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Dharnipragada R, Bostrom N, Bertogliat M, Denduluri LS, Dhawan S, Ladd B, Woodrow S, Parr AM. Sagittal balance in sitting and standing positions: A systematic review of radiographic measures. Heliyon 2024; 10:e28545. [PMID: 38590852 PMCID: PMC10999916 DOI: 10.1016/j.heliyon.2024.e28545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background Sagittal imbalance can be caused by various etiologies and is among the most important indicators of spinal deformity. Sagittal balance can be restored through surgical intervention based on several radiographic measures. The purpose of this study is to review the normal parameters in the sitting position, which are not well understood and could have significant implications for non-ambulatory patients. Methods A systematic review was performed adhering to PRISMA Guidelines. Using R-software, the weighted means and 95% confidence intervals of the radiographic findings were calculated using a random effect model and significance testing using unpaired t-tests. Results 10 articles with a total of 1066 subjects reported radiographic measures of subjects with no spinal deformity in the sitting and standing position. In the healthy individual, standing sagittal vertical axis -16.8°was significantly less than sitting 28.4° (p < 0.0001), while standing lumbar lordosis 43.3°is significantly greater than sitting 21.3° (p < 0.0001). Thoracic kyphosis was not significantly different between the two groups (p = 0.368). Standing sacral slope 34.3° was significantly greater than sitting 19.5° (p < 0.0001) and standing pelvic tilt 14.0° was significantly less than sitting 33.9° (p < 0.0001). Conclusions There are key differences between standing and sitting postures, which could lead to undue stress on surgical implants and poor outcomes, especially for non-ambulatory populations. There is a need for more studies reporting sitting and standing radiographic measures in different postures and spinal conditions.
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Affiliation(s)
- Rajiv Dharnipragada
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Nick Bostrom
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Mario Bertogliat
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Lalitha S. Denduluri
- College of Liberal Arts, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Bryan Ladd
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Sarah Woodrow
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Ann M. Parr
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
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Li Y, Qian BP, Qiu Y, Yu Y, Wang B. Risk factors of hip joint structural changes following pedicle subtraction osteotomy for ankylosing spondylitis-related thoracolumbar kyphosis: a minimum two-year observation. 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 2023; 32:2293-2302. [PMID: 37154940 DOI: 10.1007/s00586-023-07726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To determine the clinical- and surgical-related factors of hip joint structural changes in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who underwent PSO. METHODS Hip involvement was assessed by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) and defined by a score of at least 2. 52 patients with BASRI-h scores maintained and 78 patients with BASRI-h scores increased during follow-up were retrospectively reviewed. Clinical data were recorded. Radiological assessment was performed preoperatively, postoperatively, and at the final follow-up. RESULTS No significant difference existed in age, gender and follow-up time between the groups, but earlier onset of AS, longer disease and kyphotic duration, and worse Bath Ankylosing Spondylitis Functional Index (BASFI) scores at the final follow-up were observed in patients with BASRI-h scores increased (P < 0.05). Besides, global kyphosis (GK), T1-pelvic angle (TPA), pelvic tilt (PT) and anterior pelvic plane angle (APPA) were always larger in patients with BASRI-h scores increased, accompanied with more sacral fixation (P < 0.05). Multivariate logistics regression showed that earlier onset of AS, longer kyphotic duration, larger preoperative GK, sacral fixation and larger APPA during follow-up were independent risk factors. CONCLUSION Earlier onset of AS and longer kyphotic duration were the clinical risk factors of hip joint structural changes in AS patients following PSO, while larger preoperative GK, sacral fixation in PSO and larger APPA during follow-up were the surgical-related factors. Surgeons should inform patients with risk factors of the possibility for severe hip joint structural changes after PSO.
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Affiliation(s)
- Yao Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Bang-Ping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Yang Yu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
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Sculco PK, Wright T, Malahias MA, Gu A, Bostrom M, Haddad F, Jerabek S, Bolognesi M, Fehring T, Gonzalez DellaValle A, Jiranek W, Walter W, Paprosky W, Garbuz D, Sculco T, Abdel M, Boettner F, Benazzo F, Buttaro M, Choi D, Engh CA, Garcia-Cimbrelo E, Garcia-Rey E, Gehrke T, Griffin WL, Hansen E, Hozack WJ, Jones S, Lee GC, Lipman J, Manktelow A, McLaren AC, Nelissen R, O’Hara L, Perka C, Sporer S. The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium. HSS J 2022; 18:8-41. [PMID: 35082557 PMCID: PMC8753540 DOI: 10.1177/15563316211034850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review. This document provides an overview of these 4 areas, the consensus each group arrived at, and directions for future research.
