Cemented Bipolar Hemiarthroplasty for the Femoal Neckor Intertrochanteric Fracture in Elderly Patients: Multicenter Study / 대한정형외과학회잡지

Purpose: This multicenter study was carried out to estimate the clinical and radiological results of cemented bipolar endoprosthesis replacement arthroplasty of a hip fracture in patients aged over 50 years in Jeju Island. Materials and Methods: Eighty-eight hips underwent bipolar endoprosthesis in 2002. Thirty-two patients died during the follow-up period and 7 patients refused a radiological evaluation or an interview. Two patients who underwent cementless bipolar endoprosthesis were excluded. Forty- nine hips (48 patients) completed the average 27 months follow-up. A neck fracture was involved in 40 hips (39 patient) and an intertrochanteric fracture was involved in 9 hips (9 patients). The average age was 77.7 years. The results were evaluated using clinical and radiological methods. Results: At the last follow-up, the average Harris hip score was 70.1 and 22 hips (45%), which indicated excellent and good results, respectively. Among the 42 patients with normal activity at the preoperative period, 28 patients were still active at the final follow-up. The number of medical illnesses and the severity of mental deterioration were also associated with the poor Harris hip scores. The pressurization cementing technique was found to be excellent at the radiological evaluation. One femoral stem appeared to have loosened and subsided but there was no revision surgery. Conclusion: The clinical result of the cemented bipolar endoprosthesis in multicenter study showed that the only 45% of patients showed results >good. The major factors influencing the results were the postoperative activity, the number of medical illnesses, and the severity of the mental changes.

Therapy of Pulmonary Embolism under Cardiopulmonary Bypass during Bipolar Endoprosthesis of the Hip / 대한마취과학회지

Although the occurrence of fatal pulmonary embolism may be diminishing, it still accounts for a substantial proportion of postoperative deaths in the middle-aged and older persons, especially among those undergoing major orthopedic surgery, despite improvements in patient management. We experienced cardiac arrest during bipolar endoprosthesis. Cardiopulmonary resuscitation was started and the transesophageal echocardiogram showed right heart failure. We suspected acute pulmonary thromboembolism and decided to perform thromboembolectomy with cardiopulmonary bypass. A massive old blood clot and a 1.0 x 1.5 cm thrombus were removed from both pulmonary arteries. However, despite massive fluid therapy and the use of inotropic agent, the patient failed to recover successfully with postoperative management in the intensive care unit.

Bipolar Endoprosthesis in Nontraumatic Osteonecrosis of Femoral Head / 대한정형외과학회잡지

We reviewed 205 hips (in 151 patients, 125 men and 26 women) which were diagnosed osteonecrosis of femoral head and treated with bipolar endoprosthesis from 1985 to 1993 in Seoul National University Hospital to delineate the efficacy and indication of use of bipolar endoprosthesis in osteonecrosis. They were followed up for an average of 56 months (16 to 100 months). The mean age at operation was 44 years (21 to 84 years). The types of prosthesis used were as follows : Omnift (107), AML (57), Harris-Galante (19) and others (22). The preoperative Harris hip score improved from 49 points preoperatively to 89 points at last follow-up. The pain score improved from 18 points to 39 points, activity score from 9 points to 12 points and gait scare from 19 points to 31 points. The improvement pattern of activities and gait was converse, but that of pain was diverse. One hundred and seventy-eight hips (87%) were satisfactory (Harris hip score : more than 80 points) and 27 (13%) were unsatisfactory. Radiologic findings of last follow-up showed stable bony fixation in 186 hips (91%), stable fibrous fixation in 12 hips (6%) and unstable fixation in 7 hips (3%), Ten migrations of prosthesis were noted: cup migration 5 (2.4%) and stem sinking 5 (2.4%). Heterotopic ossification was noted in 9 (4.4%). Osteolysis in acetabular side was observed in 6 (3%) and in femoral side, 22 (11%). Complications were as follows : 4 stem loosening (1.9%), 5 fixed varus position of cup (2.4%) and 1 dislocation of cup (0.5%). Revision was performed in 4 (1.9%) and the causes were 1 infection, 1 protrusio acetabuli, 1 stem loosening and 1 cup dislocation. In conclusion, biopolar endoprosthesis generally gave good results. However, the improvement of pain was unpredictable. Increasing tendency of osteolysis was noted with increasing follow-up duration. Long-term follow-up is mandatory for the accurate determination of osteolysis.

