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Aubert T, Hallé A, Gerard P, Butnaru M, Graff W, Rigoulot G, Auberger G, Aubert O. Archetype analysis of the spine-hip relationship identifies distinct spinopelvic profiles. Orthop Traumatol Surg Res 2024; 110:103944. [PMID: 39048457 DOI: 10.1016/j.otsr.2024.103944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION The position of the pelvis in the sagittal plane can vary considerably between different functional positions. Adapting the position of the acetabular cup in relation to the alignment between the spine and the hip of each individual, prior to prosthesis placement, can prevent the risk of prosthetic impingement. Taken individually, risk factors for unfavorable spinopelvic kinematics can be difficult to interpret when trying to precisely predict which patients are at risk. Furthermore, the use of classifications or algorithms can be complex, most often associated with limited values and often difficult to apply in current practices of risk assessment. HYPOTHESIS We hypothesized that the deconstruction of the data matrix including age and spinopelvic parameters (SPT, LL, PI, LF and PI-LL) correlated with the analysis of spinopelvic kinematics could be used to define an individualized hip-spine relationship. MATERIAL AND METHOD We applied archetypal analysis, which is a probabilistic, data-driven and unsupervised approach, to a complete phenotype cohort of 330 patients before total hip arthroplasty to define the spinopelvic profile of each individual using the spinopelvic parameters without threshold value. For each archetype, we analyzed the spinopelvic kinematics, not implemented in the creation of the archetypes. RESULTS An unsupervised learning method revealed seven archetypes with distinct spinopelvic kinematic profiles ranging from -8.9 ° to 13.15 ° (p = 0.0001) from standing to sitting and -5. 35 ° to -10.81 ° (p = 0.0001) from supine to standing. Archetype 1 represents the "ideal" patient (A1); young patients without spinopelvic anomaly and the least at risk of mobility anomaly. Followed by 3 archetypes without sagittal imbalance according to their lumbar lordosis and pelvic incidence, from the highest to the lowest (archetypes 2-4), archetype 4 exposing a greater risk of spinopelvic kinematic anomaly compared to others. Then 2 archetypes with sagittal imbalance: archetype 5, with an immobile pelvis in the horizontal plane from standing to sitting position in anterior tilt and archetype A6, with significant posterior pelvic tilt standing, likely compensating for the imbalance and associated with the greatest anomaly of spinopelvic kinematics. Finally, archetype 7 with the stiffest lumbar spine without sagittal imbalance and significant unfavorable kinematics from standing to sitting. CONCLUSION An archetypal approach to patients before hip replacement can refine diagnostic and prognostic features associated with the hip-spine relationship and reduced heterogeneity, thereby improving spinopelvic characterization. This risk stratification of spinopelvic kinematic abnormalities could make it possible to target patients who require adapted positioning or types of implants before prosthetic surgery. LEVEL OF EVIDENCE IV retrospective study.
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Affiliation(s)
- Thomas Aubert
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France.
| | - Aurélien Hallé
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
| | - Philippe Gerard
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
| | - Michael Butnaru
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
| | - Wilfrid Graff
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
| | | | - Guillaume Auberger
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
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Romanelli F, Hong IS, Khan JA, Porter A, Jankowski JM, Liporace FA, Yoon RS. Intraoperative Fluoroscopy Versus Navigation to Determine Cup Anteversion in Direct Anterior Total Hip Replacement: A Technical Trick for Obtaining "True" Anteversion. Arthroplast Today 2024; 27:101426. [PMID: 38952777 PMCID: PMC11215948 DOI: 10.1016/j.artd.2024.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/01/2024] [Indexed: 07/03/2024] Open
Abstract
During acetabular cup positioning, intraoperative measurements of cup anteversion were taken using both fluoroscopy and navigation system. With the C-arm introduced at 40°, an anteroposterior view of the pelvis is taken. The C-arm is then centered over the hip, showing an anteverted cup with an approximate inclination of 40°. The axial C-arm is tilted away until the cup opening is visualized as a straight line, indicating that the beam of the fluoroscopy is aligned with the cup's anteversion. The tilt angle on the C-arm and anteversion reading on the navigation workstation were recorded. The high degree of agreement between fluoroscopic and navigation measurement of acetabular cup anteversion supports the use of fluoroscopy in settings with limited access to navigation systems in direct anterior total hip arthroplasty.
