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Oetojo W, Lawler P, Padley J, Pierrepont J, Schmitt D, Brown N. Influence of Contralateral Hip Status on Pelvic Tilt After Total Hip Arthroplasty. Arthroplast Today 2024; 29:101460. [PMID: 39193545 PMCID: PMC11347829 DOI: 10.1016/j.artd.2024.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/30/2024] [Accepted: 06/05/2024] [Indexed: 08/29/2024] Open
Abstract
Background Every degree of change in pelvic tilt (PT) leads to a 0.7° change in anteversion and a 0.3° change in inclination. This study aimed to determine the significance of contralateral hip arthritis on changes in PT using preoperative and postoperative anteroposterior radiographs. Methods There were 193 primary total hip arthroplasties done by 2 surgeons at a single academic tertiary referral center reviewed between September 2021 and January 2023. PT was calculated as Tilt = -(ln[(B/A) × (1/0.483)]) / 0.051. Value A is the distance from the base of the SI joint to the superior margin of the obturator foramen; value B is the height of the obturator foramen. After exclusions, contralateral hips were identified as being normal (n = 75), arthritic (n = 39) (Tönnis grade 3/4), replaced (n = 34), or having undergone simultaneous bilateral total hip arthroplasty (n = 5) on postoperative films. Difference in PT was measured between preoperative and postoperative films taken 1-3 months after surgery. Analyses for statistical significance were calculated using t-tests and one-way analysis of variance. Results Average change in PT in patients with normal contralateral hips was -5.2° with an absolute mean difference of 7.6°, -1.5° for arthritic contralateral hips with an absolute mean difference of 5.0°, -1.6° for replaced contralateral hips with a mean absolute difference of 4.3°, and 2.2° for bilateral hips with a mean absolute difference of 2.6° (P < .01). Conclusions Differences in postoperative PT changes between healthy, arthritic, and replaced contralateral hip study groups were significant. Changes in preoperative to postoperative tilt may have implications for optimal cup placement.
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Affiliation(s)
- William Oetojo
- Stritch School of Medicine, Loyola University, Maywood, IL
| | - Patrick Lawler
- Stritch School of Medicine, Loyola University, Maywood, IL
| | - James Padley
- Stritch School of Medicine, Loyola University, Maywood, IL
| | | | - Daniel Schmitt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL
| | - Nicholas Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL
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Oetojo W, Lawler P, Farooq H, Pierrepont J, Schmitt D, Brown N. Accuracy of intraoperative approximation of pelvic tilt using preoperative standing radiographs. J Orthop 2024; 54:120-123. [PMID: 38560587 PMCID: PMC10979016 DOI: 10.1016/j.jor.2024.03.026] [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: 02/29/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Background Anterior approach surgeons who utilize intraoperative fluoroscopy often try to match a preoperative radiograph as a reference for intraoperative cup position. Every degree of inaccuracy in tilt leads to a roughly 0.7° change in anteversion. This study aimed to determine how closely pelvic tilt (PT) is approximated intraoperatively when compared to preoperative anteroposterior (AP) radiographs. Methods This was a retrospective review of 193 primary THA's done by 2 surgeons at an academic tertiary referral center between September 2021-January 2023. There were 24 patients excluded for distorted anatomy, post-traumatic arthritis, insufficient x-rays, or a sacroiliac joint that could not be visualized on film. Data collected included age and BMI. PT was calculated using the formula, Tilt = -(ln((B/A) x (1/0.483)))/0.051. Value A is the distance from the base of the SI joint to the superior margin of the obturator foramen; value B is the height of the obturator foramen. Results Mean preoperative PT was 0.2° versus intraoperative PT was 3.4° (p < 0.001). Mean absolute difference was 6.5°. 48% of patients (n = 81) had an absolute difference less than 5°, 31% (n = 52) between 5° and 10°, 14% (n = 24) between 10° and 15°, and 7% (n = 12) greater than 15°. There was no correlation between BMI or age and PT discrepancy. Conclusion Of the patients, 21% had a discrepancy of 10° or greater between their preoperative radiographs and intraoperative fluoroscopic images. Surgeons should be aware of potential errors in cup positioning and be particularly diligent in high-risk cases.
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Affiliation(s)
- William Oetojo
- Stritch School of Medicine, Loyola University, Maywood, IL, 60153, USA
| | - Patrick Lawler
- Stritch School of Medicine, Loyola University, Maywood, IL, 60153, USA
| | - Hassan Farooq
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, 60153, USA
| | | | - Daniel Schmitt
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, 60153, USA
| | - Nicholas Brown
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, 60153, USA
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García-Rey E, Saldaña L. Spinopelvic interactions in total hip arthroplasty: 295 patients followed for a minimum follow-up of 10 years. Hip Int 2024; 34:487-497. [PMID: 38695378 DOI: 10.1177/11207000241248074] [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] [Indexed: 06/26/2024]
Abstract
BACKGROUND Concurrent spinal pathology is frequent in patients undergoing total hip arthroplasty (THA). In this study we examined whether spinopelvic interactions affect THA outcomes at a minimum follow-up of 10 years. PATIENTS AND METHODS 295 patients with a mean age of 63.3 (range 56‒80) years receiving a THA between 2006 and 2009 were assessed. Of these, 195 had mild lumbar disc degeneration and 100 had advanced lumbar spondylosis. We analysed the changes in the Harris Hip Score (HHS) and the survival rate for postoperative low back pain (LBP) and dislocation. Changes in acetabular component position, sacro-femoral-pubic (SFP) and pelvic obliquity (PO) angles were assessed with radiological images. RESULTS The mean HHS was lower in female patients (p = 0.009), patients >65 years of age (p < 0.001) and those with advanced lumbar spondylosis (p = 0.002). 52 (71.2%) of the patients reporting preoperative LBP experienced improvement after THA while 47 (21.1%) of those without preoperative LBP postoperatively reported new onset LBP. Female patients (p = 0.025; hazard ratio [HR]: 1.831; 95% CI, 1.081-3.101) and those with preoperative LBP (p = 0.007; HR 2.068; 95% CI, 1.221-3.504) were at a higher risk of developing postoperative LBP at 10 years. 4 out of 9 THA dislocations were late and had shown decreasing SFP angle values over time. Acetabular component inclination and anteversion angles increased over time, whereas the SFP angle was associated with sex and age and the PO angle with age and the severity of any preoperative lumbar degeneration. CONCLUSIONS Concurrent spinal pathology influences THA outcomes at a minimum follow-up of 10 years. Sex, age, and associated lumbar degeneration can affect clinical and radiological changes over time. A decrease in SFP angle values over time was found in patients sustaining late dislocation.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Laura Saldaña
- Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Bone Pathophysiology and Biomaterials Group, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
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Kamihata S, Ando W, Takao M, Hamada H, Uemura K, Sugano N. Effect of hip flexion contracture on the pelvic sagittal tilt in the supine position: A retrospective case-series study. Mod Rheumatol 2023; 33:1052-1057. [PMID: 36083017 DOI: 10.1093/mr/roac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The functional pelvic plane, which adopts the natural pelvic sagittal tilt in the supine position, is a good reference for determining the cup angle in total hip arthroplasty. However, hip flexion contracture may change pelvic tilt postoperatively by the release of contracture. This study investigated the influence of hip flexion contracture on pelvic sagittal tilt in the supine position. METHODS This study included 300 patients who underwent primary unilateral total hip arthroplasty. We divided the participants into two groups: with a preoperative hip extension angle of <0° (hip flexion contracture group) and without (non-contracture group). The pelvic sagittal tilt and femoral flexion angle were investigated using computed tomography or pelvic radiographs performed preoperatively and postoperatively. RESULTS The femoral flexion angle had significantly reduced postoperatively in the hip flexion contracture group but remained unchanged in the non-contracture group. The preoperative and postoperative pelvic sagittal tilt showed no significant differences between the two groups up to 1 year postoperatively. CONCLUSIONS The influence of hip flexion contracture on the pelvic sagittal tilt in the supine position was minimal. The functional pelvic plane in the supine position could be a good reference to ascertain the cup orientation, even in hip flexion contracture cases.
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Affiliation(s)
- Satoshi Kamihata
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
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Tanabe H, Homma Y, Yanagisawa N, Watari T, Ishii S, Shirogane Y, Baba T, Kaneko K, Ishijima M. Validation of a preoperative formula to estimate postoperative pelvic sagittal alignment and mobility before performing total hip arthroplasty for patients with hip osteoarthritis. ARTHROPLASTY 2023; 5:13. [PMID: 37020254 PMCID: PMC10077599 DOI: 10.1186/s42836-023-00171-w] [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: 07/27/2022] [Accepted: 02/01/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Although it is important to consider pelvic alignment and mobility in the standing and sitting positions before THA, it is not known how to preoperatively predict individual postoperative pelvic alignment and mobility. The purpose of this study was to investigate the pelvic alignment and mobility before and after THA, and to develop a predictive formula using preoperative factors to calculate postoperative sagittal alignment and mobility. METHODS One hundred seventy patients were assessed. The 170 patients were randomly divided into a prediction model analysis group (n = 85) and an external validation group (n = 85). In the prediction model analysis group, preoperative spinopelvic parameters were used to develop the predictive formulas to predict the postoperative sacral slope (SS) in standing and sitting positions and ΔSS. These were applied to the external validation group and assessed. RESULTS R2 in multiple linear regression models for postoperative SS in standing, SS in sitting and ΔSS were 0.810, 0.672, and 0.423, respectively. The values of predicted and postoperative parameters were very close with no significant difference: SS in standing (33.87 vs. 34.23, P = 0.834), SS in sitting (18.86 vs. 19.51, P = 0.228), and ΔSS (15.38 vs. 14.72, P = 0.619). CONCLUSION The present study showed that the pelvic alignment and mobility after THA can be predicted using preoperative factors. Although a model with higher accuracy is needed, it is important to use a predictive formula to estimate the postoperative condition before performing THA.
