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대한고관절학회> Hip & Pelvis(구 대한고관절학회지)

Hip & Pelvis(구 대한고관절학회지) update

  • : 대한고관절학회
  • : 의약학분야  >  정형외과학
  • : KCI등재
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  • : 연속간행물
  • : 계간
  • : 2287-3260
  • : 2287-3279
  • : 대한고관절학회지(~2012) → hip & pelvis(2012~)

수록정보
수록범위 : 1권1호(1989)~33권3호(2021) |수록논문 수 : 1,408
Hip & Pelvis(구 대한고관절학회지)
33권3호(2021년 09월) 수록논문
최근 권호 논문
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KCI등재

1Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

저자 : Gurvinder Singh , Ankit Khurana , Shailendra Gupta

발행기관 : 대한고관절학회 간행물 : Hip & Pelvis(구 대한고관절학회지) 33권 3호 발행 연도 : 2021 페이지 : pp. 109-119 (11 pages)

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The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (P<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level Ⅲ-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.

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2Improving Acetabular Component Positioning in Supine Direct Anterior Total Hip Arthroplasty with a Transparency Template: A Novel, Simple, and Cost-effective Technique

저자 : Sheng Xu , Jason Beng Teck Lim , Hee Nee Pang

발행기관 : 대한고관절학회 간행물 : Hip & Pelvis(구 대한고관절학회지) 33권 3호 발행 연도 : 2021 페이지 : pp. 120-127 (8 pages)

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Purpose: A novel and simple method to ensure accurate acetabular component anteversion and inclination intraoperatively with the use of a transparency template is described.
Materials and Methods: Patients who underwent total hip arthroplasty (THA) via direct anterior approach (DAA) from June 2019 to January 2020 were included. A transparency template that can be placed over the image intensifier monitor to allow surgeons an accurate reading of the acetabular component position intraoperatively was designed, developed and utilized to determine effectiveness. The first template consists of two perpendicular lines indicating the “trans-ischial line” and the “pubic symphysis/coccyx”. The second template consist of a line indicating 45° inclination and parallel lines of corresponding distances apart required to achieve 20° anteversion based on Lewinnek's formula: version=sin-1 (D1/D2), where D1: minor axis and D2: major axis of the component. This template was used throughout the acetabular part of the surgery, from reaming to impaction of component. Postoperative acetabular inclination, anteversion, surgical duration, length of stay, as well as complications were recorded.
Results: Twenty-six patients were included in this study. Mean postoperative acetabular cup inclination was 43.46±3.09° and mean version was 19.98±2.89°. A total of 21 patients (80.8%) fell within the Callanan safe zone and all 26 patients (100%) were within the Lewinnek safe zone.
Conclusion: The transparency template is a simple, reproducible, and effective tool with a minimal learning curve and no requirement for expensive equipment. This template has the potential to assist surgeons, especially those who are less experienced with DAA THA, in obtaining better postoperative radiographic outcomes.

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3The Effect of Intraoperative Radiographs on Component Position and Leg Length during Routine Posterior Approach Total Hip Arthroplasty

저자 : Nicholas M. Brown , James F. Mcdonald , Robert A. Sershon , Robert H. Hopper

발행기관 : 대한고관절학회 간행물 : Hip & Pelvis(구 대한고관절학회지) 33권 3호 발행 연도 : 2021 페이지 : pp. 128-139 (12 pages)

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Purpose: Accurate component placement and restoration of patient anatomy are critical in total hip arthroplasty (THA) surgery. Although intraoperative radiographs are sometimes utilized, it is unclear whether this practice can improve accuracy.
Materials and Methods: This study evaluated acetabular cup abduction, anteversion, leg length, and offset among 100 posterior approach THAs performed without imaging (No X-ray group) and compared them to a subsequent series of 100 THAs where an intraoperative radiograph was taken with the trial components in place (X-ray group). THAs were performed using a posterior approach by a single, experienced surgeon whose goal was to place the cup at 45° of abduction and 30° of anteversion. Supine anteroposterior pelvic digital radiographs taken at the first (nominal 4-week) postoperative visit were used for measurements.
Results: Slight differences in cup abduction (47°±6° vs 44°±6°, respectively, P=0.003) and anteversion angle (35°±6° vs 31°±6°, respectively, P<0.001) were observed between the X-ray and No X-ray groups; however, a similar proportion of cups within 10°of the target angles was observed (76% vs 83%, respectively, P=0.22). No difference in offset measurements (1.1±6.6 mm vs 0.3±6.9 mm, respectively, P=0.42) or leg lengths (0.3±3.8 mm vs 0.3±4.8 mm, respectively, P=0.94) was observed between the X-ray and No X-ray groups; however, the X-ray group showed less leg length variation (P=0.05).
Conclusion: In this study, the routine use of intraoperative radiographs was not associated with improved implant positioning for uncomplicated primary THA.

