Bearing Surface of Total Hip Arthroplasty
Overview
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1. ¼·Ð
1950-60³â´ë ÃÊâ±â Àΰø°í°üÀýÀÇ °üÀý¸éÀº MacKee-Farra°¡ metal-on-metal, Âû¸®°æÀÌ metal-on-polymer·Î ½ÃÀÛÇÏ¿´À¸¸ç, ÃÔ¸®°æÀÇ 22mmÁ÷°æÀÇ Low-friction arthroplastyÀÇ °³³äÀÇ Æú¸®¿¡Æ¿·»-±Ý¼Ó °üÀý¸éÀÌ °üÀý¸éÀÇ ¸¶Âû°è¼ö, impingement¿¡¼ ¿ì¼öÇÏ¿© Áö³ ¹Ý¼¼±âµ¿¾È ³Î¸® »ç¿ëµÇ¾ú´Ù. Âû¸®°æÀÌ Ãʱ⿡ »ç¿ëÇÑ polytetrafluoroethyleneÀº 5-6³â »çÀÌ¿¡ ½ÉÇÑ ¸¶¸ð·Î °ð ulitra-high molecular weight polyethylene(UHMWPE) ·Î ¹Ù²Ù¸ç ½ÇÇè½Ç»óÀÇ ¸¶¸ðÀ²ÀÌ 0.07-0.2mm/yÀ¸·Î, ¾à 25³â°£ 5mm ¸¶¸ð¸¦ ¿¹»óµÇ¾ú°í, metal-on -poly °üÀýÀÌ 50´ë ÀÌÈÄÀÇ È¯ÀÚ¿¡°Ô Àΰø °í°üÀý ġȯ¼úÀÇ gold standard·Î ¿©°ÜÁ³¾ú´Ù. ±×·¯³ª ÃÖ±Ù¿¡ ÀþÀº ȯÀڵ鿡°Ô ƯÈ÷ ¹«½É¸àÆ® Àΰø°í°üÀýġȯ¼úÀÇ ½ÃÇàÀÌ Áõ°¡ÇÏ¸é¼ Æú¸®¿¡Æ¿·»ÀÇ ¸¶¸ð¿¡ ÀÇÇØ ¹ß»ýÇÑ °ñ¿ëÇØ°¡ Àΰø°í°üÀýÀÇ ½ÇÆÐÀÇ ÁÖ¿äÇÑ ¿øÀÎÀ¸·Î ¹àÇôÁö°í, »õ·Î¿î °üÀý¸é¿¡ ´ëÇÑ ¿¬±¸µéÀÌ ÁøÇàµÇ¾î, ¸¶¸ð¿¡ ´ëÇØ¼ °³¼±µÈ »õ·Î¿î °üÀýµéÀÌ ÇöÀç ÀÓ»ó¿¡¼ ½ÃµµµÇ°í ÀÖ´Ù. ±×·¯³ª ´ëºÎºÐÀÇ »õ·Î¿î °üÀý¸éÀÇ ÀÓ»ó°æÇèµéÀÌ ¾ÆÁ÷ ´Ü±â Ã߽à °á°úµéÀ̰í, ÀϺΠ»õ·Î¿î °üÀý¸éÀº ºñ±³Àû Àå±â Ã߽à °á°úÀ̶ó°í ÇÏ´õ¶óµµ ¾ÆÁ÷ ºÎºÐÀû °á°ú·Î Àü¹ÝÀûÀÎ ÀÎÁ¤À» ¹Þ°í ÀÖ´Â »óŰ¡ ¾Æ´Ï´Ù. ÀÎüÀÇ °í°üÀýÀÇ °üÀý±â´ÉÀ¸·Î ÀÛ¿ë ½Ã¿¡ °í·ÁÇØ¾ß ÇÒ ±âÃÊÀû »çÇ× ¹× ÃÖ±Ù¿¡ ¹àÇôÁö°í ÀÖ´Â °í°üÀý µ¿¿ªÇаú ÇöÀç ½ÃµµµÇ°í ÀÖ´Â °¢°¢ÀÇ »õ·Î¿î °üÀýµéÀ» °£´ÜÈ÷ reviewÇϰíÀÚ ÇÑ´Ù.
2. ±âÃÊÇÐ(Basic Science)
ÀÎü³» Àΰø °í°üÀý±â´É¿¡¼ °í·ÁÇØ¾ß µÇ´Â ±âÃÊÀû »çÇ×Àº ù°, Tribology(¸¶Âû°øÇÐ)µÂ °üÀý¸éÀÇ ¸¶¸ð ±âÀü°ú Àΰø °í°üÀý µ¿¿ªÇÐÀÏ °ÍÀÌ´Ù.
