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García-Rey E, Saldaña L. Spinopelvic interactions in total hip arthroplasty: 295 patients followed for a minimum follow-up of 10 years. Hip Int 2024; 34:487-497. [PMID: 38695378 DOI: 10.1177/11207000241248074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Concurrent spinal pathology is frequent in patients undergoing total hip arthroplasty (THA). In this study we examined whether spinopelvic interactions affect THA outcomes at a minimum follow-up of 10 years. PATIENTS AND METHODS 295 patients with a mean age of 63.3 (range 56‒80) years receiving a THA between 2006 and 2009 were assessed. Of these, 195 had mild lumbar disc degeneration and 100 had advanced lumbar spondylosis. We analysed the changes in the Harris Hip Score (HHS) and the survival rate for postoperative low back pain (LBP) and dislocation. Changes in acetabular component position, sacro-femoral-pubic (SFP) and pelvic obliquity (PO) angles were assessed with radiological images. RESULTS The mean HHS was lower in female patients (p = 0.009), patients >65 years of age (p < 0.001) and those with advanced lumbar spondylosis (p = 0.002). 52 (71.2%) of the patients reporting preoperative LBP experienced improvement after THA while 47 (21.1%) of those without preoperative LBP postoperatively reported new onset LBP. Female patients (p = 0.025; hazard ratio [HR]: 1.831; 95% CI, 1.081-3.101) and those with preoperative LBP (p = 0.007; HR 2.068; 95% CI, 1.221-3.504) were at a higher risk of developing postoperative LBP at 10 years. 4 out of 9 THA dislocations were late and had shown decreasing SFP angle values over time. Acetabular component inclination and anteversion angles increased over time, whereas the SFP angle was associated with sex and age and the PO angle with age and the severity of any preoperative lumbar degeneration. CONCLUSIONS Concurrent spinal pathology influences THA outcomes at a minimum follow-up of 10 years. Sex, age, and associated lumbar degeneration can affect clinical and radiological changes over time. A decrease in SFP angle values over time was found in patients sustaining late dislocation.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Laura Saldaña
- Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Bone Pathophysiology and Biomaterials Group, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
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Pagan CA, Karasavvidis T, Vigdorchik JM, DeCook CA. Spinopelvic Motion: A Simplified Approach to a Complex Subject. Hip Pelvis 2024; 36:77-86. [PMID: 38825817 PMCID: PMC11162876 DOI: 10.5371/hp.2024.36.2.77] [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: 10/02/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 06/04/2024] Open
Abstract
Knowledge of the relationship between the hip and spine is essential in the effort to minimize instability and improve outcomes following total hip arthroplasty (THA). A detailed yet straightforward preoperative imaging workup can provide valuable information on pelvic positioning, which may be helpful for optimum placement of the acetabular cup. For a streamlined preoperative assessment of THA candidates, classification systems with a capacity for providing a more personalized approach to performance of THA have been introduced. Familiarity with these systems and their clinical application is important in the effort to optimize component placement and reduce the risk of instability. Looking ahead, the principles of the hip-spine relationship are being integrated using emerging innovative technologies, promising further streamlining of the evaluation process.
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Affiliation(s)
- Cale A. Pagan
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Chai Y, Boudali AM, Veltman ES, Farey JE, Walter WL. Evaluating pelvic tilt using the pelvic antero-posterior radiographs: A novel method. J Orthop Res 2024. [PMID: 38814154 DOI: 10.1002/jor.25907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/12/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
Pelvic tilt (PT) is an important parameter for orthopedic surgeries involving hip and spine, typically determined from sagittal pelvic radiographs. However, various challenges can compromise the feasibility of measurement from sagittal imaging, including obscured landmarks, anatomical variations, hardware interference, and limited medical resources. Addressing these challenges and with the aim of reducing radiation exposure to patients, our study developed a novel method to estimate PT from antero-posterior (AP) radiographs, using vertical distances from the pelvic outlet and obturator foramen. We correlated these measurements with PT, defined both anatomically (anterior pelvic plane, PTa) and mechanically (centers of femoral heads and sacral plate, PTm). The study explored creating linear, exponential, and multivariate regression models based on twelve 3D CT-derived pelvic models (six men, six women), simulating AP radiograph projections with controlled PTs. We then validated these models against 105 pairs of patient stereoradiographs. Statistical analysis revealed that combined exponential-linear models yielded the most accurate results, with Pearson correlation coefficients of 0.75 for PTa and 0.77 for PTm, and mean absolute errors of 3.7° ± 2.6° for PTa and 4.5° ± 3.4° for PTm, showing excellent measurement reliability (all ICCs > 0.9) without significant gender discrepancies. In conclusion, this study presents a validated, simple, and accessible method for estimating PT using AP radiograph parameters, supported by the Supporting Information S1: Excel Tool, showing great potential for clinical application in hip and spine procedures.
