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Ryan NS, Kowalski E, Antoniades S, Catelli DS, Beaulé PE, Lamontagne M, Grammatopoulos G. Do 3-dimensional Spinopelvic Characteristics Normalize After THA? A Prospective, Comparative Study Using Motion Capture Analysis. Clin Orthop Relat Res 2024; 482:1642-1655. [PMID: 39226524 PMCID: PMC11343557 DOI: 10.1097/corr.0000000000003106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/10/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Spinopelvic stiffness (primarily in the sagittal plane) has been identified as a factor associated with inferior patient-reported outcomes (PROs) and increased dislocation risk after THA. Incorporating preoperative spinopelvic characteristics into surgical planning has been suggested to determine a patient-specific cup orientation that minimizes dislocation risk. Sagittal plane radiographic analysis of static postures indicates that patients exhibit a degree of normalization in their spinopelvic characteristics after THA. It is not yet known whether normalization is also evident during dynamic movement patterns, nor whether it occurs in the coronal and axial planes as well. QUESTIONS/PURPOSES (1) Does motion capture analysis of sagittal spinopelvic motion provide evidence of normalization after THA? (2) Do changes in coronal and axial plane motion accompany those in the sagittal plane? METHODS Between April 2019 and February 2020, 25 patients agreed to undergo motion capture movement analysis before THA for the treatment of hip osteoarthritis (OA). Of those, 20 underwent the same assessment between 8 and 31 months after THA. Five patients were excluded because of revision surgery (n = 1), contralateral hip OA (n = 1), and technical issues with a force plate during post-THA assessment (n = 3), leaving a cohort total of 15 (median age [IQR] 65 years [10]; seven male and eight female patients). A convenience sample of nine asymptomatic volunteers, who were free of hip and spinal pathology, was also assessed (median age 51 years [34]; four male and five female patients). Although the patients in the control group were younger than those in the patient group, this set a high bar for our threshold of spinopelvic normalization, reducing the possibility of false positive results. Three-dimensional motion capture was performed to measure spinal, pelvic, and hip motion while participants completed three tasks: seated bend and reach, seated trunk rotation, and gait on a level surface. ROM during each task was assessed and compared between pre- and post-THA conditions and between patients and controls. Statistical parametric mapping (SPM) was used to assess the timing of differences in motion during gait, and spatiotemporal gait parameters were also measured. RESULTS After THA, patients demonstrated improvements in sagittal spinal (median [IQR] 32° [18°] versus 41° [14°]; difference of medians 9°; p = 0.004), pelvis (25° [21°] versus 30° [8°]; difference of medians 5°; p = 0.02), and hip ROM (21° [18°] versus 27° [10°]; difference of medians 6°; p = 0.02) during seated bend and reach as well in sagittal hip ROM during gait (30° [11°] versus 44° [7°]; difference of medians 14°; p < 0.001) compared with their pre-THA results, and they showed a high degree of normalization overall. These sagittal plane changes were accompanied by post-THA increases in coronal hip ROM (12° [9°] versus 18° [8°]; difference of medians 6°; p = 0.01) during seated trunk rotation, by both coronal (6° [4°] versus 9° [3°]; difference of medians 3°; p = 0.01) and axial (10° [8°] versus 16° [7°]; difference of medians 6°; p = 0.003) spinal ROM, as well as coronal (8° [3°] versus 13° [4°]; difference of medians 5°; p < 0.001) and axial hip ROM (21° [11°] versus 34° [24°]; difference of medians 13°; p = 0.01) during gait compared with before THA. The SPM analysis showed these improvements occurred during the late swing and early stance phases of gait. CONCLUSION When restricted preoperatively, spinopelvic characteristics during daily tasks show normalization after THA, concurring with previous radiographic findings in the sagittal plane. Thus, spinopelvic characteristics change dynamically, and incorporating them into surgical planning would require predictive models on post-THA improvements to be of use. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Nicholas S. Ryan
- The University of Ottawa, Human Movement Biomechanics Laboratory, Ottawa, ON, Canada
| | - Erik Kowalski
- The University of Ottawa, Human Movement Biomechanics Laboratory, Ottawa, ON, Canada
| | | | - Danilo S. Catelli
- The University of Ottawa, Human Movement Biomechanics Laboratory, Ottawa, ON, Canada
| | - Paul E. Beaulé
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Mario Lamontagne
- The University of Ottawa, Human Movement Biomechanics Laboratory, Ottawa, ON, Canada
