고관절 전 치환 성형술 후 탈구에 관한 치험 및 연구

서유성,김동진,박종석,임수재,나수균,최창욱 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

Dislocation is one of the serious complications in total hip replacement arthroplasties. The purpose of this study is to evaluate the risk factors of dislocation, including age, sex, preoperative diagnosis and bilaterality, history of previous hip surgery, positioning of component, soft tissue tension, treatment after dislocation or redislocation. Authors reviewed 190 patients of total hip replacement arthroplasty, which were performed from Jan. 1990 to Dec. 1996. 15 cases developed dislocation after surgery. Incidence of dislocation was 7.89%(15 of 190 cases). Dislocation after revision was not happened(0 of 18 cases). Inclination of acetabular cup was average 37.5° (range: 31° - 43° ). Average anteversion of the acetabular component was 18.1" by Woo and Morrey method, 11.4° by Hassan method. They were normal range except 3 cases. Dislocation was not prevented even though inclination and anteversion of acetabular cup were within normal range. Soft tissue tension is determined by change of limb and femoral neck length. Average limb length difference was -0.2mm(range; -l0mm - +10mm) and average offset difference was +1.7mm(range;-4mm - +18mm). Revision must be accomplished as soon as possible when limb shortening happen by upward migration of the acetabular component. In conclusion, anteversion of acetabular cup may be most important factor in our cases, so cup position must be fixed in proper position during operation.

자체 개발한 전치환술 검사보조기구의 임상적 유용성에 관한 고찰

박천규(Cheon kyoo Park),김찬민(Chan Min Kim),이원홍(Won Hong Lee),손순룡(Soon Yong Son),이용문(Yong Moon Lee) 대한영상의학기술학회 2006 대한영상의학기술학회 논문지 Vol.2006 No.1

Total hip replacement arthroplasty (THRA) is an useful treatment method in the patients with avascular necrosi(AVN) or degenerative arthritis(DA) to relieve pain and recovery of function. The purpose of this study is to evaluate the usefulness of a new support instrument for Total Hip Replacement Arthroplasty. THRA examination is very important before a surgical operation of hip join. but this is needed three operator. So we improved and made a new instrument for THRA. From January to march in 2004, 119 cases were examined by conventional manual method, and from January to march in 2004, 96 cases were examined by a new made instrument for THRA. The patient s correct position is to be showed the coccyx and pubic symphysis within 5mm on vertical line, and lesser trochanter of less than 5mm size. As a results, the correct position in conventional manual method was in 40%, and in the method using a new Instrument 76%. In conclusion, the method using a new Instrument for THRA examination showed a great improvement. Therefore, It will be a new kind of THRA examination.

고관절 전치환술 후 발생한 대퇴골 가성 낭종

황정수,정필현,강석,김종필,김영성,곽주영 東國大學校醫學硏究所 2005 東國醫學 Vol.12 No.1

인공 고관절 전치환술 후에 발생하는 합병증들에 대해서 여러 가지가 알려져 있다. 저자들은 54세 여자 환자에서 인공 고관절 전치환술 후에 골용해로 인해 발생한 대퇴골 근위부의 가성 낭종 1례를 드물게 체험하여 긴 대퇴 스템을 사용한 인공 고관절 재치환술, 골이식 및 시멘트 충전술을 사용하여 치료한 증례를 문헌고찰과 함께 보고하는 바이다. Many complications after total hip replacement arthroplasty are well known. We experienced a rare case of pseudocyst developed by osteolysis at proximal femur after total hip replacement arthroplasty. We report the case treated by revision total hip replacement arthroplasty using long femoral stem, autogenous and allogenous bone graft, and cementation for cyst cavity.

Postoperative Irradiation for Prevention of Heterotopic Bone Formation after Total Hip Replacement Arthroplasty

Woo Yoon Park(박우윤),Il Han Kim(김일한),Sung Whan Ha(하성환),Charn Il Park(박찬일) 대한방사선종양학회 1986 Radiation Oncology Journal Vol.4 No.1