1) °üÀýÀÇ ¸¶Âû°øÇÐ (Tribiolgy)
Àΰø °üÀýÀÇ ¸¶¸ð¿¡ °¡Àå Å« ¿ªÇÒÀ» ÇÏ´Â °ÍÀº °üÀý¸é¿¡¼ÀÇ Coefficient of Friction (¸¶Âû °Ô¼ö)À̸ç, ÀÌ´Â lubrication¿¡ ÀÇÇØ¼ ÁÖ·Î ¿µÇâÀ» ¹Þ°Ô µÇ´Âµ¥ °üÀýÀÇ lubrication Àº Å©°Ô 1) fluid-film lubrication : µÎ °üÀý¸éÀÌ ¾Ð·ÂÀÌ °¡ÇØÁø fluid·Î ¼·Î ¶³¾îÁø »óÅ·ΠÀÛ¿ëÇÏ ´Â °üÀý·Î ¸¶Âû°è¼ö´Â 0.001-0.02À̸ç, 2) boundary lubrication : µÎ °³ÀÇ °üÀý¸éÀÌ ºÒ±ÔÄ¢ÇÑ Ç¥¸éÀ¸·Î °íü¸é¿¡ ´Þ¶ó ºÙ´Â ´ÜºÐÀÚ ³»Áö, ¼öºÐÀÚ Á¤µµÀÇ µÎ²²(10-6 mm)ÀÇ ¾×ü ±âü ºÐÀÚÃþ¿¡ ÀÇÇØ ¿ÏÀüÈ÷ ºÐ¸®µÇ¾î ÀÖÁö ¾Ê°í, ºÎºÐÀûÀ¸·Î µÎ °üÀý¸éÀÌ Á÷Á¢ Á¢Ã˵Ǿî ÀÖ´Â °üÀý »óÅ·Π¸¶Âû°è¼ö´Â 0.07-0.15 ÀÌ´Ù, ±× ¿Ü fluid-film lubrication°ú boundary lubricationÀÇ È¥ÇÕÇüÅÂÀÇ 3) Mixed (¸¶Âû°è¼ö: 0.01-0.1)¿Í 4)dry(¸¶Âû°è¼ö: 0.1-2) ·Î ³ª´©¾îÁø´Ù.
ÀÎüÀÇ °üÀýÀÇ ¸¶ÂûÀº ¿¬°ñÀÌ ÈûÀ» ¹ÞÀ¸¸é ¿¬°ñ Ç¥¸éÀÇ ¹Ì¼¼Æ÷¸» ÇüÅ·Π¼¼Æ÷¾×ÀÌ ¹èÃâ À̳ª À̵¿À¸·Î ¿¬°ñ ±âÁúÀÇ º¯ÇüÀÌ ¹ß»ýÇϹǷΠÈûÀ» Èí¼öÇÏ´Â Plowing frictionÀ̸ç, ÀÎü Ȱ¸· °üÀýÀº glycoproteins°ú phospholipidsÀÇ ³óµµ¿¡ µû¸¥ viscosity, hyaluronic acidµî¿¡ µû¶ó mixed, boundary lubricationµé¿¡ ÀÇÇØ ÀÛ¿ëÇÏ´Â active multi-mode lubricationÀ̶ó°í ÇÒ ¼ö ÀÖÀ¸¸ç, ÀÎü °í°üÀýÀÇ ¸¶Âû°è¼ö´Â 0.04-0.01Á¤ µµÀÌ´Ù. Æú¸®¿¡Æ¿·»-±Ý¼Ó °üÀý¸éµµ boundary lubrication°ú mixed-film lubricationÀÌ È¥ÇÕµÈ °üÀý·Î ¸¶Âû°è¼ö´Â 0.02-0.06À̸ç, metal-on-metal °üÀýÀº 0.17, ceramic-on-
ceramic °üÀýÀº 0.001-0.06 Á¤µµ·Î º¸°íµÇ¾î ÀÖ´Ù. Hard bearing¿¡¼´Â sequaking, clicking, seizingµîÀÇ ¹ß»ýÀÌ º¸°í µÇ¾îÀÖ°í ÀÌ´Â dry typeÀÇ lubricationÀÌ ¿øÀÎÀÌ ¾Æ´Ñ°¡ »ý°¢µÈ´Ù.
