Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Early Clinical Results in the Use of a Tantalum Trabecular Metal System For Osteonecrosis of the Femoral Head

Tantalum 망상 금속 대치술을 이용한 대퇴 골두 무혈성 괴사 치료의 초기 결과

  • Kim, Jong-Oh (Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman’s University School of Medicine) ;
  • Noh, Kwon-Jae (Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman’s University School of Medicine) ;
  • Park, Hyun-Sik (Department of Orthopedic Surgery, Seoul Micro Hospital) ;
  • Do, Nam-Hoon (Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman’s University School of Medicine) ;
  • Kim, Tae-Ho (Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman’s University School of Medicine) ;
  • Son, Sun-Sang (Department of Orthopedic Surgery, National Medical Center)
  • 김종오 (이화여자대학교 의학전문대학원 목동병원 정형외과학교실) ;
  • 노권재 (이화여자대학교 의학전문대학원 목동병원 정형외과학교실) ;
  • 박현식 (서울 마이크로병원 정형외과) ;
  • 도남훈 (이화여자대학교 의학전문대학원 목동병원 정형외과학교실) ;
  • 김태호 (이화여자대학교 의학전문대학원 목동병원 정형외과학교실) ;
  • 손훈상 (국립의료원 정형외과)
  • Published : 2009.06.30

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Abstract

Purpose: To evaluate the effectiveness of core decompression using a tantalum trabecular metal system for treatment of early stage osteonecrosis of the femoral head, with a minimum follow-up of 1 year and a maximum follow-up of 5 years. Materials and Methods: Between January 2003 and August 2007, a retrospective analysis was conducted on 46 femoral heads in 36 patients (9 males and 27 females) underwent core decompression using a tantalum trabecular metal system. The mean duration of follow-up was 26 months (minimum, 1 year; maximum, 5 years). The ARCO classification system was used. The mean age of the patients was 42.9 years. The conversion to total hip arthroplasty due to aggravating hip pain was defined as a clinical failure. Results: At an average of 12 months, 18 patients (21 hips) were converted to THR. No conversion to THR in occurred in stages IA or IIA. In Stage IB, one-half of the medial lesion and all of the lateral lesions were converted to THR. One of 11 medial lesions and all of the lateral lesions in stage IC were converted to THR; 2 of 3 medial lesions and all of the lateral lesions in stage IIB were converted to THR. In stage IIC, 6 of 8 lateral lesions were converted to THR, but the central lesions were not converted. All of the lateral lesions in stage IIIC were converted to THR. Conclusion: The higher stage of ARCO classification and the more lateral position of the lesion, the greater the failure rate of the tantalum trabecular metal system. Conversion to THR from a failed tantalum trabecular system developed within 12 months postoperatively. The tantalum trabecular metal system is a useful treatment for osteonecrosis of the femoral head with a lower stage of ARCO classification and a medial location of the lesion.

목적: 대퇴 골두 무혈성 괴사 환자에 있어서 Tantalum 망상 금속 대치술을 이용한 핵심 감압술의 최단 1년에서 최장 5년까지의 추시 결과를 보고하고, Tantalum 망상 금속 대치술의 유용성에 대해 알아보고자 한다. 대상 및 방법: 2003년 1월부터 2007년 8월까지 시행한 36명의 환자, 46개의 고관절을 대상으로 하였다. 추시 기간은 최단 1년에서 최장 5년까지(평균 26개월) 이었으며, 초기 대퇴 골두 무혈성괴사의 분류는 ARCO 분류를 이용하였다. 환자의 평균 나이는 42.9세였으며, 남자가 27명, 여자가 9명이었고, 후향적 분석을 시행하였다. 임상적 실패는 대퇴 통증으로 인한 인공 고관절 치환술 시행을 기준으로 하였다. 결과: 추시 결과 18명의 환자 21례에서 Tantalum 망상 금속정 수술 후 약 12개월째 인공 고관절전치환술을 시행하였다. Stage IA는 인공 고관절로의 치환이 없었으며, stage IB는 내측 2례중 1례(50%), 외측 2례는 모두 인공 고관절 치환을 실행하였다. Stage IC는 내측 11례 중 1례(9%), 외측 3례 모두 치환술을 시행하였으며, 중심측은 4례 모두 인공관절 치환을 하지 않았다. Stage IIA는 내측 및 중심측 모두 인공 고관절 치환이 없었다. Stage IIB는 내측 3례중 2례(66.6%), 외측은 4례 모두인공 고관절 치환을 시행하였다. Stage IIC는 중심측 3례 모두 인공 고관절 치환을 하지 않았고, 외측 8례중 6례(75%)에서 인공 고관절 치환을 시행하였다. Stage IIIC는 외측 2례 모두 인공 전치환술을 시행하였다. 결론: ARCO stage가 높거나 병변이 대퇴 골두의 외측에 위치한 경우에서는 Tantalum 망상 금속 대치술을 시행하면 실패할 가능성이 높다. ARCO 초기 병변 일수록 성공률이 높았으며, 실패한 경우는 대부분 Tantalum 망상 금속정 대치술 후 12개월 이내에 인공 고관절 전치환술로 전환되었다. 낮은 ARCO stage나 병변이 대퇴골의 내측에 위치한 경우에는 Tantalum 망상 금속정대치술을 고려해 볼만하다.