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4How Does Iron Deficiency Anemia Impact Outcomes following Revision Total Hip Arthroplasty?

저자 : Mohamed M. Sylla , Lauren Gruffi , Eric S. Roth , Francis E. Rosato , Che Hang Jason Wong , Afshin E. Razi

발행기관 : 대한고관절학회 간행물 : Hip & Pelvis(구 대한고관절학회지) 33권 3호 발행 연도 : 2021 페이지 : pp. 140-146 (7 pages)

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Purpose: Studies have shown the prevalence of iron deficiency anemia (IDA) increasing worldwide, and currently the literature is limited on the impact of IDA on outcomes following revision total hip arthroplasty (RTHA). Therefore, the purpose of this study was to determine whether IDA patients undergoing RTHA have longer: 1) in-hospital lengths of stay (LOS); 2) medical complications; and 3) costs of care.
Materials and Methods: A retrospective query of a nationwide administrative claims database was performed. Using Boolean command operations, the study group consisted of all patients in the database undergoing RTHA with IDA; whereas, patients without IDA served as controls. To reduce the effects of confounding, study group patients were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities yielding 92,948 patients with (n=15,508) and without (n=77,440) IDA undergoing revision THA. A P-value less than 0.001 was considered statistically significant.
Results: IDA patients were found to have significantly longer in-hospital LOS (5 days vs. 4 days, P<0.0001). Additionally, the study showed IDA patients were found to higher incidence and odds of (73.84% vs. 11.77%, OR 5.04, P<0.0001) 90-day medical complications. IDA patients also incurred high 90-day episode of care costs ($25,597.51 vs. $20,085.70, P<0.0001).
Conclusion: After adjusting for age, sex, and medical comorbidities this study of over 92,000 patients demonstrated IDA is associated with longer in-hospital LOS, complications, and costs of care. Future studies should compare the duration and severity of IDA on outcomes.

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5Megaprosthesis Reconstruction of the Proximal Femur following Bone Tumour Resection: When Do We Need the Cup?

저자 : Riccardo Zucchini , Andrea Sambri , Michele Fiore , Claudio Giannini , Davide Maria Donati , Massimiliano De Paolis

발행기관 : 대한고관절학회 간행물 : Hip & Pelvis(구 대한고관절학회지) 33권 3호 발행 연도 : 2021 페이지 : pp. 147-153 (7 pages)

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Purpose: Reconstruction of the proximal femur after tumour resection can be performed with proximal femoral endopros-theses (PFE). Many studies have reported that bipolar hemiarthroplasty (BHA) reduce the risk of dislocation after oncological resections. However, progressive cotyloiditis which might require acetabular resurfacing (total hip arthroplasty [THA]) has been reported. The aim of this study is to compare the results of BHA and THA after proximal femur resection.
Materials and Methods: A total of 104 consecutive patients affected by primary (n=52) and metastatic (n=52) bone tumours were included. Ninety patients underwent BHA and 14 patients underwent THA. Complications were recorded and classified according to the Henderson classification. At final follow-up, patients with the implant in site were functionally evaluated with modified Harris hip score (HHS).
Results: The mean follow-up was 50 months (range, 2-171 months). Twenty-four (23.1%) patients developed major complications. Eleven (12.2%) BHA required acetabular resurfacing. Patients affected by primary bone tumours showed an increased risk of THA conversion (P=0.042). A reduced risk was observed in patients younger than 35 years (P=0.043) and in those older than 65 years (P=0.033). Dislocation occurred in four case (3.8%), in particular after THA (P=0.021). At final follow-up, 93 patients had the prosthesis in site (80 BHA and 13 THA). Mean postoperative HHS was 70 (range, 30-90).
Conclusion: The risk of dislocation is lower for bipolar endoprosthesis compared to THA. However cotyloiditis and acetabular resurfacing might occurred.

