Pub Date : 2011-12-01DOI: 10.5371/JKHS.2011.23.4.248
Y. Suh, S. Won
Total hip replacement arthroplasty (THRA) is widely performed, and is a successful orthopedic treatment method. Osteolysis, which often happens after THRA, causes a chronic inflammation stage due to wear debris in the artificial articular surface, leading to bone loss or loosening of implants. Osteolysis eventually results in shortening the lifespan of the joint. Afterwards, many researchers reported on the basis of experiments with tissue cultivation that due to the influence of wear particles, the surrounding tissues of the implants as obtained during replacement and the surrounding cells of the implants are secreting enzymes, prostaglandin, cytokine, and the like that stimulate the formation of fibrous tissues or bone resorption by osteoclasts. At this time, THRA was a main cement fixation method, so researchers thought that the loose particles of cement were the cause of osteolysis and aseptic loosening, and so they named these symptoms "cement disease". However, despite the advancement of cement techniques and the use of cement-free implants, the osteolysis problem continued to rise, leading to polyethylene wear particles being regarded as the main cause of osteolysis, and naming these symptoms "particle disease". In this way attention was drawn to new wear particles, now that it is revealed that ultra-high-molecular-weight- polyethylene (UHMWPE) or metal particles constitute the main cause. However, because no symptoms arise until serious bone defects or loosening occurs, it is difficult to diagnose or treat the disease early on. Thus, based on updated hypotheses and theories, this study examines the pathophysiology of osteolysis following THRA, as well as the diagnosis and treatment of osteolysis in the acetabular and femoral regions.
{"title":"Diagnosis and Treatment of Osteolysis","authors":"Y. Suh, S. Won","doi":"10.5371/JKHS.2011.23.4.248","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.248","url":null,"abstract":"Total hip replacement arthroplasty (THRA) is widely performed, and is a successful orthopedic treatment method. Osteolysis, which often happens after THRA, causes a chronic inflammation stage due to wear debris in the artificial articular surface, leading to bone loss or loosening of implants. Osteolysis eventually results in shortening the lifespan of the joint. Afterwards, many researchers reported on the basis of experiments with tissue cultivation that due to the influence of wear particles, the surrounding tissues of the implants as obtained during replacement and the surrounding cells of the implants are secreting enzymes, prostaglandin, cytokine, and the like that stimulate the formation of fibrous tissues or bone resorption by osteoclasts. At this time, THRA was a main cement fixation method, so researchers thought that the loose particles of cement were the cause of osteolysis and aseptic loosening, and so they named these symptoms \"cement disease\". However, despite the advancement of cement techniques and the use of cement-free implants, the osteolysis problem continued to rise, leading to polyethylene wear particles being regarded as the main cause of osteolysis, and naming these symptoms \"particle disease\". In this way attention was drawn to new wear particles, now that it is revealed that ultra-high-molecular-weight- polyethylene (UHMWPE) or metal particles constitute the main cause. However, because no symptoms arise until serious bone defects or loosening occurs, it is difficult to diagnose or treat the disease early on. Thus, based on updated hypotheses and theories, this study examines the pathophysiology of osteolysis following THRA, as well as the diagnosis and treatment of osteolysis in the acetabular and femoral regions.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"35 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":"114980740","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.2011.23.4.310
B. Park, Hong-Man Cho, Ju-Hyun Sim, Hyun-Ju Choi
Purpose: To analyze the effectiveness of inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin after debridement of an acute-immediate stage infected hip arthroplasty. Materials and Methods: Between 2002 and 2008, the cases of 13 patients with documented acute-immediate stage infections of hip arthroplasty were reviewed and followed for at least two years postoperatively (average 4.3 years). The preoperative and postoperative clinical and radiologic findings and blood laboratory work of the cases were checked. All cases were performed through retention of the implant and massive debridement and saline irrigation. Next, vancomycin-impregnated calcium sulfate cement beads were inserted. Results: After the first operation, the average interval to wait before performing a second operation was 27.7 days (17~37 days). During the second operation, the erythrocyte sediment rate and C-reactive protein were 150.97 mm/hr (34.6~339.7 mm/hr) and 76.4 mg/L (41~132 mg/L), respectively. Infectious organisms were cultured and isolated. There were 5 cases of Methicillin-resistant Staphylococcus aureus (MRSA). In addition, the results of an antibiotics sensitivity test revealed 8 cases of Vancomycin and 5 cases of 3rd generation Cephalosporin. Radiologic results showed 10 cases with a stable fixation on the last follow-up (femoral stem), and 1 case of hip joint space narrowing, called acetabular erosion. Conclusion: Inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin proved to be a useful treatment for an acute immediate infection of hip arthroplasty.
