Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Isolated Polyethylene Liner Exchange in a Revision Total Hip Arthroplasty

폴리에틸렌 삽입물을 교체한 인공 고관절 재치환술

  • Cho, Yoon-Je (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Kwak, Sang-Joon (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Chun, Young-Soo (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Rhyu, Kee-Hyung (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Kang, Dong-Geun (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Yoo, Myung-Chul (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
  • 조윤제 (경희대학교 의과대학 정형외과학교실) ;
  • 곽상준 (경희대학교 의과대학 정형외과학교실) ;
  • 전영수 (경희대학교 의과대학 정형외과학교실) ;
  • 유기형 (경희대학교 의과대학 정형외과학교실) ;
  • 강동근 (경희대학교 의과대학 정형외과학교실) ;
  • 유명철 (경희대학교 의과대학 정형외과학교실)
  • Published : 2011.12.31
⟨ Previous Next ⟩

Abstract

Purpose: To analyze the results of isolated exchange of polyethylene (PE) liners for treatment of wear and osteolysis around a well-fixed Harris-Galante (HG) cementless acetabular cup. Materials and Methods: Thirty-three PE liner changes were performed without the removal of stably ingrown implants (33 hips of 32 patients). They were able to be followed for a mean period of 92 months. Clinically, the Harris hip score (HHS), pain evaluation, and complications were evaluated. Radiologically, the annual wear rate and the size of the osteolytic lesions were measured before the operation and the latest follow-up. The bone graft incorporation scale and the development of new osleolytic lesions were checked during the final follow-up. Results: HHS improved to 89.3 at last follow-up. The size of the osteolysis was significantly reduced postoperatively. Bone graft incorporation scales were Grade I in 9 and Grade II in 14 cases. New osteolytic lesions have not developed at latest follow-up. As a complication, one case of dissociation of a liner and a periprosthetic fracture were noted. Annual wear rates during the same period were significantly reduced. There was no sign of alteration in stability of the PE liner. Conclusion: Exchange of a PE liner without removal of stable implants can be a good option for the treatment of wear and osteolysis around a stable cementless THA implant, even if the system has a weak locking mechanism, such as the HG cup. In these cases, under certain states with a higher risk of early failure in the locking mechanism, it would be better to select other revision procedures such as cup revision or cemented polyethylene liner fixation.

목적: 골성 고정된 Harris-Galante (HG) 비구컵을 제거하지 않고 폴리에틸렌 삽입물 만을 교체한 재치환술의 중기 추시 결과를 분석하고자 하였다. 대상 및 방법: 재치환술 시 골성 고정된 무시멘트 비구컵을 제거하지 않고, 폴리에틸렌 삽입물을 교체한 후, 5년 이상(평균 92개월) 추시 가능했던 33예를 대상하였다. Harris 고관절 점수, 골용해 크기 변화 및 폴리에틸렌 삽입물의 선형 마모율을 비교하였고, 이식골의 결합 정도와 새로운 골용해 병변 발생 여부를 관찰하였다. 결과: Harris 고관절 점수는 평균 89.3점으로 호전되었다. 골 이식을 시행한 군에서 골용해 크기가 감소하였고, 골 이식을 시행하지 않은 군에서 새로운 골용해의 발생은 없었다. 합병증으로 폴리에틸렌 삽입물의 해리와 치환물 주변 골절이 각 1예 있었다. 동일 관찰 시점의 비구 관절면 선형 마모율은 재치환술 전에 비하여 유의하게 감소하였다. 결론: 폴리에틸렌 삽입물 만을 교체하는 재치환술은 안전하고 효과적인 재치환술 방법으로 사료된다. 다만 잠김 기전이 약한 HG 비구컵의 특성상 조기에 잠금 장치의 손상이 발생할 위험이 높은 경우에는 비구컵 재치환술 또는 폴리에틸렌 삽입물 시멘트 고정 방법을 고려하는 것이 바람직할 것으로 사료된다.

