• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2006년도 춘계학술대회 논문집
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• pp.511-512
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• 2006

According to development of medical science and engineering, people has made efforts to solve tile discomfort of body accident as well as the life span. Many cases that reduce pain of a hip joint or limitation of motion using Revision Total Hip Replacement are getting increased. However it has not proved which material is the most appropriate. Scientists are still studying about materials of the artificial joint. In accordance with advance of science, the materials are Betting better. Recently, when Revision Total Hip Replacement is performed, typical materials are Ti-alloys Ceramics. We have studied materials of artificial joints and analyzed which one is better for human's body.

• 한국임상수의학회지
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• 제39권6호
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• pp.390-394
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• 2022

A 6-year-old, 36.5 kg castrated male Golden Retriever presented for revision surgery for left total hip replacement. The patient underwent removal of the cup and head implants due to unmanageable prosthetic hip dislocation, despite revision surgery. On physical examination, the dog showed persistent weight-bearing lameness after exercise of the left hindlimb with mild muscle atrophy. Radiographic examination revealed dorsolateral displacement of the femur with a remnant stem and bony proliferation around the cranial and caudal acetabulum rims. The surgical plan was to apply the dual mobility cup to increase the range of motion and jump distance to correct soft tissue elongation and laxity caused by a prolonged period of craniodorsal dislocation of the femur. The preparation of the acetabulum for cup fixation was performed with a 29-mm reamer, and the 29.5-mm outer shell was fixed with five 2.4-mm cortical screws. The head and medium neck of the dual-mobility system were placed on the cup, and the hip joint was reduced between the neck and stem. The dog exhibited slight weight bearing on a controlled leash walk the day after surgery. The patient was discharged 2 weeks postoperatively without any complications. Six months postoperatively, osseointegration and a well-positioned cup implant were observed, and the dog showed excellent limb function without hip dislocation until 18 months of phone call follow-up.

• Hip & pelvis
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• 제36권2호
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• pp.101-107
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• 2024

Treatment of femoral bone defects continues to be a challenge in revision total hip arthroplasty (THA); therefore, meticulous preoperative evaluation of patients and surgical planning are required. This review provides a concise synopsis of the etiology, classification, treatment strategy, and prosthesis selection in relation to femoral bone loss in revision THA. A search of literature was conducted for identification of research articles related to classification of bone loss, management of femoral revision, and comparison of different types of stems. Findings of a thorough review of the included articles were as follows: (1) the Paprosky classification system is used most often when defining femoral bone loss, (2) a primary-length fully coated monoblock femoral component is recommended for treatment of types I or II bone defects, (3) use of an extensively porous-coated stem and a modular fluted tapered stem is recommended for management of types III or IV bone defects, and (4) use of an impaction grafting technique is another option for improvement of bone stock, and allograft prosthesis composite and proximal femoral replacement can be applied by experienced surgeons, in selected cases, as a final salvage solution. Stems with a tapered design are gradually replacing components with a cylindrical design as the first choice for femoral revision; however, further confirmation regarding the advantages and disadvantages of modular and nonmodular stems will be required through conduct of higher-level comparative studies.

• Hip & pelvis
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• 제35권1호
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• pp.40-46
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• 2023

Purpose: A variety of short Exeter stems designed specifically for use in performance of total hip arthroplasty (THA) in primary and revision settings have recently been introduced. Some have been used 'off label' for hip reconstruction. The aim of this study is to report clinical and radiological results from the Exeter V40 125 mm stem in performance of primary THA and revision THA. Materials and Methods: This study had a retrospective design. Insertion of 58 (24 primary, 34 revision) Exeter V40 125 mm stems was performed between 2015 and 2017. The minimum follow-up period was two years. Assessment of the Oxford hip score (OHS), EuroQol-5 Dimension (EQ-5D), and radiological follow-up was performed at one and two years. Results: In the primary group, the preoperative, mean OHS was 13.29. The mean OHS was 32.86 and 23.39 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were at 0.14, 0.59, and 0.35, preoperatively, at one-year follow-up and two-year follow-up, respectively. In the revision group, the mean preoperative OHS was 19.41. The mean OHS was 30.55 and 26.05 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were 0.33, 0.61, and 0.48 preoperatively, at one-year follow-up and two-year follow-up, respectively. No progressive or new radiolucent lines were observed around any stem at the time of the final follow-up in all patients in both groups. Conclusion: Encouraging results regarding use of Exeter V40 125 mm stems have been reported up to two years following surgery in primary and revision THA settings.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.398-406
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• 2018