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Affiliation(s)
- Hiroki Tanabe
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Orthopaedic, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
- Department of Orthopaedic, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University, Tokyo, 113-0033, Japan
| | - Taiji Watari
- Department of Orthopaedic, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Seiya Ishii
- Department of Orthopaedic, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuichi Shirogane
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Orthopaedic, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Orthopaedic, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Orthopaedic, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Orthopaedic, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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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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7
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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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8
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How does corrective fusion surgery for adult spinal deformities affect pelvic inclination in the supine position as the reference plane for THA? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:143-150. [PMID: 34825988 DOI: 10.1007/s00590-021-03166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the changes in pelvic inclination in the supine and standing positions after spinal corrective surgery, and to identify the most predictive factor for changes in pelvic inclination with the supine position as the reference plane for total hip arthroplasty. METHODS We retrospectively analysed the data of 124 patients who underwent spinal corrective fusion surgery for adult spinal deformity between 2012 and 2016 at our institution. Spinal parameters were assessed preoperatively and postoperatively using whole spine radiographs in the standing position. The sacral slope (SS) was measured using spine and pelvis computed tomography. Differences between the preoperative and postoperative SS values in each position were calculated as Δsupine SSpre post and Δstanding SSpre post, respectively. We statistically analysed the correlations between Δsupine SS pre post and preoperative spinal parameters to determine the most useful predictor of Δ supine SSpre post. RESULTS The mean Δsupine SSpre post of 10.5°(-13°-50°) was significantly smaller than the mean Δstanding SSpre post of 13.2° (-19°-44°) (p = 0.02). Moreover, 21 patients (17%) had Δsupine SSpre post > 20°. The Δsupine SS pre post was correlated with preoperative LL (r = -0.34 p < 0.01), PT (r = 0.42 p < 0.01), and SVA (r = 0.37 p < 0.01). Preoperative supine SS (r = -0.54, p < 0.01) had the highest correlation with Δsupine SSpre post, whereas preoperative standing SS showed no correlation (r = -0.14 p = 0.12). CONCLUSION Preoperative supine SS is the most useful predictive factor for changes in supine pelvic inclination, and low preoperative values should be noted. This information should be considered for the management of patients with hip-spine syndrome.
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Okuzu Y, Miyahara T, Goto K, Kuroda Y, Kawai T, Matsuda S. Investigating sagittal spinal alignment, low back pain, and clinical outcomes after total hip arthroplasty for lumbar hyperlordosis: a retrospective study. Arch Orthop Trauma Surg 2022; 142:4007-4013. [PMID: 34825248 DOI: 10.1007/s00402-021-04266-4] [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: 06/04/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hip-spine syndrome, wherein flexion deformity of the hip might exaggerate normal lumbar lordosis (LL), was first described in 1983. It could result in subluxation of the posterior facets and cause low back pain (LBP). However, the clinical outcomes of total hip arthroplasty (THA) and spinal alignment changes in patients with lumbar hyperlordosis (hyper LL) remain unknown. We aimed to clarify the proportion of patients with hyper LL before THA and compare pre- and post-operative sagittal spinal alignment, LBP, and clinical outcomes between patients with hyper LL and those with normal LL. MATERIALS AND METHODS We investigated 278 patients who underwent primary THA between December 2015 and December 2019. Spine radiographs in the standing position were examined preoperatively and 1 year postoperatively. Patients with hyper LL were defined as having a pelvic incidence (PI) minus LL of < - 9° preoperatively. The control group included age- and sex-matched patients with normal LL, defined by a PI minus LL of - 9° to 9°. Clinical outcomes were evaluated using the visual analogue scale (VAS) for LBP, Harris hip score (HHS), Oxford hip score (OHS), and University of California, Los Angeles (UCLA) activity score. RESULTS Thirty-eight patients (13.7%) had hyper LL, and they exhibited a lower pelvic tilt, lower sagittal vertical axis, and greater sigmoid curvature than did the controls. Evaluation of changes in the spinal alignment after surgery showed that the pelvis tilted more posteriorly, and LL decreased more in the hyper LL group than in the control group. Pre- and post-operative VAS for LBP, HHS, OHS, and UCLA activity scores were not significantly different between the two groups. CONCLUSION Hyper LL in patients with hip osteoarthritis had no adverse effects on LBP and the clinical outcomes of THA. Hyper LL may partially result from a flexible and adaptable lumbo-pelvic structure.
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Affiliation(s)
- Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Takuma Miyahara
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
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10
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Fischer MCM, Tokunaga K, Okamoto M, Habor J, Radermacher K. Implications of the uncertainty of postoperative functional parameters for the preoperative planning of total hip arthroplasty. J Orthop Res 2022; 40:2656-2662. [PMID: 35266575 DOI: 10.1002/jor.25291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/23/2021] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
The functional parameters pelvic tilt (PT) and hip joint force (HJF) are required to calculate patient-specific target zones based on the range of motion (ROM) and implant loading for preoperative planning of total hip arthroplasty (THA). Both functional parameters may change after THA. The preoperative prediction of the postoperative PT and HJF is associated with a specific amount of uncertainty. The prediction uncertainty has to be considered in the preoperative planning process to avoid a suboptimal implantation. So far, very little attention has been paid to the necessary reduction of patient-specific target zones by the prediction uncertainties of postoperative functional parameters. Prediction models for the postoperative PT in standing position and for the HJF during one-leg stance as a surrogate for the peak force phase during level walking were used to quantify the reduction of the ROM- and load-based target zones of 196 Japanese THA patients. The prediction uncertainty was about 14° for the postoperative standing PT and ranged from 17% body weight to 37% body weight for the components of the HJF. On average, the prosthetic ROM-based target zone had to be significantly reduced by 43% and the load-based target zone by 39%. This led to a median reduction of the combined prosthetic ROM- and load-based target zone of 96%. The study sharpens the awareness for the substantial reduction of ROM- and load-based target zones by prediction uncertainties of the postoperative PT and HJF and highlights the importance of further research to improve prediction models for both functional parameters.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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11
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Louette S, Wignall A, Pandit H. Spinopelvic Relationship and Its Impact on Total Hip Arthroplasty. Arthroplast Today 2022; 17:87-93. [PMID: 36042938 PMCID: PMC9420424 DOI: 10.1016/j.artd.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
The dynamic, complex interaction among the spine, pelvis, and hip is often underappreciated, yet understanding it is vital for both arthroplasty and spinal surgeons. There is an increasing incidence of degenerative hip and spinal pathologies as a result of the ageing population. Furthermore, hip pathology can cause spine pathology and vice versa through “hip-spine” and “spine-hip syndrome.” Consequently, total hip arthroplasty (THA) and spinal fusion surgery, which both affect spinopelvic mobility, are also on the rise. Alteration in spinopelvic motion can affect the orientation of the acetabulum and, therefore, implant positioning in THA, leading to complications such as dislocation, impingement, aseptic loosening, and wear of components. This makes it imperative to assess spinopelvic motion and pelvic tilt prior to patients undergoing THA. In this paper, we explore how the surgeon should proceed to reduce risk of component malalignment, as well as the role of navigation systems in acetabular cup positioning.
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12
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Zhang B, Du Y, Sun J, Shen J, Li T, Zhou Y. Change of Pelvic Sagittal Tilt after Total Hip Arthroplasty in Patients with Bilateral Crowe Type IV Developmental Dysplasia of the Hip. Orthop Surg 2022; 14:919-926. [PMID: 35445552 PMCID: PMC9087458 DOI: 10.1111/os.13275] [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: 02/28/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To explore and analyze the change of pelvic sagittal tilt (PST) after total hip arthroplasty (THA) in patients with bilateral Crowe type IV developmental dysplasia of the hip (DDH). Methods The study retrospectively evaluated 43 patients with bilateral Crowe type IV DDH undergoing THA from January 2008 to June 2019 who were followed up for 12 months postoperatively. Four parameters, including the ratio between the height and width of the obturator foramina(H/W ratio), the vertical distance between the upper edge of the symphysis and the middle of the sacrococcygeal joint (SSc distance), the vertical distance between the upper edge of the symphysis and the line connecting bilateral hip centers (SC distance) and the vertical distance between the upper edge of the symphysis and the line connecting the bilateral lower ends of the sacroiliac joints (SSi distance), which could indirectly reflect the change of PST, were observed and measured by radiographs. The change of each parameter before operation, immediately after operation, and in 3, 6 and 12 months postoperatively was compared and analyzed. Results Compared with the value before operation, the H/W ratio immediately after operation and in 3, 6 and 12 months postoperatively were 0.61 ± 0.12 (t = 0.893, P = 0.377), 0.61 ± 0.11 (t = 1.622, P = 0.112), 0.67 ± 0.10 (t = 5.995, P < 0.001) and 0.76 ± 0.12 (t = −9.313, P < 0.001), respectively, and the SSc, SC and SSi distance in 6 months postoperatively were 30.12 ± 7.06 mm (t = 3.506, P = 0.002), 42.8 ± 7.7 mm (t = 5.843, P < 0.001), 129.3 ± 12.6 mm (t = 5.888, P < 0.001), respectively, and in 12 months postoperatively were 27.24 ± 7.68 mm (t = 6.510, P < 0.001), 36.1 ± 9.1 mm (t = 9.230, P < 0.001), 118.9 ± 14.9 mm (t = 8.940, P < 0.001), respectively. The radiographs obtained in 6 and 12 months postoperatively demonstrated a significantly increased H/W ratio and decreased SSc, SC and SSi distance. At the last follow‐up, the clinical evaluations significantly improved in all patients and there were no revisions. Conclusion The significant change of pelvic sagittal posterior tilt in patients with bilateral Crowe type IV DDH might be a significant phenomenon after THA, which could occur in 6 months postoperatively.
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Affiliation(s)
- Bohan Zhang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yinqiao Du
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jingyang Sun
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Junmin Shen
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.,Medical School of Nankai University, Tianjin, China
| | - Tiejian Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yonggang Zhou
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.,Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
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Pourahmadi M, Sahebalam M, Dommerholt J, Delavari S, Mohseni-Bandpei MA, Keshtkar A, Fernández-de-Las-Peñas C, Mansournia MA. Spinopelvic alignment and low back pain after total hip arthroplasty: a scoping review. BMC Musculoskelet Disord 2022; 23:250. [PMID: 35291992 PMCID: PMC8925238 DOI: 10.1186/s12891-022-05154-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Spinopelvic alignment is increasingly considered as an essential factor for maintaining an energy-efficient posture in individuals with normal or pathological status. Although several previous studies have shown that changes in the sagittal spinopelvic alignment may occur in patients undergoing total hip arthroplasty (THA), no review of this area has been completed so far. Thus, the objective of this scoping review was to summarize the evidence investigating changes in spinopelvic alignment and low back pain (LBP) following THA. DATA SOURCES We adhered to the established methodology for scoping reviews. Four electronic databases were systematically searched from inception-December 31, 2021. STUDY SELECTION We selected prospective or retrospective observational or intervention studies that included patients with THA. DATA EXTRACTION Data extraction and levels of evidence were independently performed using standardized checklists. DATA SYNTHESIS A total of 45 papers were included in this scoping review, involving 5185 participants with THA. Pelvic tilt was the most common parameter measured in the eligible studies (n = 26). The results were not consistent across all studies; however, it was demonstrated that the distribution of pelvic tilt following THA had a range of 25° posterior to 20° anterior. Moreover, decreased sacral slope and lower pelvic incidence were associated with increased risk of dislocation in patients with THA. Lumbar spine scoliosis did not change significantly after THA in patients with bilateral hip osteoarthritis (5.50°(1.16°) vs. 3.73°(1.16°); P-value = 0.29). Finally, one study indicated that LBP improvement was not correlated with postoperative changes in spinopelvic alignment parameters. Several methodological issues were addressed in this study, including no sample size calculation and no type-I error adjustment for outcome multiplicity. CONCLUSIONS Changes in spinopelvic alignment may occur after THA and may improve with time. Patients with a THA dislocation usually show abnormal spinopelvic alignment compared to patients without a THA dislocation. LBP usually improves markedly over time following THA.
