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Cardenas JM, Gordon D, Waddell BS, Kitziger KJ, Peters PC, Gladnick BP. Does Artificial Intelligence Outperform Humans Using Fluoroscopic-Assisted Computer Navigation for Total Hip Arthroplasty? Arthroplast Today 2024; 27:101410. [PMID: 38840694 PMCID: PMC11150909 DOI: 10.1016/j.artd.2024.101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/13/2024] [Accepted: 04/28/2024] [Indexed: 06/07/2024] Open
Abstract
Background Successful total hip arthroplasty (THA) relies on the correct implant position. THA accuracy can be improved with the use of intraoperative fluoroscopic-assisted computer navigation. Artificial intelligence (AI) software may enhance fluoroscopic navigation; however, the accuracy of the AI compared to human-controlled software in assessing acetabular component position and leg length discrepancy (LLD) has not been studied. Methods We analyzed 420 consecutive primary THAs performed by a single surgeon using fluoroscopic-assisted computer navigation software. The first cohort of 211 patients required inputs from a human technician (manual), while the second cohort of 209 patients used an automated version of the software controlled by AI. The intraoperative acetabular component placement (inclination and anteversion) and LLD were recorded and compared to the 2-week postoperative standing anterior-posterior pelvis radiograph. Results Ninety-four percent (199/211) of cups in the manual cohort and 95% (198/209) of cups in the AI cohort were within the Lewinnek "safe-zone" (P = 1.0). In the manual cohort, 69% (146/211) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (ie, ΔLLD ≤2 mm). In the AI cohort, 66% (137/209) of THAs had a final LLD within ±2 mm of the intraoperatively navigated LLD (P = .47). Ninety-nine percent (209/211) of hips in the manual cohort and 98% (205/209) of hips in the AI cohort had a final LLD within ±5 mm of the intraoperatively navigated LLD (P = .45). Conclusions Both AI and human-controlled versions of the same navigation platform were similarly accurate for navigating cup position within the Lewinnek "safe zone" and LLD accuracy.
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Affiliation(s)
- Justin M. Cardenas
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX, USA
| | - Dan Gordon
- Baylor University Medical Center, Dallas, TX, USA
| | - Bradford S. Waddell
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX, USA
| | - Kurt J. Kitziger
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX, USA
| | - Paul C. Peters
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX, USA
| | - Brian P. Gladnick
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX, USA
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [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: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Thummala A, Nakonezny PA, Mulligan EP, Chhabra A, Wells J. The Relationship Between Pelvic Tilt and Clinical Outcomes After Hip Preservation Surgery in Femoroacetabular Impingement Syndrome and Hip Dysplasia. Orthopedics 2023; 46:e341-e346. [PMID: 37052593 DOI: 10.3928/01477447-20230407-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Pelvic tilt is thought to be a compensatory mechanism in hip pathology, specifically in patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. This study investigated the relationship between preoperative pelvic tilt and postoperative outcomes in patients undergoing hip preservation surgery for FAIS or hip dysplasia. We reviewed a prospective hip preservation database for demographic, radiographic, and outcome data for 89 patients who underwent hip preservation surgery with a primary diagnosis of FAIS or dysplasia from 2016 to 2020. Pelvic tilt was assessed on the standing anteroposterior radiograph with the pubic symphysis to sacroiliac joint (PS-SI) distance measurement. The International Hip Outcome Tool 12 (iHOT-12), Hip Outcome Score, Harris Hip Score, UCLA activity score, and European Quality of Life-Visual Analog Scale were used to assess hip function and pain preoperatively and postoperatively. The mean pelvic tilt (PS-SI distance) was 86.4±18.3 mm for the FAIS group and 96.2±15.1 mm for the dysplasia group. The statistical analysis demonstrated a positive relationship between pelvic tilt and change in iHOT-12 score (rs=0.262, P=.019) for all 89 patients with hip pathology and, separately, a trend toward significance for the 42 patients with FAIS (rs=0.330, P=.056). No other significant relationships were observed. The improvement in iHOT-12 score was greater for patients with more anterior tilt and less for patients with posterior pelvic tilt, regardless of underlying hip etiology. These results provide intriguing insights into an initial investigation on pelvic tilt in patients undergoing hip preservation surgery. Further investigation is necessary to assess pelvic tilt preoperatively and postoperatively, spinal parameters, and longer-term outcomes. [Orthopedics. 2023;46(6):e341-e346.].