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Affiliation(s)
- Peter K. Sculco
- Hospital for Special Surgery, New York, NY, USA,Peter K. Sculco, MD, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021, USA.
| | | | | | - Alexander Gu
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Fares Haddad
- University College London Hospitals NHS Foundation Trust and Institute of Sport, Exercise & Health, London, UK
| | | | | | | | | | | | - William Walter
- Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Wayne Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Donald Garbuz
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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Loppini M, Pisano A, Ruggeri R, Della Rocca A, Grappiolo G. Pelvic tilt and functional acetabular position after total hip arthroplasty: an EOS 2D/3D radiographic study. Hip Int 2022; 33:365-370. [PMID: 35073774 DOI: 10.1177/11207000211073668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE In total hip arthroplasty (THA), the functional anatomy of the spinopelvic unit should be taken into account to provide the correct functional positioning of the implant. The relationship between the spine and the pelvis in the sagittal plane is represented by pelvic tilt (PT). The sacral slope (SS) has been proposed as a more reliable parameter than the anterior pelvic plane (APP) to express the PT. This study investigated the relationship between the APP and the SS; and the relationship between the APP and the SS, respectively, with the postoperative acetabular orientation. METHODS 45 patients undergoing primary THA were prospectively enrolled. The EOS 2D/3D system was used to perform the radiographic evaluation before and 3 months after surgery. The following parameters were measured in both standing and sitting position: SS, APP, acetabular anteversion (AA) and inclination (AI). RESULTS The SS values did not show any correlation with the values of the APP angle. The changes of the SS in the transition from the standing to the sitting position significantly correlated with the changes of the AA (r = -0.61; p < 0.0001). A weak correlation was found between the APP angle and the AA in standing position (r = -0.35; p = 0.02). CONCLUSIONS The SS accurately expresses the functional orientation of the pelvis in the sagittal plane, and the functional orientation of the cup after hip replacement. Therefore, SS could be taken into account by navigation systems in order to achieve a patient-specific functional position of the acetabular cup.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy.,Livio Sciutto Onlus Foundation, Savona Campus, University of Genova, Savona, Italy
| | - Alessandro Pisano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Riccardo Ruggeri
- IRCCS Humanitas Research Hospital, Milan, Italy.,Livio Sciutto Onlus Foundation, Savona Campus, University of Genova, Savona, Italy
| | - Antonello Della Rocca
- IRCCS Humanitas Research Hospital, Milan, Italy.,Livio Sciutto Onlus Foundation, Savona Campus, University of Genova, Savona, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Milan, Italy.,Livio Sciutto Onlus Foundation, Savona Campus, University of Genova, Savona, Italy
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Loppini M, Temporiti F, Furone R, Galli M, Grappiolo G, Gatti R. Static and dynamic pelvic kinematics after one-stage bilateral or unilateral total hip arthroplasty. Hip Int 2021; 31:729-734. [PMID: 32363933 DOI: 10.1177/1120700020921120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The pelvis rotates simultaneously around both hips along sagittal, frontal and transversal planes and its kinematics change in patients after total hip arthroplasty (THA). Consequently, it is reasonable to expect different pelvic kinematic profiles in bilateral or unilateral THA. Therefore, the aim of this study was to compare pelvic kinematics in patients with bilateral or unilateral THA. METHODS 40 patients undergoing bilateral (n = 20) or unilateral (n = 20) THA were evaluated for pelvic kinematics during standing and walking tasks using an optoelectronic system. Mean pelvic orientation was assessed during standing, whereas the Gait Variable Score (GVS), maximum and minimum peaks, range and values of pelvic tilt, obliquity and rotation during Heel-Strike and Toe-Off phases of gait cycle were calculated during walking. Data were collected the day before and at seven days after surgery. RESULTS At baseline, no between-group differences were found. At 7 days, GVS for pelvic tilt (p = 0.029) and rotation (p = 0.046) were closer to normative data in bilateral patients, who also revealed lower maximum peak of anterior tilt (p = 0.013) and lower range of pelvic tilt during gait (p = 0.031) with respect to unilateral cases. No between-group differences were found for pelvic orientation during standing at any time-point. CONCLUSIONS Bilateral patients revealed more physiological pelvic kinematics than unilateral cases. These findings underline the advantage of patients undergoing 1-stage bilateral THA and may be helpful in selecting personalised rehabilitative approaches.
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Affiliation(s)
- Mattia Loppini
- Hip and Knee Orthopaedic Surgery Department, Humanitas Clinical and Research Centre, Milan, Italy.,Humanitas University, Milan, Italy
| | - Federico Temporiti
- Humanitas University, Milan, Italy.,Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | - Roberta Furone
- Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy.,BTS S.p.A., Milan, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Guido Grappiolo
- Hip and Knee Orthopaedic Surgery Department, Humanitas Clinical and Research Centre, Milan, Italy
| | - Roberto Gatti
- Humanitas University, Milan, Italy.,Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy
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Candela V, De Carli A, Longo UG, Sturm S, Bruni G, Salvatore G, Denaro V. Hip and Groin Pain in Soccer Players. JOINTS 2021; 7:182-187. [PMID: 34235383 PMCID: PMC8253608 DOI: 10.1055/s-0041-1730978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/18/2021] [Indexed: 10/29/2022]
Abstract
Purpose The aim of this article is to illustrate the recent framework necessary to standardize studies on groin pain and review the existing literature on groin pain in football. Methods The common pathological processes underlying groin pain such as muscle, tendon or ligament strain, bone injury or fracture, sport hernia, bursitis, osteitis pubis, and hip-related diseases have been reviewed and current management options have been considered. Results Groin pain is considered a pain in pubic or lower abdominal or adductors region which can be monolateral or bilateral. It is common in high-intensity team sports and can negatively affect an athlete's professional carrier, causing serious disruption in the performance. Despite a high prevalence of groin pain in athletes, diagnosis and management of the underlying pathological processes remain a challenge for surgeons, radiologists, and physiotherapists alike. Conclusion A multidisciplinary approach is essential for patients with groin pain allowing prompt diagnosis and initiation of treatment thus facilitating more rapid return to play and preventing potential long-term sequelae of chronic groin pathology.
