Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Comparison of Simultaneous Bilateral Cementless Total Hip Replacement with Staged Bilateral Cementless Total Hip Replacement in High Risk Anesthesia Group

마취 고위험군에서 동시에 양측 고관절 무시멘트 전치환술을 시행한 군과 단계적으로 양측 시행한 군의 비교

  • Hwang, Sung-Kwan (Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University) ;
  • Kwon, Sung-Min (Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University) ;
  • Chung, Hoi-Jeong (Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University)
  • 황성관 (연세대학교 원주의과대학 정형외과학 교실) ;
  • 권성민 (연세대학교 원주의과대학 정형외과학 교실) ;
  • 정회정 (연세대학교 원주의과대학 정형외과학 교실)
  • Published : 2011.09.30
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Abstract

Purpose: Simultaneous bilateral total hip replacement (THR) has some advantages, but the efficacy of simultaneous bilateral THR is still controversial in patients with high risk ASA grade. Presently, we compared simultaneous bilateral to staged THR in high-risk patients according to the ASA grade. Materials and Methods: We retrospectively compared 60 high risk patients (ASA grade 3 and 4) with simultaneous cementless total hip replacements with a matched group of 60 patients with staged cementless total hip replacements between January, 1991 and June, 2009. Significance was determined to be p-value < 0.05. Results: Postoperative cardio-vascular complication was found in one case of simultaneous THR, and pulmonary thromboembolism was found in two cases of staged THR and in three cases of simultaneous THR. Wound infection was found in three cases of staged THR and in two cases of simultaneous THR. Delirium was found in four cases of staged THR and in five cases of simultaneous THR. Dislocation developed in two cases of staged THR and in three cases of simultaneous THR. Blood loss was higher in the staged group, but the transfusion amount was higher in the simultaneous group. Postoperative ambulation was initiated earlier in staged THR, but at the final follow-up no statistical significance was observed. Admission time and cost were reduced in simultaneous THR. Conclusion: It is considered safe to perform simultaneous cementless bilateral THA in patients with high anesthetic risk, if meticulous preoperative evaluation is done.

목적: 동시에 양측 고관절 치환술을 시행하는 경우 장점도 있으나 마취 고위험군에서는 술 후 합병증이 보고되는 등 논란의 대상이다. 이에 저자는 마취 고위험군에서 동시 시행군과 단계적 시행군을 비교하였다. 대상 및 방법: 1991년 1월부터 2009년 1월까지 본원에서 동시에 양측 무시멘트 고관절 치환술을 시행한 ASA 등급 3, 4 60명의 환자와 단계적 양측 무시멘트 고관절 치환술을 시행한 ASA 등급 3, 4 60명의 환자를 비교하였다. 통계 유의성의 판정은 p 값이 0.05 이하로 하였다. 결과: 심혈관계 합병증은 동시 양측 시행군에서만 1예 발병하였고, 폐색전증은 단계적 시행군에서 2예, 동시 시행군에서 3예, 수술 부위 감염은 단계적 시행군에서 3예, 동시 시행군에서 2예, 섬망은 단계적 시행군에서 4예, 동시 시행군에서 5예, 탈구는 단계적 시행군에서 2예, 동시 시행군에서 3예 발생하였다. 실혈량은 단계적 시행군에서, 수혈량은 동시 시행군에서 높게 나타났다. 재활은 동시 시행군에서 더 빨리 시행되었으나 최종 추시 시엔 통계적으로 유의하지 않았다. 입원 기간 및 비용은 단계적 시행군보다 동시 시행군에서 절감 효과를 보였다. 결론: 술 전 평가를 면밀히 한다면 마취 고위험군에서 동시 양측성 고관절 치환술이 안전한 수술법으로 고려될 수 있다.