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Affiliation(s)
- Mohammadreza Pourahmadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebalam
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD USA
- Myopain Seminars, Bethesda, MD USA
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD USA
| | - Somayeh Delavari
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Abbasali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina St., Shanzdah-e Azar St., P. O. Box: 6446-14155, Tehran, Iran
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Auberger G, Pansard E, Bouche PA, Marmorat JL, Judet T, Lonjon G. Pelvic position, lying on a traction table, during THA by direct anterior approach. Comparison with the standing position and influence on the acetabular cup anteversion. Orthop Traumatol Surg Res 2021; 107:103077. [PMID: 34563732 DOI: 10.1016/j.otsr.2021.103077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The placement of prostheses for a total hip arthroplasty (THA) is essential to limit complications and optimize functional results. In a recent study of more than 100 THA placed through a direct anterior approach using a traction table, we found that the mean anteversion of the cup was greater (30°) than recommended (20°). To explain this phenomenon, we considered that the anterior pelvic plane (APP), defined by the plane passing through the anterior-superior iliac spines and the pubic symphysis, which serves as a landmark for the placement and calculation of the anteversion of the cup, was not horizontal when the patient was lying on the traction table. This concept has not been evaluated so we conducted a prospective study to: 1) measure the position of the pelvis on a traction table; 2) compare to the standing position, 3) assess its impact on the anteversion of the cup. HYPOTHESIS The standing pelvic version is identical to the supine pelvic version on the traction table. MATERIAL AND METHODS A prospective 3-month monocentric study was conducted. All patients operated on for a THA by a direct anterior approach, on a traction table, were included. The position of the pelvis was assessed by measuring the tilt of the APP on lateral pelvic X-rays, while on the traction table and while standing. The impact of the position of the pelvis on the positioning of the cup, as well as the anteversion, were measured using the EOS imaging system. The anatomic anteversion of the cup was measured in relation to the APP. RESULTS Fifty-eight patients were included (32 women, 26 men) with an average age of 67 years. The tilt of the supine APP was 6°±8.3 [range of -10.5 to 31.0] (indicating a retroverted pelvis on the traction table). The difference between the tilt of the standing and lying APP (within 90°) was not significant (standing was on average 4.5° [range of -11.0 to 27.0] versus lying on the table, was on average 6° [range of -10.5 to 31.0] (p=0.75). A strong correlation was observed between the tilt of the supine APP and the anatomic anteversion of the cup (p<0.001). Thus, the more retroverted the pelvis was on the traction table, the lower the anatomic anteversion of the acetabular cup. CONCLUSION The supine pelvis on the traction table is not always horizontal and its position on the traction table is similar to its standing position, within 90 degrees. The analysis of the positioning of the preoperative pelvis appears to be essential in the planning of a THA through direct anterior approach using a traction table. LEVEL OF EVIDENCE IV; Prospective Cohort Study.
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Affiliation(s)
- Guillaume Auberger
- Department of orthopaedic and trauma surgery, Croix Saint Simon Hospital, GH Diaconnesses Croix Saint Simon, Paris, France.
| | - Erwan Pansard
- Department of orthopaedic and trauma surgery, Ambroise Paré Hospital, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France; Domont Clinic, RAMSAY Group, 85, route de Domont, 95460 Ezanville, France
| | - Pierre-Alban Bouche
- Department of orthopaedic and trauma surgery, Ambroise Paré Hospital, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France; Department of orthopaedic surgery, Raymond-Poincaré Hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - Jean-Luc Marmorat
- Department of orthopaedic surgery, Raymond-Poincaré Hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - Thierry Judet
- Department of orthopaedic surgery, Raymond-Poincaré Hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Ochiai S, Seki T, Osawa Y, Kawasaki M, Yamaguchi J, Ishiguro N. Pelvic incidence affects postoperative dislocation rate in total hip arthropalsty patients with spinal fusion. Hip Int 2021; 33:377-383. [PMID: 34693795 DOI: 10.1177/11207000211054332] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical outcome of total hip arthroplasty (THA) with and without spinal fusion (SF), and to evaluate the radiographic characteristics of patients with dislocation after THA. METHODS A case-controlled study of 53 patients (67 hips) who underwent both THA and SF was performed. The control group was matched to the SF group by age, gender and body mass index, and 106 patients (134 hips) were selected. Hip function was evaluated using the Japanese Orthopaedic Association (JOA) hip score. In addition, the incidence rates of postoperative complications were determined. Radiograph evaluation included lateral inclination and anteversion of the acetabular component. We also analysed sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). RESULTS The JOA hip score at final follow up was significantly poorer in the SF group compared to the control group. There were 5 cases of dislocations in the SF group and none in the control group. The anteversion of acetabular cup, PT, and PI were significantly higher in the SF group compare to the control group. In particular, the PI of patients with anterior dislocation were significantly higher compare to those of patients without dislocation. CONCLUSIONS Our study showed that SF is a risk factor for a poorer clinical outcome and postoperative dislocation of THA. In addition, the abnormal value of PI may be a risk factor to predict dislocation after THA with SF.
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Affiliation(s)
- Satoshi Ochiai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Watanabe S, Choe H, Kobayashi N, Ike H, Kobayashi D, Inaba Y. Prediction of pelvic mobility using whole-spinal and pelvic alignment in standing and sitting position in total hip arthroplasty patients. J Orthop Surg (Hong Kong) 2021; 29:23094990211019099. [PMID: 34060367 DOI: 10.1177/23094990211019099] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Dislocation is a major complication after total hip arthroplasty (THA), and pelvic stiffness is reportedly a significant risk factor for dislocation. This study aimed to investigate spinopelvic alignment, and identify preoperative factors associated with postoperative pelvic mobility. METHODS We enrolled 78 THA patients with unilateral osteoarthritis. The sagittal spinopelvic alignment in the standing and sitting position was measured using an EOS imaging system before and 3 months after THA. We evaluated postoperative pelvic mobility, and defined cases with less than 10° of sacral slope change as pelvic stiff type. The preoperative characteristics of those with postoperative stiff type, and preoperative factors associated with risk of postoperative stiff type were evaluated. RESULTS Sagittal spinopelvic alignment except for lumbar alignment were significantly changed after THA.A total of 13 patients (17%) were identified as postoperative pelvic stiff type. Preoperative lower pelvic and lumbar mobility were determined as significant factors for prediction of postoperative pelvic stiff type. Among these patients, nine patients (69%) did not have pelvic stiffness before THA. Preoperative factor associated with the risk of postoperative pelvic stiff type in those without preoperative stiffness was lower lumbar lordosis in standing position by multivariate regression analysis. CONCLUSION Spinopelvic alignments except lumber alignment was significantly changed after THA. The lower pelvic mobility and lumbar alignment were identified as the preoperative predictive factors for postoperative pelvic mobility. Evaluation of preoperative lumbar alignment may be especially useful for the prediction in patients with hip contractures, for these patients may possibly experience the extensive perioperative change in pelvic mobility.
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Affiliation(s)
- Shintaro Watanabe
- Department of Orthopedic Surgery, 13155Yokohama City University, Yokohama City, Kanagawa, Japan
| | - Hyonmin Choe
- Department of Orthopedic Surgery, 13155Yokohama City University, Yokohama City, Kanagawa, Japan
| | - Naomi Kobayashi
- Department of Orthopedic Surgery, 13155Yokohama City University Medical Center, Yokohama City, Kanagawa, Japan
| | - Hiroyuki Ike
- Department of Orthopedic Surgery, 13155Yokohama City University, Yokohama City, Kanagawa, Japan
| | - Daigo Kobayashi
- Department of Orthopedic Surgery, 13155Yokohama City University, Yokohama City, Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopedic Surgery, 13155Yokohama City University, Yokohama City, Kanagawa, Japan
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Bergiers S, Hothi H, Henckel J, Di Laura A, Belzunce M, Skinner J, Hart A. The in vivo location of edge-wear in hip arthroplasties : combining pre-revision 3D CT imaging with retrieval analysis. Bone Joint Res 2021; 10:639-649. [PMID: 34605661 PMCID: PMC8559968 DOI: 10.1302/2046-3758.1010.bjr-2021-0132.r1] [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] [Indexed: 11/16/2022] Open
Abstract
Aims Acetabular edge-loading was a cause of increased wear rates in metal-on-metal hip arthroplasties, ultimately contributing to their failure. Although such wear patterns have been regularly reported in retrieval analyses, this study aimed to determine their in vivo location and investigate their relationship with acetabular component positioning. Methods 3D CT imaging was combined with a recently validated method of mapping bearing surface wear in retrieved hip implants. The asymmetrical stabilizing fins of Birmingham hip replacements (BHRs) allowed the co-registration of their acetabular wear maps and their computational models, segmented from CT scans. The in vivo location of edge-wear was measured within a standardized coordinate system, defined using the anterior pelvic plane. Results Edge-wear was found predominantly along the superior acetabular edge in all cases, while its median location was 8° (interquartile range (IQR) -59° to 25°) within the anterosuperior quadrant. The deepest point of these scars had a median location of 16° (IQR -58° to 26°), which was statistically comparable to their centres (p = 0.496). Edge-wear was in closer proximity to the superior apex of the cups with greater angles of acetabular inclination, while a greater degree of anteversion influenced a more anteriorly centred scar. Conclusion The anterosuperior location of edge-wear was comparable to the degradation patterns observed in acetabular cartilage, supporting previous findings that hip joint forces are directed anteriorly during a greater portion of walking gait. The further application of this novel method could improve the current definition of optimal and safe acetabular component positioning. Cite this article: Bone Joint Res 2021;10(10):639–649.