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Affiliation(s)
- Filippo Romanelli
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Ian S. Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Jibran A. Khan
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Andrew Porter
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Jaclyn M. Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
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Tang H, Guo S, Ma Z, Wang S, Zhou Y. A patient-specific algorithm for predicting the standing sagittal pelvic tilt one year after total hip arthroplasty. Bone Joint J 2024; 106-B:19-27. [PMID: 38160697 DOI: 10.1302/0301-620x.106b1.bjj-2023-0640.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims The aim of this study was to evaluate the reliability and validity of a patient-specific algorithm which we developed for predicting changes in sagittal pelvic tilt after total hip arthroplasty (THA). Methods This retrospective study included 143 patients who underwent 171 THAs between April 2019 and October 2020 and had full-body lateral radiographs preoperatively and at one year postoperatively. We measured the pelvic incidence (PI), the sagittal vertical axis (SVA), pelvic tilt, sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis to classify patients into types A, B1, B2, B3, and C. The change of pelvic tilt was predicted according to the normal range of SVA (0 mm to 50 mm) for types A, B1, B2, and B3, and based on the absolute value of one-third of the PI-LL mismatch for type C patients. The reliability of the classification of the patients and the prediction of the change of pelvic tilt were assessed using kappa values and intraclass correlation coefficients (ICCs), respectively. Validity was assessed using the overall mean error and mean absolute error (MAE) for the prediction of the change of pelvic tilt. Results The kappa values were 0.927 (95% confidence interval (CI) 0.861 to 0.992) and 0.945 (95% CI 0.903 to 0.988) for the inter- and intraobserver reliabilities, respectively, and the ICCs ranged from 0.919 to 0.997. The overall mean error and MAE for the prediction of the change of pelvic tilt were -0.3° (SD 3.6°) and 2.8° (SD 2.4°), respectively. The overall absolute change of pelvic tilt was 5.0° (SD 4.1°). Pre- and postoperative values and changes in pelvic tilt, SVA, SS, and LL varied significantly among the five types of patient. Conclusion We found that the proposed algorithm was reliable and valid for predicting the standing pelvic tilt after THA.
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Affiliation(s)
- Hao Tang
- Department of Adult Joint Reconstruction, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, Beijing, China
| | - Shaoyi Guo
- Department of Adult Joint Reconstruction, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, Beijing, China
| | - Zhuyi Ma
- Department of Adult Joint Reconstruction, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, Beijing, China
| | - Siyuan Wang
- Department of Adult Joint Reconstruction, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Adult Joint Reconstruction, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, Beijing, China
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Aubert T, Gerard P, Auberger G, Rigoulot G, Riouallon G. Low pelvic incidence with low lordosis and distal apex of lumbar lordosis associated with higher rates of abnormal spinopelvic mobility in patients undergoing THA. Bone Jt Open 2023; 4:668-675. [PMID: 37659768 PMCID: PMC10474956 DOI: 10.1302/2633-1462.49.bjo-2023-0091.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2023] Open
Abstract
Aims The risk factors for abnormal spinopelvic mobility (SPM), defined as an anterior rotation of the spinopelvic tilt (∆SPT) ≥ 20° in a flexed-seated position, have been described. The implication of pelvic incidence (PI) is unclear, and the concept of lumbar lordosis (LL) based on anatomical limits may be erroneous. The distribution of LL, including a unusual shape in patients with a high lordosis, a low pelvic incidence, and an anteverted pelvis seems more relevant. Methods The clinical data of 311 consecutive patients who underwent total hip arthroplasty was retrospectively analyzed. We analyzed the different types of lumbar shapes that can present in patients to identify their potential associations with abnormal pelvic mobility, and we analyzed the potential risk factors associated with a ∆SPT ≥ 20° in the overall population. Results ΔSPT ≥ 20° rates were 28.3%, 11.8%, and 14.3% for patients whose spine shape was low PI/low lordosis (group 1), low PI anteverted (group 2), and high PI/high lordosis (group 3), respectively (p = 0.034). There was no association between ΔSPT ≥ 20° and PI ≤ 41° (odds ratio (OR) 2.01 (95% confidence interval (CI)0.88 to 4.62), p = 0.136). In the multivariate analysis, the following independent predictors of ΔSPT ≥ 20° were identified: SPT ≤ -10° (OR 3.49 (95% CI 1.59 to 7.66), p = 0.002), IP-LL ≥ 20 (OR 4.38 (95% CI 1.16 to 16.48), p = 0.029), and group 1 (OR 2.47 (95% CI 1.19; to 5.09), p = 0.0148). Conclusion If the PI value alone is not indicative of SPM, patients with a low PI, low lordosis and a lumbar apex at L4-L5 or below will have higher rates of abnormal SPM than patients with a low PI anteverted and high lordosis.
