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KMID : 0378019810240110043
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New Medical Journal
1981 Volume.24 No. 11 p.43 ~ p.54
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Replacement Arthroplasty of the Hip in Koreans
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李宗澈/Lee, Jong Challe
朴相元/李弘鍵/Park, Sang Won/Lee, Hong Kun
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Abstract
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Despite the fact that indications, techniques and results in the hip replacement arthroplasty in patients with idiopathic, traumatic osteoarthritis, and deformed . and dysplastic hips in European countries are well established, there has been some controversy regarding its advisability and application in the patients with severely diseased, destructed and dysplasia of the hip secondary to septic infection including tuberculosis.
Under the circumstances where living patterns, diseases and ages of the patients differ the standard technique of total or surface replacement arthroplasty of the hip in European style should be modified in such a way that the technique would facilitate to restore the function suitable to the Korean sitting.
The authors suggest several considerations in performing hip arthroplasty in Korea such as:
1. Majority of the patients are severely infected, destructed and dysplasia secondary to septic hip.
2. Patients prefer to sit or squatting on the floor rather than standing or sitting on the chair.
3. Patients are relatively younger in age, lighter in body weight and stature in the comparison with Europeans.
In view of the conditions afore-mentioned, a study was conducted to devise special operative instruments accordingly with anatomical and biomechanical evaluation, and furthermore, a clinical study was carried out during the period from 1978 to 1980 at the Department of Orthopedic Surgery, College of Medicine, Korea University. The purpose of this paper is to report the newly devised surgical instruments, technique and preliminary postoperative results of hip replacement arthroplasty on fifty patients.
There were twenty-eight male and twenty-two female patients. Twenty-five patients had a diagnosis of septic hip residua including fifteen cases of tuberculosis: seven cases in secondary osteoarthritis subsequent to congenital dislocation or Legg-Perthes disease of hip: six cases in, non-union of femur neck fracture: three cases in primary osteoarthritis: and one case in rheumatoid arthritis. In fifteen cases, Salter or Pemberton innominate
osteotomy was performed. The follow-up results of surgery in eight cases were rated excellent: in twenty-two, ´ very good: ;in -sixteen,-- good; in four; fair, and still under surveilance.
The modified methods of replacement arthroplasty of hip are as follows:
1. "S"figured antero-lateral approach facilitated a meticulous and extensive debridement
of infected residuals and diseased tissues from the acetabulum, and proximal shaft of
the femur besides femoral head and neck.
2. The displaced femoral head and neck was easily reduced in original acetabulum without osteotomy of the greater trochanter through the extensive release of gluteus medius and minimus, and rectus femoris from the muscle origin of pelvis.
3. Osteotomy of the pelvis to obtain larger acetabular socket was easily performed from the superior margin of anterior inferior iliac spine to the ilium through the exposure of the inside and outside of the pelvis.
4. Acrylic bone cement applied on acetabular cup was simultaneouly inserted into acetabular socket and this maneuver helped to prevent the unsatisfactory fixation of cup into socket from cement mixtured with blood or debris.
5. Allowance of anteversion of acetabular cup at twenty degree or more is seemingly benifited for the comfort of sitting or squatting posture on the floor.
6. Newly devised instruments of neck holder, long handle arch retractor, modified A,ifranc acetabular reamer (3mm in thickness), postural cup gauge and femoral loop curettes appear to be convenient for replacement arthroplasty, particularly with omission of resection of femoral head or greater trochanter.
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