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Affiliation(s)
- Yuan Chai
- Sydney Muskuloskeletal Health, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Institute of Future Health, South China University of Technology, Guangzhou, China
| | - A Mounir Boudali
- Sydney Muskuloskeletal Health, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ewout S Veltman
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - John E Farey
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - William L Walter
- Sydney Muskuloskeletal Health, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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Li W, Huang Y, Zou Z, Liu X, Li X. Reliability and accuracy of intraoperative fluoroscopy assessment of acetabular cup anteversion in supine direct anterior approach total hip arthroplasty. Sci Rep 2024; 14:12469. [PMID: 38816424 PMCID: PMC11139957 DOI: 10.1038/s41598-024-62964-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
Poor implantation positioning of hip prostheses is considered the primary factor affecting postoperative joint wear. Cup anteversion in direct anterior approach (DAA) total hip arthroplasty (THA) is often excessive. Intraoperative fluoroscopy (IF) are effective for improving implant placement accuracy. This study aimed to analyze IF's reliability and accuracy in assessing intraoperative anteversion. Sixty-two consecutive hips underwent primary THA utilizing DAA alongside IF for cup placement. Intraoperative anteversion was measured using IF images, while postoperative CT and standard anteroposterior (AP) radiographs were used to calculate true anteversion component angles. Differences and correlations between intraoperative and true anteversions were analyzed, and intraclass correlation coefficients (ICC) determined the inter- and intra-observer reliabilities. Excellent intra- and inter-observer reliabilities were observed for all radiographic and CT methods (ICC > 0.9). Strong correlations (PCC > 0.6) existed between anteversion measured on IF image and postoperative CT and AP pelvic measurements. Intraoperative anteversion measured on IF images (16.8 ± 3.2°) was smaller than anteversion measured postoperatively on AP X-rays (21.3 ± 4.7°, P < 0.001) and CT (22.0 ± 4.9°, P < 0.001), with average differences of 4.5°and 5.3°, respectively. Under several influencing factors, the accuracy of IF in assessing cup anteversion in DAA-THA may be limited. However, this still requires large-sample experiments for verification.
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Affiliation(s)
- Weihua Li
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yan Huang
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zehui Zou
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xuqiang Liu
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
| | - Xiaofeng Li
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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Maes V, Cossetto D. Combining inertial navigation with transacetabular ligament in total hip arthroplasty via direct anterior approach results in excellent accuracy compared to standard manual technique - A retrospective cohort study. SICOT J 2024; 10:16. [PMID: 38759152 PMCID: PMC11101203 DOI: 10.1051/sicotj/2024013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/12/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Correct acetabular component placement plays a critical role in reducing early revisions after dislocations in total hip arthroplasty (THA). Although the transverse acetabular ligament (TAL) guides anteversion, inclination can only be accurately guided by navigation. In order to overcome the initial disadvantages with navigation, an imageless, easy-to-use inertial navigation system has been recently introduced. This study aims to analyze the accuracy of inclination with this navigation system compared to the standard manual technique. METHODS Two cohorts, manual technique (MT) and navigation (NAV) cohorts, consisted of 83 and 95 patients, respectively, after exclusion criteria were applied. Inclination target was 38° and anteversion was guided by TAL. Demographic data were collected, and anteroposterior (AP) pelvic and cross-table lateral radiographs were obtained 6 weeks post-operatively. Inclination and anteversion were determined on the AP pelvic and cross-table lateral radiograph, respectively. RESULTS A mean inclination of 41.8° (±6.8°) and 38.9° (±4.4°) was found in the MT and NAV cohorts, respectively. There was no statistical difference in gender, age, and BMI. If the inclination was set within 10° of the target (i.e., 38°), 88% of the MT cohort and 97% of the NAV cohort were within the target zone. Accuracy decreased to 53% and 83%, respectively, if the target zone range was narrowed down to ± 5°. CONCLUSION Combining inertial imageless navigation for inclination and TAL as a landmark for anteversion is significantly more accurate compared to the manual technique, without having the limitations and disadvantages of current standard navigational techniques.