Keywords

References

  1. Aaron RK, Ciombor DM, Lord CF. Core decompression augmented with human decalcified bone matrix graft for osteonecrosis of the femoral head. Journal of American Academy of Orthopaedic Surgeons, 301-307, 1997.
  2. ARCO (Association Research Circulation Osseous). Committee on Terminology and Classification. ARCO News, 4: 41-46, 1992.
  3. Bobyn JD, Pilliar RM, Cameron HU, Weatherly GC. The optimum pore size for the fixation of porous-surfaced metal implants by the ingrowth of bone. Clin Orthop Relat Res, 150: 263-270, 1980.
  4. Chan TW, Dalinka MK, Steinberg ME, Kressel HY. MRI appearance of femoral head osteonecrosis following core decompression and bone grafting. Skeletal Radiol, 20: 103-107. 1991.
  5. Christie MJ. Clinical applications of Trabecular Metal. Am J Orthop, 31: 219-220, 2002. https://doi.org/10.4263/jorthoptic.31.219
  6. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Longterm results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg, 77-B: 42-49, 1995.
  7. Ficat RP. Idiopathic bone necrosis of the femoral head: early diagnosis and treatment. J Bone Joint Surg, 67-B: 3-9, 1985.
  8. Heiner A, Poggie R, Brown T. Flexural rigidity of laboratory and surgical substitutes for human fibular bone grafts. J Musculoskeletal Res. 2: 267-272, 1998. https://doi.org/10.1142/S0218957798000263
  9. Hungerford DS. Treatment of avascular necrosis in the young patient. Orthopedics, 18: 822-823, 1995.
  10. Kane SM, Ward WA, Jordan LC, Guilford WB, Hanley EN Jr. Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis. Orthopedics, 19: 869-872, 1996.
  11. Bozic KJ, Zurakowski D, Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg, 81-A: 200-209, 1995.
  12. Learmonth ID, Maloon S, Dall GC. Decompression for early atraumatic osteonecrosis of the femoral head. J Bone Joint Surg, 72-B: 387-390, 1990.
  13. Malizos KN, Karantanas AH, Varitimidis SE, Dailiana ZH, Bargiotas K, Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol, 63: 16-28, 2007. https://doi.org/10.1016/j.ejrad.2007.03.019
  14. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg, 77-A: 459-474, 1995.
  15. Nam KW, Kim YR, Yoo JJ, Koo KH, Yoon KS, Kim HJ. Fate of untreated asymptomatic osteonecrosis of the femoral joint. J Bone Joint Surg, 90-A: 477-484, 2008.
  16. Ohzono K, Saito M, Takaoka K, Ono K, Saito S, Nishina T, Kadowaki T. Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg, 73: 68-72, 1991.
  17. Park YS, Yi SR, Park YK, et al. Core decompression and impaction bone graft in avascular necrosis of the femoral head. J Korean Orthop Assoc, 34: 425-430, 1999.
  18. Pedersen DR, Brown TD, Poggie RA. Finite element characterization of a porous tantalum material for treatment of avascular necrosis. Trans Orthop Res Soc, 22: 598, 1997.
  19. Scully SP, Aaron RK, Urbaniak JR. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg, 80-A: 1270-1275, 1998.
  20. Shuler MS, Rooks MD, Roberson JR. Porous tantalum implant in early osteonecrosis of the hip: preliminary report on operative, survival, and outcomes results. J Arthroplasty, 22: 26-31, 2007. https://doi.org/10.1016/j.arth.2006.03.007
  21. Steinberg ME, Brighton CT, Corces A et al. Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation. Clin Orthop Relat Res, 249: 199-208, 1989.
  22. Steinberg ME, Steinberg DR et al. Classification systems for osteonecrosis: an overview. Orthop Clin North Am, 35: 273-283, 2004. https://doi.org/10.1016/j.ocl.2004.02.005
  23. Vail TP, Urbaniak JR. Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg, 78-A: 204-211, 1996.