관절주위 골형성은 고관절치환 성형술을 시행받은 환자의 0.6~61.7%에서 생친 수 있는 합병증이다. 저자들은 1981년 1월부터 1985년 5월까지 서울대학교병원 치료방사선과에서 고관절전치환 성형술 후 관절주위 골형성 예방을 위하여 방사선요법을 시행받은 4명의 환자(8개의 고관절)를 분석하였다. 방사선요법은 수술후 6~10일이내 시작하였으며 2,000cGy를 10회 분할 조사하였다. Modified Brooker system에 의하여 7계의 고관절에서는 Grade(1개 의고관절에서는 Grade) 2의 결과를 얻었다. 저자들의 이번 연구결과 및 문헌조사에 의하면 고관절 성형술 후 관절주위 골형성 예방을 위하여 호발군에 있어서의 방사선요법은 효과적이라고 하겠다. Heterotopic bone formation is a complication which occurs in 0.6 to 61.7% of patients after total hip replacement arthroplasty. We reviewed 4 patients (8 hips) who received postoperative irradiation on their hi ps for prevention of heterotopic bone formation in the Department of Therapeutic of Therapeutic Radiology, Seoul National University versify Hospital from January 1981 through August 1985. Radiation therapy was started 6 to 10 days postoperatively with the dosage of 2,000 cGy given in 10 fractions. As a result, 7 hips had Grade 0 and 1 hip had Grade 1 heterotopic ossification according to modified Blocker system. Our result and review of the literatures strongly support that the postoperative radiotherapy is effective for prevention of heterotopic bone formation in high risk group.

Postoperative Irradiation for Prevention of Heterotopic Bone Formation after Total Hip Replacement Arthroplasty

박우윤,김일한,하성환,박찬일,Park Woo Yoon,Kim Il Han,Ha Sung Whan,Park Charn Il The Korean Society for Radiation Oncology 1986 Radiation Oncology Journal Vol.4 No.1

관절주위 골형성은 고관절치환 성형술을 시행받은 환자의 $0.6\~61.7\%$에서 생친 수 있는 합병증이다. 저자들은 1981년 1월부터 1985년 5월까지 서울대학교병원 치료방사선과에서 고관절전치환 성형술 후 관절주위 골형성 예방을 위하여 방사선요법을 시행받은 4명의 환자(8개의 고관절)를 분석하였다. 방사선요법은 수술후 $6\~10$일이내 시작하였으며 2,000cGy를 10회 분할 조사하였다. Modified Brooker system에 의하여 7계의 고관절에서는 Grade(1개 의고관절에서는 Grade) 2의 결과를 얻었다. 저자들의 이번 연구결과 및 문헌조사에 의하면 고관절 성형술 후 관절주위 골형성 예방을 위하여 호발군에 있어서의 방사선요법은 효과적이라고 하겠다. Heterotopic bone formation is a complication which occurs in 0.6 to $61.7\%$ of patients after total hip replacement arthroplasty. We reviewed 4 patients (8 hips) who received postoperative irradiation on their hi ps for prevention of heterotopic bone formation in the Department of Therapeutic of Therapeutic Radiology, Seoul National University versify Hospital from January 1981 through August 1985. Radiation therapy was started 6 to 10 days postoperatively with the dosage of 2,000 cGy given in 10 fractions. As a result, 7 hips had Grade 0 and 1 hip had Grade 1 heterotopic ossification according to modified Blocker system. Our result and review of the literatures strongly support that the postoperative radiotherapy is effective for prevention of heterotopic bone formation in high risk group.

일차성 인공 고관절 전치환술을 전후한 혈액 손실과 수혈

남우동 ( Woo Dong Nam ),김일영 ( Il Young Kim ),유기형 ( Kee Hyung Rhyu ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.1

목적: 일차성 인공 고관절 전치환술 후의 실혈과 수혈양을 결정하는 인자를 찾고자 하였다. 방법: 인공 고관절 전치환술 시행 전후에 일반 혈액 검사와 수혈 기록이 빠짐없이 기록되어있는 60명의 환자를 대상으로 하였다. 성별, 연령, 진단, 시멘트 사용 여부, 절개의 크기 및 수술 시간, 수술 중 골절의 여부, 예측 실혈량, 수혈량, 배액관의 사용, 배액량 등을 변수로 하여 실혈 및 수혈량과의 관계를 알아 보았다. 결과: 술 직후와 술 후 1일의 혈색소 감소는 평균 3.18과 3.90 g/dL이었다. 실혈량과 변수들과의 통계적인 유의성은 없었다. 전체의 78.3%에서 평균 2.30 unit이 수혈되었다. 전체 수혈양은 술전 혈색소 수치, 배액관의 사용 및 배액량과 통계적 관련성이 있었으나 다른 변수들과는 연관이 없었다. 수혈 부작용은 수혈량이 많을수록 증가되었다. 결론: 실혈과 수혈량 모두 수술 수기와 관련된 변수들과는 연관이 없었다. 배액관을 사용하지 않은 그룹에서 전체 수혈량이 유의하게 적었으며 수술 중 수혈량이 배액량과 연관이 있으므로 수술 중 수혈을 줄이고, 배액관을 사용하지 않는 것이 전체 수혈량을 줄여 그 부작용을 감소시킬 수 있는 방법이라고 생각된다. Introduction: This study examined the factors related to the amount of blood loss and transfusion after primary total hip arthroplasty. Materials and methods: Sixty THRA patients, who had records of perioperative complete blood counts and transfusion, were enrolled in this study. Age, gender, diagnosis, use of cement, size of an incision, operative time, intraoperative crack, estimated blood loss, use of suction drain and the amount drained were used as possible variables. Results: The decrease in the serum hemoglobin level immediately after and 1 day after surgery was 3.18 and 3.90g/dL respectively. An average of 2.30 units were transfused in 78.3% of cases. The preoperative serum hemoglobin level, the use of a suction drain and the amount drained was related to the total amount of transfusion. Adverse transfusion reactions were found to be associated with the amount of transfusion Discussion: The reduction in the hemoglobin level and total amount of blood transfused showed no relationship with the variances associated with the surgical techniques. The total amount of blood transfused was significantly lower in the groups that had no suction drain. Therefore, a reduction in the volume of intraoperative transfusion and avoiding use of a suction drain can reduce the total amount of blood needed and reduce the adverse reactions of the transfusion.

