무시멘트형 비구컵 주위에 발생한 골용해

박상원 ( Sang Won Park ),백종륜 ( Jong Ryoon Baek ),이상원 ( Sang Won Lee ),이대희 ( Dae Hee Lee ) 대한고관절학회 2004 Hip and Pelvis Vol.16 No.4

목적: Harris-Galante 2형 무시멘트 비구컵 주위에 발생한 골용해에 영향을 미치는 인자들을 분석하고자 하였다. 대상 및 방법: 1991년부터 1994년 사이에 Harris-Galante 2형 무시멘트 비구컵과 Multilock 대퇴스템을 이용하여 인공고관절 전치환술을 시행하고 10년이상 추시가 가능하였던 44례를 대상으로 비구컵 주위에 발생한 골용해 발생빈도와 연령, 성별, 체중, 원인, 비구컵의 경사각, 폴리에틸렌 라이너의 두게, 폴리에틸렌 라이너의 선상 마모율과 골용해 발생과의 관계를 분석하였다. 결과: 총 44례중 18례(40.9%)에서 비구컵 주위에 골용해가 발생하였으며, Charnley와 DeLee의 2구역에서 16례로 가장 많이 발생하였다. 연령, 성별, 체중, 원인, 비구컵의 경사각과 골용해는 통계학적으로 의미있는 차이는 없었으나 폴리에틸렌 라이너의 두게, 폴리에틸렌 라이너의 선상 마모율과는 통계적으로 유의성이 있었다. 결론: Harris-Galante 2형 무시멘트형 비구컵을 이용한 인공고관절 전치환술을 시행하고 10년이상 추시시 비구컵 주위의 골용해 발생 빈도는 시간이 지남에 따라 증가하였고 폴리에틸렌 라이너의 두께, 폴리에틸렌 라이너의 선상 마모율이 골용해 발생에 영향을 미치는 것으로 나타났으며 잠금 장치가 개선된 비구컵과 폴리에틸렌 라이너의 개선 및 세라믹이나 금속과 같은 관졀면의 사용이 필요할 것으로 사료된다. Purpose: The purpose of this study was to evaluate the factors that have an influence on the osteolysis of cementless acetabular components (Harris-Galante type 2). Material and Method: From 1991 to 1994, 36 patients (44 cases) of total hip arthroplasty using a Multilock femoral stem and a Harris-Galante type 2 acetabular cup were reviewed with minimal follow-up period of 10 years. The relationship between the osteolysis and several factors such as the age, gender, weight, etiology, inclination, polyethylene liner thickness and wear rate were analyzed. Results: Osteolysis around the acetabular cup was found in 18 cases (40.9%). The most common area where this developed was zone 2 (16 cases, 36.4%). There was no statistically significant relationship between the age, gender, weight, etiology, inclination angle and the osteolysis. However, there was statistically significant correlation between the polyethylene liner thickness, wear rate and osteolysis. The average polyethylene liner thickness was 7.1 mm in cases with osteolysis and 8.1 mm in cases without osteolysis. The average wear rate was 0.26 mm/year in the osteolysis group, and 0.14 mm/year in the non-osteolysis group. Conclusion: The incidence of osteolysis in the cementless acetabular component (Harris-Galante type 2) may increase as the follow-up period increases, and it was significantly related to the thickness and wear rate of the polyethylene liner. We suggest that the acetabular component needs an improved locking mechanism, improvement for the polyethylene liner longevity, and a ceramic or metal bearing surface is needed.

무시멘트 인공 고관절 전치환술 후 대퇴골 주위에 발생한 골용해 -형태와 크기에 영향을 주는 요인들에 관한 연구-

장준동 ( Jun Dong Chang ),위영훈 ( Young Hoon We ),최수중 ( Soo Joong Choi ),장호근 ( Ho Guen Chang ),이창주 ( Chang Ju Lee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.1