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Mulford KL, Johnson QJ, Mujahed T, Khosravi B, Rouzrokh P, Mickley JP, Taunton MJ, Wyles CC. A Deep Learning Tool for Automated Landmark Annotation on Hip and Pelvis Radiographs. J Arthroplasty 2023; 38:2024-2031.e1. [PMID: 37236288 DOI: 10.1016/j.arth.2023.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Automatic methods for labeling and segmenting pelvis structures can improve the efficiency of clinical and research workflows and reduce the variability introduced with manual labeling. The purpose of this study was to develop a single deep learning model to annotate certain anatomical structures and landmarks on antero-posterior (AP) pelvis radiographs. METHODS A total of 1,100 AP pelvis radiographs were manually annotated by 3 reviewers. These images included a mix of preoperative and postoperative images as well as a mix of AP pelvis and hip images. A convolutional neural network was trained to segment 22 different structures (7 points, 6 lines, and 9 shapes). Dice score, which measures overlap between model output and ground truth, was calculated for the shapes and lines structures. Euclidean distance error was calculated for point structures. RESULTS Dice score averaged across all images in the test set was 0.88 and 0.80 for the shape and line structures, respectively. For the 7-point structures, average distance between real and automated annotations ranged from 1.9 mm to 5.6 mm, with all averages falling below 3.1 mm except for the structure labeling the center of the sacrococcygeal junction, where performance was low for both human and machine-produced labels. Blinded qualitative evaluation of human and machine produced segmentations did not reveal any drastic decrease in performance of the automatic method. CONCLUSION We present a deep learning model for automated annotation of pelvis radiographs that flexibly handles a variety of views, contrasts, and operative statuses for 22 structures and landmarks.
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Affiliation(s)
- Kellen L Mulford
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Quinn J Johnson
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tala Mujahed
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Bardia Khosravi
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Pouria Rouzrokh
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - John P Mickley
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Michael J Taunton
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Frandsen JJ, Rainey JP, Kahn TL, Blackburn BE, Pelt CE, Anderson LA, Gililland JM. A Novel Method to Calculate Functional Pelvic Tilt Using a Standing Anteroposterior Pelvis Radiograph. Arthroplast Today 2023; 21:101145. [PMID: 37274836 PMCID: PMC10238463 DOI: 10.1016/j.artd.2023.101145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 06/07/2023] Open
Abstract
Background Functional patient-specific acetabular component positioning is important in total hip arthroplasty. We preoperatively evaluate the pelvic tilt (PT) on standing anteroposterior (AP) pelvis radiographs using a novel measurement and then recreate this intraoperatively using imaging. The purpose of this study was to determine if there is a linear correlation between this novel measurement and the actual PT. Methods A retrospective study of 200 patients was performed, measuring PT on standing lateral radiographs as the angle between the anterior superior iliac spines and the pubic symphysis. On the AP pelvis radiographs, the trans-teardrop (TT) line was drawn between the teardrops. The vertical distance between the TT line and the top of the pubic symphysis (TTPS) was then measured. A ratio was made between the lengths of both lines to account for the overall size of the pelvis (TTPS/TT). Linear regression analysis was then performed between PT and TTPS/TT. Results There was a strong linear correlation between the TTPS/TT ratio on AP pelvis radiographs and PT on lateral radiographs (r = 0.785, r2 = 0.616, P < .001). On subanalysis of the female cohort, the correlation became even stronger (r = 0.864, r2 = 0.747, P < .001). Using regression analysis, a linear equation was created (PT = 97.32 [TTPS/TT] - 5.51), to calculate the PT using the TTPS/TT ratio. Conclusions There is a strong linear correlation between the TTPS/TT ratio and PT. Using this information, a surgeon can reliably use the distance between the TT line and the superior pubic symphysis on an AP radiograph to recreate the patient's functional PT intraoperatively, allowing for a more accurate patient-specific placement of the acetabular component.