{"title":"Treatment of Infected Hip Arthroplasty with Antibiotic-Impregnated Calcium Sulfate Cement","authors":"B. Park, Hong-Man Cho, Ju-Hyun Sim, Hyun-Ju Choi","doi":"10.5371/JKHS.2011.23.4.310","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.4.310","url":null,"abstract":"Purpose: To analyze the effectiveness of inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin after debridement of an acute-immediate stage infected hip arthroplasty. Materials and Methods: Between 2002 and 2008, the cases of 13 patients with documented acute-immediate stage infections of hip arthroplasty were reviewed and followed for at least two years postoperatively (average 4.3 years). The preoperative and postoperative clinical and radiologic findings and blood laboratory work of the cases were checked. All cases were performed through retention of the implant and massive debridement and saline irrigation. Next, vancomycin-impregnated calcium sulfate cement beads were inserted. Results: After the first operation, the average interval to wait before performing a second operation was 27.7 days (17~37 days). During the second operation, the erythrocyte sediment rate and C-reactive protein were 150.97 mm/hr (34.6~339.7 mm/hr) and 76.4 mg/L (41~132 mg/L), respectively. Infectious organisms were cultured and isolated. There were 5 cases of Methicillin-resistant Staphylococcus aureus (MRSA). In addition, the results of an antibiotics sensitivity test revealed 8 cases of Vancomycin and 5 cases of 3rd generation Cephalosporin. Radiologic results showed 10 cases with a stable fixation on the last follow-up (femoral stem), and 1 case of hip joint space narrowing, called acetabular erosion. Conclusion: Inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin proved to be a useful treatment for an acute immediate infection of hip arthroplasty.","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":"130706529","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 : 2011-09-01DOI: 10.5371/JKHS.2011.23.3.169
K. So, Young-yool Chung
A dislocation after total hip arthroplasty is a serious complication that is related to the component position and poor patient compliance. Therefore, the attendants and surgeons need to be aware of the risk factors for dislocations and take steps to prevent them. In addition, the surgeon should insert the components within the safe zone. The patients should also be informed of possibility of dislocations after total hip arthroplasty. Dislocations can be treated conservatively but a recurrent dislocation requires surgery. The causes of recurrent dislocations must be evaluated before surgery to achieve a high success rate.