2)°í°üÀý µ¿¿ªÇÐ( Hip kinematics )
a. Impingement ;
* ÇöÀç±îÁöÀÇ Àΰø°í°üÀýÀÇ µðÀÚÀο¡¼´Â 22mm, 28mm, 32mm¿¡¼´Â °üÀý¿îµ¿ÀÇ Çã¿ë¹üÀ§´Â 104¡Æ ¿¡¼ 127¡Æ±îÁöÀ̳ª ÀÏ»ó»ýȰ¿¡¼´Â ±× ÀÌ»óÀÇ °í°üÀý ¿îµ¿¹üÀ§°¡ ÇÊ¿äÇϱ⠶§¹®¿¡ Àΰø °í°üÀý ġȯ¼ú ÈÄ¿¡ Àΰø°í°üÀý ºÎǰ»çÀÌ¿¡ Ãæµ¹(impingement)Çö»óÀÌ ¹ß»ý ÇÒ ¼ö ÀÖ´Ù, ÃÖ±Ù¿¡ Àΰø°í°üÀý ġȯ¼ú ÈÄ¿¡ Á¦°ÅÇÑ ºñ±¸ÄÅ¿¡¼ ¾à 39%-56%¿¡¼ impingementÀÇ Áõ°Å°¡ °üÂûµÇ¾ú´Ù´Â º¸°í°¡ ÀÖ¾ú´Ù. ½ÇÆÐÇÑ °í°üÀýġȯ¼ú¿¡¼ÀÇ °á°úÀÌÁö¸¶´Â ¿¹»óº¸´Ù´Â Àΰø°í°üÀý ġȯ¼ú ÈÄ Ãæµ¹Çö»óÀÌ ¹ß»ýÇÑ´Ù´Â °ÍÀ» ¾Ë ¼ö ÀÖÀ¸¸ç, ÇâÈÄ Àΰø°í°üÀý ġȯ¼úÈÄ µ¿¿ªÇп¡ ´ëÇÑ ¿¬±¸°¡ ÇÊ¿äÇÑ »óÅÂÀÌ´Ù.
b. micro-separation :
º¸Çà½Ã Æò±Õ 1.2mm(0.8mm-2.8mm)ÀÇ °üÀý¸é ºÐ¸®°¡, ³»Àü ¹× ¿ÜÀü½Ã Æò±Õ1.7mm(1.7 - 3.0mm)ÀÇ °üÀý¸é ºÐ¸®°¡ ¹ß»ýÇÑ´Ù´Â º¸°í°¡ ÃÖ±Ù¿¡ ¹ßÇ¥µÇ¾î ÀÖ¾î ÀÌ¿¡ ´ëÇÑ ÇâÈÄ ¿¬±¸µµ ÇÊ¿äÇÏ´Ù..
1) ±âÁ¸ÀÇ Æú¸®¿¡Æ¿·»-±Ý¼Ó°üÀý
±âÁ¸ÀÇ Æú¸®¿¡Æ¿·»-±Ý¼Ó °üÀýÀº ¹Ý¼¼±â µ¿¾È 10³â 90%ÀÌ»óÀÇ ¼º°ø·üÀ» º¸¿©ÁÖ°í Àå±â°£ ÀÎü¿¡ µ¶¼º µîÀÇ ºÎÀÛ¿ëÀÇ ¹ß»ýÀÌ º¸°íµÇÁö ¾ÊÀº ¾ÈÀü¼ºÀÌ È®ÁõµÈ Àΰø°üÀý¸éÀÌ´Ù.
±×·¯³ª Æú¸®¿¡Æ¿·»ÀÇ abrasive, 3rd body wearµîÀÇ ¸¶¸ð·Î ƯÈ÷ ÀþÀº ȯÀÚ¿¡°Ô ÈçÈ÷Æú¸®¿¡Æ¿·»ÀÇ ¹Ì¼¼ ¸¶¸ðÀÔÀÚ¿¡ ÀÇÇÑ ½ÉÇÑ °ñ¿ëÇØ¸¦ ¹ß»ý½ÃÄѼ Àΰø °í°üÀýÀÇ ½ÇÆÐ³ª Àç¼ö¼úÀÌ ÇÊ¿äÇÑ ½É°¢ÇÑ ÈÄÀ¯ÁõÀÇ À¯¹ß ½ÃŰ´Â °ÍÀÌ ¹®Á¦ÀÌ´Ù.