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Affiliation(s)
| | - Joshua P. Rainey
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Lucas A. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Labott JR, Smith JRH, Mara KC, Wyles CC, Taunton MJ, Abdel MP. Pubic Symphysis to Sacrococcygeal Joint: A Poor Correlate to Other Spinopelvic Measurements. J Arthroplasty 2023:S0883-5403(23)00072-4. [PMID: 36754336 DOI: 10.1016/j.arth.2023.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The hip-spine relationship is increasingly recognized as critical for optimizing stability following total hip arthroplasty (THA). However, these measurements are not routinely obtained during THA workup. It has been suggested that insight can be gained from supine antero-posterior pelvis radiograph, measuring the distance from the superior border of the pubic symphysis to the sacro-coccygeal joint (PSCD). This study assessed the correlation between PSCD and lateral lumbar radiographic metrics in a cohort of preoperative THA patients. METHODS We retrospectively evaluated 250 consecutive patients who underwent THA with preoperative supine antero-posterior pelvis and lateral lumbar radiographs. The mean age was 68 years (range, 42 to 89), 61% were women, and the mean body mass index was 30 kg/m2 (range, 19 to 52). Two reviewers measured PSCD, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and lumbar lordosis (LL). Inter-observer reliability was calculated for all measurements, and correlation coefficients were calculated for PSCD with respect to PT, SS, PI, and LL. RESULTS Correlations between PSCD and lumbar radiographic metrics were all statistically significant, except for PI in men but graded as "weak" or "very weak" for men and women, respectively, as follows: PT = -0.30 (P < .01) and -0.46 (P < .01); SS = 0.27 (P < .01) and 0.22 (P < .01); PI = -0.04 (P = .70) and -0.19 (P = .02); and LL = 0.45 (P < .01) and 0.30 (P < .01). Inter-observer reliability was graded as "strong" for every metric. CONCLUSION The PSCD was weakly correlated with all evaluated lateral lumbar radiographic metrics in both sexes, despite strong inter-observer reliability. Therefore, PSCD cannot reliably serve as a proxy for evaluating the hip-spine relationship.
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Affiliation(s)
- Joshua R Labott
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kristin C Mara
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Peng L, Zeng Y, Wu Y, Si H, Pei F, Shen B. Radiologic restoration inaccuracy increases postoperative dislocation in primary total hip arthroplasty: a retrospective study with propensity score matching. Arch Orthop Trauma Surg 2022; 142:3995-4005. [PMID: 34821944 DOI: 10.1007/s00402-021-04263-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dislocation is a complicated process and associated with multivariate etiology and risk factors. The purpose of this study was to verify if radiologic restoration inaccuracy increases postoperative dislocation in primary total hip arthroplasty (THA) individually or synergistically. METHODS From 2017 to 2020, we identified 76 (1.9%) patients who suffered postoperative dislocations from 3926 THAs in our institution. After excluded patients with previously proven patient-related and implant-related risk factors, the remaining patients were used to match a 1:1 control patients who were without dislocation. The cup position (inclination and anteversion angles), hip offset (HO), leg length discrepancy (LLD), and abductor lever arm (ALA) were analyzed by univariate analyses and multivariate logistic regressions. RESULTS Measurements on radiographs showed excellent interobserver agreement (intraclass correlation coefficient (ICC) 0.922-0.952) and intraobserver agreements (ICC 0.933-0.967). HO restoration inaccuracy (without ± 5 mm) was associated with higher dislocation risk (OR 4.241 95% CI 1.440-12.492, P = 0.009). The restoration inaccuracy of the cup position, LLD, or ALA could not increase the dislocation risk individually. When combining the radiologic restoration inaccuracy factors, the HO + LLD restoration inaccuracy and HO + ALA restoration inaccuracy increased the odds of postoperative dislocation (OR 12.056, 95% CI 1.409-103.127, P = 0.023; OR 4.770, 95% CI 1.336-17.028, P = 0.016, respectively). Combining the four risk factors of cup safe zone, HO, LLD, and ALA, patients with 3 or 4 radiologic restoration inaccuracy factors showed a higher risk of dislocation (OR 13.500, 95% CI 1.340-135.983, P = 0.027). CONCLUSION Hip offset (HO) restoration inaccuracy increased the risk of dislocation following primary THA. Multivariate radiologic restoration accuracy is critical for the prevention of dislocation and needs to be valued by surgeons.