{"title":"The Causes and Treatment of Dislocations after Total Hip Arthroplasty","authors":"K. So, Young-yool Chung","doi":"10.5371/JKHS.2011.23.3.169","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.3.169","url":null,"abstract":"A dislocation after total hip arthroplasty is a serious complication that is related to the component position and poor patient compliance. Therefore, the attendants and surgeons need to be aware of the risk factors for dislocations and take steps to prevent them. In addition, the surgeon should insert the components within the safe zone. The patients should also be informed of possibility of dislocations after total hip arthroplasty. Dislocations can be treated conservatively but a recurrent dislocation requires surgery. The causes of recurrent dislocations must be evaluated before surgery to achieve a high success rate.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126598872","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 : 2011-09-01DOI: 10.5371/JKHS.2011.23.3.184
T. Yoon, Kyung-Soon Park, Jae-Young Moon
최근 정형외과 영역의 여러 분야에서 최소 침습 수술 (minimal invasive surgery, MIS)이 대두되고 있으며, 인 공 고관절 전치환술에서도 예외는 아니어서 Siguier 등 이 1993년부터 최소 절개 전방 도달법을 통해 인공 관절 을 시행한 후, 여러 술자들이 최소 침습 술식을 이용한 고 관절 전치환술을 시행해 왔다. 인공 고관절 전치환술에서의 최소 침습 수술은 통상적 으로 수술 절개창이 10 cm이하인 것으로 정의하고 있다. 환자들에게 있어서는 기존의 20 cm이상의 고전적 술식에 비하여 최소 침습적 술식은 몇 가지 이점을 갖고 있는데, 이는 심리적인 것으로 가장 큰 이유는 미용(cosmesis, 95%) 이며, 다음으로 신체의 훼손이 적고(less violation of the body, 93%) 그와 동시에 근육절개가 적다(less muscle cut, 89%)는 것이다. 그러나 단일 절개를 통한 최 소 침습 인공고관절 전치환술(minimally invasive total hip arthroplasty, MIS-THA)은 기존의 전통적인 방법에 비해 획기적으로 절개 부위를 줄일 수 있었지만, 단순히 수술 절개창이 작더라도 절개선 아래에서는 고식적인 방 법 못지 않은 절개가 이루어져 근육과 인대 손상 등의 연 부조직 손상을 줄이는 데는 한계가 있었다. 최근에는 최 소 침습(minimally invasive)이라는 용어보다는 최소 절 개(mini-incision) 술식이라는 용어가 적합하다는 주장들 이 주류를 이룬다. 또한 최소 침습 수술 시 수술 시야가 좋 지 않으며 이로 인하여 삽입물이 제대로 위치하지 않을 가 능성 및 그에 따른 탈구와 신경 손상 등의 합병증이 증가 할 수 있다고 보고되고 있으며, 이는 숙련되지 않은 의사 의 경우 발생 위험이 크다. 최소 절개 술식의 성공 요소 로 가장 중요한 것이 적합한 환자의 선택이며, 또한 적절한 적응증에서의 수술 시행 및 정확한 수술 술기의 습 득이 필요하다. 이에 저자들은 현재 사용되고 있는 MISTHA의 수술 술기에 대하여 기술하고자 한다.
最近在整形外科领域的各个领域微创手术(minimal invasive surgery、mis)大豆,骨关节前置球环术也不例外,siguier等从1993年开始,至少切开前方到达法施行后,通过人工关节,各种酒者利用微创酒仪式,关节前置环酒一直奉行。人工骨关节前置手术中的微创手术通常被定义为手术开叉低于10厘米。病人来说,现有的20厘米以上的经典式相比,微创式酒酒具有几个优势,这就是有心理的东西的最大原因是美容(cosmesis, 95%),其次,要有身体的损坏(less violation of the body, 93%的气节)与此同时,肌肉少(less muscle cut, 89%)的。但是，与传统的方法相比，最小创人工髋关节置换术(英语:minimally invasive total hip arthroplasty, MIS-THA)可以大幅减少切开部位。即使手术切开窗很小，在切开线下面也会进行不亚于古式方法的切开，因此在减少肌肉和韧带损伤等软组织损伤上存在一定的局限性。最近，比起“最小侵袭(minimally invasive)”的用语，“最少切割(mini-incision)术式”的用语更为合适的主张成为主流。另外，在进行微创手术时，手术视野不佳，因此插入物不能正常位置，可能会增加脱臼和神经损伤等并发症，这对于不熟练的医生来说，发生的危险很大。最小切开术式的成功要素，最重要的是适合患者的选择，并且需要在适当的适应症下进行手术及学习正确的手术技巧。为此，作者们想对目前使用的MISTHA的手术技术进行记述。
{"title":"Minimally Invasive Surgical Technique for Total Hip Arthroplasty","authors":"T. Yoon, Kyung-Soon Park, Jae-Young Moon","doi":"10.5371/JKHS.2011.23.3.184","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.3.184","url":null,"abstract":"최근 정형외과 영역의 여러 분야에서 최소 침습 수술 (minimal invasive surgery, MIS)이 대두되고 있으며, 인 공 고관절 전치환술에서도 예외는 아니어서 Siguier 등 이 1993년부터 최소 절개 전방 도달법을 통해 인공 관절 을 시행한 후, 여러 술자들이 최소 침습 술식을 이용한 고 관절 전치환술을 시행해 왔다. 인공 고관절 전치환술에서의 최소 침습 수술은 통상적 으로 수술 절개창이 10 cm이하인 것으로 정의하고 있다. 환자들에게 있어서는 기존의 20 cm이상의 고전적 술식에 비하여 최소 침습적 술식은 몇 가지 이점을 갖고 있는데, 이는 심리적인 것으로 가장 큰 이유는 미용(cosmesis, 95%) 이며, 다음으로 신체의 훼손이 적고(less violation of the body, 93%) 그와 동시에 근육절개가 적다(less muscle cut, 89%)는 것이다. 