Background: Hypoalbuminemia (serum albumin < 3.5 g/dL) is associated with increased morbidity and mortality in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, costs associated with hypoalbuminemia remain unknown. This study investigated the effect of serum albumin on direct treatment costs, length of stay (LOS), and readmissions for primary and revision THA and TKA patients. Methods: All adult patients at a single institution undergoing primary or revision THA or TKA between January 2014 and December 2016 were retrospectively reviewed. Patients were stratified by preoperative serum albumin level. The primary outcome was total direct costs at index hospitalization. Secondary outcomes included LOS and readmission within 30 days. Multivariable regressions were utilized to adjust for demographics and comorbidities. Results: Of 3,785 patients, 114 (3.0%) had hypoalbuminemia. After adjustment, hypoalbuminemia was associated with a 16.2% increase in costs (${\beta}=0.162$; 95% confidence interval [CI], 0.112 to 0.213; p < 0.001), representing an average cost increase of $3,383 (95% CI, $2,281 to $4,485) relative to costs for serum albumin > 4.5 g/dL. The increased total costs were significantly higher in revision ($4,322, p = 0.034) than in primary ($3,446, p < 0.001) procedures. In adjusted regression, each 1.0 g/dL increase in serum albumin yielded a 6.6% reduction in costs (${\beta}=-0.066$; 95% CI, -0.090 to -0.042]; p < 0.001), for average savings of $1,282 (95% CI, $759 to $1,806) per unit albumin. Adjusted regressions demonstrated that a 1-point increase in serum albumin reduced readmissions by 53% (odds ratio, 0.47; 95% CI, 0.31-0.73; p = 0.001) and LOS by 0.6 days (${\beta}=-0.60$; 95% CI, -0.76 to -0.44; p < 0.001). Conclusions: Hypoalbuminemia is associated with increased total direct costs, LOS, and readmissions following primary and revision THA and TKA. Future efforts to predict and address total costs should take into consideration the patient's preoperative serum albumin levels.

• Journal of Trauma and Injury
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• 제37권1호
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• pp.89-96
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• 2024

The indications for total hip replacement are increasing and not limited to osteoarthritis. Total hip replacement may also be done for trauma and pathological fractures in patients otherwise physiologically fit and active. This trend has led to an inevitable rise in complications such as periprosthetic femoral fracture. Periprosthetic femoral fracture can be challenging due to poor bone quality, osteoporosis, and stress fractures. We present a case of periprosthetic femoral fracture in a 71-year-old woman with some components of an atypical femoral fracture. The fracture was internally fixed but was subsequently complicated by infection, implant failure needing revision, and later stress fracture. She was on a bisphosphonate after her index total hip replacement surgery for an impending pathological left proximal femur fracture, and this may have caused the later stress fracture. Unfortunately, she then experienced implant breakage (nonunion), which was treated with a biplanar locking plate and bone grafting. The patient finally regained her premorbid mobility 13 months after the last surgery and progressed satisfactorily towards bony union.

• Hip & pelvis
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• 제35권2호
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• pp.122-132
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• 2023

Purpose: The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique. Materials and Methods: A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B anterosuperior medial acetabular bone loss from 2013-2019 with a minimum clinical follow-up period of two years. Twelve cases in 12 patients were identified. Baseline demographics, intraoperative variables, surgical outcomes, and patient reported outcomes were acquired. Results: The implant survivorship was 91% with component failure requiring re-revision in only one patient at a mean follow-up period of 36.2 months (range, 24-72 months). Three patients (25.0%) experienced complications, including re-revision for component failure, inter-prosthetic dual-mobility dissociation, and periprosthetic joint infection. Of seven patients who completed the HOOS, JR (hip disability and osteoarthritis outcome score, joint replacement) survey, five patients showed improvement. Conclusion: Excellent outcomes can be achieved using the dome technique for management of massive anterosuperior medial acetabular defects in revision THA with survivorship of 91% at a mean follow-up period of three years. Conduct of future studies will be required in order to evaluate mid- to long-term outcomes for this technique.

• 대한정형외과학회지
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• 제55권3호
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• pp.244-252
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• 2020