There are many investigations about the femoral osteolysis including the patterns and size of the lesion. However, the factors, which influence the patterns and size of the femoral osteolysis, are not well known. Purposes of the study were to evaluate the patterns of the femoral osteolysis, to analyze the planimetric and approximate volumetric values of the lesion after cementless total hip arthroplasty and to evaluate the factors, which influence the patterns and size of the femoral osteolysis. We analyzed 120 hips who had undergone cementless THA using Harris Galante pomus prosthesis (Zimmer, Warsaw, Indiana) in 49 hips and Anatomic components (Zimmer, Warsaw, Indiana) in 71 hips. After an average of 4.9 years (range 4-10 years), 45 cases (37.5%) showed femoral osteolysis on the radiograph. The mean rate of linear wear was 0.24+-0.14mm in the cases of the femoral osteolysis. The size of the femoral osteolysis was correlated with duration, stem type, linear wear amount and linear wear rate. The linear wear amount showed higher correlation than the linear wear rate. In this study, the factors which influence the patterns of the femoral osteolysis were not found. Among eight cases of the revision, five cases required the revision due to severe femoral osteolysis lesion and polyethylene liner wear without the loosening of the prosthesis. We could confum that the size of osteolysis is important factor for the result of THA. Therefore, it is necessary to carefully follow-up the patients which show the osteolytic lesion and include the size of osteolysis in the item of the evaluation for the result of THA.

Harris-Galante 무시멘트 비구 부품과 동반 사용된 무시멘트 대퇴 사입물 주위의 골내막 골용해

김영호 ( Young Ho Kim ),최필근 ( Pil Geun Choi ),송준민 ( Joon Min Song ),나수균 ( Soo Kyoon Rah ),최창욱 ( Chang Uk Choi ),김창진 ( Chang Jin Kim ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.2

Authors reviewed 159 cases of total hip arthroplasty which had used uncemented femoral components associated with Harris-Galante uncemented metal backed acetabular component and followed more than 1 year at least to identify overall incidence of osteolysis, incidence of osteolysis according to type of implant, time of first noted, radiographic distribution of osteolysis with its shape and size and correlation between osteolysis and relevant factors. The results were followings: 1) Overall incidence of femoral endosteal osteolysis in the use of three kind of uncemented femoral components associated with Harris Galente, uncemedted metal backed acetabular component was 6.3% 2) Osteolysis was first noted radiographically at 12 to 55 months(mean, 27months) postoperatively. 3) In most patients, osteolysis occurred at Zone 2, 3,5, 6 on AP radiograph and Zone 3,5,6 on lateral radiograph, where was distal to porous pad. 4) Mean liner wear rate in patient with osteolysis was 0.46 mm/year, which was higher than that reported previously and mean wear rate in cases with progression of osteolysis was higher than that without progression of osteolysis. 5) No correlation could be found between thickeness of polyethylene liner and osteolysis.

3D CT를 이용한 비구 컵 주위 골용해 측정 및 임상 결과와의 관련성

손원용 ( Won Yong Shon ),오종건 ( Jong Gun Oh ),윤호현 ( Ho Hyun Yun ),윤지열 ( Ji Yeol Yoon ),김승주 ( Seung Ju Kim ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.1

