Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지

Cementless Total Hip Arthroplasty Using a Ceramic on Ceramic Bearing Surfaces in Patients 60 or More Years Old

60세 이상의 환자에서 세라믹-세라믹 관절면 무시멘트형 인공 고관절 전치환술

  • Lee, Woo-Suk (Department of Orthopedic Surgery, College of Medicine, Yonsei University) ;
  • Cho, Sung-Jin (Department of Orthopedic Surgery, College of Medicine, Konyang University) ;
  • Jeon, Taek-Soo (Department of Orthopedic Surgery, College of Medicine, Inje University, Haeundae Hospital) ;
  • Kim, Sang-Bum (Department of Orthopedic Surgery, College of Medicine, Konyang University) ;
  • Heo, Youn-Moo (Department of Orthopedic Surgery, College of Medicine, Konyang University) ;
  • Yi, Jin-Woong (Department of Orthopedic Surgery, College of Medicine, Konyang University) ;
  • Park, Won-Ki (Department of Orthopedic Surgery, College of Medicine, Konyang University)
  • 이우석 (연세대학교 의과대학 정형외과교실) ;
  • 조성진 (건양대학교 의과대학 정형외과학교실) ;
  • 전택수 (인제 대학교 해운대 백병원 정형외과교실) ;
  • 김상범 (건양대학교 의과대학 정형외과학교실) ;
  • 허윤무 (건양대학교 의과대학 정형외과학교실) ;
  • 이진웅 (건양대학교 의과대학 정형외과학교실) ;
  • 박원기 (건양대학교 의과대학 정형외과학교실)
  • Published : 2010.06.30
⟨ Previous Next ⟩

Abstract

Purpose: To investigate clinical and radiographic results for cementless total hip arthroplasty (THA) using ceramicon-ceramic articulation in patients over 60 years old. Materials and Methods: Between May 2000 and February 2007, we analyzed 44 THAs that used ceramic-onceramic articulation in 34 patients aged 60 or older. The mean follow-up duration was 3.2 years; the mean age was 66.8 years. Clinical and radiographic evaluations were carried out. Risk factors for dislocation were evaluated. Results: Final Harris hip scores increased to an average of 90 points from an average of 51 points preoperatively. Radiographic findings demonstrated that fixations around the stems and the acetabular cups were stable. There was no aseptic loosening and osteolysis around the implants. There were 10 cases of posterior dislocation within 3 months postoperatively. Two revisions were done, one due to a recurrent dislocation and one to a ceramic head fracture. Risk factors for dislocation were ASA score, cup anteversion angle and total anteversion angle. Conclusion: Cementless THAs using ceramic-on-ceramic articulation for patients aged sixty or more elicits good clinical and radiographic results. Because of the high rate of early dislocation and damage to the ceramic, we call attention to the position of the implants and postoperative management in elderly, debilitated patients.

목적: 60세 이상 환자에서 무시멘트형 인공 고관절 전치환술의 초기 임상적, 방사선학적 결과 및 합병증을 분석하고자 하였다. 대상 및 방법: 2000년 5월부터 2007년 2월까지 세라믹-세라믹 관절면 무시멘트형 인공 고관절 전치환술을 시행받고 2년 이상 추시 가능하였던 34명 44예를 대상으로 하였다. 평균 연령은 66.8세 이었고, 평균 추시기간은 3.2년이었다. 임상적, 방사선학적 결과와 탈구에 영향을 미치는 인자를 분석하였다. 결과: Harris 고관절 점수는 술 전 평균 51점에서 최종 추시시 평균 90점으로 증가하였고 대퇴 삽입물과 비구컵은 안정적인 고정을 보였다. 비구컵과 대퇴 삽입물에서 삽입물의 이완, 골용해 등은 관찰되지 않았다. 10예에서 후방 탈구가 발생하였는데, 전례에서 수술 후 3개월 내에 발생하였다. 재발성 탈구 1예와 세라믹 헤드 파손 1예에서 재치환술을 시행하였다. 탈구의 위험인자로는 ASA score, 비구컵 전염각, 비구와 대퇴 삽입물 전염각의 합이 탈구와 관련성이 있었다. 결론: 60세 이상의 환자에서 시행한 세라믹-세라믹 관절면 무시멘트 인공 고관절 전치환술은 우수한 결과를 보였으나 조기 탈구와 세라믹 골두 손상의 위험성이 있으므로, 전신상태가 좋지 않은 노인환자에서는 삽입물의 위치와 수술 후 처치에 주의를 요한다.

