3 cases of dislocation. Conclusion: We obtained favorable clinical and radiologic outcomes in revision total hip arthroplasty using a cementless femoral stems. However, thigh pain and stress shielding resulted from the diameter of femoral stem being too large.

Wagner 재치환 주대를 이용한 대퇴 주대의 재치환술

강창수(Chang Soo Kang),양호준(Ho Jun Yang) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.1

Korea Between 1992 and 1996, 9cases involving Wagner SL femoral revision stems(Protek, Berne,Switzerland) were operated upon our hospital. The Wagner revision stem was designed to revise loosened femoral implant with extensive bone resorption and damage in the prosthetic bed. The indications were: 8 cases of extensive bone resorption and destruction of the proximal prosthetic bed and one periprosthetic fracture. The average follow up time was 40 months. The average age of the patients was 49.2 years(ranging 43 to 60 years). The average preoperative Harris hip score was 48.2 points, postoperative 85.7 points. 7 cases showed that, within a few months, new bone was developing in the proximal femoral bone defect. Subsidence of the stem was noted in 3 patients(ranging 6m/m to 15m/m), but was asymptomatic and did not require re-operation. We recommend the Wagner SL femoral revision stem, not as a routine procedure to treat loosening, but for patients with severe femoral bone resorption after THA or periprosthetic fractures,Girdlestone situation, and geriatric patients with peritrochanteric or subtrochanteric fractures.

광범위 세공 피복 대퇴 주대를 사용한 고관절 재치환술의 단기 추시 결과 보고

문경호,강준순,조규정,이동주,정새롬 대한고관절학회 2004 Hip and Pelvis Vol.16 No.1

Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems

( Hyung Gyu Jang ),( Kyung Jae Lee ),( Byung Woo Min ),( Hee Uk Ye ),( Kyung Hwan Lim ) 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3

Purpose: The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. Materials and Methods: Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. Results: The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. Conclusion: Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up.

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.

Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems

장형규,이경재,민병우,예희욱,임경환 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3

Purpose: The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. Materials and Methods: Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. Results: The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. Conclusion: Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up.