Keywords

References

  1. Berry DJ. Management of osteolysis around total hip arthroplasty. Orthopedics. 1999;22:805-8.
  2. D'Antonio JA, Capello WN, Borden LS, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126-37.
  3. O'Brien DA, Rorabeck CH. Managing bone loss in revision total hip arthroplasty: the aetabulum. Instr Course Lect. 2006;55:263-77.
  4. Benson ER, Christensen CP, Monesmith EA, Gomes SL, Bierbaum BE. Particulate bone grafting of osteolytic femoral lesions around stable cementless stems. Clin Orthop Relat Res. 2000;381:58-67.
  5. Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as part of a total hip replacement. J Bone Joint Surg Am. 1997;79:1628-34.
  6. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9:33-44. https://doi.org/10.1016/0883-5403(94)90135-X
  7. Rubash HE, Sinha RK, Maloney WJ, Paprosky WG. Osteolysis: surgical treatment. Instr Course Lect. 1988;47:321-9.
  8. Dorr LD, Wan Z, Gruen T. Functional results in total hip replacement in patients 65 years and older. Clin Orthop Relat Res. 1997;336:143-51.
  9. Hozack WJ, Bicalho PS, Eng K. Treatment of femoral osteolysis with cementless total hip revision. J Arthroplasty. 1996;11:668-72. https://doi.org/10.1016/S0883-5403(96)80004-0
  10. Schmalzried TP, Fowble VA, Amstutz HC. The fate of pelvic osteolysis after reoperation. No recurrence with lesional treatment. Clin Orthop Relat Res. 1998;350:128- 37.
  11. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20-32.
  12. Kim HJ, Lee JH, Oh HC, Kim YM, Kim SR. A comparision of osteolysis in bipolar hemiarthroplasty and total hip arthroplasty. J Korean Orthop Assoc. 2000;35: 83-8.
  13. Maloney WJ, Peters P, Engh CA, Chandler H. Severe osteolysis of the pelvic in association with acetabular replacement without cement. J Bone Joint Surg Am. 1993; 75:1627-35.
  14. Schmalzried TP, Guttmann D, Grecula M, Amstutz HC. The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg Am. 1994;76:677-88.
  15. Lie SA, Hallan G, Furnes O, Havelin LI, Engesaeter LB. Isolated acetabular liner exchange compared with complete acetabular component revision in revision of primary uncemented acetabular components: a study of 1649 revisions from the Norwegian Arthroplasty Register. J Bone Joint Surg Br. 2007;89:591-4. https://doi.org/10.1302/0301-620X.89B5.18623
  16. Clohisy JC, Harris WM. The Harris-Galante porouscoated acetabular component with screw fixation. An average ten-year follow-up study. J Bone Joint Surg Am. 1999;81:66-73.
  17. Gonzalez della Valle A, Ruzo PS, Li S, Pellicci P, Sculco TP, Salvati EA. Dislodgment of polyethylene liners in first and second-generation Harris-Galante acetabular components. A report of eighteen cases. J Bone Joint Surg Am. 2001;83-A:553-9.
  18. Lachiewicz PF, Soileau ES. Polyethylene liner exchange of the Harris-Galante porous I and II acetabular components without cement: results and complications. J Arthroplasty. 2006;21:992-7. https://doi.org/10.1016/j.arth.2005.06.019
  19. Rohrl SM, Nivbrant B, Snorrason F, Karrholm J, Nilsson KG. Porous-coated cups fixed with screws: a 12-year clinical and radiostereometric follow-up study of 50 hips. Acta Orthop. 2006;77:393-401. https://doi.org/10.1080/17453670610046316
  20. Talmo CT, Kwon YM, Freiberg AA, Rubash HE, Malchau H. Management of polyethylene wear associated with a well-fixed modular cementless shell during revision total hip arthroplasty. J Arthroplasty. 2011;26:576-81. https://doi.org/10.1016/j.arth.2010.05.028
  21. Rubash HE, Sinha RK, Paprosky W, Engh CA, Maloney WJ. A new classification system for the management of acetabular osteolysis after total hip arthroplasty. Instr Course Lect. 1999;48:37-42.