Clinical and Functional Outcomes of the Exeter V40 Short Stem in Primary and Revision Arthroplasty: Does the Indication Affect Outcomes in the Short Term?

Nemandra Amir Sandiford,Scott M. Bolam,Irrum Afzal,Sarkhell Radha 대한고관절학회 2023 Hip and Pelvis Vol.35 No.1

Purpose: A variety of short Exeter stems designed specifically for use in performance of total hip arthroplasty(THA) in primary and revision settings have recently been introduced. Some have been used ‘off label’ for hip reconstruction. The aim of this study is to report clinical and radiological results from the Exeter V40 125 mm stem in performance of primary THA and revision THA. Materials and Methods: This study had a retrospective design. Insertion of 58 (24 primary, 34 revision) Exeter V40 125 mm stems was performed between 2015 and 2017. The minimum follow-up period was two years. Assessment of the Oxford hip score (OHS), EuroQol-5 Dimension (EQ-5D), and radiological follow-up was performed at one and two years. Results: In the primary group, the preoperative, mean OHS was 13.29. The mean OHS was 32.86 and 23.39 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were at 0.14, 0.59, and 0.35, preoperatively, at one-year follow-up and two-year follow-up, respectively. In the revision group, the mean preoperative OHS was 19.41. The mean OHS was 30.55 and 26.05 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were 0.33, 0.61, and 0.48 preoperatively, at one-year follow-up and two-year follow-up, respectively. No progressive or new radiolucent lines were observed around any stem at the time of the final follow-up in all patients in both groups. Conclusion: Encouraging results regarding use of Exeter V40 125 mm stems have been reported up to two years following surgery in primary and revision THA settings.

슬관절과 고관절 전치환술 환자의 수혈에 영향을 미치는 병원특성 요인 분석

오지영(Oh, Ji-Young),김상미(Kim, Sang-Mi),이성아(Lee, Seong-A) 한국산학기술학회 2015 한국산학기술학회논문지 Vol.16 No.6

저출산 고령화로 헌혈인구는 감소하고, 노년층의 혈액사용량은 증가할 것으로 예상되어 혈액부족과 수혈의 안정성 문제가 대두되고 있다. 이에 본 연구에서는 만성 퇴행성관절염인 슬관절과 고관절 전치환술 환자의 수혈에 영향을 주는 요인 을 분석하고자 하였다. 이를 위해 건강보험심사평가원의 2011년 환자표본자료 중 입원환자 5,370명을 대상으로 하였으며, SPSS 20 프로그램을 이용하여 로지스틱 회귀분석을 실시하였다. 독립변수로 사용된 변수는 병원특성과 환자특성으로 병원 특성은 의료기관 종류, 설립구분, 기관소재지와 가동병상수를, 환자특성으로는 성, 연령, 중증도, 전신마취유무, 주 진단, 빈혈 유무와 의료보험종류로 구분하였다. 분석결과, 슬관절전치환술 환자의 수혈에 유의한 영향을 미치는 변수로는 의료기관 종류, 기관소재지, 성, 연령, 중증도, 주 진단, 빈혈유무였으며, 고관절전치환술 환자의 수혈에 유의한 영향을 주는 변수로는 의료기관 종류, 기관소재지, 성, 연령, 중증도, 전신마취유무, 빈혈유무였다. 수혈현황과 영향요인을 분석한 본 연구는 비용 효과적이며, 양질의 의료를 위한 기초자 료로 활용될 수 있을 것으로 기대한다. The problems related with blood supply shortage and the stability of blood transfusion are on the rise, as it is expected that the blood doners will decrease but the blood use amount for aged population will increase, owing to low birth and aged population increase. The purpose of this study is to analyze the hospital characteristics which affect patients receiving and non-receiving blood transfusion for the knee and hip total replacement arthroplasty. Data were collected from Health Insurance Review and Assessment Service's 2011 sample data, and 5,370 inpatients were abstracted from them. Logistic regression analysis was performed, using SPSS 20. Independent variables used are hospital characteristics variables and patient characteristics variables. Hospital characteristics variables are hospital type, ownership, residence and the number of usable beds, and patient characteristics variables are gender, age, severity, type of anesthesia, main diagnosis, whether or not of anemia and insurance class. At the result of this study, it was found that hospital type, region, gender, age, severity, main diagnosis and whether or not of anemia were the factors that mostly affected the blood transfusion for knee arthroplasty. And hospital type, residence, gender, age, severity, type of anesthesia and whether of not of anemia were the factors that mostly affected the blood transfusion for hip arthroplasty. In addition to that, it is expected that this research which analyzed the present state of blood transfusion and its influence factors are cost effective, and would make a good use of preliminary data for good quality of medical service.