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Affiliation(s)
- Sean Bergiers
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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Spinopelvic Biomechanics and Total Hip Arthroplasty: A Primer for Clinical Practice. J Am Acad Orthop Surg 2021; 29:e888-e903. [PMID: 34077399 DOI: 10.5435/jaaos-d-20-00953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
Abnormal spinopelvic motion from spine pathology is associated with inferior outcomes after total hip arthroplasty, including inferior patient-reported outcomes, increased rates of instability, and higher revision rates. Identifying these high-risk patients preoperatively is important to conduct the appropriate workup and formulate a surgical plan. Standing and sitting lateral spinopelvic radiographs are able to identify and quantify abnormal spinopelvic motion. Depending on the type of spinopelvic deformity, some patients may require increased anteversion, increased offset, and large diameter heads or dual mobility articulations to prevent dislocation. This review article will provide the reader with practical information that can be applied to patients regarding the terminology, pathophysiology, evaluation, and management of total hip arthroplasty patients with spinopelvic pathology.
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19
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Rainer WG, Abdel MP, Freedman BA, Berry DJ, Taunton MJ. Pelvic Tilt and the Pubic Symphysis to Sacrococcygeal Junction Distance: Risk Factors for Hip Dislocation Observed on Anteroposterior Pelvis Radiographs. J Arthroplasty 2021; 36:S367-S373. [PMID: 33795173 DOI: 10.1016/j.arth.2021.02.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dislocation after total hip arthroplasty (THA) is among the most common causes of early revision in contemporary practice. Abnormal spinopelvic alignment increases risk for dislocation, but methods to identify such are limited and can be complex. We sought to determine the effect of pelvic tilt, using a novel radiographic measurement, on dislocation risk by evaluating those with and without a history of dislocation. METHODS Using our institutional total joint registry, we identified 10,082 primary THAs performed between 2006 and 2015. Postoperatively, 177 dislocated (1.7%). Dislocators were matched 1:1 to control patients who did not dislocate. Pelvic tilt was calculated using the pubic symphysis to sacrococcygeal junction distance (PSCD) from a supine anteroposterior pelvis radiograph both preoperatively and postoperatively. The association between dislocation and both pelvic tilt and PSCD was then evaluated by logistic regression. Mean follow-up was 3 years. RESULTS Patients who dislocated had more posterior pelvic tilt (mean pelvic tilt of 57° vs 60°; P = .02) and smaller PSCDs (mean 41 mm vs 46 mm; P = .04) than controls. Patients with a PSCD <0 mm (symphysis above sacrococcygeal junction) had 9-fold odds of dislocation compared to those with a PSCD >50 (odds ratio 9; P = .006). CONCLUSION Patients who dislocated following primary THA had more posterior pelvic tilt. Additionally, those with a PSCD <0 had 9-fold odds of dislocation. Assessing the PSCD can alert a surgeon of increased risk for dislocation and identification of a negative PSCD should encourage further investigation or optimization of the preoperative plan to minimize dislocation risk. LEVEL OF EVIDENCE Level IV, case-control study.
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Affiliation(s)
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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20
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Tateiwa T, Endo K, Matsuoka Y, Ishida T, Shishido T, Yamamoto K. Pelvic tilt after total hip arthroplasty in patients with osteoarthritis of the hip. J Orthop Surg (Hong Kong) 2021; 28:2309499020918317. [PMID: 32329384 DOI: 10.1177/2309499020918317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is important to understand postoperative global sagittal spinal alignment after total hip arthroplasty (THA) to prevent not only the following hip complications but also progressing lumbar degeneration. The purpose of this study was to progress the analysis of the global sagittal spinal alignment between before and after THA in patients without large lower limbs discrepancy. SUBJECTS AND METHODS The subjects were 87 patients with bilateral hip osteoarthritis (OA) before unilateral primary THA. We measured sagittal vertical axis (SVA), lumbar lordotic angle, sacral slope, pelvic tilt (PT), and pelvic incidence (PI) and compared the postoperative change of those parameters. Excluded criteria were Crowe classification types II, III, and IV and more than 10 mm of leg length difference, spinal scoliosis (Cobb angle > 25°), and lumbar kyphosis. RESULTS The correlation coefficient between preoperative factors and postoperative sagittal alignments revealed that postoperative SVA has correlation with age (r = 0.46, p < 0.008) and preoperative PT (r = 0.42, p = 0.015). Postoperative PT had a correlation with preoperative PI (r = 0.46, p = 0.007). The change of PT after operation had negative correlation to preoperative PT (r = -0.47, p < 0.01) and PI (r = -0.38, p = 0.03). Multiple regression analysis revealed that the change of PT = 4.979 - 0.235 × preoperative PT (p < 0.05). Therefore, when preoperative PT was less than 20°, the postoperative PT would become larger than the preoperative one. CONCLUSION (1) In patient with hip OA without large lower limbs discrepancy, the postoperative PT after THA correlated with PI. (2) The postoperative change of PT was influenced by preoperative PT.
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Affiliation(s)
- Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tsunehito Ishida
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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21
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Shareghi B, Mohaddes M, Kärrholm J. Pelvic tilt between supine and standing after total hip arthroplasty an RSA up to seven years after the operation. J Orthop Res 2021; 39:121-129. [PMID: 32484957 DOI: 10.1002/jor.24759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 02/04/2023]
Abstract
The pose of the prosthetic components after total hip arthroplasty (THA) is commonly evaluated on conventional radiographs. Any change of the pelvic position after the operation in supine and between supine and standing position with time will influence validity of the measurements. We evaluated the changed pelvic tilt angle (PTA) in supine and standing position up to 7 years after operation. The aims of our study were (a) to evaluate if the PTA change over time after THA, (b) to assess any difference in PTA between supine and standing positions, and (c) to investigate whether factors such as gender, the condition of the opposite hip or low-back pain have any influence on PTA after THA. Repeated radiostereophotogrammetric radiographs of 106 patients were studied. Patients had been examined in the supine position postoperatively, and in both supine and standing positions at 6 months and 7-year follow-up. Measurements of supine patients showed an increasing mean posterior pelvic tilt over time. From supine to standing, the pelvis tilted in the opposite direction. At 6 months, the mean anterior tilt was 3.6° ± 3.8° (confidence interval [CI]: 2.8° to 4.3°) which increased to 6.4° ± 3.9° (CI: 5.7° to 7.2°) at 7 years. The mean changes in pelvic rotations around the longitudinal and sagittal axis were less than 1 degree, in both positions. In individual patients, this change reached about 11.0 degrees in supine and 18.0 degrees when standing.
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Affiliation(s)
- Bita Shareghi
- Department of Orthopaedics, The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Abstract
Pelvic motion acting as a hinge between the spine and hips is essential to maintain proper balance during bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment occurs.This pelvic rotation can affect functional acetabular orientation, and consequently functional cup positioning if a total hip arthroplasty (THA) is needed. Pelvic retroversion, frequently associated with degenerative spinal changes, implies an increase of acetabular version.Patients with flexible lumbar spines (spine users) protect the hip joint. Patients with stiff, degenerated or fused lumbar spines (hip users) demand higher hip mobility, placing the THA at risk.Pelvises in retroversion place the THA at risk for anterior dislocation when standing. In contrast, pelvises in anteversion or with low pelvic incidence (PI) can place THA at risk for posterior dislocation when sitting.Try to set the cup in an anatomic position. However, bear in mind that low PI pelvises may need more acetabular ante-inclination, and high PI pelvises more acetabular retroversion.If surgery is needed, start first by addressing the hip, except in patients with compensation (high pelvic retroversion), who may need spine surgery first to place the pelvis, and consequently the acetabulum, in a proper position. Cite this article: EFORT Open Rev 2020;5:522-533. DOI: 10.1302/2058-5241.5.200032.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Eduardo García-Rey
- Hip Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain
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Fischer MCM, Tokunaga K, Okamoto M, Habor J, Radermacher K. Preoperative factors improving the prediction of the postoperative sagittal orientation of the pelvis in standing position after total hip arthroplasty. Sci Rep 2020; 10:15944. [PMID: 32994419 PMCID: PMC7524714 DOI: 10.1038/s41598-020-72782-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022] Open
Abstract
The aims of this study were to investigate if the sagittal orientation of the pelvis (SOP) in the standing position changes after total hip arthroplasty (THA) and evaluate what preoperative factors may improve the prediction of the postoperative standing SOP in the context of a patient-specific functional cup orientation. 196 primary THA patients from Japan were retrospectively selected for this study. Computed tomography imaging of the pelvis, EOS imaging of the lower body and lateral radiographs of the lumbar spine in the standing position were taken preoperatively. Common biometrics and preoperative Harris Hip Score were recorded. The EOS imaging in the standing position was repeated three months following THA. A 3D/2.5D registration process was used to determine the standing SOP. Thirty-three preoperative biometric, morphological and functional parameters were measured. Important preoperative parameters were identified that significantly improve the prediction of the postoperative standing SOP by using multiple linear LASSO regression. On average, the SOP changed significantly (p < 0.001) between the preoperative and postoperative standing position three months after THA by 3° ± 4° in the posterior direction. The age, standing lumbar lordosis angle (LLA) and preoperative supine and standing SOP significantly (p < 0.001) improve the prediction of the postoperative standing SOP. The linear regression model for the prediction of the postoperative standing SOP is significantly (p < 0.001) improved by adding the parameters preoperative standing SOP and LLA, in addition to the preoperative supine SOP, reducing the root mean square error derived from a leave-one-out cross-validation by more than 1°. The mean standing SOP in Japanese patients changes already three months after THA in comparison to the preoperative value. The preoperative factors age, LLA, supine and standing SOP can significantly improve the prediction of the postoperative standing SOP and should be considered within the preoperative planning process of a patient-specific functional cup orientation.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany.