±âÁ¸ÀÇ 28mm headÀÇ °æ¿ì¿¡ ³â°£ ¼±»ó ¸¶¸ð°¡ 0.12mm/y ÀÎ °æ¿ì¿¡ ¿¬°£ ¸¶¸ðÀÔÀÚÀÇ º¼·ýÀº 60-100mm3·Î º¸°íµÇ°í ÀÖÀ¸³ª, ½ÇÁ¦·Î´Â ±¹³»ÀÇ º¸°íµÈ °á°ú´Â ±× ÀÌ»óÀ¸·Î Æò±Õ 100-200mm3ÀÌ»óÀÌ´Ù. Æò±Õ ¸¶¸ðÀÔÀÚÀÇ Å©±â°¡ 0.5-6um3¶ó°í ÇÒ ¶§¿¡ ³â °£ Àû¾îµµ 1011( 7.4x1010-1.5x1011)ÀÌ»óÀÇ ¸¶¸ðÀÔÀÚ ¹ß»ýÇϸç, ÀÌ´Â ÇÑ ½ºÅÜ °í°üÀýÀ» ¿òÁ÷ À϶§ ¸¶´Ù ¾à 74,000-150,000°³ ÀÌ»óÀÇ Æú¸®¿¡Æ¿·» ¸¶¸ðÆíÀÌ ¹ß»ýÇϰí, ÇÑ °³ÀÇ macrophage °¡ ¾à 60°³ÀÇÆú¸®¿¡Æ¿·» ÀÔÀÚ¸¦ ÈíÀÔ ÇÑ´Ù°í ÇÒ¶§¿¡ ¾à 109 macrophage °¡ ÇÊ¿äÇϰí, ÇÑ °³ÀÇ macrophageÀÇ Æò±Õ 10um ±æÀ̶ó°í Çϰí, »ª»ªÀÌ Â÷ÀÖ´Ù°í ÇÒ ¶§¿¡ ¾à 1000um3ÀÇ(1cm3)ÀÇ ¾çÀÇ °ø°£ÀÌ ÇÊ¿äÇÏ°Ô µÈ´Ù. ÀϹÝÀûÀ¸·Î ³â°£ ¸¶¸ðÀ²ÀÌ 0.2mm ÀÌ»ó, ³â°£ ¸¶¸ð º¼·ýÀÌ 150mm3 ÀÌ»óÀÌ ¹ß»ýÇÏ¸é °ñÈí¼ö Çö»óÀÌ ¹ß»ý À§Çèµµ °¡ ³ô´Ù. 22mm head °æ¿ì¿¡´Â ¼±»ó ¸¶¸ðÀ²ÀÌ 28mm °æ¿ìº¸´Ù ¸¹À¸³ª ¸¶¸ðº¼·ýÀº Àû °í, 32mm headÀÇ °æ¿ì¿¡´Â ¼±»ó ¸¶¸ðÀ²Àº ÀûÀº ÆíÀ̳ª, ³â°£ ¸¶¸ðÀ²ÀÌ Áõ°¡ÇÏ¿© ±× µ¿ ¾È Æú¸®¿¡Æ¿·»-±Ý¼Ó °üÀý¿¡¼´Â »ç¿ëÇÏÁö ¸øÇÏ¿´´Ù.
ÀÌ·¯ÇÑ Æú¸®¿¡Æ¿·»ÀÇ ¸¶¸ð´Â ¼Òµ¶À» À§ÇØ ½ÃÇàÇÏ´Â ¹æ»ç¼± Á¶»ç¿¡ ÀÇÇØ ¹ß»ýÇÏ´Â free radicalÀÌ °ø±âÁßÀÇ »ê¼Ò¿¡ ÀÇÇØ »êÈ(oxidation)°¡ µÇ¾î Æú¸®¿¡Æ¿·»ÀÇ ¹°¼ºÀÇ ¾àÈ, Ư È÷ brittleness°¡ Áõ°¡µÇ´Â °ÍÀÌ ¸¶¸ð¸¦ Áõ°¡ ½ÃŰ´Â ÁÖ¿äÀÎÀ̾ú´Ù.
3. Highly Cross-linked Æú¸®¿¡Æ¿·»
silane, peroxide¸¦ »ç¿ëÇÏ´Â ÈÇÐÀû ¹æ¹ý°ú ¹æ»ç¼± Á¶»ç¹æ¹ýÀ¸·Î Æú¸®¿¡Æ¿·»À» cross-linkingÀ» ½ÃŲ Æú¸®¿¡ÅÚ·»Àº ¸¶¸ð°¡ °¨¼ÒÇϰí, Æú¸®¿¡Æ¿·»ÀÇ »êȰ¡ °¨¼ÒÇÏ´Â