Keywords

References

  1. Alfaro-Adrian J, Bayona F, Rech JA, Murray DW. Oneor two-stage bilateral total hip replacement. J Arthroplasty. 1999;14:439-45. https://doi.org/10.1016/S0883-5403(99)90099-2
  2. Saito S, Tokuhashi Y, Ishii T, Mori S, Hosaka K, Taniguchi S. One-versus two-stage bilateral total hip arthroplasty. Orthopedics. 2010;33. doi: 10.3928/01477447-20100625-07.
  3. Berend ME, Ritter MA, Harty LD, et al. Simultaneous bilateral versus unilateral total hip arthroplasty an outcomes analysis. J Arthroplasty. 2005;20:421-6. https://doi.org/10.1016/j.arth.2004.09.062
  4. Macaulay W, Salvati EA, Sculco TP, Pellicci PM. Singlestage bilateral total hip arthroplasty. J Am Acad Orthop Surg. 2002;10:217-21.
  5. Ritter MA, Randolph JC. Bilateral total hip arthroplasty: a simultaneous procedure. Acta Orthop Scand. 1976;47: 203-8. https://doi.org/10.3109/17453677608989719
  6. Park YS, Park YK, Choi HJ. Results of bilateral total hip arthroplasty-one stage 265 versus two stage procedure. J Korea Hip Soc. 1998;10:211-5.
  7. Parvizi J, Pour AE, Peak EL, Sharkey PF, Hozack WJ, Rothman RH. One-stage bilateral total hip arthroplasty compared with unilateral total hip arthroplasty: a prospective study. J Arthroplasty. 2006;21 Suppl:26-31. https://doi.org/10.1016/j.arth.2006.04.013
  8. Bhan S, Pankaj A, Malhotra R. One-or two-stage bilateral total hip arthroplasty: a prospective, randomised, controlled study in an Asian population. J Bone Joint Surg Br. 2006;88:298-303. https://doi.org/10.1302/0301-620X.88B3.17048
  9. Tarity TD, Herz AL, Parvizi J, Rothman RH. Ninety-day mortality after hip arthroplasty: a comparison between unilateral and simultaneous bilateral procedures. J Arthroplasty. 2006;21 Suppl:60-4. https://doi.org/10.1016/j.arth.2006.05.016
  10. Swanson KC, Valle AG, Salvati EA, Sculco TP, Bottner F. Perioperative morbidity after single-stage bilateral total hip arthroplasty: a matched control study. Clin Orthop Relat Res. 2006;451:140-5.
  11. Bracy D, Wroblewski BM. Bilateral Charnley arthroplasty as a single procedure. A report on 400 patients. J Bone Joint Surg Br. 1981;63-B:354-6.
  12. Kim YH, Kwon OR, Kim JS. Is one-stage bilateral sequential total hip replacement as safe as unilateral total hip replacement? J Bone Joint Surg Br. 2009;91:316-20. https://doi.org/10.1302/0301-620X.91B3.21817
  13. Hwang SK, Lee CH. Postoperative delirium after hip arthroplasty in the elderly. J Korea Hip Soc. 2010;22:151-8. https://doi.org/10.5371/jkhs.2010.22.2.151
  14. Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003; 43:459-69. https://doi.org/10.1046/j.1537-2995.2003.00348.x
  15. Shih CH, Ho WB. One-stage versus two-stage bilateral autophor ceramic total hip arthroplasty. Clin Orthop Relat Res. 1985;193:141-5.
  16. Cammisa FP Jr, O'Brien SJ, Salvati EA, et al. One-stage bilateral total hip arthroplasty. A prospective study of perioperative morbidity. Orthop Clin North Am. 1988; 19:657-68.
  17. Ritter MA, Stringer EA. Bilateral total hip arthroplasty: a single procedure. Clin Orthop Relat Res. 1980;149:185-90.
  18. Hearn SL, Bicalho PS, Eng K, Booth RE Jr, Hozack WJ, Rothman RH. Comparison of cemented and cementless total hip arthroplasty in patients with bilateral hip arthroplasties. J Arthroplasty. 1995;10:603-8. https://doi.org/10.1016/S0883-5403(05)80203-7
  19. Clarke MT, Green JS, Harper WM, Gregg PJ. Cement as a risk factor for deep-vein thrombosis. Comparison of cemented TKR, uncemented TKR and cemented THR. J Bone Joint Surg Br. 1998;80:611-3. https://doi.org/10.1302/0301-620X.80B4.8612