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Affiliation(s)
- Vincent Maes
- Royal North Shore Hospital, Department of Orthopaedic and Traumatic Surgery Reserve Rd, St Leonards NSW 2065 Sydney Australia
- University Hospitals Leuven, Department of Orthopaedic and Traumatic Surgery 49 Herestraat Leuven 3000 Belgium
| | - David Cossetto
- South Coast Orthopaedic Clinic 70 Bridge Road Nowra NSW 2541 Australia
- Nowra Private Hospital, Department of Orthopaedic Surgery Weeroona PI Nowra NSW 2541 Australia
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Waters GC, Jones C, D'Alessandro P, Yates P. Functional assessment of component positioning in patients with groin pain after total hip arthroplasty as a tool to guide management. Hip Int 2024; 34:336-343. [PMID: 37861204 DOI: 10.1177/11207000231205843] [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: 10/21/2023]
Abstract
BACKGROUND Persisting groin pain post total hip arthroplasty (THA) is a common and complex issue that can be difficult to diagnose and manage. Acetabular component positioning is often implicated. AIMS AND METHODS We used a previously well described and validated functional positioning protocol to determine if functional acetabular malpositioning was a factor in groin pain post THA and hence to determine if acetabular revision would be indicated. We compared patient-specific functional acetabular positioning to traditional CT evaluation of cup position and assessment of anterior cup overhang. RESULTS 39 patients with groin pain post-THA were investigated. Functional acetabular malpositioning was diagnosed in 31% (12/39). Revision THA was performed in those 12 patients, resulting in resolution of functional malpositioning (100%), with an overall accuracy of 5.6° (range 1-12), and resolution of groin pain in 67% (8/12). 33% (4/12) of the revised implants had functional positioning located outside the traditional "40/20 zone". Comparison with CT indicated that 40% (4/10) of implants with anterior overhang were well positioned, however only 50% (6/12) of functionally malpositioned implants had CT evidence of anterior cup prominence. Of the 8/12 revision patients who had resolution of their groin pain, only 1 had cup prominence. CONCLUSIONS This study suggests that the utilisation of a patient specific functional positioning algorithm in the analysis of persistent groin pain following THA can assist in identifying the underlying cause of pain and help to guide treatment. For a functionally malpositioned acetabulum, revision surgery offers a potential resolution of groin pain.
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Affiliation(s)
| | | | | | - Piers Yates
- University of Western Australia, Fremantle Hospital and Health Service, Perth, WA, Australia
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Łaziński M, Niemyjski W, Niemyjski M, Olewnik Ł, Drobniewski M, Synder M, Borowski A. Mobility of the lumbo-pelvic-hip complex (spinopelvic mobility) and sagittal spinal alignment - implications for surgeons performing hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:1945-1953. [PMID: 38554202 DOI: 10.1007/s00402-024-05241-5] [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: 05/31/2023] [Accepted: 02/17/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION The optimal positioning of the hip prosthesis components is influenced by the mobility and balance of the spine. The present study classifies patients with pathology of the spino-pelvic-hip complex, showing possible methods of preventing hip dislocations after arthroplasty. HYPOTHESIS Hip-Spine Classification helps arthroplasty surgeons to implant components in more patient-specific position. MATERIALS AND METHODS The group of 100 patients treated with total hip arthroplasty. Antero-posterior (AP) X-rays of the pelvis in a standing position, lateral spine (standing and sitting) and AP of the pelvis (supine after the procedure) were analyzed. We analyzed a change in sacral tilt value when changing from standing to sitting (∆SS), Pelvic Incidence (PI), Lumbar Lordosis (LL) Mismatch, sagittal lumbar pelvic balance (standing position). Patients were classified according to the Hip-Spine Classification. Postoperatively, the inclination and anteversion of the implanted acetabular component were measured. RESULTS In our study 1 A was diagnosed in 61% of all cases, 1B in 18%, 2 A in 16%, 2B in 5%. 50 out of 61 (82%) in group 1 A were placed within the Levinnek "safe zone". In 1B, 2 A, 2B, the position of the acetabular component was influenced by both the spinopelvic mobility and sagittal spinal balance. The mean inclination was 43.35° and the anteversion was 17.4°. CONCLUSIONS Categorizing patients according to Hip-Spine Classification one can identify possible consequences the patients at risk. Pathology of the spino-pelvic-hipcomplex can lead to destabilization or dislocation of hip after surgery even though implanted according to Lewinnek's indications. Our findings suggest that Lewinnek safe zone should be abandoned in favor of the concept of functional safe zones.