목적: 골반골 주위에서 발생한 골 용해 크기 및 위치를 측정하고 임상 성적과의 관련성을 알아 보고자 하였다. 대상 및 방법: 무 시멘트형 비구컵을 사용한 인공 고관절 전치환술을 받은 환자 97명(116례)에게 3D CT가 시행되었고, 이중 명확한 골 용해를 가진 40례(31환자)에 대해 연구를 시행하였다. 대상 환자들은 수술 후 6-12주에 방사선 사진을 촬영하였고, 추시 기간이 18개월 이상이며 감염의 과거력이 없었다. 골 용해의 크기 1 cm3미만(A), 1 cm3에서 2 cm3미만(B), 2 cm3에서 3 cm3미만(C), 3 cm3(D) 이상의 4개의 군으로 분류 하였으며, 골 용해의 위치를 전방, 후방, 상방, 하방, 중앙의 5 군으로 분류하였다. 골 용해 크기, 골 용해 위치, 폴리에틸렌 마모와 임상결과(Harris hip score)간의 관련성을 통계학적으로 분석하였다. 결과: 골 용해군의 평균 체적은 3.2 cm3이었으며(A군 14례, B군 11례, C군 4례, D군은 11례) 골 용해 크기와 임상성적간에 통계적으로 유의한 상관관계를 보였다(Rs=-0569). 그러나 골 용해의 위치에 따른 분류 상 전방 18례, 상방 5례, 후방 10례, 하방 33례, 중앙 32례이었으며 골 용해 위치와 임상성적간에 통계적으로 유의한 차이는 없었다(P=0.35). 결론: 골 용해 크기와 임상 성적 사이에는 의미있는 상관 관계가 보였고(Rs=-0569), 특히 3 cm3 이상의 골 용해 군에서는 통계학적으로 유의한 임상성적의 감소가 관찰 되었다(P=0.022). 이는 추 후 골 용해에 대한 치료를 결정하는데 있어 하나의 지침이 될 수 있으리라 사료된다. Purpose: We wanted to measure the size of the osteolysis of the pelvis and to quantify its location and we wanted to assess the correlation of these measurements with the clinical result. Materials and methods: We evaluated 40 hips (31 patients) that showed definitive osteolysis among 116 hips (97 patients) that underwent 3 dimensional CT scanning post-operatively after total hip arthroplasties with using cementless acetabular cups. The inclusion criteria were a follow up duration of more than 18 months and no history of infection. The radiographs were obtained at the 6th to 12th week postoperatively. The size of pelvic osteolysis was divided into 4 groups (less than 1 cm3 (A), between 1 cm3 to 2 cm3 (B), between 2 cm3 to 3 cm3 (C), more than 3 cm3 (D)), and the location of osteolysis was divided into 5 groups (anterior, posterior, superior, inferior and central) The size and location of osteolysis and the wear of the polyethylene were analysed in relation to the clinical outcome, which was assessed using the Harris Hip Score). Results: The average size of the osteolysis was 3.2 cm3 (A 14 cases in group A, B 11 cases in group B, C 4 cases in group C, and D 11 cases in group D). There was significant correlation between the size of the osteolysis and the clinical outcome (Rs=-0569). However, there was no significant correlation between the osteolysis location (Anterior: 18 cases, Superior: 5 cases, Posterior: 10 cases, Inferior: 33 cases and Central: 32 cases) and the clinical outcome (P=0.35). Conclusion: There is a significant correlation between the size of the osteolysis and the Harris Hip Score (Rs=-0569). Especially, a pelvic osteolysis of more than 3 cm3 was found to be correlated with a decreased postoperative HHS (P=0.022). We hope that these results may be useful to help guide the treatment of osteolysis.

LIM Homeobox Transcription Factor 1-β Expression is Upregulated in Patients with Osteolysis after Total Ankle Arthroplasty and Inhibits Receptor Activator of Nuclear Factor-κB Ligand-Induced Osteoclast Differentiation in Vitro

김갑순,Jeong Eun Han,이근배,김낙성 대한골대사학회 2022 대한골대사학회지 Vol.29 No.3

Background: Osteolysis is one of the most common problems that occurs after total hip and knee arthroplasty and has recently become a significant problem after total ankle arthroplasty (TAA). In this study, we investigated the role of LIM homeobox transcription factor 1-β (Lmx1b) in osteoclast differentiation. By evaluating the expression profiles as- sociated with osteolysis following TAA treatment, Lmx1b was found to be differentially expressed in patients with osteolysis after TAA. Methods: To identify the important genes associated with osteolysis after TAA, RNA sequencing was performed by analyzing 8 pa- tient samples: 5 primary TAA samples (control group) and 3 TAA samples revised for flex- ion instability (osteolysis group). By analyzing the differentially expressed genes and gene ontologies, Lmx1b expression was found to be upregulated in the osteolysis group compared to that in the control group. Focusing on the role of Lmx1b in bone cells, Lmx1b was overexpressed by a retrovirus in osteoclast precursor cells. The cultured cells were stained with tartrate-resistant acid phosphatase, and the expression of osteoclast- related genes was analyzed using real-time polymerase chain reaction. Results: Lmx1b overexpression in osteoclast precursors suppresses osteoclast formation and resorptive activity. The expression of osteoclast marker genes was significantly reduced during os- teoclast differentiation by Lmx1b overexpression. Furthermore, Lmx1b is associated with nuclear factor of activated T cells 1 (NFATc1) and inhibited NFATc1 translocation into the nucleus. Conclusions: These results provide novel insights into the anti-bone resorp- tive effect of Lmx1b on osteolysis after TAA and may lead to the development of effec- tive preventative and therapeutic strategies for peri-implant osteolysis.

