Hip & pelvis

  • 제22권4호
  • /
  • Pages.253-259
  • /
  • 2010
  • /
  • 2287-3260(pISSN)
  • /
  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지
DOI QR코드

DOI QR Code

고관절 고위 탈구 환자에서 전자하 단축 절골술을 이용한 조립식 무시멘트형 고관절 전치환술

Modular Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Patients with High Hip Dislocation

  • 임병호 (성균관대학교 의과대학 삼성서울병원 정형외과) ;
  • 문영완 (성균관대학교 의과대학 삼성서울병원 정형외과) ;
  • 임승재 (성균관대학교 의과대학 삼성서울병원 정형외과) ;
  • 이희수 (성균관대학교 의과대학 삼성서울병원 정형외과) ;
  • 박윤수 (성균관대학교 의과대학 삼성서울병원 정형외과)
  • Lim, Byung-Ho (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Moon, Young-Wan (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Seung-Jae (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Hee-Soo (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Youn-Soo (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 발행 : 2010.12.31
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 고관절 고위 탈구 환자에서 시행한 전자하 단축 절골술을 이용한 조립식 무시멘트형 고관절 전치환술의 임상적 및 방사선학적 추시 결과를 보고하고자 한다. 대상 및 방법: 1996년 5월부터 2008년 6월까지 고관절 고위 탈구 환자 중 진성 비구에 비구 컵을 위치시키기 위하여 전자하 단축 절골술을 시행하고 근위 조립식 무시멘트형 대퇴 스템을 이용한 고관절 전치환술을 시행 받은 23명(24예)을 대상으로 하였다. 남자 6명, 여자 17명이었으며, 평균 나이는 44세였다. 수술 후 추시 기간은 평균 5.6년이었다. 결과: Harris 고관절 점수는 수술 전 평균 53점에서 수술 후 평균 88점으로 향상되었고(P<0.001), 21예(87.5%)에서 양호 혹은 우수의 결과를 얻었다. 폴리에틸렌 마모에 의한 비구 컵 이완으로 수술 후 12년에 재치환술을 시행 받은 1예를 제외한 모든 예에서 최종 추시 시 삽입물의 안정고정 소견을 관찰할 수 있었다. 총 4예(17%)에서 합병증이 발생하였는데, 탈구 1예, 일시적 대퇴신경 마비 2예, 전자하 절골술 부위 불유합 1예가 있었다. 결론: 고관절 고위 탈구 환자에서 전자하 단축 절골술을 이용한 조립식 무시멘트형 고관절 전치 환술을 시행하여 절골술 부위의 추가 고정을 최소화하면서 우수한 임상 결과를 얻을 수 있었다.

Purpose: The purpose of this study was to report on the results of performing modular cementless total hip arthroplasty with a simultaneous subtrochanteric shortening osteotomy in patients with high hip dislocation. Materials and Methods: We evaluated 23 patients (24 hips) with high hip dislocation and who had undergone total hip arthroplasty using a proximally modular cementless stem in combination with a subtrochanteric shortening osteotomy in order to place the acetabular cup at the level of the anatomic hip center between May 1996 and June 2008. There were 6 males and 17 females with a mean age of 44 years. The mean duration of follow-up was 5.6 years. Results: The mean Harris hip score improved from 53 points preoperatively to 88 points at the time of final followup (PP<0.001), and there were good or excellent results in 21 hips (87.5%). There was one instance of isolated loosening of the acetabular component. With the exception of one hip requiring revision surgery at 12 years postoperatively because of polyethylene wear and cup loosening, all the remaining components were well-fixed at the time of the last follow-up. A total of 4 hips (17%) had complications during follow-up; one dislocation, two transient femoral nerve palsies and one nonunion of the subtrochanteric osteotomy site. Conclusion: Modular cementless total hip arthroplasty with a subtrochanteric shortening osteotomy in patients with high hip dislocation was associated with excellent clinical outcomes while it minimized additional fixation of the osteotomy site.