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Cotter BD, Innmann MM, Dobransky JS, Merle C, Beaulé PE, Grammatopoulos G. Does Functional Cup Orientation Change at Minimum of 10 Years After Primary Total Hip Arthroplasty? J Arthroplasty 2020; 35:2507-2512. [PMID: 32444235 DOI: 10.1016/j.arth.2020.04.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cup orientation has been shown to influence the postoperative risk of impingement and dislocation following total hip arthroplasty (THA) and may change over time due to changes in pelvic tilt that occur with aging. The purpose of this study is to determine if there is a significant change in acetabular cup inclination and anteversion over a 10-year period following THA. METHODS A retrospective, multisurgeon, single-center cohort study was conducted of 46 patients that underwent THA between 1995 and 2002. A total of 46 patients were included, with a median age at surgery of 56 years, and a median time between initial postoperative radiograph and the most recent one being 13.5 years (minimum 10 years). Cup orientation was measured from postoperative and follow-up supine anterior-posterior pelvic radiographs. Using a validated software, inclination and anteversion were calculated at each interval and the change in cup anteversion and inclination angle was determined. Furthermore, the difference in the sacro-femoral-pubic angle was measured, reflecting the difference in pelvic tilt between intervals. RESULTS No significant difference was detected between measurements taken from initial postoperative radiograph and measurements a minimum of 10 years later (P > .45), with the median (interquartile range) change in anteversion, inclination, and sacro-femoral-pubic being 0° (-1° to 3°), 1° (-3° to 2°), and 0° (-2° to 3°), respectively. CONCLUSION Our study found no significant change in functional cup orientation a minimum of 10 years after THA. No shifts in functional cup orientation as a result of altering spinopelvic alignment seemed to be present over a 10-year period.
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Affiliation(s)
- Brendan D Cotter
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Moritz M Innmann
- Department of Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Johanna S Dobransky
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Christian Merle
- Department of Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, Ontario, Canada
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25
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Dislocation rate and its risk factors in total hip arthroplasty with concurrent extensive spinal corrective fusion with pelvic fixation for adult spinal deformity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:283-290. [PMID: 32816054 DOI: 10.1007/s00590-020-02764-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Though there are several reports on the high dislocation rates following total hip arthroplasty (THA) before or after spinal surgery, the literature specific to extensive spinal corrective fusion with pelvic fixation for adult spinal deformity is limited. This study determined the rate and risk of hip dislocation after THA and extensive spinal corrective fusion. METHODS We retrospectively analyzed the data of 23 adults (27 hips) who underwent both extensive spinal corrective fusion with pelvic fixation and THA between 2010 and 2018. Surgery-related characteristics were investigated from medical records, while standing anteroposterior pelvic radiographs and lateral spinal radiographs were used to measure spinal alignment parameters and THA acetabular orientation. Patients were grouped based on the occurrence of dislocation, and the rate and risk of dislocation were compared. RESULTS The rate of THA dislocations was extremely high-22% (6 of 27 hips) of patients. All dislocations occurred posteriorly in patients with prior THAs that were performed using the posterior approach. The pelvic tilt was significantly greater in patients with THA dislocations (p = 0.02) than in those without. Cup radiographic anteversion in the supine (p = 0.02) and standing (p = 0.05) positions was significantly smaller in patients with dislocations than in those without. CONCLUSION Total hip arthroplasty concurrent with extensive spinal corrective fusion with pelvic fixation for adult spinal deformity has an extremely high rate of posterior hip dislocation. The posterior surgical approach and prior THA were high risk factors for dislocation. Hip and spine surgeons need focused pre-surgical planning to account for this risk.
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Widmer KH. The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components. Clin Orthop Relat Res 2020; 478:1904-1918. [PMID: 32732575 PMCID: PMC7371099 DOI: 10.1097/corr.0000000000001233] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lewinnek's recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. QUESTIONS/PURPOSES (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. METHODS A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation referencing to body planes was used: cups were abducted from 20° to 70°, and anteverted from -10° to 40°. Stems were rotated from -10° to 40° anteversion, neck-shaft angles varied from 115° to 143°, and head sizes varied from 28 to 40 mm. Hip movements up to the point of prosthetic impingement were tested, including simple flexion/extension, internal/external rotation, ab/adduction, combinations of these, and activities of daily living that were known to trigger dislocation. For each combination of parameters, the impingement-free combined target zone was determined. Maximizing the size of the combined target zone was the optimization criterion. RESULTS The combined target zones for impingement-free cup orientation had polygonal boundaries. Their size and position in the diagram changed with stem anteversion, neck-shaft angle, head size, and target ROM. The largest target zones were at neck-shaft angles from 125° to 127°, at stem anteversions from 10° to 20°, and at radiographic cup anteversions between 17° and 25°. Cup anteversion and stem anteversion were inverse-linearly correlated supporting the combined-anteversion concept. The range of impingement-free cup inclinations depended on head size, stem anteversion, and neck-shaft angle. For a 127°-neck-shaft angle, the lowest cup inclinations that fell within the target zone were 42° for the 28-mm and 35° for the 40-mm head. Cup anteversion and combined version depended on neck-shaft angle. For head size 32-mm cup, anteversion was 6° for a 115° neck-shaft angle and 25° for a 135°-neck-shaft angle, and combined version was 15° and 34° respectively. CONCLUSIONS The shape, size, and location of the combined target zones were dependent on design and implantation parameters of both components. Changing the prosthesis design or changing implantation parameters also changed the combined target zone. A maximized combined target zone was found. It is mandatory to consider both components to determine the accurate impingement-free prosthetic ROM in THA. CLINICAL RELEVANCE This study accurately defines the hypothetical impingement-free, design-specific component orientation in THA. Transforming it into clinical precision may be the case for navigation and/or robotics, but this is speculative, and as of now, unproven.
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Affiliation(s)
- Karl-Heinz Widmer
- K.-H. Widmer, Medical Faculty University of Basel, Basel, Switzerland
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Ueno T, Kabata T, Kajino Y, Takagi T, Ohmori T, Yoshitani J, Tsuchiya H. Influence of pelvic sagittal tilt on 3-dimensional bone coverage in total hip arthroplasty: a simulation analysis. Hip Int 2020; 30:288-295. [PMID: 31409140 DOI: 10.1177/1120700019868780] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND In total hip arthroplasty with computer navigation assistance, cup orientation is generally determined according to the coordinate system relative to the functional pelvic plane (FPP). However, there is a large difference in the cup anteversion between a posterior pelvic tilt relative to the computed tomography (CT) table in the sagittal plane and anterior pelvic tilt, even when the cup is set at the same orientation angle according to each FPP. The present study analysed this difference from the viewpoint of 3-dimensional (3D) coverage of the acetabular component (3D coverage) to determine how the 3D acetabular coverage is altered with changes in pelvic sagittal tilt. METHODS We analysed 3D-simulated acetabular coverage measured in 3D pelvic models reconstructed from the preoperative CT data of 50 patients. In each patient, we created 5 pelvic models with a sagittal tilt of 10° increments between 20° anterior tilt and 20° posterior tilt relative to the CT table. RESULTS We found that 3D coverage decreased as the pelvis tilted posteriorly. Particularly, there were significant differences between the pelvis with 20° anterior tilt and that with neutral tilt (p < 0.001). There was also a difference between the pelvis with neutral tilt and that with a 20° posterior tilt (p < 0.01). The mean decrease in 3D coverage between the pelvis with neutral tilt and that with 20° posterior tilt was 7.2 ± 1.6%. CONCLUSIONS We found that 3D coverage differed among pelvis with different sagittal tilts when the cup orientation angle was determined according to FPP.
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Affiliation(s)
- Takuro Ueno
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Tomoharu Takagi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Takaaki Ohmori
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Junya Yoshitani
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
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Kanto M, Maruo K, Tachibana T, Fukunishi S, Nishio S, Takeda Y, Arizumi F, Kusuyama K, Kishima K, Yoshiya S. Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty. Orthop Surg 2019; 11:438-442. [PMID: 31148364 PMCID: PMC6595105 DOI: 10.1111/os.12469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the impact of spinopelvic parameters and hip contracture on change in the pelvic tilt (PT) after Total hip arthroplasty (THA). Methods One hundred patients (15 male and 85 female) who underwent THA were included in this prospective study. Radiographic data were obtained preoperatively and 1 year after THA. Radiographic parameters included sagittal anterior pelvic plane (APP), sagittal vertical axis (SVA), sacral slope (SS), pelvic inclination (PI), and lumbar lordosis angle (LL). The APP was defined as the angle between the anterior pelvic plane and the vertical plane. A positive value indicates pelvic retroversion. Postoperative changes in PT were divided into three groups: the PA group (pelvic anteversion, ΔAPP < −5°), the PR group (pelvic retroversion, ΔAPP > 5°), and the PT group (minimal change, ΔAPP ≤ ± 5°). The Kruskal–Wallis test and the Steel–Dwass test were used to compare the preoperative and postoperative spinopelvic parameters among the three groups. The Spearman's rank correlation coefficient was used to evaluate the correlation between ΔAPP and spinopelvic parameters. Results Minimal change in pelvic tilt was observed in 59% of patients, while pelvic anteversion was observed in 16% of patients and pelvic retroversion was observed in 25% of patients. There were no significant changes in the spinopelvic parameters, including TK, LL, SVA, LL, SS, and APP after THA. The Femoral angle (FA) was significantly decreased after THA (P < 0.001). Preoperative APP was significantly more retroverted in the PA group than the PR group, and the PT group (6.8 ± 12.2, 0.2 ± 9.9, −8.3 ± 8.3, P < 0.001). Preoperative SS, PI‐LL, and PI were significantly smaller in the PA group than the PT group and the PR group. A significant negative correlation was identified between preoperative APP and ΔAPP (r = −0.418, P < 0.001). Conclusion Approximately 60% of the patients did not have any marked change in PT after THA. Preoperative APP was the only predictive factor associated with marked anterior or posterior change in PT.
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Affiliation(s)
- Makoto Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shigeo Fukunishi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shoji Nishio
- Department of Orthopaedic Surgery, Takarazuka City Hospital, Japan
| | - Yu Takeda
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuki Kusuyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuya Kishima
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Tezuka T, Inaba Y, Kobayashi N, Choe H, Higashihira S, Saito T. The influence of patient factors on femoral rotation after total hip arthroplasty. BMC Musculoskelet Disord 2018; 19:189. [PMID: 29885651 PMCID: PMC5994239 DOI: 10.1186/s12891-018-2110-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/24/2018] [Indexed: 11/25/2022] Open
Abstract
Background A postoperative change in femoral rotation following total hip arthroplasty (THA) might be the cause of dislocation due to the change in combined anteversion. However, very few studies have evaluated the femoral rotation angle following THA, or the factors that influence femoral rotation. We aimed to evaluate changes in femoral rotation after THA, and to investigate preoperative patient factors that influence femoral rotation after THA. Methods This study involved 211 hips treated with primary THA. We used computed tomography to measure the femoral rotation angle before and one week after THA. In addition, multiple regression analysis was performed to evaluate preoperative patient factors that could influence femoral rotation after THA. Results The femoral rotation angle was 0.2 ± 14° externally before surgery and 4.4 ± 12° internally after surgery (p < 0.001). Multiple regression analysis revealed that sex (β = 0.19; p = 0.003), age (β = 0.15; p = 0.017), preoperative anatomical femoral anteversion (β = − 0.25; p = 0.002), and preoperative femoral rotation angle (β = 0.36; p < 0.001) were significantly associated with the postoperative femoral rotation angle. The final model of the regression formula was described by the following equation: [postoperative femoral rotation angle = 5.41 × sex (female: 0, male: 1) + 0.15 × age - 0.22 × preoperative anatomical femoral anteversion + 0.33 × preoperative femoral rotation angle - 10.1]. Conclusion The current study showed the mean internal change of 4.6° in the femoral rotation angle one week after THA. Sex, age, preoperative anatomical femoral anteversion and preoperative femoral rotation were associated with postoperative femoral rotation. The patients who were male, older, and who exhibited lesser preoperative anatomical femoral anteversion or greater preoperative femoral rotation angles, tended to demonstrate an externally rotated femur after THA. Conversely, patients who were female, younger, and who exhibited greater preoperative anatomical femoral anteversion or lesser preoperative femoral rotation angles, tended to demonstrate an internal rotation of the femur after THA.
