Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.282
Y. Cho, S. Kwak, Y. Chun, K. Rhyu, D. Kang, M. Yoo
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.
{"title":"Isolated Polyethylene Liner Exchange in a Revision Total Hip Arthroplasty","authors":"Y. Cho, S. Kwak, Y. Chun, K. Rhyu, D. Kang, M. Yoo","doi":"10.5371/JKHS.2011.23.4.282","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.282","url":null,"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.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126872855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.258
Y. Lim, Bum Yong Park, Yong Sik Kim
인공 고관절 전치환술은 환자의 고통을 경감하는데 유 용한 방법이며, 인공관절 전치환술 후 환자의 기능이 정상 화 되기 위해서는 고관절의 생체역학이 정상으로 복원되 어야 한다. 이를 위해서는 대퇴 주두의 offset과 함께 다리 길이의 복원이 함께 이루어져야 한다. 하지 부동은 수술 후 환자들이 불만족을 느끼는 흔한 원인들 중에 하나로 특 히 미국에서는 인공 고관절 전치환술 후에 발생하는 가장 흔한 의료소송의 한 원인이 되고 있다. 이상적으로 반대측이 정상이라면 인공관절 전치환술 후 양측 하지 길이는 같아야 한다. 그러나 실제로 하지 길이 를 완벽하게 맞추는 것은 쉽지 않다. 대개 수술한 쪽이 길 어지는 경우가 많은데 그 차이가 큰 경우 파행 및 요통의 원인이 될 수 있다. 하지 부동의 정도를 최소화하면 수 술 후 신경마비, 파행, 이차적 동통 유발 등의 합병증을 방 지 하고 수술의 효과를 최소화 할 수 있기 때문에, 수술 시 하지 길이의 오차를 최소화하는 방법을 강구 해야 한다. 수술 후 하지 부동의 정도가 심하지 않으면 파행, 동통, 신경 마비 등의 문제는 잘 생기지 않는다. 6 mm 이상 신 장이 되면 환자는 다리 길이의 차이를 느끼게 되고 1 cm 이상이 되면 불편감을 느끼기 시작하며, 2 cm 이상에서는 신발 굽을 이용한 하지 부동의 교정을 하여야 한다. 2.5 cm 이상에서는 좌골신경 마비 등의 신경증세가 올 수 있 다. 본 논문에서는 인공관절 전치환술 후 발생할 수 있는 하지 부동의 원인 및 예방법에 대해 알아 보고, 저자들이 하지 부동의 최소화를 위해 사용하는 방법을 소개하고자 한다.
{"title":"Fixing Leg Length Discrepancies after Total Hip Arthroplasty","authors":"Y. Lim, Bum Yong Park, Yong Sik Kim","doi":"10.5371/JKHS.2011.23.4.258","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.258","url":null,"abstract":"인공 고관절 전치환술은 환자의 고통을 경감하는데 유 용한 방법이며, 인공관절 전치환술 후 환자의 기능이 정상 화 되기 위해서는 고관절의 생체역학이 정상으로 복원되 어야 한다. 이를 위해서는 대퇴 주두의 offset과 함께 다리 길이의 복원이 함께 이루어져야 한다. 하지 부동은 수술 후 환자들이 불만족을 느끼는 흔한 원인들 중에 하나로 특 히 미국에서는 인공 고관절 전치환술 후에 발생하는 가장 흔한 의료소송의 한 원인이 되고 있다. 이상적으로 반대측이 정상이라면 인공관절 전치환술 후 양측 하지 길이는 같아야 한다. 그러나 실제로 하지 길이 를 완벽하게 맞추는 것은 쉽지 않다. 대개 수술한 쪽이 길 어지는 경우가 많은데 그 차이가 큰 경우 파행 및 요통의 원인이 될 수 있다. 하지 부동의 정도를 최소화하면 수 술 후 신경마비, 파행, 이차적 동통 유발 등의 합병증을 방 지 하고 수술의 효과를 최소화 할 수 있기 때문에, 수술 시 하지 길이의 오차를 최소화하는 방법을 강구 해야 한다. 수술 후 하지 부동의 정도가 심하지 않으면 파행, 동통, 신경 마비 등의 문제는 잘 생기지 않는다. 6 mm 이상 신 장이 되면 환자는 다리 길이의 차이를 느끼게 되고 1 cm 이상이 되면 불편감을 느끼기 시작하며, 2 cm 이상에서는 신발 굽을 이용한 하지 부동의 교정을 하여야 한다. 2.5 cm 이상에서는 좌골신경 마비 등의 신경증세가 올 수 있 다. 본 논문에서는 인공관절 전치환술 후 발생할 수 있는 하지 부동의 원인 및 예방법에 대해 알아 보고, 저자들이 하지 부동의 최소화를 위해 사용하는 방법을 소개하고자 한다.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131983061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.303
Jong Seok Park, W. Kim, Jaewan Soh, Byung-Woong Jang, Tae-Heon Kim, Y. Suh
Purpose: We propose to improve the use of Proximal Femoral Nail Anti-rotation in Korea by reporting anatomical measurements of the normal Korean proximal femur. Materials and Methods: A total of 230 patients were enrolled who had all experienced a femoral intertrochanteric fracture and undergone the Proximal Femoral Nail Anti-rotation surgical procedure between February 2007 and April 2011. We measured the neck-shaft angle and endosteal width at the isthmus of a normal femur, and the distance between the greater trochanter and the nail tip of the Proximal Femoral Nail Anti-rotation in post-operative plain radiography. We analyzed the average and standard deviations of the measurements. We also investigated correlations with the patient gender. Results: The average neck-shaft angle and endosteal width at the isthmus were 129.7。