Ư¼ºÀ» °¡Áö°Ô µÈ´Ù. . ÀÌ·¯ÇÑ cross linkingÀÇ Çü¼ºÀÌ ¸¹À»¼ö·Ï polyethyleneÀÇ wear À²ÀÌ °¨¼ÒÇÏ°Ô µÈ´Ù. ±× °¨¼ÒÀ²Àº radiationÀÇ ¾çÀÌ ¸¹À»¼ö·Ï °¨¼ÒÇÏ°Ô µÇ´Âµ¥ »ýü¿Ü ½Ç Çè¿¡¼ 5 Mrads Á¶»ç ½Ã 90%, 10 MradsÁ¶»ç ½Ã´Â 100%±îÁö wearÀ²ÀÌ °¨¼ÒÇÑ´Ù°í º¸°íÇϰí ÀÖ´Ù. ±×·¯³ª ¹Ý¸é¿¡ UHMWPEÀÇ mechanical properties¿¡ ´ëÇØ¼´Â, ³í¶õÀÌ ÀÖÀ¸³ª, ¹æ»ç¼±Á¶»ç·®¿¡ ¹Ýºñ·ÊÇÏ¿© Æú¸®¿¡Æ¿·»ÀÇ ¹°¸®Àû °µµ°¡ °¨¼ÒÇÑ´Ù´Â º¸°í°¡ ÀÖ À¸¸ç, Yield strength°¡ 15-30%, ElongationÀÌ 45%±îÁö, Modulus of Elasticity´Â 27%±îÁö °¨¼ÒÇÑ´Ù°í ÇÑ´Ù. ´õ±¸³ª °¡Àå Áß¿äÇÑ mechanical propertiesÁßÀÇ ÇϳªÀÎ toughness°¡ÀÇ °¨¼Ò°¡ È®½ÇÈ÷ ÀְԵǴµ¥, ½ÇÇè½Ç°á°ú¿¡ µû¸£¸é toughness¸¦ °¡Àå Àß ³ªÅ¸³»´Â J intergral test¿¡¼ 5 Mrads Á¶»ç½Ã49%, 10 Mrads½Ã´Â 64%±îÁö °µµ°¡ ¾àÇÏ¿©Áø´Ù´Â ½ÇÇè º¸°í°¡ ÀÖ´Ù. ÀÌ·¯ÇÑ mechanical strengthÀÇ º¯È°¡ ÇâÈÄ highly cross-linked UHMWPE »ç¿ë½Ã polyethyleneÀÇ fracture·Î ÀÎÇÑ failureÀÇ ¹ß»ý ÇÒ ¼ö ÀÖ´Ù´Â °ÍÀÌ °¡Àå ¿ì·ÁµÇ´Â ´ÜÁ¡ÀÌ´Ù. ¶ÇÇÑ highly cross-linked UHMWPEÀÇ ¸¶¸ð ÀÔÀÚ°¡ ´õ Ȱ¼ºÈ µÈ »ý¹°ÇÐÀû ¹ÝÀÀÀ» À¯¹ßÇÑ´Ù´Â º¸°í¿Í Ç¥¸é ¼Õ»óÀ» ¹ÞÀº °ñµÎ¿¡¼´Â
¸¶¸ð°¡ ´õ ½ÉÇÏ´Ù´Â ÁÖÀåµµ ÀÖ´Ù.
ÇöÀç±îÁö »ýü³»¿¡¼ÀÇ cross linked polyethyleneÀÇ °á°ú´Â 100 Mrad gamma irradiationÇÑ OonishÀÇ °á°ú¿Í SilaneÀ» »ç¿ëÇÑ WroblewskiÀÇ °á°ú¿¡¼ ¸¶¸ð°¡ »ó´ç È÷ °¨¼ÒÇÑ °ÍÀ» º¸°íÇϰí ÀÖÀ¸³ª, Ç¥º»¼ö Àû°Å³ª ¿Í Ã߽à ±â°£ÀÌ ¾ÆÁ÷ ª´Ù. ÇöÀç »ç ¿ëÇϱ⠽ÃÀÛÇϰí ÀÖ´Â cross linked polyethyleneÀ» »ç¿ëÇÑ Æú¸®¿¡Æ¿·»-±Ý¼Ó °üÀý¸é ÀÌ Ã¼¿Ü ¸¶¸ð½ÇÇè¿¡¼´Â ±âÁ¸ÀÇ Æú¸®¿¡Æ¿·»º¸´Ù 42%-100% ¸¶¸ð°¡ °¨¼ÒÇÏ´Â °ÍÀÌ Áõ ¸íµÇ¾úÀ¸¸ç, ÃÖ±Ù º¸°íµÈ 5³â°£ Ã߽à ÀÓ»ó°á°ú¿¡ ³â°£ ¼±»ó¸¶¸ð°¡ 0.036mm/y ´ëÁ¶±º º¸´Ù ¾à 76%ÀÇ ¸¶¸ð °¨¼Ò¸¦ ¹ßÇ¥ÇÑ º¸°í°¡ ÀÖÀ¸³ª, È®½ÇÇÑ ÀÓ»ó°á°ú´Â Àå±â Ã߽ð¡ ÇÊ ¿äÇÑ »óÅÂÀÌ´Ù.