그러나 단일 절개를 통한 최 소 침습 인공고관절 전치환술(minimally invasive total hip arthroplasty, MIS-THA)은 기존의 전통적인 방법에 비해 획기적으로 절개 부위를 줄일 수 있었지만, 단순히 수술 절개창이 작더라도 절개선 아래에서는 고식적인 방 법 못지 않은 절개가 이루어져 근육과 인대 손상 등의 연 부조직 손상을 줄이는 데는 한계가 있었다. 최근에는 최 소 침습(minimally invasive)이라는 용어보다는 최소 절 개(mini-incision) 술식이라는 용어가 적합하다는 주장들 이 주류를 이룬다. 또한 최소 침습 수술 시 수술 시야가 좋 지 않으며 이로 인하여 삽입물이 제대로 위치하지 않을 가 능성 및 그에 따른 탈구와 신경 손상 등의 합병증이 증가 할 수 있다고 보고되고 있으며, 이는 숙련되지 않은 의사 의 경우 발생 위험이 크다. 최소 절개 술식의 성공 요소 로 가장 중요한 것이 적합한 환자의 선택이며, 또한 적절한 적응증에서의 수술 시행 및 정확한 수술 술기의 습 득이 필요하다. 이에 저자들은 현재 사용되고 있는 MISTHA의 수술 술기에 대하여 기술하고자 한다.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122169669","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 : 2011-09-01DOI: 10.5371/JKHS.2011.23.3.225
U. Yoon, H. Min, Jinsoo Kim, Hyun Seok Oh, In Hwa Chung, Ki-Hong Park, J. Seo
Ganglions commonly occur on the hand, wrist, knee, ankle and foot, with occasional development around the hip joint. Ganglion in the acetabular fossa is rare. We present a case of a ganglion in the acetabular fossa of the hip with treatment.
{"title":"Ganglion Cyst in Acetabular Fossa of the Hip Joint - Case Report -","authors":"U. Yoon, H. Min, Jinsoo Kim, Hyun Seok Oh, In Hwa Chung, Ki-Hong Park, J. Seo","doi":"10.5371/JKHS.2011.23.3.225","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.3.225","url":null,"abstract":"Ganglions commonly occur on the hand, wrist, knee, ankle and foot, with occasional development around the hip joint. Ganglion in the acetabular fossa is rare. We present a case of a ganglion in the acetabular fossa of the hip with treatment.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131750590","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 : 2011-09-01DOI: 10.5371/JKHS.2011.23.3.213
S. Kwak, Y. Chun, K. Rhyu, D. Huh, M. Yoo, Y. Cho
Purpose: To evaluate the clinical and radiographic outcomes of the revision total hip arthroplasty using the acetabular reinforcement ring. Materials and Methods: Thirty-six acetabular revisions were performed in 36 patients with use of the reinforcement ring and structural or morselized allograft, between 1997 and 2005, in thirty-six patients. According to the AAOS classification, thirty-four cases of acetabular defects were Ttype III, and two were Ttype IV. Mean follow-up period after surgery was 7.2 years. Results: The mean Harris hip score was 92.3, which was significantly increased compared with the preoperative score. (p<0.001). There were five failures: a case of aseptic loosening of Muller ring, two cases of infection (5.4%) and two cases of hip dislocation (5.4%). Graft incorporation and bone remodeling occurred successfully in all hips, but in the case of aseptic loosening in which the ring fixation had been inadequate at the time of surgery. The success rate was 91.7% with a mean follow-up of 7.2 years, if the cases of revision or loosening of the component were classified into failure cases. Conclusion: Patients treated with acetabular revision with three kinds of reinforcement ring had reconstitution of periacetabular bone stock as well as good clinical and radiographic results. For the good results, the secure implant fixation during the surgery should be confirmed and we should completely understand the characters of the each kinds of reinforcement rings.