(111.0~138.3。 ) and 14.5 mm (9.7~23.1 mm), respectively. The average protruded nail length was 4.9 mm (1.0~15.0 mm). The femur neck-shaft angle had a correlation ratio with gender (p=0.000). However, the endosteal width at the isthmus level and the protruded nail length had no correlation ratio with gender (p=0.108, 0.573, respectively). Conclusion: Until now, in intertrochanteric fracture operations using Proximal Femoral Nail Anti-rotation, the selection of devices has been extremely limited. Through this study we present the average Korean anatomical neckshaft angle, endosteal width of the femur, and protruding length of the nail tip. We expect that these numerical values can be used in the production of new devices with shorter proximal nails, which would be more appropriates for Koreans.
目的:我们建议通过报告正常韩国股骨近端解剖测量来改善韩国股骨近端防旋转的使用。材料和方法:在2007年2月至2011年4月期间，共有230例患者经历了股骨粗隆间骨折并接受了股骨近端钉抗旋转手术。我们在术后平片中测量了正常股骨峡部颈轴角和骨内宽度，以及股骨大转子与股骨近端防旋转钉尖之间的距离。我们分析了测量结果的平均值和标准差。我们还调查了与患者性别的相关性。结果:峡部颈轴角和骨内宽度平均为129.7。(111.0~138.3 .)14.5 mm (9.7~23.1 mm)。平均突出钉长度为4.9 mm (1.0~15.0 mm)。股骨颈干角与性别有相关性(p=0.000)。峡部骨内膜宽度和甲突长度与性别无相关性(p分别为0.108、0.573)。结论:到目前为止，股骨近端防旋钉在股骨粗隆间骨折手术中，装置的选择非常有限。通过这项研究，我们介绍了韩国人平均解剖颈轴角、股骨骨内宽度和趾尖突出长度。我们期望这些数值可以用于生产更适合韩国人的近端钉更短的新装置。
{"title":"Anatomical Measurement of Normal Korean Proximal Femur Using Plain Radiography: A Problem when using Proximal Femoral Nail Anti-rotation","authors":"Jong Seok Park, W. Kim, Jaewan Soh, Byung-Woong Jang, Tae-Heon Kim, Y. Suh","doi":"10.5371/JKHS.2011.23.4.303","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.303","url":null,"abstract":"Purpose: We propose to improve the use of Proximal Femoral Nail Anti-rotation in Korea by reporting anatomical measurements of the normal Korean proximal femur. Materials and Methods: A total of 230 patients were enrolled who had all experienced a femoral intertrochanteric fracture and undergone the Proximal Femoral Nail Anti-rotation surgical procedure between February 2007 and April 2011. We measured the neck-shaft angle and endosteal width at the isthmus of a normal femur, and the distance between the greater trochanter and the nail tip of the Proximal Femoral Nail Anti-rotation in post-operative plain radiography. We analyzed the average and standard deviations of the measurements. We also investigated correlations with the patient gender. Results: The average neck-shaft angle and endosteal width at the isthmus were 129.7。(111.0~138.3。 ) and 14.5 mm (9.7~23.1 mm), respectively. The average protruded nail length was 4.9 mm (1.0~15.0 mm). The femur neck-shaft angle had a correlation ratio with gender (p=0.000). However, the endosteal width at the isthmus level and the protruded nail length had no correlation ratio with gender (p=0.108, 0.573, respectively). Conclusion: Until now, in intertrochanteric fracture operations using Proximal Femoral Nail Anti-rotation, the selection of devices has been extremely limited. Through this study we present the average Korean anatomical neckshaft angle, endosteal width of the femur, and protruding length of the nail tip. We expect that these numerical values can be used in the production of new devices with shorter proximal nails, which would be more appropriates for Koreans.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125938951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.237