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Affiliation(s)
- Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Angelo De Carli
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza," Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Sofia Sturm
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Giorgio Bruni
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza," Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
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7
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Validity of the EOS-determined pelvic parameters and orientation with pelvic positional variation: a phantom study. Sci Rep 2021; 11:10468. [PMID: 34001983 PMCID: PMC8129068 DOI: 10.1038/s41598-021-89958-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 04/30/2021] [Indexed: 02/03/2023] Open
Abstract
The EOS is a medical imaging system that incorporates simultaneous orthogonal images, producing three-dimensional (3D) reconstructions of the whole skeletal system in various functional positions. Despite growing interest in the pelvic 3D position, the validity of the EOS has not yet been well studied. We investigated the trueness and precision of EOS imaging for pelvic parameters and orientation and assessed whether the measurement using the EOS was affected by the pelvic orientation itself. The orientation of the anterior pelvic plane and pelvic parameters of a custom-made pelvic phantom were measured by three raters using the EOS, and the measurements obtained were compared with the true values. The standard deviations of the measurement errors were 3.23°, 0.26°, 0.23°, 2.98°, 0.88°, and 3.22° for flexion, obliquity, rotation, pelvic incidence, spinopelvic tilt, and sacral slope, respectively. The root-mean square averages of the standard deviation of each measurement were 4.05°, 0.41°, 0.28°, 4.80°, 0.99°, and 5.13°, respectively. The measurement errors for sacral slope correlated significantly with geometric means of flexion, obliquity, and rotation (r = 0.364, p = 2.67 × 10-11). The EOS rendered accurate and reliable measurements regarding pelvic 3D position, even with positional variation, but positional variation could affect measurements of sacral slope.
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8
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Di Martino A, Bordini B, Ancarani C, Viceconti M, Faldini C. Does total hip arthroplasty have a higher risk of failure in patients who undergo lumbar spinal fusion? Bone Joint J 2021; 103-B:486-491. [PMID: 33641423 DOI: 10.1302/0301-620x.103b3.bjj-2020-1209.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Total hip arthroplasty (THA) patients undergoing or having a prior lumbar spine fusion (LSF) have an increased risk of mechanical complications. The aim of this registry-based, retrospective comparative cohort study is to assess the longer term survival of THA in patients who have undergone a LSF during a 17-year period (2000 to 2017). METHODS A registry-based population study was conducted on 679 patients who underwent both THA and LSF surgeries. Patients were identified from the regional arthroplasty data base and cross linked to patients with LSF from the regional hospital discharge database between 2000 and 2017. Demographic data, diagnosis leading to primary THA, primary implant survival, perioperative complications, number and causes of failure, and patients requiring revision arthroplasty were collated and compared. For comparison, data from 67,919 primary THAs performed during the same time time period were also retrieved and analyzed. RESULTS Patients undergoing THA and LSF showed homogeneous demographic data compared to those undergoing THA alone, but a significantly lower eight-year THA implant survival (96.7 vs 96.0, p = 0.024) was observed. Moreover, THA plus LSF patients showed increased incidence of mechanical complications in the first two years after THA surgery compared to THA alone patients. CONCLUSION This registry-based population study shows that approximately 679 (1%) THA patients were subjected to LSF. Patients undergoing THA and LSF have an increased risk of mechanical complications with their THA and a slightly increased risk of revision arthroplasty. Cite this article: Bone Joint J 2021;103-B(3):486-491.
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Affiliation(s)
- Alberto Di Martino
- First Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristina Ancarani
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Viceconti
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Cesare Faldini
- First Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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9
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Ueno T, Kabata T, Kajino Y, Inoue D, Ohmori T, Yoshitani J, Ueoka K, Yamamuro Y, Tsuchiya H. Anterior pelvic plane tilt poorly estimates the sagittal body alignment due to internal rotation of innominate bone. J Orthop Res 2021; 39:580-589. [PMID: 32478909 DOI: 10.1002/jor.24760] [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: 12/08/2019] [Revised: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023]
Abstract
This study investigated the influence of the rotation of innominate bone on anterior pelvic plane (APP) tilt, the angle formed by the APP, and coronal plane of the body to determine whether the provision of proper information about the sagittal balance of the body by the value of the APP tilt (APPT). In total, 244 patients (171 females, 73 males) who were candidates for total hip or knee arthroplasty, periacetabular osteotomy, or shelf arthroplasty were included. The rotational angle of the innominate bone was quantified using computed tomography images at the level of the anterior superior, and anterior inferior iliac spine, and ischiopubic portion. Clustering analysis was performed to identify subtypes of innominate bone rotation. High, intermediate, and low internal rotational alignment groups were identified in females, characterized by rotational angles. Males were treated as one group, and no intergroup differences were observed in sacral slope (SS) and pelvic incidence. However, intergroup differences in APPT were found, indicating a variation in APPT irrespective of sagittal body balance. A negligible relationship between SS and APPT was observed in the high-internal-rotation group, intermediate-internal-rotation group, and male group, whereas a moderate correlation found in the low-internal-rotation group (r = .59). The results could suggest surgeons that the value of the APPT provides no information on the sagittal balance; therefore, it may be ignored for acetabular component positioning during preoperative planning for total hip arthroplasty.