{"title":"Revision Total Hip Arthroplasty Using Acetabular Reinforcement Ring - Midterm Follow-up Result -","authors":"S. Kwak, Y. Chun, K. Rhyu, D. Huh, M. Yoo, Y. Cho","doi":"10.5371/JKHS.2011.23.3.213","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.3.213","url":null,"abstract":"Purpose: To evaluate the clinical and radiographic outcomes of the revision total hip arthroplasty using the acetabular reinforcement ring. Materials and Methods: Thirty-six acetabular revisions were performed in 36 patients with use of the reinforcement ring and structural or morselized allograft, between 1997 and 2005, in thirty-six patients. According to the AAOS classification, thirty-four cases of acetabular defects were Ttype III, and two were Ttype IV. Mean follow-up period after surgery was 7.2 years. Results: The mean Harris hip score was 92.3, which was significantly increased compared with the preoperative score. (p<0.001). There were five failures: a case of aseptic loosening of Muller ring, two cases of infection (5.4%) and two cases of hip dislocation (5.4%). Graft incorporation and bone remodeling occurred successfully in all hips, but in the case of aseptic loosening in which the ring fixation had been inadequate at the time of surgery. The success rate was 91.7% with a mean follow-up of 7.2 years, if the cases of revision or loosening of the component were classified into failure cases. Conclusion: Patients treated with acetabular revision with three kinds of reinforcement ring had reconstitution of periacetabular bone stock as well as good clinical and radiographic results. For the good results, the secure implant fixation during the surgery should be confirmed and we should completely understand the characters of the each kinds of reinforcement rings.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129321232","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 : 2011-09-01DOI: 10.5371/JKHS.2011.23.3.221
Kyung-Soon Park, T. Yoon, Jae-Young Moon, Qin Sheng Hu
Implant removal is a recognized mandatory procedure for the treatment of infected total hip arthroplasty (THA). After the implant removal, the surgeon has two surgical options; one-stage exchange arthroplasty or two-stage exchange arthroplasty. However, Girdle stone resection arthroplasty becomes the reasonable surgical option when a patient is considered to be able to tolerate both operations aforementioned but with bone stock inadequate for reconstructive surgery. Trochanteroplasty is a procedure, usually used in septic infant hips to salvage femoral-pelvic articulation, to redirect the cartilage of the trochanteric apophysis and provide a substitute for the absence of a femoral head, in the expectation that the greater trochanter will remodel to the shape of the acetabulum. Dobbs et al. concluded that trochanteroplasty can provide a stable, painless, functional hip, with improved gait and less leg-length discrepancy than predicted when no reconstructive effort is attempted. The authors describe a case of revision THA performed 4 years after trochanteroplasty for uncontrolled infected THA in a 65-year-old male patient, and provided a review of pertinent English literature. The patient was informed that his case data would be submitted for publication, and provided consent.