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Kim Y, Vergari C, Tokuyasu H, Shimizu Y, Takemoto M. The Impact of Pelvic Incidence on Spinopelvic and Hip Alignment and Mobility in Asymptomatic Subjects. J Bone Joint Surg Am 2024:00004623-990000000-01109. [PMID: 38781320 DOI: 10.2106/jbjs.23.00493] [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] [Indexed: 05/25/2024]
Abstract
BACKGROUND The influence of pelvic incidence (PI) on spinopelvic and hip alignment and mobility has not been well investigated. The aim of this study was to evaluate the influence of PI on spinopelvic and hip alignment and mobility, including the pelvic-femoral angle (PFA) and motion (ΔPFA), in functional positions in a cohort of asymptomatic volunteers. METHODS This was a single-center, prospective, cross-sectional study. We included 136 healthy volunteers (69% female; mean age, 38 ± 11 years; mean body mass index, 22 ± 3 kg/m2) divided into 3 subgroups on the basis of their PI: PI < 45° (low PI), 45° ≤ PI ≤ 60° (medium PI), and PI > 60° (high PI). We made full-body lateral radiographs in free-standing, standing with extension, relaxed-seated, and flexed-seated positions. We measured the sacral slope (SS), lumbar lordosis (LL), and PFA. We calculated lumbar (∆LL), pelvic (∆SS), and hip (∆PFA) mobilities as the change between the standing (i.e., standing with or without extension) and sitting (i.e., relaxed-seated or flexed-seated) positions. RESULTS There were significant differences between some of the 3 subgroups with respect to the LL, SS, and PFA in each of the 4 positions. There were no significant differences in ΔLL, ΔSS, or ΔPFA between the 3 groups when moving from a standing to a sitting position. PI had an inverse linear correlation with PFAextension (R = -0.48; p < 0.0001), PFAstanding (R = -0.53; p < 0.0001), PFArelaxed-seated (R = -0.37; p < 0.0001), and PFAflexed-seated (R = -0.47; p < 0.0001). However, PI was not correlated with ΔPFAstanding/relaxed-seated (R = -0.062; p = 0.48) or ΔPFAextension/flexed-seated (R = -0.12; p = 0.18). Similarly, PI was not significantly correlated with ΔLL or ΔSS in either pair of positions. CONCLUSIONS This study confirmed that spinopelvic and hip parameters in functional positions were affected by PI, whereas lumbar, pelvic, and hip mobilities did not depend on PI. These findings suggest that hip surgeons should consider the PI of the patient to determine the patient's specific functional safe zones before and after total hip arthroplasty. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Youngwoo Kim
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, Paris, France
| | | | - Yu Shimizu
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
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van Erp JH, Gielis WP, Arbabi V, de Gast A, Weinans H, Kaas L, Castelein RM, Schlösser TP. Unravelling the hip-spine dilemma from the CHECK-cohort: is sagittal pelvic morphology linked to radiographic signs of femoroacetabular impingement? Hip Int 2023; 33:1079-1085. [PMID: 36571206 DOI: 10.1177/11207000221145670] [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: 12/27/2022]
Abstract
INTRODUCTION To date the aetiology of femoroacetabular impingement (FAI) is still not completely understood. There are mechanical theories that suggest symptomatic FAI is linked to sagittal pelvic morphology and spinopelvic-femoral dynamics. The aim of this study is to evaluate the relation of sagittal pelvic morphology and orientation to radiographic signs of FAI. Additionally, we test whether the relation between FAI and spinopelvic parameters differs in osteoarthritic hips. METHODS From a prospective, observational cohort study, 1002 patients between 45 and 65 years old with a first episode of knee or hip pain were followed for 8 years. All patients who had lateral lumbar radiographs and clinical and radiographic follow-up of the hips were included in the present study. Range of internal rotation of the hip as well as radiographic signs of FAI (alpha and Wiberg angle) and presence of hip osteoarthritis (Kellgren and Lawrence) were systematically measured at baseline. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS)) were measured at 8-year follow-up. Associations between PI, PT, SS and FAI parameters were tested using generalised estimating equations. RESULTS 421 subjects, 842 hips, were included. No significant relations between PI, PT or SS and alpha or Wiberg angle were found. Comparison of hips with and without radiological sign(s) of FAI showed no differences in PI, PT or SS. There was no relation between range of internal rotation of the hip and spinopelvic parameters. CONCLUSION Sagittal pelvic morphology and orientation are not related to the presence of radiological signs of FAI in this study population.