Bipolar Endoprosthesis between Femoral Neck Fracture and Avascular Necrosis of Femoral Head: Comparison of the Acetabular Migration and Function / 대한정형외과학회잡지

In 1974, bipolar hip prosthesis was developed by Giliberty and Bateman to reduce the problems of unipolar prosthesis, including acetabular wear and acetabular protrusion, but the indications for it are still controversial. From July, 1988, to February, 1991, at Pusan maryknoll hospital, 37 hips in 33 patients of femoral neck fracture (25 hips) and avascular necrosis (12 hips) with relatively normal acetabular articular cartilage were treated with bipolar hip prosthetic replacement. The thirty-seven cases were reviewed for more than 3 years(range, 3 years to 4 years 8 months: average, 3 years 10 months), and assessed in terms of acetabular migration and function. The authors compared the datas of the femoral neck fracture with those of the avascular necrosis of femoral head. There was no statistical difference between two groups in function. But the acetabular migration of bipolar hip prosthesis used in femoral neck fracture was lesser than that of avascular necrosis of femoral head, and the serial acetabular migration disclosed gradual decrease. The authors concluded that the results of bipolar endoprosthesis used in femoral neck fracture was superior than those of avascular necrosis of femoral head with relatively normal acetabular articular cartilage.

Bipolar Endoprosthesis with Acetabular Bone Graft in Dysplasia of the Hip: Report of eight cases / 대한정형외과학회잡지

Total hip replacement arthroplasty is one of the excellent treatment modalities of adult hip joint disease. But those who have severe dysplasia of the hip usually require augmentation of acetabular bone stock in order to carry out the total hip replacement arthroplasty and technical difficulties are often encountered in estabilishing an adequate acetabular bed for the prosthesis. From July 1988 to January 1990, we attempted to treat patients of dysplastic hip by bipolar endoprosthesis with acetabular bone graft using femoral head autograft in 8 patients and then reviewed these cases. The mean follow up period was 3 years ranging from 1 year and 10 months to 3 years and 10 months. The results obtained were as follows : 1. All the bone grafts were united well(average bone union time : 5.3 months). 2. According to Gerber and Harris' classification, there was no evidence of resorption of the graft in 1 case, and there were minor resorption in 5 cases, moderate resorption in 1 case, and major resorption in 1 case. 3. The average preoperative Harris hip score was 47.5 points and the average Harris hip score at last follow up was 79.0 points. 4. Because of the high rate of graft resorption and component migration, bipolar endoprosthesis with acetabular bone graft was not to be recommended as a reconstructive procedure for the dysplastic hip which have segmental bony deficiency in the acetabulum.

Treatment of Degenerative Arthritis of the Hip Using Bipolar Endoprosthesis / 대한정형외과학회잡지