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Affiliation(s)
- Taro Tezuka
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
| | - Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Syota Higashihira
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Tomoyuki Saito
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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30
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Kochman A, Goral A, Kozak J, Marek W, Morawska-Kochman M, Synder M. Preoperative Ultrasonographic Assessment of the Anterior Pelvic Plane for Personalized Total Hip Replacement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:949-958. [PMID: 29027688 DOI: 10.1002/jum.14431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/07/2017] [Accepted: 07/15/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Correct positioning of the acetabular component is a key factor in minimizing the risk of dislocation after total hip replacement (THR) surgery. A "safe" orientation of the cup is usually defined by 2 angles measured between its geometric axis and the anterior pelvic plane. However, in the current state-of-the-art approach to THR surgery, the intraoperative orientation of the anterior pelvic plane cannot be measured. Even less is known about the functional orientation of the pelvis, which determines the postoperative orientation of the cup during the patient's everyday activities. The aim of this article is to present an original approach to personalized THR surgery, in which the necessary measurements are done preoperatively without interfering with the surgical work flow, and the individual orientation of the cup is obtained without navigation using standard tools that are available in the operating room. METHODS To quantify the effect of the anatomic conditions on the final orientation of the cup, we measured the orientation of the anterior pelvic plane in 43 patients scheduled for THR using a newly developed noninvasive method based on ultrasonography and mobile devices. RESULTS Our results confirm a large variability of the pelvic orientation in both supine and standing positions. We further show how this variability affects the final position of the cup and discuss its consequences for the patient. Finally, we explore a few practical solutions for individualized cup placement, including our own approach, which is based on tilting of the operating table. CONCLUSIONS In this work, we show that the common guidelines used today for cup implantation can only be effectively applied to a small portion of the population. In most cases, it is crucial that the orientation of the cup is readjusted for the particular anatomy of the individual patient.
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Affiliation(s)
| | - Adrian Goral
- Department of Measurements and Electronics, Akademia Górniczo-Hutnicza University of Science and Technology, Krakow, Poland
| | | | - Wojciech Marek
- Department of Trauma and Orthopedics, Hospital of the Ministry of Internal Affairs, Wroclaw, Poland
| | - Monika Morawska-Kochman
- Department and Clinic of Otolaryngology Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Synder
- Medical University of Lodz Clinic of Orthopedics and Pediatric Orthopedics, Lodz, Poland
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Nishiwaki T, Hata R, Oya A, Nakamura M, Matsumoto M, Kanaji A. Pelvic Tilt Displacement Before and After Artificial Hip Joint Replacement Surgery. J Arthroplasty 2018; 33:925-930. [PMID: 29122388 DOI: 10.1016/j.arth.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/20/2017] [Accepted: 10/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prediction of pelvic displacement before total hip arthroplasty (THA) is important for accurate acetabular implant placement. This study aimed to evaluate the effect of contralateral joint conditions on pelvic displacement after THA. METHODS A total of 355 cases that underwent computed tomography before and after THA for osteoarthritis due to developmental dysplasia were assessed. The pelvic plane was based on preoperative and postoperative day 1 computed tomography images. The displacement in the anteversion direction was expressed as +. Subjects with a minimal joint space <2 mm in the contralateral hip joint were in group N; subjects with ≥2 mm were in group W; subjects with THA were in group P; and subjects who underwent THA simultaneously on both sides were in group B. The Bartlett test was used when conducting the equal variance test among the groups. The F test was used for pairwise comparison. A P value <.01 was considered statistically significant. RESULTS Groups N, W, P, and B had 49, 227, 55, and 24 cases, respectively, and their displacements were -0.2° ± 2.7°, 0.8° ± 3.9°, 0.5° ± 2.6°, and 1.1° ± 4.0°, respectively; the variance between the groups was significantly different (P = .0001). The differences between groups W and N (P = .0020), between groups W and P (P = .0003), and between groups P and B (P = .0086) were statistically significant. CONCLUSION When the contralateral joint space is wide, the variance of the displacement is high. The contralateral joint affects pelvic displacement.
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Affiliation(s)
- Toru Nishiwaki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryosuke Hata
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akihito Oya
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Arihiko Kanaji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Chronological changes in functional cup position at 10 years after total hip arthroplasty. Hip Int 2017; 27:477-482. [PMID: 28218372 DOI: 10.5301/hipint.5000487] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period. METHODS We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery. RESULTS Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion. CONCLUSIONS Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.
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Inoue D, Kabata T, Kajino Y, Taga T, Hasegawa K, Yamamoto T, Takagi T, Ohmori T, Tsuchiya H. The influence of surgical approach on postoperative pelvic tilt after total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:1131-1138. [DOI: 10.1007/s00590-017-1946-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/11/2017] [Indexed: 12/29/2022]
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Chang JD, Kim IS, Bhardwaj AM, Badami RN. The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications. Hip Pelvis 2017; 29:1-14. [PMID: 28316957 PMCID: PMC5352720 DOI: 10.5371/hp.2017.29.1.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/31/2017] [Accepted: 02/09/2017] [Indexed: 12/27/2022] Open
Abstract
In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.
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Affiliation(s)
- Jun-Dong Chang
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - In-Sung Kim
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Atul M Bhardwaj
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Ramachandra N Badami
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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Does Pelvic Sagittal Inclination in the Supine and Standing Positions Change Over 10 Years of Follow-Up After Total Hip Arthroplasty? J Arthroplasty 2017; 32:877-882. [PMID: 27693053 DOI: 10.1016/j.arth.2016.08.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Functional anteversion and inclination of the cup change as the pelvic sagittal inclination (PSI) changes. The purposes of this study were to investigate the chronological changes of PSI during a 10-year follow-up period after total hip arthroplasty (THA) and to report the characteristics of patients who showed a greater than 10° change in the PSI from the supine to the standing position. METHODS The subjects were 70 patients who were followed up for 10 years after THA. PSI values in the supine and standing positions were measured by 2D-3D matching using computed tomography images and pelvic radiographs. PSI values before THA and 1, 5, and 10 years after THA were compared in both the supine and standing positions. RESULTS Supine PSI showed less than 5° of change, whereas standing PSI showed a significant decrease with time over the 10-year period. Although 43% of patients with less than 10° of difference in the PSI between the supine and standing positions before THA increased PSI posteriorly (reclining) more than 10° in standing from the supine position at 10 years, no late dislocation was observed. CONCLUSION Supine PSI showed no significant change, but standing PSI showed a significant increase posteriorly with time over a 10-year period. However, this PSI change did not reach the level that it caused negative consequences such as late dislocation. The pelvic position in the supine position might still be a good functional reference position of the pelvis for aiming to achieve proper cup alignment at 10 years.
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Pierrepont J, Hawdon G, Miles BP, Connor BO, Baré J, Walter LR, Marel E, Solomon M, McMahon S, Shimmin AJ. Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. Bone Joint J 2017; 99-B:184-191. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0098.r1] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/25/2016] [Indexed: 11/05/2022]
Abstract
Aims The pelvis rotates in the sagittal plane during daily activities. These rotations have a direct effect on the functional orientation of the acetabulum. The aim of this study was to quantify changes in pelvic tilt between different functional positions. Patients and Methods Pre-operatively, pelvic tilt was measured in 1517 patients undergoing total hip arthroplasty (THA) in three functional positions – supine, standing and flexed seated (the moment when patients initiate rising from a seated position). Supine pelvic tilt was measured from CT scans, standing and flexed seated pelvic tilts were measured from standardised lateral radiographs. Anterior pelvic tilt was assigned a positive value. Results The mean pelvic tilt was 4.2° (-20.5° to 24.5°), -1.3° (-30.2° to 27.9°) and 0.6° (-42.0° to 41.3°) in the three positions, respectively. The mean sagittal pelvic rotation from supine to standing was -5.5° (-21.8° to 8.4°), from supine to flexed seated was -3.7° (-48.3° to 38.6°) and from standing to flexed seated was 1.8° (-51.8° to 39.5°). In 259 patients (17%), the extent of sagittal pelvic rotation could lead to functional malorientation of the acetabular component. Factoring in an intra-operative delivery error of ± 5° extends this risk to 51% of patients. Conclusion Planning and measurement of the intended position of the acetabular component in the supine position may fail to predict clinically significant changes in its orientation during functional activities, as a consequence of individual pelvic kinematics. Optimal orientation is patient-specific and requires an evaluation of functional pelvic tilt pre-operatively. Cite this article: Bone Joint J 2017;99-B:184–91.