{"title":"Trochanteroplasty for the Treatment of Uncontrolled Infected Total Hip Arthroplasty - A Case Report -","authors":"Kyung-Soon Park, T. Yoon, Jae-Young Moon, Qin Sheng Hu","doi":"10.5371/JKHS.2011.23.3.221","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.3.221","url":null,"abstract":"Implant removal is a recognized mandatory procedure for the treatment of infected total hip arthroplasty (THA). After the implant removal, the surgeon has two surgical options; one-stage exchange arthroplasty or two-stage exchange arthroplasty. However, Girdle stone resection arthroplasty becomes the reasonable surgical option when a patient is considered to be able to tolerate both operations aforementioned but with bone stock inadequate for reconstructive surgery. Trochanteroplasty is a procedure, usually used in septic infant hips to salvage femoral-pelvic articulation, to redirect the cartilage of the trochanteric apophysis and provide a substitute for the absence of a femoral head, in the expectation that the greater trochanter will remodel to the shape of the acetabulum. Dobbs et al. concluded that trochanteroplasty can provide a stable, painless, functional hip, with improved gait and less leg-length discrepancy than predicted when no reconstructive effort is attempted. The authors describe a case of revision THA performed 4 years after trochanteroplasty for uncontrolled infected THA in a 65-year-old male patient, and provided a review of pertinent English literature. The patient was informed that his case data would be submitted for publication, and provided consent.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115775699","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 : 2011-09-01DOI: 10.5371/JKHS.2011.23.3.165
D. Sun
대표적으로 측방 또는 전측방 도달법과 후방 도달법으 로 분류되는 인공 고관절 전치환 술의 수술적 도달법은 도 달의 용이성, 수술시간의 단축, 수술 시 출혈의 감소, 술 후 합병 발생 등의 다양한 조건을 고려하여 술자의 선호도 를 선택한다. 본 논문에서는 국내 및 미국 등의 여러 술자 들에 의하여 널리 사용되고 있는 후방 도달법에 대한 요 약을 통해 장단점을 설명하고, 이를 개선하기 위해 최근 김 등에 의해 소개된 바 있는 고관절 주위 단외회전근 (short external rotator)의 절단을 최소화하여 술후 관절 탈구 등의 합병증을 현저히 감소시켰다고 보고한 수정 후 방 도달법을 소개하고자 한다. 후방 도달 법은 술기가 용 이하고 수술시 출혈이 적고 감염이나 고관절 주위 화골성 근염 발생이나 외전근 손상, 감염률, 전색 등의 합병이 다 른 도달법에 비하여 적은 큰 장점을 가지고 있어 많은 술 자들이 선호하고 있는 도달 방법이지만 비구 노출이 제한적이고 좌골신경 손상의 위험이 있으며 특히 탈구율 0.3~2%로 보고 되는 측방 도달법에 비하여 술 후 관절 탈 구의 위험이 2~7%로 다소 증가한다는 단점을 가지고 있 는 것이 사실이다. 따라서 여러 장점과 더불어 관절 탈구의 위험을 현저히 감소 시킬 수 있다면 후방 도달법은 훨씬 더 많은 술자들이 가장 선호하는 수술 도달법이 될 것이며 본 논문에 소개하는 수정 후방 도달법은 하나의 좋 은 대안이 될 것으로 사료된다.