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Affiliation(s)
- Mariusz Łaziński
- Szpital Wojewódzki im. Jana Pawła II w Bełchatowie, Oddział Chirurgii Urazowo- Ortopedycznej, Bełchatów, Poland
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, ul. Pomorska 251, Lodz, Poland
| | - Włodzimierz Niemyjski
- Szpital Wojewódzki im. Jana Pawła II w Bełchatowie, Oddział Chirurgii Urazowo- Ortopedycznej, Bełchatów, Poland
| | - Michał Niemyjski
- Szpital Wojewódzki im. Jana Pawła II w Bełchatowie, Oddział Chirurgii Urazowo- Ortopedycznej, Bełchatów, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Marek Drobniewski
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, ul. Pomorska 251, Lodz, Poland
| | - Marek Synder
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, ul. Pomorska 251, Lodz, Poland
| | - Andrzej Borowski
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 92-213 Lodz, ul. Pomorska 251, Lodz, Poland.
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Spencer-Gardner L, Nunley B, Gómez-Hoyos J, Wells J, Khoury AN. Sagittal Pelvic Tilt Directly Influences the Ischiofemoral Space: A Cadaveric Study. Orthopedics 2024; 47:167-171. [PMID: 38285553 DOI: 10.3928/01477447-20240122-03] [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: 01/31/2024]
Abstract
BACKGROUND Ischiofemoral impingement (IFI) is understood to be a pain generator in the deep gluteal space. Femoral position is known to influence the ischiofemoral space (IFS), but there has been no study examining the effect of sagittal pelvic tilt on the IFS. The purpose of this study was to determine whether changes in pelvic tilt in the sagittal plane lead to changes in the dimensions of the IFS. MATERIALS AND METHODS Five fresh frozen cadavers (10 hips) were used for this anatomic study. The specimens were skeletonized and placed in the prone position with the pelvis fixed to a custom-built hinged table. A digital inclinometer was used to tilt the pelvis -10°, 0°, and 10° simulating posterior, neutral, and anterior pelvic tilt, respectively. Digital calipers were used to measure the dimensions of the IFS in all three positions of sagittal pelvic tilt. RESULTS Changes in pelvic tilt resulted in significant changes in the dimensions of the IFS. Mean IFS dimensions measured 29.3±9.7 mm, 37.2±9.0 mm, and 24.3±9.2 mm in the neutral, anterior, and posterior pelvic tilt positions, respectively (P<.0001). CONCLUSION Changes in sagittal pelvic tilt influence the dimensions of the IFS, with posterior pelvic tilt noted to significantly decrease the IFS when compared with neutral and anterior pelvic tilt. These findings suggest that further evaluation of sagittal spinopelvic balance in the etiology of symptomatic IFI may be warranted. [Orthopedics. 2024;47(3):167-171.].
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Verhaegen JCF, Alves Batista N, Foster R, Graham R, Phan P, Grammatopoulos G. What patient parameters influence lumbar stiffness in patients with hip pathology? J Orthop Res 2024; 42:1054-1065. [PMID: 37997704 DOI: 10.1002/jor.25749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
Lumbar stiffness leads to greater hip dependence to achieve sagittal motion and increases instability after total hip arthroplasty (THA). We aimed to determine parameters that influence lumbar stiffness among patients with hip pathology. We hypothesized that modifiable (degenerative changes, spinal canal stenosis, facet orientation) and nonmodifiable factors (muscle condition) would be associated with lumbar spine stiffness. In this retrospective case-cohort study from a tertiary referral center, consecutive patients presenting at a hip specialist clinic underwent standing and deep-seated radiographic assessment to measure lumbar lordosis (∆LL) (stiffness: ∆LL < 20°), hip flexion (∆PFA: pelvic femoral angle), and degree of degenerative-disc-disease (DDD) (facet osteoarthritis, disc height, endplate proliferative changes). Of these, 65 patients were selected with previous lumbar spine magnetic resonance imaging, allowing to determine lumbar facet orientation, spinal canal stenosis (Schizas classification), and flexor- and extensor-muscle atrophy (Goutallier classification). Mean ∆LL was 45° (range: 11°-72°) and four patients (6%) exhibited spine stiffness. Patients with multilevel DDD (n = 22) had less ∆LL than those with no/single level (n = 43) DDD (34° [range: 11°-53°] vs. 51° [21°-72°]; p < 0.001). Number of DDD levels correlated strongly with ∆LL (ρ = -0.642; p < 0.001). Spinal stiffness was only seen in patients with ≥4 DDD levels. There was no correlation between ∆LL and facet orientation (p > 0.05). ∆LL correlated strongly with extensor atrophy at L3-L4 (ρ = -0.473), L4-L5 (ρ = -0.520), and L5-S1 (ρ = -0.473) and poorly with flexors at L4-L5 (ρ = -0.134) and L5-S1 (ρ = -0.227). Lumbar stiffness is dependent on modifiable (muscle atrophy) and nonmodifiable (extend of DDD) factors. This can guide nonoperative management of hip pathology, emphasizing the relevance of core muscle rehabilitation to improve posture and stiffness. Identification ≥4 DDD levels should alert surgeons of increased THA instability risk. Level of evidence: level IV, cohort series.
