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Hafez MA, Jaramaz B, DiGioia AM. Pelvic flexion/extension and its impact on functional acetabular alignment and stability following total hip replacement. INTERNATIONAL ORTHOPAEDICS 2024; 48:1039-1047. [PMID: 38110775 PMCID: PMC10933161 DOI: 10.1007/s00264-023-06060-w] [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: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE Dislocation following total hip arthroplasty (THA) remains a significant clinical problem and can occur even with optimal implant alignment. We hypothesized that different patterns of pelvic flexion/extension (PFE) during daily activities may influence acetabular alignment and contribute to impingement and instability following THA. Recently, there has been an increased interest in spinopelvic alignment and its impact on THA. Therefore, this study aimed to identify different patterns of PFE that could be predictive of instability following THA. METHODS A range of motion (ROM) simulator was used to demonstrate the effects of different patterns of PFE on ROM and impingement. The findings were applied to PFE measurements obtained from 84 patients in standing and sitting positions. RESULTS Three different categories of PFE were identified: normal, hypermobile, and stiff. ROM simulator revealed that changes in PFE had affected ROM and impingement significantly. Patients in the stiff pelvis category, even with "optimal" implant alignment, were more susceptible to implant impingement. CONCLUSIONS The different patterns of PFE during daily activities could affect acetabular alignment and stability following THA. We propose a classification system that can identify different types of PFE and predict their effects on the stability of prostheses following THA. Hence, we believe that patients with unfavorable PFE may require modified cup alignment.
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Affiliation(s)
- Mahmoud A Hafez
- The Orthopaedic Department, October 6 University, Giza, Egypt.
| | | | - Anthony M DiGioia
- The Bone and Joint Center, Magee Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Qoreishy M, Movahedinia M, Keyhani S, Salehi B, Goodarzi M, Naghibi B. Evaluation of changes in radiographic spinopelvic parameters after primary total hip arthroplasty and its relationship with short-term patient function. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:225-230. [PMID: 37428225 DOI: 10.1007/s00590-023-03639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) is commonly used worldwide in pelvic osteoarthritis treatment. This surgery can change the spinopelvic parameters, which in turn affects the performance of the patients after surgery. However, the relationship between functional disability following THA and spinopelvic alignment is not completely understood. The limited available studies have also been conducted on the population with spinopelvic malalignments. This study aimed to examine the changes in spinopelvic parameters after primary THA in patients with normal preoperative spinopelvic characteristics and the association of these parameters with the performance, gender, and age of the patients after THA. METHODS Fifty-eight eligible patients with unilateral primary hip osteoarthritis (HOA) scheduled for total hip arthroplasty between February and September 2021 were studied. Spinopelvic parameters including pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured before surgery and three months after surgery, and the relationship between these parameters and patients' performance (Harris hip score) was assessed. Also, the relationship between the age and gender of the patients with these parameters was evaluated. RESULTS The mean age of study participants was 46.03 ± 14.25. Three months after THA, sacral slope decreased with the mean difference of 4.31 ± 10.26 degrees (p = 0.002) and Harris hip score (HHS) increased by 19.41 ± 26.55 points (p < 0.001). With increasing age in patients, the mean SS and PT decreased. Among the spinopelvic parameters, SS (β = 0.11) had a greater effect than PT on postoperative HHS changes and among the demographic parameters, age (β = -0.18) had a greater effect on HHS changes than gender. CONCLUSION Spinopelvic parameters are associated with age, gender, and patient's function after THA as sacral slope decreased and HHS increased after THA, and aging is accompanied by lowering of PT and SS.
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Affiliation(s)
- Mohamad Qoreishy
- Orthopedic Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Movahedinia
- Orthopedic Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Keyhani
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi Manesh Street, Shariati Street, Tehran, Iran
| | - Bentolhoda Salehi
- Medicine Faculty, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Goodarzi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi Manesh Street, Shariati Street, Tehran, Iran
| | - Bahram Naghibi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi Manesh Street, Shariati Street, Tehran, Iran.
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Di Martino A, Bordini B, Geraci G, Ancarani C, D'Agostino C, Brunello M, Guidotti C, Viceconti M, Faldini C. Impact of previous lumbar spine surgery on total hip arthroplasty and vice versa: How long should we be concerned about mechanical failure? 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; 32:2949-2958. [PMID: 37498345 DOI: 10.1007/s00586-023-07866-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/13/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION This registry study aims to assess the prevalence and demographic characteristics of patients with lumbar spine (LS) surgical procedures who undergo total hip arthroplasty (THA), to compare the long-term survival and causes of failure of THA in patients who previously underwent LS fusion and non-fusion surgical procedures, and to evaluate the risk of undergoing a revision LS surgery after THA. MATERIALS AND METHODS Patients who underwent LS surgery followed by THA were identified by cross-referencing data from the Orthopedic Prosthetic Implants Registry and the Regional Hospital Discharge Database. Three groups of THA patients were identified: patients who underwent previous lumbar surgery with fusion (LS fusion-THA), without fusion (LS non-fusion-THA), and a control group with only THA (No LS surgery-THA). Demographic data, THA survival, number and causes of failure, and data on revision procedures on THA and LS were collected. RESULTS Of the total of 79,984 THA, 2.2% of patients had a history of LS procedures. THA only patients showed better results, while patients in the LS fusion-THA group had worse implant survival at 5-year follow-up. In the LS fusion-THA and LS non-fusion-THA, mechanical THA failures were more frequent in the first two years after implantation. There were no differences between groups regarding the risk of undergoing LS revision surgery. CONCLUSIONS LS surgery negatively affects THA survivorship. In patients who previously underwent LS fusion and non-fusion surgical procedures, most THA failure occurs in the first two years after implant. The study contributes to the understanding of the relationship between the hip and the LS and provides useful guidance for clinical practice.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, Bologna, Italy.
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via Barbiano 1/10, 40136, Bologna, Italy
| | - Giuseppe Geraci
- 1st Orthopaedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, Bologna, Italy
| | - Cristina Ancarani
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via Barbiano 1/10, 40136, Bologna, Italy
| | - Claudio D'Agostino
- 1st Orthopaedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, Bologna, Italy
| | - Matteo Brunello
- 1st Orthopaedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, Bologna, Italy
| | - Claudio Guidotti
- 1st Orthopaedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, Bologna, Italy
| | - Marco Viceconti
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via Barbiano 1/10, 40136, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, Bologna, Italy
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