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6Factors Associated with Mechanical Complications in Intertrochanteric Fracture Treated with Proximal Femoral Nail Antirotation

저자 : Oog-jin Shon , Chang Hyun Choi , Chan Ho Park

발행기관 : 대한고관절학회 간행물 : Hip & Pelvis(구 대한고관절학회지) 33권 3호 발행 연도 : 2021 페이지 : pp. 154-161 (8 pages)

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Purpose: Although proximal femoral nail antirotation (PFNA; Synthes, Switzerland) has demonstrated satisfactory results when used for the treatment of intertrochanteric fractures, mechanical complications may occur. To better quantify the risk of mechanical complications when proximal femoral nail antirotation is used to treat intertrochanteric fractures, this study aimed to: (1) characterize the frequency of mechanical complications and extent of blade sliding and their correlation with reduction quality and (2) identify factors associated with mechanical complications.
Materials and Methods: A review of medical records from 93 patients treated for intertrochanteric fractures with a minimum of 6-months of follow-up between February 2014 and February 2019 was conducted. Blade position was evaluated using Tip-apex distance (TAD) and Cleveland index. The extent of blade sliding was evaluated using the adjusted Doppelt's method for intramedullary nailing. Individuals were classified as having or not having mechanical complications, and reduction quality and radiologic outcomes were compared between the two groups.
Results: Mechanical complications occurred in 12 of 94 hips (12.8%), with 11 out of 12 being from the intramedullary reduction group. There was no significant difference in TAD between groups; however, there were significant differences were noted in Cleveland index, AO/OTA classification, reduction quality and extent of blade sliding. The mean blade sliding distance was 1.17 mm (anatomical group), 3.28 mm (extramedullary group), and 6.11 mm (intramedullary group), respectively (P<0.001). Data revealed that blade sliding was an associated factor for mechanical complications (odds ratio 1.25, 95% confidence interval 1.03-1.51).
Conclusion: The extent of blade sliding determined using the adjusted Doppelt's method was significantly associated with mechanical complications suggesting that prevention of excessive sliding through proper intraoperative reduction is important to help achieve satisfactory treatment outcomes.

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7Additional Reduction Screw Fixation Technique for Pertrochanteric Hip Fractures: A Novel Method to Prevent Excessive Sliding in Cephalomedullary Nail Surgery

저자 : Chul-ho Kim , Han Soul Kim , Dou Hyun Moon

발행기관 : 대한고관절학회 간행물 : Hip & Pelvis(구 대한고관절학회지) 33권 3호 발행 연도 : 2021 페이지 : pp. 162-166 (5 pages)

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Extramedullary (EM) reduction, defined as the medial cortex of the head-neck fragment located outside the medullary canal of the distal shaft fragment, has been introduced to prevent excessive postoperative sliding or failure of the lag screw in pertrochanteric fracture surgeries. Favorable EM reduction results have recently been reported in several clinical and biomechanical studies. Despite these efforts, maintaining the head-neck fragment in an EM position is periodically a difficult and challenging problem. Herein, the technique for reduction and maintenance of the head-neck fragment was introduced in an EM position using a Kirschner wire and partially threaded cannulated screw fixation via screw fixation from EM to the head-neck fragment, which was positioned inferior to the lag screw on the femoral calcar, also called the reduction screw. The authors utilized this reduction screw in 34 pertrochanteric fracture surgeries using a cephalomedullary nail and fracture union was acheive in all cases by a minimum one-year follow-up period without surgical complications.

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8Pulmonary Embolism after Core Decompression of the Femoral Head Using Injectable Bone Graft Substitute: A Case Report

저자 : Oriol Pujol , Marius Aguirre , Alberto Gargallo , Maria-luz Uria , Luis Riera , Daniel Pacha

발행기관 : 대한고관절학회 간행물 : Hip & Pelvis(구 대한고관절학회지) 33권 3호 발행 연도 : 2021 페이지 : pp. 167-172 (6 pages)

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The authors report a rare complication regarding the case of an 18-year-old female with bilateral osteonecrosis of the femoral head (ONFH) secondary to the treatment and hematopoietic stem cell transplant (HSCT) of an acute lymphoblastic leukemia (ALL). The patient underwent a bilateral necrotic bone debridement and core decompression (CD) surgery with injectable synthetic bone graft, which unfortunately caused a pulmonary injectable bone graft substitute embolism.

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