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Affiliation(s)
- Jeroen C F Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Orthopaedics & Traumatology, University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, AZ Monica, Antwerp, Belgium
| | - Nuno Alves Batista
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ryan Foster
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ryan Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Philippe Phan
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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LaCour M, Nachtrab J, Nguyen T, Dessinger GM, Jacobs A, Komistek R. 3D preoperative predictions of in vivo hip stability and edge loading for neutral and lipped liners. J Orthop Res 2024. [PMID: 38624253 DOI: 10.1002/jor.25855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 04/17/2024]
Abstract
Hip dislocation is one of the leading causes of failure and revision surgery for total hip arthroplasty. To reduce dislocation rates, lipped liners have been designed with an elevated portion of the rim, to increase jump distance and maintain greater contact area. While it has been documented that lipped liners help reduce dislocation, the objective of this study is to investigate whether lipped liners also help reduce smaller instances of hip micromotion, separation, and edge loading. This study uses an advanced three-dimensional preoperative planning tool to analyze 10 patients, each implanted with both a neutral and lipped liner. Patients within the simulation performed stance phase of gait, and each cup was implanted with the rotation center aligned with the preoperative acetabulum center as well as shifted medially by 2, 4, 6, 8, and 10 mm, yielding 120 total simulations. Specific postoperative outcomes-of-interest included specified component offset, resultant in vivo hip forces, hip separation, and contact area to evaluate edge loading. The planner predicted a reduction in hip separation and an increase in articulating contact area for when using a lipped liner compared to a neutral liner. Additionally, regardless of liner type, increases in hip separation corresponded to decreases in contact area, therefore resulting in edge loading of the liner. Together, this indicates that improper component alignment and offsets may lead to an increase in hip separation and edge loading, but the use of a lipped liner may provide improved stability and resistance to this micromotion.
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Affiliation(s)
- Michael LaCour
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA
| | - Jarrod Nachtrab
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA
| | - Thang Nguyen
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA
| | - Garett M Dessinger
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA
| | | | - Richard Komistek
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA
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11
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Hardwick-Morris M, Twiggs J, Miles B, Al-Dirini RMA, Taylor M, Balakumar J, Walter WL. Determination of preoperative risk factors for iliopsoas tendonitis after total hip arthroplasty: A simulation study. J Orthop Res 2024. [PMID: 38587991 DOI: 10.1002/jor.25856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/28/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
This study aims to identify preoperative risk factors for iliopsoas tendonitis after total hip arthroplasty, a complication typically attributed to acetabular cup position and orientation, using a validated iliopsoas impingement detection simulation. Analyzing CT scans and X-rays of 448 patients using a validated preoperative planning protocol, patients were simulated for iliopsoas impingement and categorized into at-risk and not at-risk groups based on a prior validation study, with a 23% at-risk incidence. Implementing a propensity score matching algorithm to reduce covariate imbalance, we identified factors that may exacerbate risk of iliopsoas tendonitis. Parameters that were investigated included standing pelvic tilt, functional femoral rotation, and the difference between the planned acetabular cup diameter and native femoral head diameter (ΔC-NFH). Comparing pelvic tilt, we found a significant difference between the groups (at-risk: -6.0°, not at-risk: -0.7°; p << 0.01). A similar trend was noted for ΔC-NFH (at-risk: +5.7 mm, not at-risk: +5.1 mm; p = 0.01). Additional simulations of at-risk patients indicated increased anteversion of the acetabular cup reduces impingement risk more effectively than medialisation. These findings suggest that spinopelvic parameters may exacerbate iliopsoas irritation risk, underscoring their importance in preoperative planning and patient expectation management. Similar findings of a greater than 6 mm difference between cup size and native femoral head diameter being a significant risk for iliopsoas tendonitis have been observed before, underscoring its potential veracity. These results may provide surgeons with a simple threshold that can be used in determining a cup size to reduce the risk of iliopsoas tendonitis.