K. Hwang, Young-Hoo Kim
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.
{"title":"Revision Total Hip Arthroplasty of an Acetabular Cup with Acetabular Bone Defects","authors":"K. Hwang, Young-Hoo Kim","doi":"10.5371/JKHS.2011.23.4.237","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.237","url":null,"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.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129284181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.318
Se-Ang Jang, Youngho Cho, Y. Byun, H. Cho, Sung Choi, Hyun-Seong Yoo
The proximal femoral nail anti-rotation (PFNA) is a useful device to fix trochanteric fractures of the proximal femur. We report a case of postoperative penetration of the helical blade through the femoral head into the hip joint without any sign of rotational or varus instability in the fracture.
{"title":"A Case Report of Unique Complications of PFNA Penetration of the Blade into the Hip Joint","authors":"Se-Ang Jang, Youngho Cho, Y. Byun, H. Cho, Sung Choi, Hyun-Seong Yoo","doi":"10.5371/JKHS.2011.23.4.318","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.318","url":null,"abstract":"The proximal femoral nail anti-rotation (PFNA) is a useful device to fix trochanteric fractures of the proximal femur. We report a case of postoperative penetration of the helical blade through the femoral head into the hip joint without any sign of rotational or varus instability in the fracture.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124025769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.229
Kang-Il Kim, K. Rhyu, Kye-Youl Cho, Dae-Seok Huh
Despite the overall satisfactory results of total hip arthroplasty, post-operative complications continue to occur. To minimize these problems, computer-assisted total hip arthroplasty using navigation or robot-assisted systems is being developed. A navigation system is defined as a system that locates a position in three-dimensional space and traces the target spot, and a robot-assisted system is defined as a system that performs operations automatically with mechanical robot arms based on prior preoperative planning. Computer-assisted surgeries have shown superior results to conventional methods in implant positioning, fixation, and accurate lower extremity alignment in the limited reports available. However, computer-assisted surgeries take longer compared to conventional methods. Due to the extra time needed, the risk of postoperative infection and blood loss is considered to be higher. Nevertheless, robot-assisted system is being developed for the field of hip arthroplasty, and thus its efficacy and accuracy needs to be further investigated. Since these methods have other advantages compared to conventional methods, they are the focus of much interest.