{"title":"Modified Posterior Approach to Total Hip Arthroplasty","authors":"D. Sun","doi":"10.5371/JKHS.2011.23.3.165","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.3.165","url":null,"abstract":"대표적으로 측방 또는 전측방 도달법과 후방 도달법으 로 분류되는 인공 고관절 전치환 술의 수술적 도달법은 도 달의 용이성, 수술시간의 단축, 수술 시 출혈의 감소, 술 후 합병 발생 등의 다양한 조건을 고려하여 술자의 선호도 를 선택한다. 본 논문에서는 국내 및 미국 등의 여러 술자 들에 의하여 널리 사용되고 있는 후방 도달법에 대한 요 약을 통해 장단점을 설명하고, 이를 개선하기 위해 최근 김 등에 의해 소개된 바 있는 고관절 주위 단외회전근 (short external rotator)의 절단을 최소화하여 술후 관절 탈구 등의 합병증을 현저히 감소시켰다고 보고한 수정 후 방 도달법을 소개하고자 한다. 후방 도달 법은 술기가 용 이하고 수술시 출혈이 적고 감염이나 고관절 주위 화골성 근염 발생이나 외전근 손상, 감염률, 전색 등의 합병이 다 른 도달법에 비하여 적은 큰 장점을 가지고 있어 많은 술 자들이 선호하고 있는 도달 방법이지만 비구 노출이 제한적이고 좌골신경 손상의 위험이 있으며 특히 탈구율 0.3~2%로 보고 되는 측방 도달법에 비하여 술 후 관절 탈 구의 위험이 2~7%로 다소 증가한다는 단점을 가지고 있 는 것이 사실이다. 따라서 여러 장점과 더불어 관절 탈구의 위험을 현저히 감소 시킬 수 있다면 후방 도달법은 훨씬 더 많은 술자들이 가장 선호하는 수술 도달법이 될 것이며 본 논문에 소개하는 수정 후방 도달법은 하나의 좋 은 대안이 될 것으로 사료된다.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129734835","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 : 2011-09-01DOI: 10.5371/JKHS.2011.23.3.174
Joong-Myung Lee
인공 고관절 치환술에서 발생하는 대퇴 스템 주위 골절 은 인공고관절 치환술의 적응증의 확대로 인공 고관절 치 환술 및 이로 인한 인공 고관절 재치환술의 증가, 낙상의 위험이 있는 고령의 환자의 증가로 점차 증가하는 추세이 다. 특히 낙상의 위험이 있는 고령 환자에서는 골다공증 이 있는 경우 치료는 매우 어렵게 된다. 대퇴 스템 주위 골 절은 일단 발생하면 보통의 골절 치료로는 어려우며, 다양 한 합병증을 유발하고, 인공 고관절 치환술의 장기결과에 악영향을 줄 수 있어 다양한 분류 방법과 치료 방법이 제 시되고 있다. 대퇴 스템 주위 골절은 처음하는 수술에서 0.4%, 재치환술에서 2.1% 정도 나타나는 것으로 보고되 고 있다. 그리고 골절은 크게 수술 중 또는 수술 후 조기에 발생하는 골절과 수술 후 후기에 발생하는 골절로 나뉠 수 있으며, 치료 방법에서 약간의 차이가 있다. 여기에서 인 공 고관절 치환술 후에 발생하는 대퇴 스템 주위 골절의 치료방법에 대해 기술하였다. 수술 후 발생한 대퇴 스템 주위 골절
{"title":"Periprosthetic Femoral Fractures after Hip Arthroplasty","authors":"Joong-Myung Lee","doi":"10.5371/JKHS.2011.23.3.174","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.3.174","url":null,"abstract":"인공 고관절 치환술에서 발생하는 대퇴 스템 주위 골절 은 인공고관절 치환술의 적응증의 확대로 인공 고관절 치 환술 및 이로 인한 인공 고관절 재치환술의 증가, 낙상의 위험이 있는 고령의 환자의 증가로 점차 증가하는 추세이 다. 특히 낙상의 위험이 있는 고령 환자에서는 골다공증 이 있는 경우 치료는 매우 어렵게 된다. 대퇴 스템 주위 골 절은 일단 발생하면 보통의 골절 치료로는 어려우며, 다양 한 합병증을 유발하고, 인공 고관절 치환술의 장기결과에 악영향을 줄 수 있어 다양한 분류 방법과 치료 방법이 제 시되고 있다. 대퇴 스템 주위 골절은 처음하는 수술에서 0.4%, 재치환술에서 2.1% 정도 나타나는 것으로 보고되 고 있다. 그리고 골절은 크게 수술 중 또는 수술 후 조기에 발생하는 골절과 수술 후 후기에 발생하는 골절로 나뉠 수 있으며, 치료 방법에서 약간의 차이가 있다. 여기에서 인 공 고관절 치환술 후에 발생하는 대퇴 스템 주위 골절의 치료방법에 대해 기술하였다. 수술 후 발생한 대퇴 스템 주위 골절","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121142664","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 : 2011-09-01DOI: 10.5371/JKHS.2011.23.3.200
S. Hwang, S. Kwon, H. Chung
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.
{"title":"Comparison of Simultaneous Bilateral Cementless Total Hip Replacement with Staged Bilateral Cementless Total Hip Replacement in High Risk Anesthesia Group","authors":"S. Hwang, S. Kwon, H. Chung","doi":"10.5371/JKHS.2011.23.3.200","DOIUrl":"https://doi.org/10.5371/JKHS.2011.23.3.200","url":null,"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.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128481909","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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