골시멘트를 사용하지 않는 인공고관절 성형술에서 대퇴스템 주위의 골용해에 대한 분석 -이극성 반치환 성형술과 전치환 성형술의 비교-

박상원 ( Sang Won Park ),박종훈 ( Jong Hoon Park ),구자성 ( Ja Seong Koo ) 대한고관절학회 1996 Hip and Pelvis Vol.8 No.2

Periprosthetic osteolysis may be the most common cause of late failure after total hip arthroplasty perfomed without cement and its incidence is increasing with time. The purpose of this study was to find out the incidence and the characters of the periprosthetic osteolysis and to analyse its relation with the possible factors; age, sex, body weight, size of the acetabular cup or the femoral stem, stability of the femoral stem, and clinical score. The authors analysed twenty-one cases in eighteen patients of bipolar hemiarthroplasty and twenty-eight cases in twenty-five patients of total hip arthroplasty inserted with non-circumferential porous coated femoral stem of Harris-Galante type and femoral head of 28 millimeter diameter from Jan. 1985 to Dec. 1991. All of the patients were followed up for at least four years. The results obtained were as follows: l. Over all incidence of periprosthetic osteolysis was 38% in bipolar hemiarthroplasty and 35.7% in total hip arthroplasty. 2. The pattern of osteolysis in bipolar hemiarthroplasty was 3 focal, 4 multifocal and 1 diffuse osteolysis, and in total hip arthroplasty, 3 focal, 4 multifocal, and 3 diffuse osteolysis.

무시멘트형 인공고관절 전치환술에서 스템의 형태에 따른 대퇴부의 골용해증 위치와 유병율

이상홍 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.2

Background and Objectives: The biologic reaction to particulate wear debris had implicated as a causative factor in periprosthetic osteolysis following total joint arthroplasty. It has been suggested that the prevalence, location and severity of osteolytic defects is related to several factors including access of wear particules generated at the articulation to the implant-bone interface. The purpose of this study was to examine the inflence of femoral component design on the location and prevalence of diaphyseal osteolysis. Materials and Methods: 101 patient (119 hips) who had had a Harris-Galante (HG) total hip arthroplasty (THA) were matched by age, weight, sex, and diagnosis, with 100 patients (122 hips) who had had a Multilock THA X-rays were reviewed and the location of osteolytic lesions were noted using Gruen's zonal analysis. Results: In the HG group, the overall prevalence of femoral osteolysis was 47%(56/119). Among the 38 of the 56 cases in the HG group with osteolysis, the lesions were in Gruen zones 3, 4 and 5 around the distal protions of the stem. In contrast, no diaphyseal osteolysis was noted in the Multilock group at comparable length of follow up (p<0.05). In the HG group, 7 patients had required femoral revisions for progressive femoral osteolysis. None of the Multilock stems required revision surgery. Histologic examination of the tissue from the osteolytic areas demonstrated a characteristic foreign body granuloma with particulate polyethylene noted in all cases. Conclusion: The presence of polyethylene in the osteolytic defects around the distal portion of the stem supports the concept of the effective joint space as this material obviously came from the hip articulation. The significant difference in diaphyseal osteolysis comparing the HG and Multilock stems at comparable follow-up times lends credence to the gasket theory. Based on this data, it does appear that circumferential porous coatings arc a relative barrier to the ingress of at least clinically significant amounts of wear debris generated at the hip articulation. Incomplete or patch porous coatings are like to provide a conduit for wear particles to gain access ot the implant-bone interface.