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Affiliation(s)
- Takuro Ueno
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ken Ueoka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yuki Yamamuro
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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10
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Hatem M, Nimmons SJ, Khoury AN, Martin HD. Spinopelvic Parameters Do Not Predict the Sagittal Orientation of the Acetabulum. Orthop J Sports Med 2020; 8:2325967120957420. [PMID: 33117848 PMCID: PMC7570799 DOI: 10.1177/2325967120957420] [Citation(s) in RCA: 3] [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: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The orientation of the acetabulum has a fundamental role in impingement and instability of the hip, and the spinopelvic parameters are thought to predict the sagittal orientation of the acetabulum (SOA). However, similar to the acetabular version (axial orientation) and inclination (coronal orientation), the cephalic or caudal orientation of the acetabulum in the sagittal plane, or SOA, may primarily be an intrinsic feature of the acetabulum itself. Purpose: To determine whether the spinopelvic parameters predict the sagittal orientation of the acetabulum in individuals without lumbar deformity. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A retrospective analysis was performed in 89 patients (94 hips; 62 female, 27 male; mean ± SD age, 45.9 ± 15.4 years) without lumbosacral deformity who underwent magnetic resonance arthrogram (MRA) for assessment of hip pain. The SOA was determined in the sagittal cut MRA. A line was drawn at the distal limit of the anterior and posterior acetabular horns longitudinally to the transverse ligament, and the angle between this line and the axial plane represented the SOA. The sacral slope, pelvic incidence, and spinopelvic tilt were determined using a 3-dimensional cursor and the axial, sagittal, and coronal cuts. All MRA studies were performed with the patient in the supine position. Results: The SOA had a mean ± SD cephalic orientation of 18° ± 6.6°. No significant correlation was observed between the SOA and the sacral slope (r = –0.03; P = .77). A weak correlation was observed between the SOA and the pelvic incidence (r = 0.22; P = .03) and between the SOA and the spinopelvic tilt (r = 0.41; P < .01). Conclusion: The SOA cannot be presumed based on the spinopelvic parameter. Similar to the well-known parameters to assess the axial and coronal orientation of the acetabulum, the assessment of the SOA demands acetabular-specific parameters. Additional studies are necessary to assess the SOA in asymptomatic hips, including disparities between genders. Clinically significant values for abnormal SOA of the acetabulum remain to be defined.
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Affiliation(s)
- Munif Hatem
- Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Scott J Nimmons
- Baylor University Medical Center at Dallas, Dallas, Texas, USA
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11
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Impact of spinal alignment and stiffness on impingement after total hip arthroplasty: a radiographic study of pre- and post-operative spinopelvic alignment. 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 2020; 30:2443-2449. [PMID: 32918604 DOI: 10.1007/s00586-020-06589-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Recent studies have revealed the impact of spinopelvic factors on the risk of dislocation after total hip arthroplasty (THA). This study examined the risk factors of impingement that can lead to dislocation using pre- and postoperative spinopelvic radiographs. METHODS We studied 143 consecutive patients with end-stage hip osteoarthritis who were eligible for THA at our institute. Pre-operative pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), sagittal vertical axis (SVA) in the standing and sitting position, and centre-edge angle (CE) were measured. The post-operative SS, LL, SVA, femoral shaft angle, and radiographic alignment of the acetabular component were also measured. We performed a multiple linear regression analysis to determine the risk factors for anterior and posterior impingement using pre-operative demographic and radiographic parameters. The clearance of anterior and posterior implant impingement was used for the surrogate-dependent variable for dislocation. RESULTS A total of 95 patients were included in the analysis. There were significant differences in SS, LL, and SVA between the standing and sitting positions (P < 0.001). A multiple linear regression analysis showed that the PI-LL, LL changes, and CE were associated with the posterior impingement (β = - 0.21, 0.24, and -0.27, respectively). Moreover, PI-LL was also associated with the anterior impingement in the sitting position (β = - 0.27). CONCLUSION Our results suggest that a flatback with a rigid spine leads to posterior impingement, and a well-balanced spine leads to anterior impingement, which can be a potential risk factor for dislocation.
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Khoury AN, Hatem M, Bowler J, Martin HD. Hip-spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain. J Hip Preserv Surg 2020; 7:390-400. [PMID: 33948195 PMCID: PMC8081421 DOI: 10.1093/jhps/hnaa054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
The term 'hip-spine syndrome' was introduced in recognition of the frequent occurrence of concomitant symptoms at the hip and lumbar spine. Limitations in hip range of motion can result in abnormal lumbopelvic mechanics. Ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion are increasingly linked to abnormal hip and spinopelvic biomechanics. The purpose of this narrative review is to explain the mechanism by which these three abnormal hip pathologies contribute to increased low back pain in patients without hip osteoarthritis. This paper presents a thorough rationale of the anatomical and biomechanical characteristics of the aforementioned hip pathologies, and how each contributes to premature coupling and limited hip flexion/extension. The future of hip and spine conservative and surgical management requires the implementation of a global hip-spine-pelvis-core approach to improve patient function and satisfaction.