Total hip replacement arthroplasty is the most commonly used method in the surgical treatment of degenrative arthritis of the hip nowadays. If degenrative arthritic changes of the hip is caused mainly by abnormal femoral head, and the acetabular chnages are secondary to it, replacement of the femoral head without acetabular implanting can be expected to elicit regenerative acetabular changes secondary to the newly implanted femoral head component with spherical contour. 8 cases of degenerative arthritis of the hip were treated with bipolar endoprosthesis at the Seoul National University Hospital from January, 1987 to November, 1988 Acetabular reaming to the subchondral bone was performed in all the cases. In 2 cases, bone graft was added for augmentation of the thin medial wall. The mean follow-up was 15.5 months ranging from 12 to 26 months. The results were compared with 18 cases treated with total hip replacement arthroplasty during the same period. Both two groups showed no significant difference in the postoperative improvement of the range of motion and Harris score. In 2 cases treated with bipolar endoprosthesis, follow-up radiographs demonstrated some improvement of the degenerative changes such as subchondral sclerosis or cyst, which suggests the occurrence of the regenerative reaction in the scetabular side. 7 cases among 8 cases were pain-free, and 1 case had mild pain. In conclusion, bipolar endoprosthesis can be considered as another useful, less invasive method with shorter operation time in the surgical treatment of degenerative arthritis of the hip although more expericnces and longer follow-up are needed.

Cementless Bipolar Endoprosthesis / 대한정형외과학회잡지

The bipolar endoprosthesis was first reported by Giliberty, as well as Bateman in 1974. There were several reports indicating less acetabular erosion in bipolar endoprosthesis than in unipolar, Even if there was a problem of dislocation and valgus position of cup of initial design, the prosthesis of nowadays is useful in failed total hips with erosion of the acetabulum as well as hip with normal acetabular cartilage. The authors reviewed and analysed 44 cases of cementless bipolar endoprosthesis (Self Centering Universal Hip replacement utilizing the Tri-Lock total hip femoral stem), operated at the department of orthopaedic surgery, Hanyang University Hospital from June 1984 to May 1987. The following results were obtained. 1. There were 18 males and 25 females. 2. 22 cases were idiopathic avascular necrosis with relatively good acetabulum, 21 cases of fracture of femoral neck and 1 case of metastatic adenocarcinoma. 3. Average operation time eas 1 hour and 10 minutes and average amount of transfusion; 650cc. 4. We used 42 Watson-Jones approach and 2 Charnley's. 5. The common size of metal cup was 45–53mm in men and 43–47mm in women. 6. The size of prosthetic femoral head was equal to normal head in 16 cases, larger than normal in 14 cases, smaller than normal in 14 cases. 7. There were 2 case of intraoperative undisplaced fracture of femur and one case of heterotopic ossification. 8. There were motion of outer and inner bearing when the extremity was abducted and adducted on serial roentgenogram during a period between 2 years and 5 years. 9. Average Harris hip rating score was 38.5, preoperatively and 95.2, postoperatively.

Comparative Functional Evaluation of Cementless Bipolar Endoprosthesis and Cementless Total Hip Replacement Arthroplasty in Avascular Necrosis of the Femoral Head in Adult / 대한정형외과학회잡지

In these days, there are two main ways in the treatment of the avascular necrosis of the femoral head in adult by prosthetic replscement; total hip replacement and bipolar endoprosthesis. So far, no study has been performed on the post-operative functional evaluation of them. Therefore it is difficult to decide which one is preferred to the other in the treatment of avascular necrosis of the femoral head in adult. In order to evaluate the functions of the prosthetic joints, the authors reviewed the results of 18 cases of cementless bipolar endoprosthesis(abbreviated as CBE) and 22 csses of cementless total hip replscement arthroplasty(abbreviated as CTHRA), performed at the Department of Orthopedic Surgery, Seoul National University Hospital, during the period from February, 1984 to May, 1986. The following results were obtained. 1. The average ages of CBE and CTHRA groups at the time of operation were 48.5 years and 37.5 years, respectively. 2. The average follow-ups of CBE and CTHRA were 15.7 months and 30.5 months, respectively. 3. By Meyer's modification of Marcus and Enneking classification, the sverage stages of CBE and CTHRA groups were 3.7 and 4.4 respectively. 4. According to Harris hip rating score system, Harris scores were increased as much as 30.5 in CBE group and 30.6 in CTHRA group. 5. In the aspects of functional improvement and relief of pain, the two groups showed no significant difference. However, the operation was essier, and the damage to the acetabular bone was less in CBE group. For these reasons, CBE was believed to be the preferred choice of treatment of avascular necrosis of femoral head in adult.