ÀåÁ¡Àº ù°, ÀÌ¹Ì 40³â°£ Æú¸®¿¡ÅÚ·»À» °ñ¿ëÇØ À̿ܿ¡ ÀÎü¿¡ ºÎÀÛ¿ëÀÌ ¾øÀÌ »ç¿ëÇÑ °æÇèÀÌ¸ç µÑ°, Æ÷¸®¿¡Æ¿·»À» »ç¿ë½Ã elevated lip liner, offset liner, constrained typeÀÇ linerµéÀ» »ç¿ë ÇÒ ¼ö ÀÖ°í, Æ÷¸®¿¡Æ¿·»ÀÇ Ãæ°ÝÀ» Èí¼ö ÇÒ ¼ö ÀÖ´Â ¹°¼ºÀ¸·Î impingement, º¸Çà ½Ã micro-separationµîÀÇ Çö»ó¿¡ hard-hard bearingº¸´Ù ¿ì¿ùÇÏ ´Ù.
4. Ceramic-ceramic bearing
¼¼¶ó¹ÍÀº ź¼º°è¼ö°¡ ¾ÆÁÖ ³ôÀº ´Ü´ÜÇϸç(hard), ¸¶¸ð¿¡´Â °ÇÑ ¹°ÁúÀ̳ª ÀÌ¿¡ ºñÇØ ÀÎÀå °µµ´Â ³·°í, ¿¬¼º(ductility)ÀÇ ¹°¼ºÀÌ °ÅÀÇ ¾ø¾î Ãæ°Ý¿¡ ±úÁö±â°¡ ½¬¿î ¹°ÁúÀÌ´Ù. 1970³â´ëºÎÅÍ Àΰø °í°üÀý¿¡ »ç¿ëµÇ±â ½ÃÀÛÇÏ¿´À¸¸ç, Ãʱ⿡´Â 13%ÀÇ ½ÇÆÐÀ²À» º¸°í µÇ´Âµ¥ ¼¼¶ó¹ÍÀÇ fracture ¿Í ÀÌ¿ÏÀÌ ÁÖ¿ä ¿øÀÎÀ̾ú´Ù. ÃÊâ±â ¼¼¶ó¹Í headÀÇ °ñÀýÀÇ ¹ß »ýÀ²Àº ¸¹°Ô´Â 10/130 Á¤µµ·Î º¸°í µÇ¾úÀ¸³ª, ±×µ¿¾È ¼¼¶ó¹ÍÀÌ Á¦Á¶°úÁ¤ÀÇ Çâ»óÀ¸·Î ÃÖ ±Ù¿¡´Â 5-6³â¿¡ 0.4%-0.02%À¸·Îº¸°íµÇ°í ÀÖ´Ù.
ÀåÁ¡Àº ù°, ´Ü´ÜÇÏ°í ºÎ½Ä¿¡ °Çϸç, Ä£¼ö¼º(wettability)À¸·Î °üÀý¸é¿¡ fluid film À±È° À» À¯µµ ÇÒ ¼ö ÀÖ¾î ¸¶Âû°è¼ö°¡ ¼¼ °üÀýÁß¿¡ °¡Àå ¿ì¼ö ÇÒ ¼ö ÀÖÀ¸¸ç, ȸ¼öµÈ ¼¼¶ó¹Í °ü ÀýÀÇ ³â°£ ¼±»ó¸¶¸ð°¡ 2-20um/y, ¸¶¸ðº¼·ýÀÌ 0,02-0.05mm3/y·Î ¿ì¼öÇÏ´Ù. µÑ°´Â biocompatibility·Î ¼¼¶ó¹Í ¸¶¸ð ÀÔÀÚ´Â Æò±Õ 0.5um(0.13-78.4um)ÀÌÇÏ·Î ´ë½Ä¼¼Æ÷¿¡ ÀÇ ÇÏ¿© Æ÷½ÄµÇ¾î, ´Ü¹éºÐÇØÈ¿¼Ò¸¦ ¹èÃâÇÏ¿© »ý¹°ÇÐÀû ¹ÝÀÀÀ» Ȱ¼º½ÃŰ´Â Á¤µµ°¡ Àû´Ù. ±×·¯ ³ª ¼¼¶ó¹Í ¸¶¸ðÀÔÀÚµé ¿ª½Ã °ñ¿ëÇØ À¯¹ß ÇÑ´Ù°í º¸°íµÇ¾î ÀÖ´Ù.