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Affiliation(s)
- Anthony N Khoury
- Hip Preservation Center, Baylor University Medical Center at Dallas, 411 N. Washington Ave, Suite 7300, Dallas, TX 75246, USA
| | - Munif Hatem
- Hip Preservation Center, Baylor University Medical Center at Dallas, 411 N. Washington Ave, Suite 7300, Dallas, TX 75246, USA
| | - Joshua Bowler
- Orthopedic Surgery Department, Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX 75246, USA
| | - Hal David Martin
- Hip Preservation Center, Baylor University Medical Center at Dallas, 411 N. Washington Ave, Suite 7300, Dallas, TX 75246, USA
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Dardenne G, Pluchon JP, Letissier H, Guezou-Philippe A, Gerard R, Lefèvre C, Stindel E. Accuracy and Precision of an Ultrasound-Based Device to Measure the Pelvic Tilt in Several Positions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:667-674. [PMID: 31665548 DOI: 10.1002/jum.15141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES A new ultrasound-based device is proposed to measure the patient-specific pelvic tilt in different daily positions. The aim of this study was to assess the accuracy of this device as well as the intraobserver and interobserver precisions. METHODS The accuracy was assessed by performing several tilt measurements with the device on a testing mechanical bench. The error was defined as the difference between the tilt measured with the device and the tilt provided by this test bench. Three physicians, a novice, an intermediate, and an expert user, were also asked to perform 10 measurements on 3 healthy volunteers with low, medium, and high body mass indices to analyze the intraobserver and interobserver precisions. These 10 measurements were performed in the standing, sitting, and supine positions. RESULTS The mean accuracy of the device ± SD was 1.1° ± 0.7° (range, 0°-4.0°). The interobserver and intraobserver precisions were excellent whatever the body mass index and good to excellent according to the positions. There was no learning curve, and the time required to complete the measurements was approximately 5 minutes. CONCLUSIONS This study presents an accurate and precise noninvasive device for measurement of the pelvic tilt in different positions.
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Affiliation(s)
- Guillaume Dardenne
- Centre Hospitalier Universitaire Brest, Brest, France
- Laboratoire de Traitement de l'Information Médicale (LaTIM), Unité Mixte de Recherche (UMR) 1101, Institut National de la Santé et de la Recherche Médicale (INSERM), Brest, France
| | | | - Hoel Letissier
- Centre Hospitalier Universitaire Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
- Laboratoire de Traitement de l'Information Médicale (LaTIM), Unité Mixte de Recherche (UMR) 1101, Institut National de la Santé et de la Recherche Médicale (INSERM), Brest, France
| | - Aziliz Guezou-Philippe
- Université de Bretagne Occidentale, Brest, France
- Laboratoire de Traitement de l'Information Médicale (LaTIM), Unité Mixte de Recherche (UMR) 1101, Institut National de la Santé et de la Recherche Médicale (INSERM), Brest, France
| | - Romain Gerard
- Clinique Keraudren, Grand Large, Service Orthopédie, Brest, France
| | - Christian Lefèvre
- Centre Hospitalier Universitaire Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
- Laboratoire de Traitement de l'Information Médicale (LaTIM), Unité Mixte de Recherche (UMR) 1101, Institut National de la Santé et de la Recherche Médicale (INSERM), Brest, France
| | - Eric Stindel
- Centre Hospitalier Universitaire Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
- Laboratoire de Traitement de l'Information Médicale (LaTIM), Unité Mixte de Recherche (UMR) 1101, Institut National de la Santé et de la Recherche Médicale (INSERM), Brest, France
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Uemura K, Takao M, Otake Y, Koyama K, Yokota F, Hamada H, Sakai T, Sato Y, Sugano N. Reproducibility of pelvic sagittal inclination while acquiring radiographs in supine and standing postures. J Orthop Surg (Hong Kong) 2020; 27:2309499019828515. [PMID: 30798713 DOI: 10.1177/2309499019828515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Pelvic position on the sagittal plane is usually evaluated with the pelvic sagittal inclination (PSI) angle from a single radiograph. However, the reproducibility of pelvic positioning has not been investigated, and thus, the validity of measuring the PSI from a single film/time point is not understood. Herein, the reproducibility of a patient's pelvic positions in supine and standing postures was analyzed. METHODS A total of 34 patients who underwent either a pelvic osteotomy or total hip arthroplasty were enrolled in this study. Preoperative radiographs in both supine and standing postures were acquired twice (first X-ray and second X-ray) within 6 months; preoperative computed tomography (CT) images of the full pelvis were also acquired in a supine posture (preop-CT). To eliminate measurement variability, each PSI was automatically measured from radiographs and CT images through the use of CT segmentation and landmark localization followed by intensity-based 2D-3D registration. The absolute difference of PSI among each image was calculated and the intra-class correlation coefficient (ICC) in each posture was also analyzed. RESULTS The median absolute differences of PSI in the supine posture were 1.3° between the first and second X-rays, 1.2° between the first X-ray and preop-CT, and 1.3° between the second X-ray and preop-CT. The median absolute difference of PSI in the standing posture was 1.5°. The ICC was 0.965 (95% CI: 0.939-0.981) in supine and 0.977 (95% CI: 0.954-0.988) during standing. CONCLUSIONS Pelvic positions in supine and standing postures are reproducible. Thus, measuring the PSI from a single radiograph is reliable.