{"title":"Computer-Assisted Total Hip Arthroplasty","authors":"Kang-Il Kim, K. Rhyu, Kye-Youl Cho, Dae-Seok Huh","doi":"10.5371/JKHS.2011.23.4.229","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.229","url":null,"abstract":"Despite the overall satisfactory results of total hip arthroplasty, post-operative complications continue to occur. To minimize these problems, computer-assisted total hip arthroplasty using navigation or robot-assisted systems is being developed. A navigation system is defined as a system that locates a position in three-dimensional space and traces the target spot, and a robot-assisted system is defined as a system that performs operations automatically with mechanical robot arms based on prior preoperative planning. Computer-assisted surgeries have shown superior results to conventional methods in implant positioning, fixation, and accurate lower extremity alignment in the limited reports available. However, computer-assisted surgeries take longer compared to conventional methods. Due to the extra time needed, the risk of postoperative infection and blood loss is considered to be higher. Nevertheless, robot-assisted system is being developed for the field of hip arthroplasty, and thus its efficacy and accuracy needs to be further investigated. Since these methods have other advantages compared to conventional methods, they are the focus of much interest.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117192935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.275
B. Kang, Jue-Hee Lee, Y. Jung, Jin Hong Kim, Yongmoon Han, E. Jang, Kyoung-Won Kim
� Purpose: The purpose of this study was to evaluate the clinical and radiological outcomes after total hip arthroplasty using the S-ROM modular system for osteonecrosis of the femoral head, and to compare the results between the groups using metal-on-metal articulation and ceramic-on-ceramic articulation. Materials and Methods: Sixty-six patients (78 hips) with osteonecrosis of the femoral head were evaluated after primary total hip arthroplasty between January 2001 and December 2004, using an S-ROM proximal modular femoral stem. The average follow-up was 77 months (range, 60 to 122 months) and all patients were followed for more than five years. Results: The average Harris hip score improved from 53 points to 88.5 points at the final follow-up. At the latest radiologic evaluation, sixty-seven stems had bony ingrowth stability, and 10 stems had stable fibrous ingrowth. However, one stem had diffuse extensive osteolysis and loosening, which was revised at 9 years. Postoperative complications included 4 cases of heterotrophic ossificiation, 1 case of linear fracture after insertion of the femoral stem, 1 case of dislocation, 2 cases of infection, and 1 case of extensive osteolysis and loosening. There were 3 cases of revision and Kaplan-Meier survivorship analysis with revision estimated at a 95.7% chance of survival for the femoral component during 122 months. Conclusion: Our study showed that total hip arthroplasty using the S-ROM modular system with metal-on-metal articulation or ceramic-on-ceramic articulation had favorable clinical and radiological mid- to long-term results.
{"title":"Cementless Total Hip Arthroplasty Using a Modular Femoral Component in Patients with Femoral Head Osteonecrosis: Comparison of Metal-on-Metal and Ceramic-on-Ceramic Articulation","authors":"B. Kang, Jue-Hee Lee, Y. Jung, Jin Hong Kim, Yongmoon Han, E. Jang, Kyoung-Won Kim","doi":"10.5371/JKHS.2011.23.4.275","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.275","url":null,"abstract":"� Purpose: The purpose of this study was to evaluate the clinical and radiological outcomes after total hip arthroplasty using the S-ROM modular system for osteonecrosis of the femoral head, and to compare the results between the groups using metal-on-metal articulation and ceramic-on-ceramic articulation. Materials and Methods: Sixty-six patients (78 hips) with osteonecrosis of the femoral head were evaluated after primary total hip arthroplasty between