안정된 Harris-Galante 비구컵 주위의 골용해의 치료 -비구컵 보존군과 재치환군 간의 비교-

한승범 ( Seung Beom Han ),박종훈 ( Jong Hoon Park ),경봉수 ( Bong Soo Kyeong ),김태권 ( Tae Kwon Kim ),박상원 ( Sang Won Park ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.1

Purpose: We analyzed and compared 30 clinical cases of acetabular osteolysis around a stably fixed acetabular cup, and this was managed by changing the liner along with retaining or revising the cup. Materials and Methods: We analyzed 30 patients who underwent acetabular component revision or retention with a bone graft for osteolysis around a stably fixed Harris-Galante acetabular cup and these patients were followed up for more than 2 years. There were 7 cases with a conserved the acetabular cup and only the liner was changed, and 23 cases with a totally revised acetabular component. We compared the size of the acetabular cup, the thickness of the polyethylene liner, the progression of osteolysis and the clinical outcomes. Results: The Harris hip score was improved in both groups. In the retention group, during an average of 59.9 months of follow up, 7 cases showed stable fixation and 3 cases showed locally advanced osteolysis. In the revision group, during an average of 57.2 months of follow up, all 20 cementless acetabular cups showed stable fixation. Conclusion: We suggest that in patients with osteolysis around the stable cementless acetabular cup, both methods show satisfactory clinical outcomes. But considering recurrence of osteolysis, cup revision is more reliable than changing the liner with a bone graft.

인공 관절 시행 후 발생한 대퇴부 골용해의 진단과 치료

조명래 ( Myung Rae Cho ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.2

목적: 대퇴부 골용해의 진단 및 치료 방법을 알아보고자 한다. 내용: 골용해(osteolysis)는 마모입자에 의한 생물학적 반응으로 인공관절의 수명에 가장 큰 영향을 미치는 가장 흔하고 중요한 합병증이다. 그러나 심각한 골결손 및 이완이 발생하기 전까지 증세가 나타나지 않아 조기 진단과 치료에 어려움이 있다. 조기진단과 정확한 치료를 시행하기 위해 대퇴부 골용해시 나타날 수 있는 임상적 소견 및 방사선 소견 등을 살펴보고 필요한 약물치료 및 수술적 치료방법 등을 살펴보았다. 결론: 인공관절의 재질 및 디자인의 향상으로 마모 입자의 발생이 감소되어 골용해가 줄어들고 있으나 여전히 문제가 존재하는 상태로 골용해 방지를 위해 지속적인 노력이 필요할 것으로 사료된다. Purpose: To evaluate the diagnosis and treatment of femoral osteolysis. Contents: Osteolysis developed from biologic interaction by wear debris, is one of the common and important complications, which is the most influencing factor of the durability of artificial joint. However, it is difficult to diagnose and treat femoral osteolysis early, because there are no symptoms until a serious bone loss occurs. For the accurate treatment and the early diagnosis of femoral osteolysis, we evaluated the clinical and radiological findings, and also evaluated the medical and surgical managements. Conclusion: From the improvement of the quality and design of artificial joint, femoral osteolysis is reducing these days. However, it still remains a problem, so consistent effort are required to reduce it.

Cervical Myelopathy Induced by Posterior Vertebral Body Osteolysis after Cervical Disc Arthroplasty

Man Kyu Choi,Jun Ho Lee 대한신경외과학회 2023 Journal of Korean neurosurgical society Vol.66 No.5

Cervical disc arthroplasty (CDA) has become more widespread and diverges from the conventional technique used in anterior cervical fusion for cervical degenerative disc disease. As arthroplasty has become a popular treatment option, few complications have been reported in the literature. These include subsidence, expulsion, posterior avulsion fractures, heterotopic ossification, and osteolysis. One of the critical complications is osteolysis, but current studies on this subject are limited in terms of not elucidating the incidence, etiology, and consequences. The authors present two cases, who presented with clinical signs of gradually worsening myelopathy induced by posterior vertebral body osteolysis, 2 years after CDA. Subsequently, the patient underwent posterior decompression and fusion without prosthesis removal. Postoperatively, the clinical symptoms gradually resolved, with no severe deficits. The present rare cases highlight the osteolysis that occurs after CDA, which can cause cervical myelopathy, and suggest spine surgeons to be alert to this fatal complication.