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Affiliation(s)
- Keisuke Uemura
- 1 Department of Orthopaedic Medical Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masaki Takao
- 1 Department of Orthopaedic Medical Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshito Otake
- 2 Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Koki Koyama
- 2 Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Futoshi Yokota
- 2 Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Hidetoshi Hamada
- 3 Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takashi Sakai
- 3 Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshinobu Sato
- 2 Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Nobuhiko Sugano
- 1 Department of Orthopaedic Medical Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Feng JE, Anoushiravani AA, Eftekhary N, Wiznia D, Schwarzkopf R, Vigdorchik JM. Techniques for Optimizing Acetabular Component Positioning in Total Hip Arthroplasty: Defining a Patient-Specific Functional Safe Zone. JBJS Rev 2020; 7:e5. [PMID: 30817692 DOI: 10.2106/jbjs.rvw.18.00049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- James E Feng
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY.,Department of Orthopaedics, Albany Medical Center, Albany, New York
| | - Nima Eftekhary
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY
| | - Daniel Wiznia
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY.,Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY
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Gu J, Feng H, Feng X, Zhou Y. Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA. BMC Musculoskelet Disord 2020; 21:39. [PMID: 31954404 PMCID: PMC6969977 DOI: 10.1186/s12891-020-3043-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Limitations in the lumbar spine movement reduce lumbar vertebral motion and affect spinopelvic kinematics. We studied the influence of lumbar intervertebral disc degeneration on spinofemoral movement, from standing to sitting, in patients undergoing total hip arthroplasty (THA). Methods Of 138 consecutive patients scheduled for THA due to unilateral avascular necrosis (AVN) of the femoral head, those with ≥3 discs with University of California at Los Angeles (UCLA) disc degeneration score > 1 were defined as the lumbar degenerative disc disease (LDD) group, and the remaining patients constituted d the control group. Full body anteroposterior and lateral EOS images in the standing and sitting positions were obtained. Pelvic incidence (PI), L1 slope (L1 s), lumbar lordosis angle (LL), pelvic tilt (PT), sacral slope (SS), femoral slope (Fs), sagittal vertical axis (SVA), hip flexion, lumbar spine flexion, and total spinofemoral flexion were measured on the images and compared between groups. Results No significant between-group differences were observed in the height, weight, body mass index, AVN staging, or PI, SS, and Fs on standing. The LDD group included more females and older patients, had 5° lesser LL, 5° greater PT, and larger SVA. From standing to sitting, the PI remained constant in both groups. Total spinofemoral flexion was 7° less, lumbar spine flexion 16° less, L1 slope change 6° less, and SS change 8° less, and hip flexion was 7° more in the LDD than in the control group. The spine/hip flexion ratio was significantly lower in the LDD group (0.3 versus 0.7; p < 0.001). On regression analysis, the LDD group (p < 0.001) and older age (p = 0.048) but not sex, weight, or height were significant univariate predictors of decreased spine/hip ratio. Conclusions Patients with LDD leant more forward and had a larger pelvis posterior tilt angle on standing and a decreased lumbar spine/hip flexion ratio, with more hip joint flexion, on sitting, to compensate for reduced lumbar spine flexion. Surgeons should be aware that elderly patients with multiple LDD have significantly different spinofemoral movements and increased risk of posterior dislocation post-THA. Preoperative patient identification, intraoperative surgical technique modification, and individualized rehabilitation protocols are necessary.
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Tilt-adjusted Cup Anteversion in Patients with Severe Backward Pelvic Tilt is Associated with the Risk of Iliopsoas Impingement: A Three-dimensional Implantation Simulation. Clin Orthop Relat Res 2019; 477:2243-2254. [PMID: 31169628 PMCID: PMC6999943 DOI: 10.1097/corr.0000000000000830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior overhang of the acetabular component is associated with iliopsoas impingement, which may cause groin pain and functional limitations after THA. However, little is known about the relationship between component overhang and functional alignment of the acetabular component. CT-based image simulation may be illuminating in learning more about this because CT images are more effective than radiographs for evaluating the component's overhang and position. QUESTIONS/PURPOSES Using CT simulations based on preoperative data of nondysplastic and dysplastic hips, we asked: (1) What are the differences in the amount of component overhang, defined as the mediolateral distance from the component's edge to the native acetabular bony boundary on axial images (axial overhang), and as the AP distance on sagittal images (sagittal overhang) among pelvises with neutral and posterior tilt (in which the cephalad portion of the pelvis is more posterior than the caudad portion in the sagittal plane) in patients with dysplastic hips and those with nondysplastic hips? (2) Are increments in the amount of component overhang associated with a difference in the likelihood that the iliopsoas tendon will impinge against the edge of the acetabular component, after controlling for native acetabular abduction and anteversion and the presence of dysplasia? METHODS A total of 128 hips (dysplastic group: 73 hips; nondysplastic group: 55 hips) were evaluated. We defined a dysplastic hip as one with a lateral center-edge angle of less than 20° on AP radiographs. Pelvic models with neutral (0°) and 10° and 20° of posterior tilt were created from CT data. In simulations, acetabular component models were implanted into the true acetabulum with a tilt-adjusted orientation angle that was defined as the component's angle based on a reference for the functional pelvic plane (coronal plane of the body) in each pelvic model. Axial and sagittal component overhang were measured on CT images. Axial overhang of at least 12 mm and sagittal overhang