January 2001 and December 2004, using an S-ROM proximal modular femoral stem. The average follow-up was 77 months (range, 60 to 122 months) and all patients were followed for more than five years. Results: The average Harris hip score improved from 53 points to 88.5 points at the final follow-up. At the latest radiologic evaluation, sixty-seven stems had bony ingrowth stability, and 10 stems had stable fibrous ingrowth. However, one stem had diffuse extensive osteolysis and loosening, which was revised at 9 years. Postoperative complications included 4 cases of heterotrophic ossificiation, 1 case of linear fracture after insertion of the femoral stem, 1 case of dislocation, 2 cases of infection, and 1 case of extensive osteolysis and loosening. There were 3 cases of revision and Kaplan-Meier survivorship analysis with revision estimated at a 95.7% chance of survival for the femoral component during 122 months. Conclusion: Our study showed that total hip arthroplasty using the S-ROM modular system with metal-on-metal articulation or ceramic-on-ceramic articulation had favorable clinical and radiological mid- to long-term results.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116264578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.297
J. Kang, K. Moon, R. Kim, S. Na
Purpose: The size of the necrotic lesion is known to be the most important prognostic factor in osteonecrosis of the femoral head (ONFH). We evaluated the accuracy and relationship of three different measuring methods of necrotic lesions for ONFH. Materials and Methods: Sixty hips that had ONFH were measured on an MRI by two orthopaedic surgeons using Steinberg, Kim, and modified Kerboul methods. Based on the lesion size of the necrosis as measured with the computerized Steinberg method, the hips were divided into Group I (small lesion: less than 15%), Group II (medium lesion: 15~30%), and Group III (large lesion: more than 30%). Data of the Kim and modified Kerboul methods were reclassified by statistical analysis according to the groups classified by the Steinberg method. Results: Average lesion size of Group I (16 hips) was 10.92%, the average size of Group II (33 hips) was 21.68%, and the average size of Group III (11 hips) was 36.80%. We established a new criteria of the Kim and modified Kerboul methods based on Steinberg. The Kim method was reclassified into Groups I (less than 18%), II (18~33%), and III (33% or more). And the modified Kerboul method was divided into Groups I (less than 200.6。 ), II (200.6~262.4。 ), and III (more than 262.4。 ) as well. Conclusion: New criteria for the Kim and modified Kerboul method would be a useful indicator for the prognosis and treatment plan in ONFH.
目的:已知坏死灶的大小是影响股骨头骨坏死(ONFH)预后的最重要因素。我们评估了三种不同的ONFH坏死病变测量方法的准确性和相关性。材料和方法:由两名骨科医生使用Steinberg, Kim和改进的Kerboul方法在MRI上测量60个有ONFH的髋关节。根据电脑化Steinberg法测定的坏死灶大小，将髋关节分为小病变小于15%组、中病变15~30%组、大病变大于30%组。根据Steinberg方法分类的分组，对Kim方法和改进的kerboull方法的数据进行统计分析。结果:ⅰ组(16髋)平均病变大小为10.92%，ⅱ组(33髋)平均病变大小为21.68%，ⅲ组(11髋)平均病变大小为36.80%。我们建立了新的Kim标准，并在Steinberg的基础上改进了Kerboul方法。Kim法重新分为I组(小于18%)、II组(18~33%)和III组(33%以上)。将改进的Kerboul方法分为I组(小于200.6)。， ii (200.6~262.4 .)和III(超过262.4。)也结论:新的Kim标准和改进的Kerboul方法可作为ONFH预后和治疗方案的有效指标。
{"title":"Measurement of Necrotic Lesion in Osteonecrosis of Femoral Head","authors":"J. Kang, K. Moon, R. Kim, S. Na","doi":"10.5371/JKHS.2011.23.4.297","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.297","url":null,"abstract":"Purpose: The size of the necrotic lesion is known to be the most important prognostic factor in osteonecrosis of the femoral head (ONFH). We evaluated the accuracy and relationship of three different measuring methods of necrotic lesions for ONFH. Materials and Methods: Sixty hips that had ONFH were measured on an MRI by two orthopaedic surgeons using Steinberg, Kim, and modified Kerboul methods. Based on the lesion size of the necrosis as measured with the computerized Steinberg method, the hips were divided into Group I (small lesion: less than 15%), Group II (medium lesion: 15~30%), and Group III (large lesion: more than 30%). Data of the Kim and modified Kerboul methods were reclassified by statistical analysis according to the groups classified by the Steinberg method. Results: Average lesion size of Group I (16 hips) was 10.92%, the average size of Group II (33 hips) was 21.68%, and the average size of Group III (11 hips) was 36.80%. We established a new criteria of the Kim and modified Kerboul methods based on Steinberg. The Kim method was reclassified into Groups I (less than 18%), II (18~33%), and III (33% or more). And the modified Kerboul method was divided into Groups I (less than 200.6。 ), II (200.6~262.4。 ), and III (more than 262.4。 ) as well. Conclusion: New criteria for the Kim and modified Kerboul method would be a useful indicator for the prognosis and treatment plan in ONFH.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123669314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.262
Jong Won Kim, Young-Soo Jang, H. Park, J. Rha, J. Yang, Jae-Hyuk Choi, Sung Ju Bae
Purpose: There are numerous opinions about the methods and usefulness of minimizing leg length discrepancies after hip arthroplasty. In this study, we tried to evaluate the usefulness of an intraoperative x-ray in addition to preoperative templating for minimizing leg length discrepancy. Materials and Methods: We reviewed pre- and post-operative pelvis AP x-rays of 46 patients who underwent hip arthroplasty due to a traumatic femoral neck fracture or intertrochanteric fracture between May 2008 and February 2009. A leg length discrepancy is the difference in vertical distance between a horizontal line drawn along the bottom of the ischial tuberosities and the most inferior points of the lesser trochanter. It was measured in a pelvis AP x-ray. In each case, pre-operative templating was performed and an intraoperative pelvis AP x-ray was taken again to assess the accuracy of preoperative planning. Implant positions were readjusted when necessary. Results: The mean post-operative leg-length discrepancy was 0.3 mm (SD, 3.1 mm). The range was from -5.8 mm to +5.9 mm. Conclusion: Combining preoperative templating and intraoperative x-rays is a useful method of minimizing leg length discrepancy during hip arthroplasty.
目的:关于减少髋关节置换术后腿长差异的方法和有效性有许多意见。在本研究中，我们试图评估除术前模板外术中x线片对最小化腿长差异的有用性。材料和方法:我们回顾了2008年5月至2009年2月间46例因外伤性股骨颈骨折或股骨粗隆间骨折接受髋关节置换术的患者的术前和术后骨盆AP x线。腿长差是指沿坐骨结节底部绘制的水平线与小粗隆最下方点之间的垂直距离差。通过骨盆AP x线片测量。在每个病例中，术前都进行了模板制作，术中再次拍摄骨盆AP x线片以评估术前计划的准确性。必要时调整种植体位置。结果:术后平均腿长差0.3 mm (SD, 3.1 mm)。射程从-5.8 mm到+5.9 mm。结论:术前模板与术中x线相结合是减少髋关节置换术中腿长差异的有效方法。
{"title":"Useful Method for Minimizing Leg Length Discrepancies in Hip Arthroplasty: Use of an Intraoperative X-ray","authors":"Jong Won Kim, Young-Soo Jang, H. Park, J. Rha, J. Yang, Jae-Hyuk Choi, Sung Ju Bae","doi":"10.5371/JKHS.2011.23.4.262","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.262","url":null,"abstract":"Purpose: There are numerous opinions about the methods and usefulness of minimizing leg length discrepancies after hip arthroplasty. In this study, we tried to evaluate the usefulness of an intraoperative x-ray in addition to preoperative templating for minimizing leg length discrepancy. Materials and Methods: We reviewed pre- and post-operative pelvis AP x-rays of 46 patients who underwent hip arthroplasty due to a traumatic femoral neck fracture or intertrochanteric fracture between May 2008 and February 2009. A leg length discrepancy is the difference in vertical distance between a horizontal line drawn along the bottom of the ischial tuberosities and the most inferior points of the lesser trochanter. It was measured in a pelvis AP x-ray. In each case, pre-operative templating was performed and an intraoperative pelvis AP x-ray was taken again to assess the accuracy of preoperative planning. Implant positions were readjusted when necessary. Results: The mean post-operative leg-length discrepancy was 0.3 mm (SD, 3.1 mm). The range was from -5.8 mm to +5.9 mm. Conclusion: Combining preoperative templating and intraoperative x-rays is a useful method of minimizing leg length discrepancy during hip arthroplasty.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120963103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.268