키워드

참고문헌

  1. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979;61:15-23. https://doi.org/10.2106/00004623-197961010-00004
  2. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996;78:683-92.
  3. Charnley J, Feagin JA. Low-friction arthroplasty in congenital subluxation of the hip. Clin Orthop Relat Res. 1973;91:98-113. https://doi.org/10.1097/00003086-197303000-00015
  4. Eskelinen A, Helenius I, Remes V, Ylinen P, Tallroth K, Paavilainen T. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am. 2006;88:80-91.
  5. Bruce WJ, Rizkallah SM, Kwon YM, Goldberg JA, Walsh WR. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty. 2000;15:617-26. https://doi.org/10.1054/arth.2000.4335
  6. Makita H, Inaba Y, Hirakawa K, Saito T. Results on total hip arthroplasties with femoral shortening for Crowe's group IV dislocated hips. J Arthroplasty. 2007;22:32-8.
  7. Reikeraas O, Lereim P, Gabor I, Gunderson R, Bjerkreim I. Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases. Acta Orthop Scand. 1996;67:33-6. https://doi.org/10.3109/17453679608995605
  8. Chareancholvanich K, Becker DA, Gustilo RB. Treatment of congenital dislocated hip by arthroplasty with femoral shortening. Clin Orthop Relat Res. 1999;360:127-35. https://doi.org/10.1097/00003086-199903000-00016
  9. Park MS, Kim KH, Jeong WC. Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia. J Arthroplasty. 2007;22:1031-6. https://doi.org/10.1016/j.arth.2007.05.011
  10. Nagoya S, Nagao M, Takada J, Kuwabara H, Kaya M, Yamashita T. Efficacy of cementless total hip arthroplasty in patients on long-term hemodialysis. J Arthroplasty. 2005;20:66-71. https://doi.org/10.1016/j.arth.2004.09.055
  11. Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Joint Surg Am. 2009;91:2213-21. https://doi.org/10.2106/JBJS.H.01024
  12. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20-32.
  13. Latimer HA, Lachiewicz PF. Porous-coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg Am. 1996;78:975-81.
  14. 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.
  15. Malchau H, Ka¨rrholm J, Wang YX, Herberts P. Accuracy of migration analysis in hip arthroplasty. Digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand. 1995;66:418-24. https://doi.org/10.3109/17453679508995578
  16. Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty. 2003;18 Suppl:68-73.
  17. Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old. A five-year follow-up study. J Bone Joint Surg Am. 1981;63:1426-34.
  18. Dorr LD, Takei GK, Conaty JP. Total hip arthroplasties in patients less than forty-five years old. J Bone Joint Surg Am. 1983;65:474-9. https://doi.org/10.2106/00004623-198365040-00007
  19. Halley DK, Wroblewski BM. Long-term results of low-friction arthroplasty in patients 30 years of age or younger. Clin Orthop Relat Res. 1986;211:43-50.
  20. Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br. 1990;72:205-11.
  21. Becker DA, Gustilo RB. Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult. Preliminary report and description of a new surgical technique. J Arthroplasty. 1995;10:313-8. https://doi.org/10.1016/S0883-5403(05)80180-9
  22. Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am. 2004;86-A:242-50.
  23. Koulouvaris P, Stafylas K, Sculco T, Xenakis T. Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction. A new surgical technique. J Arthroplasty. 2008;23:992-8. https://doi.org/10.1016/j.arth.2007.09.013
  24. Decking J, Decking R, Schoellner C, Fuerderer S, Rompe JD, Eckardt A. Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. Arch Orthop Trauma Surg. 2003;123:357-62. https://doi.org/10.1007/s00402-003-0554-4
  25. Huo MH, Zatorski LE, Keggi KJ. Oblique femoral osteotomy in cementless total hip arthroplasty. Prospective consecutive series with a 3-year minimum follow-up period. J Arthroplasty. 1995;10:319-27. https://doi.org/10.1016/S0883-5403(05)80181-0
  26. Sener N, Tozun IR, Asik M. Femoral shortening and cementless arthroplasty in high congenital dislocation of the hip. J Arthroplasty. 2002;17:41-8.
  27. Yasgur DJ, Stuchin SA, Adler EM, DiCesare PE. Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip. J Arthroplasty. 1997;12:880-8. https://doi.org/10.1016/S0883-5403(97)90157-1
  28. Carlsson A, Bjo¨rkman A, Ringsberg K, von Schewelov T. Untreated congenital and posttraumatic high dislocation of the hip treated by replacement in adult age: 22 hips in 16 patients followed for 1-8 years. Acta Orthop Scand. 2003;74:389-96. https://doi.org/10.1080/00016470310017677
  29. Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res. 1987;218:136-41.
  30. Erdemli B, Yilmaz C, Atalar H, Guzel B, Cetin I. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty. 2005;20:1021-8. https://doi.org/10.1016/j.arth.2005.02.003
  31. Nagoya S, Kaya M, Sasaki M, Tateda K, Kosukegawa I, Yamashita T. Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip. J Bone Joint Surg Br. 2009;91:1142-7. https://doi.org/10.1302/0301-620X.91B9.21736

피인용 문헌

  1. Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy in Patients with High Hip Dislocation vol.26, pp.1, 2010, https://doi.org/10.5371/hp.2014.26.1.22