of at least 4 mm were defined as thresholds increasing the likelihood of iliopsoas impingement according to previous studies. When determining the amount of overhang of the acetabular component, we controlled for abduction and anteversion of the native acetabulum and the presence of dysplasia by performing a multivariable logistic regression analysis. RESULTS In dysplastic hips, axial overhang increased by a mean ± SD of 5 ± 1 mm (Bonferroni adjusted p < 0.001; 95% CI, 4.7-5.1) from 0° to 10° of posterior tilt and by 5 ± 1 mm (p < 0.001; 95% CI, 4.9-5.3) from 10° to 20° of posterior tilt. Sagittal overhang increased by 1 ± 0 mm (p < 0.001; 95% CI, 1.0-1.0) from 0° to 10° of posterior tilt and by 1 ± 0 mm (p < 0.001; 95% CI, 1.0-1.0) from 10° to 20° of posterior tilt. In nondysplastic hips, axial overhang increased by a mean of 5 ± 0 mm (p < 0.001; 95% CI, 4.7-5.0) from 0° to 10° of posterior tilt and by 5 ± 1 mm (p < 0.001; 95% CI, 4.6-5.0) from 10° to 20° of posterior tilt. Sagittal overhang increased by 1 ± 0 mm (p < 0.001; 95% CI, 1.0-1.1) from 0° to 10° of posterior tilt and by 1 ± 0 mm (p < 0.001; 95% CI, 1.0-1.1) from 10° to 20° of posterior tilt. After controlling for the presence of dysplasia, we found that native acetabular abduction and anteversion and posterior pelvic tilt, presence of dysplasia (p = 0.030; adjusted odds ratio [OR], 2.2; 95% CI, 1.1-4.6), native acetabular anteversion (p < 0.001; adjusted OR, 1.4; 95% CI, 1.3-1.5), and 10° and 20° of backward tilt compared with 0° of tilt (10° of posterior tilt: p < 0.001; adjusted OR, 15; 95% CI, 5.5-41; 20° of posterior tilt: p < 0.001; adjusted OR, 333; 95% CI, 96-1157) were independently associated with axial overhang of at least 12 mm; the model showed high goodness of fit (Nagelkerke's r = 0.68). In contrast, native acetabular anteversion (p < 0.001; adjusted OR, 1.2; 95% CI, 1.1-1.2) and 20° of backward tilt compared with 0° of tilt (p = 0.015; adjusted OR, 2.2; 95% CI, 1.2-4.0) were independently associated with sagittal overhang of at least 4 mm; the model had low goodness of fit (Nagelkerke's r = 0.20). CONCLUSIONS Acetabular component overhang is more severe when the pelvis tilts posteriorly. Moreover, posterior pelvic tilt, the presence of dysplasia, and higher native acetabular anteversion were independently associated with an increased risk of component overhang. When 20° of posterior tilt was adjusted, the risk of severe overhang was especially increased. CLINICAL RELEVANCE Based on these results, surgeons can attempt to prevent severe overhang in patients with posterior pelvic tilt by increasing component anteversion and abduction; when component anteversion is increased by 8° and abduction is increased by 2° from the target angle of 15° of anteversion and 40° of abduction in patients with posterior tilt of 20°, the risk of severe overhang is reduced to by approximately one-twentieth. However, it is still unclear how much the degree of component anteversion should be increased when surgeons attempt to prevent anterior prosthetic dislocation at the same time. Future studies such as prospective clinical trials evaluating both prosthetic dislocation and iliopsoas impingement in patients with posterior tilt might clarify this issue.
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CORR Insights®: Tilt-adjusted Cup Anteversion in Patients with Severe Backward Pelvic Tilt is Associated with the Risk of Iliopsoas Impingement: A Three-dimensional Implantation Simulation. Clin Orthop Relat Res 2019; 477:2255-2257. [PMID: 31389877 PMCID: PMC6999929 DOI: 10.1097/corr.0000000000000875] [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: 01/31/2023]
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Longo UG, Ciuffreda M, Candela V, Berton A, Maffulli N, Denaro V. Hip scores: A current concept review. Br Med Bull 2019; 131:81-96. [PMID: 31436810 DOI: 10.1093/bmb/ldz026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION During the past decades, several rating scales have been developed to assess the functional status of patients with hip pain. SOURCE OF DATA A search in Medline, PubMed, Cochrane and CINAHL was performedusing combinations of the following'hip', 'scoring system', 'scale', 'scores', 'outcome assessment', 'arthroplasty', 'arthroscopy' and 'clinical evaluation'. AREAS OF AGREEMENT A total 16 scoring systems are currently available for the evaluation of the hip. AREAS OF CONTROVERSY Two types of questionnaires are available: physician-rated and patient-rated questionnaires. GROWING POINTS Each hip score consists of different domains. Interpreting these domains becomes sometimes difficult, because, even though they can be common to more than one scoring system, each stresses them in a different way. AREAS TIMELY FOR DEVELOPING RESEARCH Although many scoring systems have been used to evaluate hip function, we are still far from a single outcome evaluation system which is reliable, valid and sensitive.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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Pascual-Garrido C. Editorial Commentary: The Hip-Spine Connection in Patients Undergoing Hip Arthroscopy: Should We Learn From Total Hip Replacement and Counsel Patients Differently If They Have Had Previous Back Surgery? Arthroscopy 2019; 35:451-452. [PMID: 30712623 DOI: 10.1016/j.arthro.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 02/02/2023]
Abstract
Disorders of the adult hip and spine are common, and there is evidence that there is a hip-spine connection in patients with hip femoroacetabular impingement (FAI). Many reports have shown that patients undergoing lumbar fusion and subsequent total hip arthroplasty have a higher risk of complications and worse outcomes following total hip arthroplasty. However, there has been a paucity of research on the effect of a history of lumbar spine surgery in patients undergoing hip arthroscopy for the treatment of FAI. Variations in lumbar lordosis, pelvic incidence, tilt, and sacral slope may modify the degree of FAI, symptoms, and patient-reported outcomes following hip arthroscopy. In the future, we should continue our efforts to better understand the impact that limited range of motion in the spine has in joint mechanics of the hip and the possibility of affecting patient-reported outcomes after hip arthroscopy. Future studies incorporating novel imaging technology, such as EOS, may be an objective way of assessing the effect of abnormal spine-pelvic function in patients with hip FAI.
