대퇴골두 무혈성괴사증에 시행한 양극성 고관절 반치환술

Abstract

Forty-one hips in 38 patients with avascular necrosis of the femoral head were treated with primary cementless bipolar hemiarthroplasty with porous coated femoral components from May 1988 to May 1992.The cases were observed for more than three years(range, three to 6 years 4 months). The average age of the patients at the time of surgery was 46 years(range, 26 to 67 years). Patients were assessed using the modified Harris hip score, as well as serial radiographs. The average hip score at the latest follow-up examination was 84. Six hips required revision surgery on the acetabular side due to bipolar head migration. Review of radiographs demonstrated femoral stem loosening in 1 hip and bipolar head migration in 8 hips(20%). Endocortical femoral osteolysis developed in 5 hips(12.2%). These increased failure rates may be associated with high activity levels of younger patients, poor bone quality in calcar and trochanteric region of avascular necrosis of femoral head, polyethylene particles produced by persistent cyclic impingement of the stem neck on the rim of the bipolar head and a more rapid degeneration of the acetabular cartilage in response to articulation with a metallic bipolar head. The authors believe that these high failure rates make bipolar arthroplasty a less appealing option for the treatment avascular necrosis of the femoral head.