목적: 대퇴골 전치환술은 사지재건술의 극단적 술식 중 하나이며 증례가 드물어 이에 대한 연구는 주로 술식 후의 합병증에 대한 분석이며 본 술식의 적응증에 대한 분석은 미미하다. 저자들은 대퇴골 전치환술 36예의 1) 종양적 문제로 치환술을 받은 환자의 생존에 관련된 예후인자, 2) 치환물 및 하지의 생존율, 3) 치환물을 3년 이상 추시한 예의 합병증, 최종 하지 상태 및 기능적 결과를 알아보고자 하였다. 대상 및 방법: 대퇴골 전치환술을 받은 이유에 따라 원발성 종양에 의한 경우(15예, 1군), 오인 수술 및 국소재발로 인한 경우(16예, 2군), 재건물 실패로 인한 경우(5예, 3군)의 세 군으로 분류하였다. 환자 생존인자 분석 항목은 나이, 성별, 전치환술 원인, 항암요법 전후 종양 부피 변화, 절제연, 국소재발이었다. 결과: 전체 36예의 5년 환자 생존율은 31.5%±16.2%였다. 종양과 관련된 적응증으로 치환술을 받은 31예의 5년 생존율은 21.1%±15.6%였다. 항암요법 전후 종양의 크기가 같거나 감소한 10예의 5년 생존율은 50.0%±31.0%로 크기가 증가한 13예의 0.0%±0.0%보다 유의하게 높았다(p=0.02). 광범위 절제연을 얻은 12예의 5년 생존율은 41.7%±27.9%로 변연부 절제연의 0.0%±0.0% 보다 유의하게 높았다(p=0.03). 성별, 나이, 대퇴골 전치환술을 시행받은 원인, 치환술 후 국소 재발여부와 생존율과의 유의한 차이는 없었다. 치환물 36예에서 5년 생존율은 16.6%±18.2%였다. 하지의 10년 생존율은 85.9%±14.1%였다. 최종 추시상 종양인 공관절을 유지한 것이 12예, 회전성형술은 2예, 슬관절 상부 절단술 1예, 관절고정술 1예였다. 대퇴골 전치환술 후 3년 이상 추시가 가능했던 16예 중 수술이 필요했던 주 합병증이 14예, 보존적 치료만 했던 저등급 감염이 2예였다. 수술한 환자 14예 중 감염이 10예(71.4%)예, 국소재발이 2예, 고관절 탈구, bushing 파손, 대퇴동맥 폐색이 각각 1예였다. 결론: 종양과 관련된 적응증으로 대퇴골 전치환술을 시행한 환자 중 항암요법 후 종양의 크기가 커지거나 절제연이 불량한 경우, 환자가 조기에 사망하는 경우가 많았다. 따라서 전치환술의 시행에 신중해야 할 것으로 생각된다. 장기 생존 환자에서도 감염률이 높고 기능적 결과도 만족스럽지 않으나 현재 적응증을 고려했을 때 대퇴골 전치환술은 사지보존을 위한 최선의 방법으로 보인다.

• Journal of Yeungnam Medical Science
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• 제2권1호
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• pp.11-22
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• 1985

본 영남의대 정형외과학 교실에서는 1983년 5월부터 1985년 2월말까지 치료한 노년층의 대퇴경부 골절 환자 30예 중 추시가 가능했던 18예를 골절의 양상 및 치료 방법에 따라 분석한 결과를 요약하면 다음과 같다. 1. 총 18예 중 여자가 11예, 남자 7예로 고령의 여자에 호발하였다. 2. 60대 이상의 골절 11예 중 8 예가 경도의 외상에 의하였고 4 예가 심각한 골조송증을 동반하였다. 3. 골절의 양상으로는 총 18예 중 4 예가 비전위 골절, 11예가 전위된 골두하 골절, 3 예가 전위된 중간경부 골절이었다. 특히 60대 이상의 골절 11예는 3예가 비전위 골절, 나머지 8 예가 전위된 골두하 골절이었다. 4. 치료 방법은 총 18예 중 13예에서 도수정복 및 다발성 철침 고정술을 시행하였고, 4예에서 대퇴골두 치환술을 1예에서 특별한 처치를 하지 않았다. 5. 내고정술을 시행한 비전위 골절 4예에서는 합병증을 초래하지 않았고, 전위된 골절 9예 중 4예에서 합병증을 초래하였는데 전 예가 전위된 골두하 골절이었다. 6. 전위된 골두하 골절로 내고정술을 시행한 6 예중 3예에서 3일이내에 치료하였는데 이 중 l 예에서 과내반 정복 상태로 합병증을 초래하였고 3일 이상 지연된 3예에는 전 예에서 합병증을 초래 하였다. 7. 전위된 골두하 골절 6예 중 과외반 정복된 2예에서는 합병증이 발생하지 않았고 과내반 정복된 3예와 수상후 1주일 이후에 양호한 정복 상태인 1예 모두 합병증이 발생하였다. 노년기의 대퇴경부 골절 환자의 치료시에 합병증의 발생은 대개 골절의 양상 및 치료 시기에 의해 결정되며, 내고정술시에는 조속한 시간내에 해부학적 정복 혹은 외반 정복을 시도하는 것이 바람직하며 특히 고령의 환자에서 전위된 골두하 골절로 치료의 지연, 정복의 불가능, 과내반 정복 및 고관절에 기존 질병이 있는 경우에는 일차적인 대퇴골두 치환술 혹은 고관절 치환술이 바림직할 것으로 사료된다.