Clinical Study of Acetabular Erosion and Motion of Two Components in Bipolar Arthroplasty / 대한정형외과학회잡지

The success of Moore and Thompson endoprosthesis in arthroplasty of the hip during the past three decades has prompted their continued use with but few alterations. Recently, to reduce the intolerance of acetabular cartilage and bone to frictional shear forces, the conventional endoprosthesis was modified, so many types of bipolar arthroplasty were introduced and implanted. But, the movements of the two components and acetabular erosion are rather controversial still. Among the 51 cases of bipolar endoprosthesis those have been operated at department of orthopaedic surgery, National Medical Center from 1981 to 1986, we analysed 40 cases for acetabular erosion and 22 cases for motion study of two components under the fluoroscopy. Following results were obtained, 1. Among 40 cases, there was no true protrusio acetabuli and increased CE angle in 12 cases(30%), which were limited to cartilage. 2. Under the fluoroscopic study, we found motion at inner and outer bearing joint in 14 cases, inner bearing joint only in 6 cases and outer bearing only in 2 cases. 3. The CE angle was increased more in younger age group than older group. 4. According to indication of bipolar arthroplasty, CE angle was increased more in disease group than trauma group. 5. The CE angle was increased more in leg length discrepancy and head piece size discrepancy group than the other group. 6. The CE angle can be substituted for joint space measurement. 7. The CE angle was increased more in low Harris hip rating score group. 8. Harris hip rating score had no correlation to motion of two components.

Clinical Results of Bipolar Endoprosthesis / 대한정형외과학회잡지

In 1974, bipolar endoprosthesis was first introduced by Bateman & Giliberty. It has theoretical advantages including minimizing acetabular wear, possible reduction of incidence of stem loosening, lessening of dislocation and easy revision procedure. Various methods for the treatment of fracture of the femur neck have been developed & performed, but it is still called “the unsolved fracture” in certain situation. But the role of it as primary treatment of fracture of the femur neck continues to be controversial. Current clinical results encourage its continued use and expansion of indication. Authors reviewed and analysed 21 cases of bicentric endoprosthesis and 1 case of Giliberty endoprosthesis those have been operated at the Department of Orthopaedic Surgery, National Medical Center from 1981 to 1983. Following results were obtained, l. According to disorder distribution, 14 cases were neglected fracture of femur neck, 2 old fracture, 1 idiopathic femoral head necrosis and 2 avascular necrosis & 1 non-union complicated by femoral neck fracture. 2. Among 20 cases, 8 cases were operated within 1/2 1 month after injury and 6 cases within 1 3months 3. Harris lateral appmach was used in 16 cases (80%) and Modified Gibson approach in 4 cases (20%). There were no significant differences in morbidity during operation and postoperative complication. 4. We used femoral stems those head diameter was 22 and 32mm(Charnley & Miiller type) and head pieces those diameter was 48-51 mm in male and 44–48 mm in Ifemale. 5. 3 cases were stiff in inner bearing without acetabular erosion. 6. In 6 cases more than 2 years followup 1 degree CE angle of Wiberg was increased in 2 cases of youngage respectively without associated hip joint pain. 7. Although inclination of head piece was vertical in 8 cases, fracture and dislocation were not found. 8. The circumference of head piece and opposite femoral head was measured and compared. There were 12 cases (mean 12.6 mm) that of head piece larger than opposite femoral head and 3 cases smaller than opposite femoral head. 9. There was 4 cases of complication (3 patients) and still no reoperation and revision converted to T.H.R. 10. With regard to average 18 months of follow-up, 7 cases of 81–90 Harris hip-rating score, 6 of 91–100, 4 of 71–80 and 3 of 61–70.