´ÜÁ¡Àº ù° ¼¼¶ó¹ÍÀº ź¼º°è¼ö ³ôÀº ´Ü´ÜÇÑ ¹°ÁúÀ̳ª, ÃÖ±Ù¿¡ °³¼±µÇ¾ú´Ù ÇÏ´õ¶óµµ ¿¬¼º °ú ÀÎÀå·ÂÀÌ ¾àÇÏ¿© Ãæ°Ý¿¡ °ñÀý ¹ß»ýÀÇ À§Ç輺ÀÌ ÀÖÀ¸¸ç °ñÀýµÈ ÈÄ Àç¼ö¼úÀÌ ¾î·Á¿î °ÍÀº Àß ¾Ë·ÁÁ® ÀÖ´Ù. °ñÀýÀº ¼¼¶ó¹Í °ñµÎ¿Í ´ëÅð½ºÅÛÀÇ °æºÎ(trunnion)»çÀÌ¿¡¼, ¼¼¶ó¹Í ¶óÀ̳ʰ¡ ¼ö¼úÁß ¿Ü°úÀÇ Á¶ÀÛÀÇ À߸ø°ú, Áö¼ÓÀûÀÎ °í°üÀýÀÇ micro-separation¿¡ ÀÇÇÑ ÇÇ ·Î °ñÀýÀ¸·Î ¹ß»ý ÇÒ ¼ö ÀÖ´Ù. µÑ°´Â °í°üÀý ġȯ¼ú ÈÄ ¹ß»ýÇÒ ¼ö ÀÖ´Â impingementÀÇ Ãæ°ÝÀ» Èí¼öÇÏ´Â ´É·ÂÀÌ ¾ø¾î ¼¼¶ó¹Í °üÀýÀ» »ç¿ë½Ã ÀÓÇöõÆ®ÀÇ °íÁ¤ À§Ä¡(position)ÀÇ Çã¿ë¹üÀ§°¡ Àû´Ù. ImpingmentÀÇ ¹ß»ýÀº ¼¼¸®¹Í ¶óÀ̳ÊÀÇ chippingÀ̳ª °ñÀýÀÇ ¹ß»ýÀÇ À§ ÇèÀÌ ÀÖ´Ù. ¼¼Â°, micro-separation À¸·Î Ç¥¸éÀÇ ¼Õ»óÀÌ (Strip wear) ¹ß»ý ÇÒ ¼ö ÀÖ´Ù.
±×·¯³ª ÃÖ±Ù¿¡ º¸°íµÈ Biolox femoral headÀÇ °æ¿ì¿¡ 0.014%-0.004%ÀÇ °ñÀý ¹ß»ýÀ², sandwich typeÀÇ ¼¼¶ó¹Í°üÀýÀÇ 3-5³â°£ 0-0.5% °ñ¿ëÇØ¿Í 0%ÀÇ °ñÀýÀÇ ¿ì¼öÇÑ °á°úµé ÀÌ º¸°íµÇ¾îÀÖ´Ù. ±×·¯³ª ÃÖ±Ù¿¡ ¼¼¶ó¹Í °üÀý¿¡¼ ÀÏ»ó»ýȰÁß¿¡ ¼¼¶ó¹Í °í°üÀýÀÇ 0.6%
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5. Metal-on-metal bearing
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(Reference)
1. Adolph V. Lombardi,Jr, Facs* Thomas H.Mallory, Facs* Douglas, Richard D. Komist´Ù, Rpbert A. Fada and Eric J. Northcut L An In Vivo Determination of THA Pistoning During Activity. The J of Arthtoplasty Vol.15, No6. 703-709,2000.
2.Barrack, Robert L MD; Burak, Corey MD; Skinner, Harry B MD, PHD: Concerns about Ceramics in THA. Clinical Orthopaedics and Related Research: Volume(429) December 2004:73-79.
3. Benson MK, Goodwin PG, Brostoff J: Metal sensitivity in patients with joint replacement arthroplasties. BMJ 4:374-375,1975.
4. Bizot P, Larrouy M, Witvoet J, Sedel L, Nizard R: Press-fit metal-backed alumina sockets: A minim- um 5-year followup study. Clin Orthop Relat Res 379:134-142, 2000.
5. Brodner W, Bitzan P, Meisinger V, et al: Elevated serum cobalt with metal-on-metal articulating surfaces. J Bone Joint Surg 79B:316-321,1997.
6. Brodner W, Grohs JG, Bitzan P, et al: Serum cobalt and serum chromium level in 2 patients with chronic renal failure after total hip prosthesis implantation with metal-on-metal gliding contact. Z Orthop Ihre Grenzgeb 138:425-429,2000.
7. Brown SR, Davies WA, DeHeer DH, et al: Long-term survival of McKee-Farrar total hip prostheses. Clin Orthop Relat Res 402:157-163,2002.
8. Chan FW, Bobyn JD, Medley JB, et al: Wear and lubrication of metal-on-metal hip implants. Clin Orthop Relat Res 369-10-24,1999.
9. Cambell P, Shen FW, McKellop H: Biologic and tribologic considerations of alternative bearing surfaces. Clin Orthop Relat Res 418:98-111, 2004.
10. Catelas I, Campbell PA, Dorey F, et al: Serum-quantitative analysis of cytokines in metal-on-metal THA tissues and their relationship to metal particles. Biomaterials 24:4785-4797,2003.
