Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Revision Total Hip Arthroplasty of an Acetabular Cup with Acetabular Bone Defects

비구 결손을 동반한 인공 고관절 비구컵 재치환술

  • Hwang, Kyu-Tae (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Kim, Young-Ho (Department of Orthopedic Surgery, College of Medicine, Hanyang University)
  • 황규태 (한양대학교 의과대학 정형외과학교실) ;
  • 김영호 (한양대학교 의과대학 정형외과학교실)
  • Published : 2011.12.31
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Abstract

Recently, the incidence of revision total hip arthroplasty (THA) has increased following primary THA. Bone stock deficiency presents the major challenge in acetabular reconstruction during revision hip arthroplasty. The reasons for such acetabular defects include osteolysis, bone resportion following cup loosening, iatrogenic damage resulting from cup or cement removal during revision THA, and cup migration. The pre-operative assessment of acetabular bone stock, including the amount and location of pelvic osteolysis before revision surgery, is a critical preoperative preparation for the treatment of bone deficiency. In cases with mild acetabular defects, a variety of surgical options are available for treating. However, in cases with severe segmental, cavitary, or combined acetabular defects, controversies have existed so far about the most optimal treatment. Thereby, we tend to introduce the most commonly-adopted classification system of acetabular defects and management options using high hip center cups, oblong cups, structural allografts, morselized allografts with bipolar cups, morselized allografts with cementless cups, morselized allografts with acetabular reinforcement devices, and revisions with trabecular metal augmentations.

일차성 인공 고관절 치환술의 시행이 증가됨에 따라 최근 인공 고관절 재치환술의 빈도도 증가하고 있다. 비구 주위 골결손은 비구컵 재치환술시 고려해야 하는 가장 큰 문제점 중의 하나이다. 비구골 결손의 발생 원인으로는 일차 인공 고관절 전치환술 후 발생한 골용해(osteolysis), 비구컵 해리(loosening)에 의한 골흡수, 비구컵 또는 골시멘트 제거시 비구 골조직의 손상, 비구컵의 전위(migration) 등이 있다. 비구 골결손은 술전에 양과 위치를 파악하여 결손부 처치에 대한 준비를 하여야 하며 비구 결손이 경미한 경우에는 어떠한 방법을 사용하여도 큰 문제가 없지만 비구결손이 심한 분절형(segmental) 골결손, 공동형(cavitary) 골결손, 복합형(combined) 골결손 등의 경우에는 아직까지 비구 재건 방법에 대해 논란이 있다. 이에 지금까지 가장 많이 사용되고 있는 비구 결손의 분류법을 소개하고, 비구 결손 재건술 시 사용되는 비구컵 상방 전위 삽입, 편심 비구컵의 사용, 구조성 동종골 이식, 동종 파쇄골 (morselized bone) 이식 후 이극성 반치환술, 동종 파쇄골 이식 후 무시멘트 비구컵의 사용, 동종 파쇄골 이식 후 시멘트 비구컵의 사용, 동종 파쇄골 이식 후 비구컵 보강 기기의 사용, 망상 금속 보충물을 이용한 재치환술 등에 대해서 알아보고자 한다.

Keywords

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