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Affiliation(s)
- Thomas Aubert
- Department of Orthopaedic Surgery, Deaconess Saint Simon Cross Hospital Group, Paris, Île-de-France, France
| | - Philippe Gerard
- Department of Orthopaedic Surgery, Deaconess Saint Simon Cross Hospital Group, Paris, Île-de-France, France
| | - Guillaume Auberger
- Department of Orthopaedic Surgery, Deaconess Saint Simon Cross Hospital Group, Paris, Île-de-France, France
| | | | - Guillaume Riouallon
- Orthopaedic department, Paris Saint Joseph Hospital Group, Paris, Île-de-France, France
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High Prevalence of Spinopelvic Risk Factors in Patients With Post-Operative Hip Dislocations. J Arthroplasty 2023; 38:706-712. [PMID: 35598762 DOI: 10.1016/j.arth.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Excessive standing posterior pelvic tilt (PT), lumbar spine stiffness, low pelvic incidence (PI), and severe sagittal spinal deformity (SSD) have been linked to increased dislocation rates. We aimed to determine the prevalence of these 4 parameters in a cohort of unstable total hip arthroplasty (THA) patients and compare these to a large representative control population of primary THA patients. METHODS Forty-eight patients with instability following primary THA were compared to a control cohort of 9414 THA patients. Lateral X-rays in standing and flexed-seated positions were used to assess PT and lumbar lordosis (LL). Computed tomography scans were used to measure PI and acetabular cup orientation. Thresholds for "at risk" spinopelvic parameters were standing posterior PT ≤ -15°, lumbar flexion (LLstand-LLseated) ≤ 20°, PI ≤ 41°, PI ≥ 70°, and SSD (PI-LLstand mismatch ≥ 20°). RESULTS There were significant differences in mean spinopelvic parameters between the dislocating and control cohorts (P < .001). There were no differences in mean PI (58° versus 56°, respectively, P = .29) or prevalence of high and low PI between groups. 67% of the dislocating patients had one or more significant risk factors, compared to only 11% of the control. A total of 71% of the dislocating patients had cup orientations within the traditional safe zone. CONCLUSION Excessive standing posterior PT, low lumbar flexion, and a severe SSD are more prevalent in unstable THAs. Pre-op screening for these parameters combined with appropriate planning and implant selection may help identify at risk patients and reduce the prevalence of dislocation.
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Guezou-Philippe A, Clave A, Marchadour W, Letissier H, Lefevre C, Stindel E, Dardenne G. Functional safe zone for THA considering the patient-specific pelvic tilts: An ultrasound-based approach. Int J Med Robot 2023; 19:e2486. [PMID: 36427293 DOI: 10.1002/rcs.2486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Abstract
The usual Lewinnek orientation for cup positioning in total hip arthroplasty is not suitable for all patients as it does not consider the patient mobility. We propose an ultrasound-based approach to compute a Functional Safe Zone (FSZ) considering daily positions. Our goal was to validate it, and to evaluate how the input parameters impact the FSZ size and barycentre. The accuracy of the FSZ was first assessed by comparing the FSZ computed by the proposed approach and the true FSZ determined by 3D modelling. Then, the input parameters' impact on the FSZ was studied using a principal component analysis. The FSZ was estimated with errors below 0.5° for mean anteversion, mean inclination, and at edges. The pelvic tilts and the neck orientation were found correlated to the FSZ mean orientation, and the target ROM and the prosthesis dimensions to the FSZ size. Integrated into the clinical workflow, this non-ionising approach can be used to easily determine an optimal patient-specific cup orientation minimising the risks of dislocation.