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Affiliation(s)
- Joost Hj van Erp
- Clinical Orthopaedic Research Center - mN, Zeist, The Netherlands
- Department of Orthopaedics, Diakonessenhuis, Utrecht, The Netherlands
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Willem-Paul Gielis
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Vahid Arbabi
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
- Orthopedic-BioMechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Iran
| | - Arthur de Gast
- Clinical Orthopaedic Research Center - mN, Zeist, The Netherlands
- Department of Orthopaedics, Diakonessenhuis, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Laurens Kaas
- Department of Orthopaedic Surgery, St. Antonius hospital, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Tom Pc Schlösser
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
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Lee TS, Kwon HM, Park JY, Kim DK, Kang KT, Park KK. Could We Expect Postoperative Cup Anteversion after Total Hip Arthroplasty Using Postoperative Plain Anteroposterior and Lateral Radiograph? A Three-Dimensional Experimental Operation Study. J Clin Med 2023; 12:6664. [PMID: 37892802 PMCID: PMC10607240 DOI: 10.3390/jcm12206664] [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: 09/16/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND A postoperative radiograph in total hip arthroplasty (THA) is usually obtained to evaluate the inclination and anteversion of the acetabular components. However, there is no gold-standard method for calculating the exact inclination and anteversion of the acetabular components on post-THA radiographs. We aimed to measure the actual anteversion of the acetabular component on postoperative radiographs by obtaining correlation data between the virtual and actual acetabular component positioning using virtual three-dimensional (3D) surgery. METHODS A total of 64 hip scans of 32 patients who underwent lower-extremity computed tomography (CT) were retrospectively reviewed. We reconstructed 3D models of the 64 hips using customized computer software (Mimics). Furthermore, to identify the safe zone of acetabular component position in THA, we performed virtual 3D surgery simulations for five anteversion (-10°, 0°, 10°, 20°, and 30°) and five inclination (20°, 30°, 40°, 50°, and 60°) types. We analyzed the acetabular anatomy using 3D models to measure the radiographic, anatomical, and operative anteversion (RA, AA, OA) and inclination (RI, AI, OI) angles. Additionally, we used the Woo-Morrey (WM) method to calculate the anteversion angle in the reconstructed cross-table lateral (CL) radiographs and determined the correlation between these measurements. RESULTS The safe zone of the acetabular component was visualized on post-THA CL radiographs using the WM method of anteversion measurement based on the different anteversions and inclinations of the acetabular component. The AA, RA, OA, OI, and WM differed significantly between males and females (p value < 0.05). As the anatomical inclination or anteversion increased, the WM anteversion measurements also increased. The radiographic anteversion measurement best matched the WM method of measurement, followed by anatomical and operative methods. CONCLUSIONS The actual anteversion of the acetabular component after THA can be measured on CL radiographs with the WM method using a 3D virtual program, with good reproducibility.