S. Yim, M. Jang, J. Yoon, Sang Hyok Lee, Hee-kyung Kang
Purpose: We believe that cemented femoral stems will relieve the stiffness of ceramic-based bearings, resulting in reduced complication of ceramic-on-ceramic bearing total hip arthroplasty (THA). The purpose of this study was to evaluate the midterm effect of ceramic-on-ceramic bearing THA using cemented femoral stems. Materials and Methods: We studied 32cases (30 patients) of THA using ceramic-on-ceramic bearing cemented femoral stems and 33 cases (31 patients) of THA using ceramic-on-ceramic bearing cementless femoral stems. All total hip arthroplasties were performed between January 2004 and December 2005 and were followed up for more than 5 years. The clinical results and radiographic results were evaluated. Results: The mean HHS improved from points pre-operatively to points at the last follow-up in both the cemented and cementless stem groups (P<0.05). The mean WOMAC score also improved from points pre-operatively to points at the last follow-up in both the cemented and cementless stem groups (P<0.05). But no statistically significant difference was noted between the cemented and cementless stem groups in HHS and WOMAC scores (P=0.304, P=0.769). There were 3 patients with a sense of discomfort on ambulation and 5 patients with thigh pain in the cementless stem group and no cases in the cemented stem group. There was no instance of acetabular loosening in either group. Subsidenc of the cemented femoral stem was less than 1mm in 30 cases and less than 2 mm in 2 cases. All cementless femoral stems acquired firm bony union. Conclusion: Midterm results showed no statistical links between ceramicon-ceramic-bearing THA using cemented femoral stems or cementless femoral stems.
{"title":"Ceramic-on-Ceramic Bearing Total Hip Arthroplasty: Five-Year Midterm Follow-up Results","authors":"S. Yim, M. Jang, J. Yoon, Sang Hyok Lee, Hee-kyung Kang","doi":"10.5371/JKHS.2011.23.4.268","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.268","url":null,"abstract":"Purpose: We believe that cemented femoral stems will relieve the stiffness of ceramic-based bearings, resulting in reduced complication of ceramic-on-ceramic bearing total hip arthroplasty (THA). The purpose of this study was to evaluate the midterm effect of ceramic-on-ceramic bearing THA using cemented femoral stems. Materials and Methods: We studied 32cases (30 patients) of THA using ceramic-on-ceramic bearing cemented femoral stems and 33 cases (31 patients) of THA using ceramic-on-ceramic bearing cementless femoral stems. All total hip arthroplasties were performed between January 2004 and December 2005 and were followed up for more than 5 years. The clinical results and radiographic results were evaluated. Results: The mean HHS improved from points pre-operatively to points at the last follow-up in both the cemented and cementless stem groups (P<0.05). The mean WOMAC score also improved from points pre-operatively to points at the last follow-up in both the cemented and cementless stem groups (P<0.05). But no statistically significant difference was noted between the cemented and cementless stem groups in HHS and WOMAC scores (P=0.304, P=0.769). There were 3 patients with a sense of discomfort on ambulation and 5 patients with thigh pain in the cementless stem group and no cases in the cemented stem group. There was no instance of acetabular loosening in either group. Subsidenc of the cemented femoral stem was less than 1mm in 30 cases and less than 2 mm in 2 cases. All cementless femoral stems acquired firm bony union. Conclusion: Midterm results showed no statistical links between ceramicon-ceramic-bearing THA using cemented femoral stems or cementless femoral stems.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122633779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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