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Affiliation(s)
- J. Pierrepont
- The University of Sydney, School of Aerospace,
Mechanical and Mechatronic Engineering, Building J07, Sydney NSW
2006, Australia and Optimized Ortho, 17 Bridge
Street, Pymble NSW 2073, Australia
| | - G. Hawdon
- Malabar Orthopaedic Clinic, 43
The Avenue, Windsor, VIC
3181, Australia
| | - B. P. Miles
- Optimized Ortho, 17
Bridge Street, Pymble NSW 2073, Australia
| | - B. O’ Connor
- Optimized Ortho, 17
Bridge Street, Pymble NSW 2073, Australia
| | - J. Baré
- Melbourne Orthopaedic Group, 33
The Avenue, Windsor, VIC
3191, Australia
| | - L. R. Walter
- Peninsula Orthopaedics, 812
Pittwater Rd, Dee Why, NSW
2099, Australia
| | - E. Marel
- Peninsula Orthopaedics, 812
Pittwater Rd, Dee Why, NSW
2099, Australia
| | - M. Solomon
- Sydney Orthopaedic Specialists, Suite
29, Prince of Wales Private Hospital, Randwick
NSW 2031, Australia
| | - S. McMahon
- Monash University, 43
The Avenue, Windsor VIC 3181, Australia
| | - A. J. Shimmin
- Monash
University, 43 The Avenue, Windsor VIC 3181, Australia and Melbourne
Orthopaedic Group, 33 The Avenue, Windsor, VIC
3191, Australia
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Bedard NA, Martin CT, Slaven SE, Pugely AJ, Mendoza-Lattes SA, Callaghan JJ. Abnormally High Dislocation Rates of Total Hip Arthroplasty After Spinal Deformity Surgery. J Arthroplasty 2016; 31:2884-2885. [PMID: 27612605 DOI: 10.1016/j.arth.2016.07.049] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of concurrent spinopelvic fusion and THA and identify the risk of THA dislocation in patients with concurrent spinopelvic fusion. METHODS We retrospectively reviewed an institutional database of spinal deformity patients and the Humana Inc data set to identify patients with concurrent THA and spinopelvic fusion. The prevalence of concurrent THA and spinopelvic fusion was identified, as was the risk of dislocation for all cohorts. RESULTS Of 328 patients with spinopelvic fusions at our institution, 15 patients (4.6%) were found to have concurrent THA. Similarly, within the Humana database among 1049 patients with spinopelvic fusion, 4.6% had a concurrent THA. Among the 58,692 THA patients identified, only 0.1% had a concurrent spinopelvic fusion. A THA dislocation was observed in 3 of 15 patients (20.0%) and 3 of 18 THA (16.7%) within our institutional review. Within the Humana database, 8.3% of patients with THA and spinopelvic fusion went on to have a dislocation of their THA compared to 2.9% of patients with THA and no history of spinopelvic fusion (relative risk: 2.9 [1.2-7.6]). CONCLUSION Among patients with spinopelvic fusion, the prevalence of concurrent THA is 4.6%, and among primary THA patients, the prevalence of concurrent spinopelvic fusion is 0.1%. An alarmingly high THA dislocation rate has been demonstrated among THA patients with concurrent spinopelvic fusion at our institution (20%) and within a large national database (8.3%).
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Affiliation(s)
- Nicholas A Bedard
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher T Martin
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sean E Slaven
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Andrew J Pugely
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | - John J Callaghan
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Repeated posterior dislocation of total hip arthroplasty after spinal corrective long fusion with pelvic fixation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:100-106. [DOI: 10.1007/s00586-016-4880-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 09/24/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
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Sing DC, Barry JJ, Aguilar TU, Theologis AA, Patterson JT, Tay BK, Vail TP, Hansen EN. Prior Lumbar Spinal Arthrodesis Increases Risk of Prosthetic-Related Complication in Total Hip Arthroplasty. J Arthroplasty 2016; 31:227-232.e1. [PMID: 27444852 DOI: 10.1016/j.arth.2016.02.069] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/28/2016] [Accepted: 02/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Degenerative hip disorders often coexist with degenerative changes of the lumbar spine. Limited data on this patient population suggest inferior functional improvement and pain relief after surgical management. The purpose of this study is to compare the rates of prosthetic-related complication after primary total hip arthroplasty (THA) in patients with and without prior lumbar spine arthrodesis (SA). METHODS Medicare patients (n = 811,601) undergoing primary THA were identified and grouped by length of prior SA (no fusion, 1-2 levels fused [S-SAHA], and ≥3 levels fused [L-SAHA]). RESULTS Compared with controls, patients with prior SA had significantly higher rates of complications including dislocation (control: 2.36%; S-SAHA: 4.26%; and L-SAHA: 7.51%), revision (control: 3.43%, S-SAHA: 5.55%, and L-SAHA: 7.77%), loosening (control: 1.33%, S-SAHA: 2.10%, and L-SAHA: 3.04%), and any prosthetic-related complication (control: 7.33%, S-SAHA: 11.15% [relative risk: 1.52], and L-SAHA: 14.16% [relative risk: 1.93]) within 24 months (P < .001). CONCLUSION The interplay of coexisting degenerative hip and spine disease deserves further attention of both arthroplasty and spine surgeons.
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Affiliation(s)
- David C Sing
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Jeffrey J Barry
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Thomas U Aguilar
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Alexander A Theologis
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Joseph T Patterson
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Bobby K Tay
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Thomas P Vail
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Erik N Hansen
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
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Inaba Y, Kobayashi N, Suzuki H, Ike H, Kubota S, Saito T. Preoperative planning for implant placement with consideration of pelvic tilt in total hip arthroplasty: postoperative efficacy evaluation. BMC Musculoskelet Disord 2016; 17:280. [PMID: 27412447 PMCID: PMC4944317 DOI: 10.1186/s12891-016-1120-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background In total hip arthroplasty (THA), tilting of the pelvis alters the cup placement angles. Thus, the cup angles need to be planned with consideration of the effects of pelvic tilt. In the present study, we evaluated the efficacy of preoperative planning for implant placement with consideration of pelvic tilt in THA, and the accuracy of a CT-based computer navigation for implant positioning. Methods We examined 75 hips of 75 patients who underwent THA and were followed-up for one year postoperatively. The patients were divided into three groups (anterior, intermediate, posterior tilt) according to their preoperative pelvic tilt. Preoperative planning for implant placement was made with consideration of pelvic tilt and a CT-based navigation was used to execute the preoperative planning. Cup inclination, cup anteversion, and combined anteversion (CA) in supine and standing positions were examined 1 year after THA. The accuracy of the computer navigation was also examined. Results Mean CA was 35.0 ± 5.8° in supine position and 39.3 ± 5.7° in standing position. CA did not differ among the three subgroups (anterior, intermediate, posterior tilt) in either supine or standing position, indicating implant placements to be equally effective. The desired CA (37.3°) was midway between those in supine and standing positions for each subgroup. Respective mean absolute errors between preoperative planning and postoperative CT measurement was 5.3 ± 5.2° for CA. Conclusion We obtained favorable THA results with preoperative planning with consideration of pelvic tilt by demonstrating supine and standing CA to be unaffected by preoperative pelvic tilt one year postoperatively. Mean absolute error of CA between preoperative planning and postoperative measurement was 5° with use of the CT-based navigation.
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Affiliation(s)
- Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Haruka Suzuki
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - So Kubota
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Pierannunzii L. Letter to the Editor: Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty: When Does it Matter? J Arthroplasty 2016. [PMID: 26199193 DOI: 10.1016/j.arth.2015.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Suzuki H, Inaba Y, Kobayashi N, Ishida T, Ike H, Saito T. Postural and Chronological Change in Pelvic Tilt Five Years After Total Hip Arthroplasty in Patients With Developmental Dysplasia of the Hip: A Three-Dimensional Analysis. J Arthroplasty 2016; 31:317-22. [PMID: 26276573 DOI: 10.1016/j.arth.2015.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 07/01/2015] [Accepted: 07/15/2015] [Indexed: 02/01/2023] Open
Abstract
The pelvis generally tilts to the posterior with movement from the supine to standing position, and with time after total hip arthroplasty (THA). This study aimed to investigate changes in pelvic tilt from the preoperative supine position to the standing position at 5 years after THA (pelvic change, PC). We measured pelvic tilt using a 2D-3D matching technique in 77 unilaterally affected patients who underwent primary THA. PC in 8% of all patients was ≤-20°, and the greatest PC was -25°. In these patients, posterior pelvic tilt continued up to 5 years after THA. These patients were older, and their lumbo-lordotic angle was small. For such cases, cup orientation should be planned to account for continuous posterior change in pelvic tilt after THA.
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Affiliation(s)
- Haruka Suzuki
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Takashi Ishida
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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Influence of Pelvic Tilt on Polyethylene Wear after Total Hip Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2015; 2015:327217. [PMID: 26258136 PMCID: PMC4519540 DOI: 10.1155/2015/327217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/06/2015] [Indexed: 11/17/2022]
Abstract
We aimed to evaluate the effects of pelvic tilt on polyethylene wear after total hip arthroplasty (THA). A total of 105 joints treated with primary THA were included; conventional polyethylene (CPE) liners were used in 43 hips and highly cross-linked polyethylene (HXLPE) liners were used in the remaining 62 hips. The pelvis was tilted 6° posteriorly in the standing position as compared to the supine position, which resulted in significant increases of 1.7° and 2.8° in cup inclination in the CPE and HXLPE groups, respectively. Moreover, the change in pelvic tilt resulted in significant increases of 3.6° and 4.9° in cup anteversion in the CPE and HXLPE groups, respectively. For the CPE group, multiple regression analysis showed a significant association between the angle of pelvic tilt (PTA) and cup inclination and the polyethylene wear ratio. The adjusted R2 of the regression model was larger for measures obtained in the standing position as compared to the supine position. For the HXLPE group, there was no significant relationship between radiographic parameters and polyethylene wear. Close observation of polyethylene wear is recommended for patients with severe posterior pelvic tilt who have undergone THA with conventional polyethylene.
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Zhang Y, Cheng T, Zhang XL. Changes in Intra-pelvic Obliquity Angle 0-2 Years After Total Hip Arthroplasty and Its Effects on Leg Length Discrepancy: A Retrospective Study. Chin Med J (Engl) 2015; 128:1346-50. [PMID: 25963356 PMCID: PMC4830315 DOI: 10.4103/0366-6999.156780] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Total hip arthroplasty (THA) is one of the most effective treatments for phase III and IV hip arthrosis. Lower limb length balancing is one of the determining factors of a successful surgery, particularly in patients with developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate the postoperative change in intra-pelvic obliquity (intra-PO) angle in the coronal plane and its effects on leg length discrepancy (LLD) within 2 years. Methods: A total of 78 patients (70 females, 8 males) were enrolled in this study. All patients were suffering from DDH with varying degrees of LLD. Pelvic plain radiographs were collected before and after the operation. The intra-PO angles were measured 0, 0.5, 1 and 2 years after THA. At the same time, postoperative LLD was measured with blocking test. Results: PO changed significantly in the first year after THA surgery (0 year vs. 0.5 year, P < 0.01; 0.5 year vs. 1 year, P < 0.01), and the changing value of intra-PO angle (ΔPO) slowed down substantially during the first 2 years after THA (0.5 year vs. 0.5–1 year, P < 0.01; 0.5–1 year vs. 1–2 years, P < 0.01). With the change in intra-PO angle, LLD also got narrow within the 1st year (0 year vs. 0.5 year, P < 0.01; 0.5 year vs. 1 year, P < 0.01). Elderly patients had a smaller intra-PO angle reduction (Group A vs. Group B, P = 0.01; Group B vs. Group C, P < 0.01). Conclusions: Intra-PO angle and LLD gap narrowed with time after THA surgery. In particular, elderly patients had smaller change in intra-PO angle.