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Affiliation(s)
- Tae Sung Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
| | - Jun Young Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
| | - Dong Ki Kim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
| | - Kyoung Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
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van Erp JHJ, Hüsken MFT, Filipe MD, Snijders TE, Kruyt MC, de Gast A, Schlösser TPC. Did the dislocation risk after primary total hip arthroplasty decrease over time? A meta-analysis across six decades. Arch Orthop Trauma Surg 2023; 143:4491-4500. [PMID: 36357707 PMCID: PMC10293125 DOI: 10.1007/s00402-022-04678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND While continuous optimization is attempted to decrease the incidence of dislocation after total hip arthroplasty (THA), dislocation remains a major complication. This meta-analysis aims to analyze the evolution of the dislocation risk after primary THA over the decades and to evaluate its potential publication bias. PATIENTS AND METHODS A systematic search was performed according to the PRISMA guidelines for this meta-analysis in the literature published between 1962 and 2020. MEDLINE, Cochrane and Embase databases were searched for studies reporting the dislocation risk and length of follow-up. Studies that reported on revision rates only and did not mention separate dislocations were excluded. All study designs were eligible. Study quality was assessed by existing quality assessment tools adjusted for arthroplasty research. Overall risk and yearly dislocation rates were calculated and related to historical time frame, study design, sample size and length of follow-up. RESULTS In total, 174 studies were included with an overall moderate quality. In total there were 85.209 dislocations reported in 5.030.293 THAs, showing an overall dislocation risk of 1.7%, with a median follow-up of 24 months. The overall dislocation risk classified per decade decreased from 3.7% in 1960-1970 to 0.7% in 2010-2020. The yearly dislocation rate decreased from 1.8 to 0.7% within these same decades. There was no significant correlation between the reported dislocation risk and the duration of follow-up (p = 0.903) or sample size (p = 0.755). The reported dislocation risk was higher in articles with registry data compared to other study designs (p = 0.021). CONCLUSION The dislocation risk in THA has been decreasing over the past decades to 0.7%. Non-selective registry studies reported a higher dislocation risk compared to studies with selective cohorts and RCTs. This indicates that the actual dislocation risk is higher than often reported and 'real-world data' are reflected better in large-scale cohorts and registries.
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Affiliation(s)
- J H J van Erp
- Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands.
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M F T Hüsken
- Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - M D Filipe
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T E Snijders
- Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - M C Kruyt
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Developmental Bioengineering, Twente University, Enschede, The Netherlands
| | - A de Gast
- Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - T P C Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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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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van der Gronde BATD, Schlösser TPC, van Erp JHJ, Snijders TE, Castelein RM, Weinans H, de Gast A. Current Evidence for Spinopelvic Characteristics Influencing Total Hip Arthroplasty Dislocation Risk. JBJS Rev 2022; 10:01874474-202208000-00004. [PMID: 36000764 DOI: 10.2106/jbjs.rvw.22.00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Decreased pelvic mobility and pelvic retroversion may result from spinal degeneration and lead to changes in the orientation of the acetabular implant after total hip arthroplasty (THA). While multiple patient and surgery-related factors contribute to THA dislocations, there is increasing evidence that sagittal spinopelvic dynamics are relevant for THA stability. The aim of this systematic review was to assess the relationship between previously described sagittal spinopelvic characteristics and implant dislocations after primary THA. METHODS A comprehensive literature search in the PubMed and Embase databases was conducted for studies reporting on spinopelvic morphology, alignment, pathology, or surgery and THA dislocations. Risk of bias was assessed using the MINORS criteria. Because of high heterogeneity in study methodology, a synthesis of best evidence was performed. Odds ratios (ORs), relative risks (RRs), and effect sizes (g) were calculated. RESULTS Fifteen studies (1,007,900 THAs) with quality scores of 15 to 23 out of 24 were included. Nine different spinopelvic alignment parameters (8 studies, g = 0.14 to 2.02), spinal pathology (2 studies, OR = 1.9 to 29.2), and previous spinal fusion surgery (8 studies, OR = 1.59 to 23.7, RR = 3.0) were found to be related to THA dislocation. Conflicting results were found for another sagittal pelvic morphology parameter, pelvic incidence. CONCLUSIONS Several sagittal spinopelvic patient characteristics were found to be related to THA dislocation, and the associated risks were greater than for other patient and surgery-related factors. Future research is needed to determine which of those characteristics and parameters should be taken into account in patients undergoing primary THA. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- B A T D van der Gronde
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| | - T P C Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J H J van Erp
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands.,Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T E Snijders
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| | - R M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Biomechanical Engineering, Technical University Delft, Delft, the Netherlands
| | - A de Gast
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
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Ebramzadeh E. CORR Insights®: A Modeling Study of a Patient-specific Safe Zone for THA: Calculation, Validation, and Key Factors Based on Standing and Sitting Sagittal Pelvic Tilt. Clin Orthop Relat Res 2022; 480:206-208. [PMID: 34525000 PMCID: PMC8673973 DOI: 10.1097/corr.0000000000001976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/25/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Edward Ebramzadeh
- Director, The J. Vernon Luck Sr. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA Department of Orthopaedic Surgery, Los Angeles, CA, USA
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