Effect of restrictive blood transfusion on postoperative acute kidney injury after total hip replacement arthroplasty: a prospective randomized controlled trial

Hyo Jung Son,Yoon Ji Choi,Ji Yoon Lee,Young Jin Ro 조선대학교 의학연구원 2020 Medical Bilogical Science and Engineering Vol.3 No.1

Blood transfusion is an important method of fluid management and benefits patients when properly used; however, it involves the risk of side effects such as critical organ damage. This study was designed to evaluate the efficacy and safety of a restrictive transfusion strategy (transfusion threshold of hemoglobin 8 g/dL) compared to a conventional transfusion strategy (transfusion threshold of hemoglobin 10 g/dL) on postoperative AKI among patients undergoing total hip replacement arthroplasty (THRA). Patients undergoing THRA were divided into two groups: restrictive transfusion strategy (n=72) and conventional transfusion strategy (n=72). Stroke volume variation was performed to maintain methods, complications, and preoperative and postoperative laboratory tests. They were categorized according to changes in plasma creatinine (Cr) concentration within 48 hours after THRA using Acute Kidney Injury Network criteria. Acute kidney injury (AKI) occurred in three patients (4.2%) in the restrictive transfusion strategy group and two patients (2.8%) in the conventional transfusion strategy group (p=0.99). The mean serum Cr levels 48 hours after surgery were 0.76±0.36 and 0.66±0.20 mg/dL in the restrictive transfusion strategy group and the conventional transfusion strategy group, respectively (p=0.30). Perioperative restrictive transfusion or conventional transfusion in patients undergoing elective THRA is not related to AKI when maintaining proper volume status during surgery.

Effect of restrictive blood transfusion on postoperative acute kidney injury after total hip replacement arthroplasty: a prospective randomized controlled trial

Hyo Jung Son,Yoon Ji Choi,Ji Yoon Lee,Young Jin Ro 조선대학교 의학연구원 2020 Medical Bilogical Science and Engineering Vol.1 No.1

Blood transfusion is an important method of fluid management and benefits patients when properly used; however, it involves the risk of side effects such as critical organ damage. This study was designed to evaluate the efficacy and safety of a restrictive transfusion strategy (transfusion threshold of hemoglobin 8 g/dL) compared to a conventional transfusion strategy (transfusion threshold of hemoglobin 10 g/dL) on postoperative AKI among patients undergoing total hip replacement arthroplasty (THRA). Patients undergoing THRA were divided into two groups: restrictive transfusion strategy (n=72) and conventional transfusion strategy (n=72). Stroke volume variation was performed to maintain methods, complications, and preoperative and postoperative laboratory tests. They were categorized according to changes in plasma creatinine (Cr) concentration within 48 hours after THRA using Acute Kidney Injury Network criteria. Acute kidney injury (AKI) occurred in three patients (4.2%) in the restrictive transfusion strategy group and two patients (2.8%) in the conventional transfusion strategy group (p=0.99). The mean serum Cr levels 48 hours after surgery were 0.76±0.36 and 0.66±0.20 mg/dL in the restrictive transfusion strategy group and the conventional transfusion strategy group, respectively (p=0.30). Perioperative restrictive transfusion or conventional transfusion in patients undergoing elective THRA is not related to AKI when maintaining proper volume status during surgery.