11. Didier Hannouche, MD; Moussa Hamadouche,MD,PhD; Remy Nizard,MD,PhD; Pascal Bizot,MD; Alain Meunier,PhD; and Laurent Sedel,MD: Ceramics in Total Hip Replacement. Clinical Orthopaedics and Related Research Number 430:62-71,January 2005.
12. Doorn PF, Mirra JM, Campbell PA, et al: Tissue reaction to metal on metal total hip prostheses. Clin Orthop Relat Res 329(Suppl): S187-S205,1996.
13. Dowson D, Hardaker C, Flett M, et al: A hip joint simulator study of the performance of metal-on-metal joints. Part II. J Arthroplasty 19(Suppl 3):124-130,2004.
14. Edwards B, Folcik M, Gossling HR: Cobalt, chromium, and nickel conceptrations in body fluids of patients with porous-coated knee or hip prostheses. J Orthop Res 7:307-315,1989.
15. Garcia-Cimbrelo E, Martinez-Sayanes JM, Minuesa A, Munuera L: Ceramic-ceramic prosthesis after 10 years. J Arthroplasty 11:773-781, 1996.
16. James A.D'Antonio, MD; Michael T.Manley, PhD; William N.Capello, MD; Benjamin E.Bierbaum,MD; Rama Ramakrishnan, MS; Marybeth Naughton, BS; and Kate Sutton, MA, ELS: Five-year Experience with Crossfire Highly Cross-linked Polyethylene. Clinical Orthopaedics and Related Research Number 441:143-150, December 2005.
17. James A.D'Antonio, MD; William N.Capello, MD; Michael T.Manley, PhD; Marybeth Naughton, BS; and Kate Sutton, MA, ELS: A Titanium-encased Alumina Ceramic Bearing for Total Hip Arthroplasty. Clinical Orthopaedics and Related Research Number 441:151-158, December 2005.
18. James Clayton: New joints for the Millennium: wear control in total replacement hip joint. Publication on 5 January 2001,335-358.
19. John M. Cuckler,MD: The Rationale for Metal-on-Metal Total Hip Arthroplasty: Clinical Orthopaedics and Related Research Number 441:132-136,December 2005.
20. I C Clarke, V Good, P Williams, D Schroeder, L Anissian, A Stark, H Oonishi, J Schuldies and G Gustafson: Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements. Invited paper for the Special Millennium Issue published in Proceedings Part H, 2000, Vol.214, Issue H1.
21. Kim SY, Kyung HS, Ihn JC, et al: Cementless Metasul metal-on-metal total hip arthroplasty in patients less than fifty years old. J Bone Joint Surg 86A:2475-2481,2004.
22. MacDonald SJ: Metal-on-Metal total hip arthroplasty: The concerns. Clin Orthop Relat Res 429:86-93, 2004.
23. McKellop H, Shen FW, Lu B, Campbell P, Salovey R: Development of an extremely wear-resistant Ultra high molecular weight polyethylene for total hip replacements. J Orthop Res 17:157-167,1999.
24. Mauricio Silva,MD; Christian Heisel,MD; and Thomas P. Schmalzried, MD: Metal-on-Metal Total Hip Replacement. Clinical Orthopaedics and Related Research Number 430:53-61,January 2005.
25. Oonishi H, Nishida M, Kawanabe K, et al : Wear of high-dose gamma irradiated polyethylene in total joint replacememtn: Long term radiolgical evaluation> Trans Orthopedic Res. Soc, 1998;23;97
26. Park YS, Moon YW, Lim SJ, Yang JM, Ahn G, Choi : Early osteolysis following second generation meetal-on-metal hip replacement. Journal of bone and joint Surg. 87(A)-7:1515-1521,2005.
27. Seppo Santavirta, Max Bohler, William H Harris, Yrjo T Konttinen, Reijo Lappalainen, Orhun Muratoglu, Claude Rieker and Martin Salzer: Alternative materials to improve total hip replacement tribology. Acta Orthop Scand; 74 (4):380-388,2003.
28. Sychterz CJ, Orishimo KF, Engh CA: Sterilization and polyethylene wear: Clinical studies to support laboratory data. J Bone Joint Surg 86A:1017-1022, 2004.
29. Yoon TR, Rowe SM, Jung ST, Seon KJ, Maloney WJ: Osteolysis in association with a total hip arthroplasty with ceramic bearing surfaces. J Bone Joint Surg 80A:1459-1468, 1998. 30. Willert HG, Buchhom GH. Fayyazi A> Flury R. Windler M. Koster G. Lohmann CH: metal-on-metal bearing and hypersensitivity in patients with artificial hip joints. Journal of bone and joint Surg. 87(A)-1:28-36,2005. |