Keywords

References

  1. Levy RN, Levy CM, Snyder J, Digiovanni J. Outcome and long-term results following total hip replacement in elderly patients. Clin Orthop Relat Res. 1995;316:25-30.
  2. McAuley JP, Moore KD, Culpepper WJ, 2nd, Engh CA. Total hip arthroplasty with porous-coated prostheses fixed without cement in patients who are sixty-five years of age or older. J Bone Joint Surg Am. 1998;80:1648-55.
  3. Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop. 2009. [Epub ahead of print]
  4. Kim SY, Kim YG, Yeo JY, Kim DH, Ihn JC. Ceramic-onceramic bearing total hip arthroplasty in young patients with osteonecrosis of femoral head. J Korean Orthop Assoc. 2004;39:233-8.
  5. Lee S, Kim JH, Ko DO, Jeon YW, Yang SJ, Ryu CW. Ceramic on ceramic hybrid type total hip arthroplasty in patients with more than 65 years of age - minimum 5-year follow-up results. J Korean Hip Soc. 2008;20:91-7.
  6. Jolles BM, Zangger P, Leyvraz PF. Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty. 2002;17:282-8. https://doi.org/10.1054/arth.2002.30286
  7. Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295-306.
  8. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;257:107-28.
  9. Gruen TA, McNeice GM, Amstutz HC."Modes of failure"of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17-27.
  10. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20-32.
  11. Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;405:46-53. https://doi.org/10.1097/00003086-200212000-00006
  12. Meek RM, Allan DB, McPhillips G, Kerr L, Howie CR. Epidemiology of dislocation after total hip arthroplasty. Clin Orthop Relat Res. 2006;447:9-18. https://doi.org/10.1097/01.blo.0000218754.12311.4a
  13. Bader R, Steinhauser E, Zimmermann S, Mittelmeier W, Scholz R, Busch R. Differences between the wear couples metal-on-polyethylene and ceramic-on-ceramic in the stability against dislocation of total hip replacement. J Mater Sci Mater Med. 2004;15:711-8.
  14. Sexton SA, Walter WL, Jackson MP, De Steiger R, Stanford T. Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement. J Bone Joint Surg Br. 2009;91:1448-53. https://doi.org/10.2106/JBJS.H.00222
  15. Colwell CW, Jr., Hozack WJ, Mesko JW, et al. Ceramicon- ceramic total hip arthroplasty early dislocation rate. Clin Orthop Relat Res. 2007;465:155-8.
  16. D'Antonio J, Capello W, Manley M, Naughton M, Sutton K. Alumina ceramic bearings for total hip arthroplasty: five-year results of a prospective randomized study. Clin Orthop Relat Res. 2005;436:164-71.
  17. Masaoka T, Yamamoto K, Shishido T, et al. Study of hip joint dislocation after total hip arthroplasty. Int Orthop. 2006;30:26-30. https://doi.org/10.1007/s00264-005-0032-4
  18. Morrey BF. Instability after total hip arthroplasty. Orthop Clin North Am. 1992;23:237-48.
  19. Paterno SA, Lachiewicz PF, Kelley SS. The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. J Bone Joint Surg Am. 1997;79:1202-10.
  20. Newington DP, Bannister GC, Fordyce M. Primary total hip replacement in patients over 80 years of age. J Bone Joint Surg Br. 1990;72:450-2.
  21. Fackler CD, Poss R. Dislocation in total hip arthroplasties. Clin Orthop Relat Res. 1980;151:169-78.
  22. Berry DJ, von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am. 2004;86-A:9-14.
  23. Ha YC, Kim SY, Kim HJ, Yoo JJ, Koo KH. Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. Clin Orthop Relat Res. 2007;458:106-10.
  24. Park YS, Hwang SK, Choy WS, Kim YS, Moon YW, Lim SJ. Ceramic failure after total hip arthroplasty with an aluminaon- alumina bearing. J Bone Joint Surg Am. 2006;88:780-7. https://doi.org/10.2106/JBJS.E.00618
  25. Koo KH, Ha YC, Jung WH, Kim SR, Yoo JJ, Kim HJ. Isolated fracture of the ceramic head after thirdgeneration alumina-on-alumina total hip arthroplasty. J Bone Joint Surg Am. 2008;90:329-36. https://doi.org/10.2106/JBJS.F.01489
  26. Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW. High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res. 2008;466:1438-43. https://doi.org/10.1007/s11999-008-0177-8
  27. Walter WL, O'Toole GC, Walter WK, Ellis A, Zicat BA. Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty. 2007;22:496-503. https://doi.org/10.1016/j.arth.2006.06.018
  28. Jarrett CA, Ranawat AS, Bruzzone M, Blum YC, Rodriguez JA, Ranawat CS. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. 2009;91:1344-9. https://doi.org/10.2106/JBJS.F.00970