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Morosato F, Traina F, Cristofolini L. Standardization of hemipelvis alignment for in vitro biomechanical testing. J Orthop Res 2018; 36:1645-1652. [PMID: 29194747 DOI: 10.1002/jor.23825] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/23/2017] [Indexed: 02/04/2023]
Abstract
Although in vitro biomechanical tests are regularly performed, the definition of a suitable reference frame for hemipelvic specimens is still a challenge. The aims of the present study were to: (i) define a reference frame for the human hemipelvis suitable for in vitro applications, based on robust anatomical landmarks; (ii) identify the alignment of a hemipelvis based on the alignment of a whole pelvis (including right/left and male/female differences); (iii) identify the relative alignment of the proposed in vitro reference frame with respect to a reference frame commonly used in gait analysis; (iv) create an in vitro alignment procedure easy, robust and inexpensive; (v) quantify the intra-operator repeatability and inter-operator reproducibility of the procedure. A procedure to univocally identify the anatomical landmarks was created, exploiting the in vitro accessibility of the specimen's surface. Through the analysis on 53 CT scans (106 hemipelvises), the alignment of the hemipelvis based on the alignment of a whole pelvis was analyzed: differences between male/female and right/left hemipelvises were not statistically significant To overcome the uncertainty in the identification of the acetabular rim, a standard acetabular plane was defined. An alignment procedure was developed to implement such anatomical reference frame. The intra-operator repeatability and the inter-operator reproducibility were quantified with four operators, on male and female hemipelvises. The intra-operator repeatability was better than 1.5°. The inter-operator reproducibility was better than 2.0°. Alignment in the transverse plane was the most repeatable. The presented procedure to align hemipelvic specimens is sufficiently robust, standardized, and accessible. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1645-1652, 2018.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, Via Umberto Terracini 24/26, Bologna, 40131, Italy
| | | | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, Via Umberto Terracini 24/26, Bologna, 40131, Italy
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Loppini M, Longo UG, Caldarella E, Rocca AD, Denaro V, Grappiolo G. Femur first surgical technique: a smart non-computer-based procedure to achieve the combined anteversion in primary total hip arthroplasty. BMC Musculoskelet Disord 2017; 18:331. [PMID: 28764697 PMCID: PMC5539744 DOI: 10.1186/s12891-017-1688-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background The relevance of prosthetic component orientation to prevent dislocation and impingement following total hip arthroplasty (THA) has been widely accepted. We investigated the use of a non-computer-based surgery to address the reciprocal orientation of the acetabular and femoral components. Methods In the femur first technique, the cup is positioned relative to the stem. When the definitive antetorsion of femoral component is fixed, the cup is positioned in a compliant anteversion to the stem. Clinical and radiographic assessments were performed before and 3 months after THA. Radiographic assessment was performed in standing position with the EOS 2D/3D radiography system. 3D images were used to preoperative anterior pelvic plane (APP) angle, postoperative acetabular inclination (AI) and anteversion (AA), and postoperative stem antetorsion. Clinical assessment was performed with Harris Hip Score (HHS). Results Forty patients (40 hips) underwent primary THA with an average age of 61 years (range, 36–84). Average HHS increased from 43 ± 5 (range, 37–52) preoperatively to 97 ± 6 (range, 86–100) at the last follow-up (P < 0.0001). Average combined anteversion value of cup with liner and stem was 38° ± 9° (range, 12°-55°). Average AI value of cup with liner was 39° ± 6° (range, 30°-55°) in the group with standard stem and 45° ± 7° (range, 39°-58°) in the group with varized stem (P = 0.007). Relationship analysis showed no correlation between the combined anteversion values of the cup with liner and stem with APP angle values (r = 0.26, P = 0.87). Conclusions Femur first technique allows the surgeon to achieve a combined anteversion ranging from 25° to 50° with a cup inclination ranging from 30° to 50°. The cup is positioned according to the functional plane of the patient regardless the preoperative pelvic tilt.
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Affiliation(s)
- Mattia Loppini
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. .,Humanitas University, Via Alessandro Manzoni 113, 20089, Rozzano, Milan, Italy.
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria, Rome, Italy
| | - Emanuele Caldarella
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Antonello Della Rocca
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria, Rome, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
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