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Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Carender CN, Feuchtenberger BW, DeMik DE, An Q, Brown TS, Bedard NA. Can Abnormal Spinopelvic Relationships be Identified by Anteroposterior Pelvic Radiographs? J Arthroplasty 2022; 37:507-512. [PMID: 34843911 DOI: 10.1016/j.arth.2021.11.032] [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: 10/15/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Abnormal spinopelvic relationships may place patients at an increased risk for instability after primary total hip arthroplasty. The purpose of this study was to determine if radiographic markers on a standing anteroposterior (AP) pelvis radiograph could identify patients with sagittal spinopelvic imbalance or spinal stiffness. METHODS Patients undergoing primary total hip arthroplasty at a single institution from 2017 to 2020 with standing AP pelvis radiographs and sitting/standing lateral radiographs were identified. AP pelvis radiographs were assessed for the following: lumbosacral hardware, spine osteophytes, disc space narrowing, scoliosis>5°, pelvic obliquity>5°, and overlap of the sacrococcygeal junction/pubic symphysis. Patients with spinopelvic imbalance and/or spinopelvic stiffness were identified. Univariate and multivariate analyses were performed. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS Four hundred eighty-six patients were included. Prevalence of isolated sagittal spinopelvic imbalance and isolated spinopelvic stiffness was 12% and 21%, respectively; 11% of patients had sagittal imbalance and stiffness. Overlap of the sacrococcygeal junction/pubic symphysis (OR = 10.2, 95% CI = 5.3-19.8) and presence of lumbosacral hardware (OR = 4.4, 95% CI = 2.0-9.4) were markers of an increased risk of combined sagittal imbalance and stiffness. Seventy-nine percent of patients with overlap of the sacrococcygeal junction and pubic symphysis and 82% of patients with lumbosacral hardware had an abnormal spinopelvic relationship. CONCLUSION Isolated sagittal imbalance and stiffness were difficult to predict on standing AP pelvis radiographs. Overlap of the sacrococcygeal junction/pubic symphysis and presence of lumbosacral hardware associated with a higher risk of combined sagittal imbalance/stiffness and were present in ≥79% of patients with an abnormal spinopelvic relationship. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Christopher N Carender
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - David E DeMik
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Qiang An
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Timothy S Brown
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
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Fritz JK, Waddell BS, Kitziger KJ, Peters PC, Gladnick BP. Is Dislocation Risk due to Posterior Pelvic Tilt Reduced With Direct Anterior Approach Total Hip Arthroplasty? J Arthroplasty 2021; 36:3692-3696. [PMID: 34330601 DOI: 10.1016/j.arth.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pelvic tilt affects acetabular anteversion, and thus total hip arthroplasty (THA) dislocation risk. The pubic symphysis-sacrococcygeal distance (PSCD) is an indicator of pelvic tilt, and a PSCD < 0 mm (ie, excessive posterior pelvic tilt) is associated with a 3.7-fold increase in postoperative dislocation rate. However, it is not known if the direct anterior (DA) approach might reduce this dislocation rate, specifically in high-risk populations such as negative PSCD. METHODS Standing anteroposterior radiographs were reviewed for 510 consecutive DA THAs to determine PSCD. Patients were separated into 2 groups: (1) PSCD > 0 mm (PSCD[+]) and (2) PSCD < 0 mm (PSCD[-]). Incidence of dislocation was determined. We recorded if patients had spinal deformity or lumbar fusion. Continuous variables were analyzed using Student's t-test, categorical variables were analyzed using Fisher's exact test, and a sample size calculation was performed. RESULTS Three hundred fifty-eight hips (70.2%) were PSCD[+], while 152 hips (29.8%) were PSCD[-]. Three dislocations (3/510 hips, 0.6%) occurred. Two dislocators were in the PSCD[-] group (2/152 hips, 1.3%) and 1 dislocator was in the PSCD[+] group (1/358 hips, 0.3%) (P = .21). Twenty-four patients had degenerative scoliosis (24/510, 4.7%), of which 1 had a dislocation (1/24, 4.2%); 2 dislocations occurred in nonscoliosis patients (2/486, 0.4%) (P = .134). Twenty-seven patients had lumbar spinal fusion (27/510, 5.3%), of which there were no dislocations (0/27, 0.0%); all dislocations were in nonfusion patients (3/483, 0.6%) (P = 1.0). CONCLUSION We demonstrate no increased risk for THA dislocation in patients with a PSCD < 0 mm who have undergone a DA approach. These data would suggest a protective effect of the DA approach against dislocation, even in historically high-risk populations.
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Affiliation(s)
- Justin K Fritz
- Department of Orthopaedic Surgery, Baylor Univeristy Medical Center, Dallas, TX
| | - Bradford S Waddell
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX; Department of Orthopaedic Surgery, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Kurt J Kitziger
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX; Department of Orthopaedic Surgery, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Paul C Peters
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX; Department of Orthopaedic Surgery, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Brian P Gladnick
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, TX; Department of Orthopaedic Surgery, Texas Health Presbyterian Hospital Dallas, Dallas, TX
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