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Affiliation(s)
- Aziliz Guezou-Philippe
- LaTIM - UMR1101, Brest, France.,Université de Bretagne Occidentale, Brest, France.,CHRU de Brest, Brest, France
| | - Arnaud Clave
- LaTIM - UMR1101, Brest, France.,Clinique Saint George, Nice, France
| | - Wistan Marchadour
- LaTIM - UMR1101, Brest, France.,Université de Bretagne Occidentale, Brest, France
| | - Hoel Letissier
- LaTIM - UMR1101, Brest, France.,CHRU de Brest, Brest, France
| | - Christian Lefevre
- LaTIM - UMR1101, Brest, France.,Université de Bretagne Occidentale, Brest, France.,CHRU de Brest, Brest, France
| | - Eric Stindel
- LaTIM - UMR1101, Brest, France.,CHRU de Brest, Brest, France
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Chen M, Kaneuji A, Takahashi E, Fukui M, Ichiseki T, Kawahara N. Angular changes in pelvic tilt and cup orientation at a minimum of eighteen years after primary total hip arthroplasty with an uncemented cup. INTERNATIONAL ORTHOPAEDICS 2023; 47:75-81. [PMID: 36323872 DOI: 10.1007/s00264-022-05610-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/07/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Changes in pelvic tilt angle (PTA) and cup orientation have been reported in patients after total hip arthroplasty, but the current literature generally has a brief follow-up period. This study will be the first to report PTA and cup orientation changes in the supine position for a minimum 18 years after total hip arthroplasty (THA) and investigate the factors associated with pelvic tilt and cup orientation changes. METHODS In this study, 101 patients (120 hips) who underwent THA were retrospectively analyzed. The aims of our study were to evaluate the PTA and cup orientation change over 18 years after THA to assess differential PTA, cup inclination, and anteversion. We also investigated whether factors such as gender, body mass index, and age have any influence on PTA and cup orientation after THA. RESULTS Patients showed a significant incremental change in PTA pre-operatively, immediately post-operatively, and at final follow-up. Cup orientation increased significantly at the final follow-up compared to the immediate post-operative period. Gender subgroup analysis showed that PTA was significantly greater in females than in males at the final follow-up (p = 0.025). Age subgroup analysis showed that PTA was significantly greater in the over 60 years group than in the other groups. CONCLUSION Our patients showed significant changes in PTA and cup orientation at a minimum 18 years after surgery, especially in females over 60 years. Female patients over 60 are a risk factor after THA.
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Affiliation(s)
- Mingliang Chen
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan.
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Makoto Fukui
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Toru Ichiseki
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
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Susanna H, Jussi R, Teemu K, Kati K. Association between sagittal spinal alignment and mechanical complications after primary total hip arthroplasty: a systematic review. J Int Med Res 2022; 50:3000605221116976. [PMID: 35971315 PMCID: PMC9386850 DOI: 10.1177/03000605221116976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Total hip arthroplasty (THA) affects pelvic posture and spinal alignment. These postural changes may further predispose patients to mechanical complications (MCs) after THA. The aim of this study was to conduct a systematic review to investigate whether any high-quality studies have assessed the association between sagittal spinal alignment and MCs after primary THA. Methods Inclusion criteria for studies were adult patients (age ≥18 years), primary THA, pre- and postoperative spinopelvic standing sagittal radiographs acquired preoperatively and at a minimum of 6-month follow-up, measurements of spinopelvic parameters, and reporting of possible MCs after THA. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results Six articles met the inclusion criteria. Although several studies confirmed the importance of spinal alignment when planning THA, these mainly investigated pelvic mobility as a risk factor for THA dislocation. Radiological follow-up imaging practices varied, and studies focused on different individual spinopelvic parameters. Conclusion Based on our study findings, no conclusions can be drawn regarding the association between sagittal spinal alignment and MCs after primary THA. Further research is needed to improve our knowledge of the connection between MCs after THA and sagittal spinal alignment.
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Affiliation(s)
- Hiltunen Susanna
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Repo Jussi
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Karjalainen Teemu
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Kyrölä Kati
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
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Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy. J Clin Med 2022; 11:jcm11154416. [PMID: 35956033 PMCID: PMC9369831 DOI: 10.3390/jcm11154416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022] Open
Abstract
Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects.
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PINHEIRO RÔMULOPEDROZA, DEFINO MATHEUSPIPPA, GARCIA FLÁVIOLUIS. EFFECTS OF HIP FLEXION CONTRACTURE ON SAGITTAL SPINOPELVIC PARAMETERS. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e249453. [PMID: 36092183 PMCID: PMC9425921 DOI: 10.1590/1413-785220223004e249453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/11/2021] [Indexed: 12/02/2022]
Abstract
Objective: To assess the influence of hip flexion contracture on lumbar lordosis and spinopelvic parameters and the changes in these parameters after total hip arthroplasty (THA). Methods: Twenty adult patients with hip osteoarthritis were divided into two groups (ten patients with hip flexion contracture and ten without contracture). Patients were assessed preoperatively and six months after THA using the radiographic parameters sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). Results: No statistical difference was found between pre- and postoperative LL values in the groups. After THA, both groups had increased PT and the group without hip flexion contracture had reduced SS. Conclusion: Patients with hip osteoarthritis and hip flexion contracture tend to have an increased LL in the orthostatic position compared to patients without contracture, but with no statistical significance. After THA, PT increased in both groups and SS decreased in patients without hip contracture. Studies should further investigate the role of hip flexion contracture on pelvic mobility and spinopelvic parameters to better understand these relations. Level of Evidence III, Case-Control Study.
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