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Affiliation(s)
| | | | - Xian-Long Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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45
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Tamura S, Miki H, Tsuda K, Takao M, Hattori A, Suzuki N, Yonenobu K, Sugano N. Hip range of motion during daily activities in patients with posterior pelvic tilt from supine to standing position. J Orthop Res 2015; 33:542-7. [PMID: 25492855 DOI: 10.1002/jor.22799] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 12/04/2014] [Indexed: 02/04/2023]
Abstract
In most patients with hip disorders, the anterior pelvic plane (APP) sagittal tilt does not change from supine to standing position. However, in some patients, APP sagittal tilt changes more than 10° posteriorly from supine to standing position. The purpose of this study was to both examine APP sagittal tilt and investigate the hip flexion and extension range of motion (ROM) required during daily activities in these atypical patients. Patient-specific 4-dimensional (4D) motion analysis was performed for 50 hips from 44 patients who had undergone total hip arthroplasty. All patients divided into two categories, such as atypical patients for whom the pelvis tilted more than 10° posteriorly from supine to standing position preoperatively (19 hips from 18 patients) and the remaining typical patients (31 hips from 26 patients). The required hip flexion and extension angles did not differ significantly between atypical patients and typical patients. In conclusion, the hip flexion ROM during deep bending activities and hip extension ROM during extension activities required in those atypical patients with pelvic tilt more than 10° backward from supine to standing position did not shift in the direction of extension.
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Affiliation(s)
- Satoru Tamura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
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Lazennec JY, Rousseau MA, Brusson A, Folinais D, Amel M, Clarke I, Pour AE. Total Hip Prostheses in Standing, Sitting and Squatting Positions: An Overview of Our 8 Years Practice Using the EOS Imaging Technology. Open Orthop J 2015; 9:26-44. [PMID: 25861404 PMCID: PMC4384273 DOI: 10.2174/1874325001509010026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/16/2015] [Accepted: 01/26/2014] [Indexed: 11/30/2022] Open
Abstract
More total hip arthroplasty (THA) is performed worldwide and especially in younger and more active patients compared to earlier decades. One of the focuses of THA research in the future will be on optimizing the radiological follow-up of these patients using 2D and 3D measurements of implants position while reducing the radiation dose delivered. Low-dose EOS® imaging is an innovative slot-scanning radiograph system providing valuable information in patient functional positions (standing, sitting and even squatting positions). EOS has been proven accurate and reliable without significant inconvenience caused by the metallic artifacts of implants. The ability to obtain precise data on implant orientation according to the patient posture opens new perspectives for a comprehensive analysis of the pelvic frontal and sagittal balance and its potential impact on implants function and failures. We report our 8 years experience on our first 300 THA patients using this technology routinely for pre and post op evaluation. Our results will be compared and confronted with the actual literature about this innovative technology. We shall especially emphasize our experience about patients with abnormal posture and the evolution of the subject over time, because the phenomenon of an aging spine is frequently associated with the process of aging hips.
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Affiliation(s)
- Jean-Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital, Assistance Publique - Hopitaux de Paris, UPMC, 47-83 Boulevard de l'hôpital, 75013 Paris, France ; BiomechanicsLab (LBM), Arts et Metiers Paris-Tech, Paris, France ; Department of Anatomy, UPMC, 105 Boulevard de l'hôpital, 75013 Paris, France
| | - Marc-Antoine Rousseau
- BiomechanicsLab (LBM), Arts et Metiers Paris-Tech, Paris, France ; Department of Orthopaedic and Trauma Surgery, Avicenne Hospital, Assistance Publique - Hopitaux de Paris, 125 rue de Stalingrad, 93009, Bobigny, France
| | - Adrien Brusson
- Department of Anatomy, UPMC, 105 Boulevard de l'hôpital, 75013 Paris, France
| | | | - Maria Amel
- Department of Anatomy, UPMC, 105 Boulevard de l'hôpital, 75013 Paris, France
| | - Ian Clarke
- Loma Linda University Medical Center, Director Peterson Research Center at Loma Linda University, California, USA
| | - Aidin Eslam Pour
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Standing or supine x-rays after total hip replacement - when is the safe zone not safe? Hip Int 2014; 24:616-23. [PMID: 25096454 DOI: 10.5301/hipint.5000173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 02/04/2023]
Abstract
An acetabular prosthesis orientated outside the 'safe zone' is one of the key contributing factors in increasing complications after total hip replacement (THR). Although acetabular orientation is routinely assessed using supine x-rays, standing x-rays have been proposed because a change in body position alters pelvic tilt and therefore acetabular orientation. This study aimed to assess whether acetabular components orientated within the 'safe zone' in supine can also be outside the 'safe zone' in standing. Thirty patients (12M, 18F) had lateral and antero-posterior pelvic x-rays taken in standing and supine positions six weeks post THR. Pelvic tilt and acetabular orientation (anteversion and inclination) were measured and compared with respect to the limits of the 'safe zone'. In standing, the pelvis was relatively posteriorly tilted and both acetabular anteversion and inclination increased (p<0.0001). In 16 patients the acetabulum was orientated within the 'safe zone' in supine but outside the 'safe zone' in standing. Patients were significantly more likely to be outside the 'safe zone' in standing than when supine (p<0.0001).
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Rapid hip osteoarthritis development in a patient with anterior acetabular cyst with sagittal alignment change. Case Rep Orthop 2014; 2014:523426. [PMID: 25405044 PMCID: PMC4227374 DOI: 10.1155/2014/523426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/09/2014] [Indexed: 12/01/2022] Open
Abstract
Rapidly destructive coxarthrosis (RDC) is rare and develops unusual clinical course. Recent studies suggest multiple possible mechanisms of the development of RDC. However the exact mechanism of RDC is still not clear. The difficulty of the study on RDC is attributed to its rareness and the fact that the data before the onset of RDC is normally unavailable. In this report, we presented the patient having the radiographic data before the onset who had rapid osteoarthritis (OA) development after contralateral THA, which meets the current criteria of RDC. We thought that the increased posterior tilt of the pelvis after THA reinforced the stress concentration at pre-existed anterior acetabular cyst, thereby the destruction of the cyst was occurred. As a result the rapid OA was developed. We think that there is the case of rapid osteoarthritis developing due to alternating load concentration by posterior pelvic tilt on preexisting anterior acetabular cyst such as our patient among the cases diagnosed as RDC without any identifiable etiology. The recognition of sagittal alignment changes and anterior acetabular cyst may play important role in prediction and prevention of the rapid hip osteoarthritis development similar to RDC.
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The reliability of the anterior pelvic plane for computer navigated acetabular component placement during total hip arthroplasty: prospective study with the EOS imaging system. Orthop Traumatol Surg Res 2014; 100:S287-91. [PMID: 25129705 DOI: 10.1016/j.otsr.2014.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/01/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Computer navigated total hip arthroplasty is mostly based on the use of the anterior pelvic plane (APP) as a reference. EOS is a new imaging system that provides three-dimensional analysis of the pelvis in a functional position with a low dose of radiation. The aim of this study was to evaluate the reliability of the APP for placement of the cup during computer navigated THA using EOS. HYPOTHESIS The reliability of the APP is limited for the placement of the acetabular cup during computer navigated THA. MATERIALS AND METHODS This was a prospective monocentric study using the EOS imaging system evaluating 44 patients in the standing position three months after computer navigated THA (Orthopilot). Reproducibility of EOS measurements were analyzed using SterEOS software and the reliability of the navigation data for the position of the cup were assessed. RESULTS Intra and interobserver reproducibility of the measurements of the orientation of the cup by EOS were good with correlation coefficients above 93% and 95% and confidence intervals of less than ±5°. Mean cup inclination and anteversion were 41.3° and 20.9° and 44.3° and 29.5° respectively in operatively and post-operatively. The differences between measurements of operative cup inclination using computer assisted navigation and the post-operative EOS measurements were significant (P<0.05) with a correlation coefficient of less than 40%. DISCUSSION Our study confirms the lack of precision of the APP as a reference for positioning of the acetabular component, especially in relation to anteversion. Although for many years the APP was considered to be a global reference, in fact, it is subject to significant inter-individual variations and variations during changes in position. These factors, associated with the difficulty of determining the preoperative APP, explain the lack of reliability of this reference. Preoperative evaluation of the orientation of APP by EOS and its integration into the navigation system could help the operator position these components. LEVEL OF EVIDENCE Level III Prospective diagnostic case controlled study.
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Miki H, Kyo T, Kuroda Y, Nakahara I, Sugano N. Risk of edge-loading and prosthesis impingement due to posterior pelvic tilting after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2014; 29:607-13. [PMID: 24933660 DOI: 10.1016/j.clinbiomech.2014.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proper implant orientation is essential for avoiding edge-loading and prosthesis impingement in total hip arthroplasty. Although cup orientation is affected by a change in pelvic tilt after surgery, it has been unclear whether surgeons can prevent impingement and edge-loading by proper positioning by taking into account any change in pelvic alignment associated with alteration of hip range of motion. METHODS We simulated implant orientation without edge-loading and prosthesis impingement, even with a change in pelvic tilt and associated change in hip range of motion after surgery, by collision detection using implant models created with computer-aided design. FINDINGS If posterior pelvic tilting with a corresponding hyperextension change in hip range of motion after surgery remains within 10°, as occurs in 90% of cases, surgeons can avoid edge-loading and impingement by correctly orienting the implant, even when using a conventional prosthesis. However, if a 20° change occurs after surgery, it may be difficult to avoid those risks. INTERPRETATION Although edge-loading and impingement can be prevented by performing appropriate surgery in most cases, even when taking into account postoperative changes in pelvic tilt, it may also be important to pay attention to spinal conditions to ensure that pelvic tilting is not extreme because of increasing kyphosis.
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Affiliation(s)
- Hidenobu Miki
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
| | - Takayuki Kyo
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
| | - Yasuo Kuroda
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
| | - Ichiro Nakahara
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
| | - Nobuhiko Sugano
- Department of Orthopedic Surgery, Medical School of Osaka University, Osaka, Japan.
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