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Affiliation(s)
- Max Hardwick-Morris
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Joshua Twiggs
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
| | - Brad Miles
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
| | - Rami M A Al-Dirini
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Mark Taylor
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | | | - William L Walter
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Chai Y, Boudali AM, Khadra S, Dasgupta A, Maes V, Walter WL. Evaluating Pelvic Tilt Using the Pelvic Antero-Posterior Projection Images: A Systematic Review. J Arthroplasty 2024; 39:1108-1116.e2. [PMID: 37871860 DOI: 10.1016/j.arth.2023.10.035] [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: 07/04/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Pelvic tilt (PT) is a routinely evaluated parameter in hip and spine surgeries, and is usually measured on a sagittal pelvic radiograph. This may not always be feasible due to limitations such as landmark visibility, pelvic anomaly, and hardware presence. Tremendous efforts have been dedicated to using pelvic antero-posterior (AP) radiographs for assessing sagittal PT. Thus, this systematic review aimed to collect these methods and evaluate their performances. METHODS Two independent reviewers searched the PubMed, Ovid, Cochrane, and Web of Science databases in June 2023 with backward reference trailing (Google Scholar archive). There were 30 studies recruited. Risk of bias was assessed using the prediction model risk of bias assessment tool. The relevant data were tabulated in a standardized form for evaluating either the absolute PT or relative PT. Disagreement was resolved by discussing with the senior author. RESULTS There were 19 parameters from pelvic AP projection images involved, with 4 studies which used artificial intelligence, eyeball, or statistical shape method not involving a specific parameter. In comparing the PT values from pelvic sagittal images with those extrapolated from antero-posterior projection images, the highest correlation coefficient was found to be 0.91. The mean absolute difference (error) was 2.6°, with a maximum error reaching 10.9°. Most studies supported the feasibility of using AP parameters to calculate changes in PT. CONCLUSIONS No individual AP parameter was found to precisely estimate absolute PT. However, relative PT can be derived by evaluating serial AP radiographs of a patient in varying postures, employing any AP parameters.
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Affiliation(s)
- Yuan Chai
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia
| | - A Mounir Boudali
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia
| | - Sam Khadra
- Faculty of Medicine and Health, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Amrita Dasgupta
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vincent Maes
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia; Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - William L Walter
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia; Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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Pluchon JP, Gérard R, Stindel E, Lefèvre C, Letissier H, Dardenne G. Variations in pelvic tilt during day-to-day activities after total hip arthroplasty measured with an ultrasound system. Orthop Traumatol Surg Res 2024; 110:103792. [PMID: 38081356 DOI: 10.1016/j.otsr.2023.103792] [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: 11/02/2022] [Revised: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION The pelvis plays a major role in the orientation of total hip arthroplasty (THA) implants and consequently, on the postoperative stability of the new hip joint. The relationship between the spine and pelvis affects the functional orientation of the acetabular cup, although this relationship differs between individuals and the positions encountered in everyday life. We believe this should be factored in when planning the THA procedure. This led us to conduct an in vivo ultrasound study to document the values of pelvic tilt in standing, sitting and lying positions in patients who have advanced hip osteoarthritis, before and after they undergo THA. HYPOTHESIS The pelvic tilt when standing, sitting and lying supine does not change significantly after THA. MATERIALS AND METHODS The pelvic tilt, defined as the angle between the anterior pelvic plane and a vertical line was measured using an ultrasound device in 30 patients before the THA procedure and again 6 months later in standing, sitting and lying positions. The measurements were done during an office visit with the patient on an examination table for the lying position, on a chair for the sitting position and with the heels and occiput against the wall for the standing position. RESULTS The preoperative and 6-month postoperative pelvic tilt were -5.6̊±10.4̊ [-30.6̊; 11.7̊] and -5.8̊±7.9̊ [-20.6̊; 10.4̊] (p=0.4129) when standing, -44.5̊±6.10 [-53.8̊; -23.9̊] and -43.5̊±6.9̊ [-54.4̊; -17.3̊] (p=0.5760) when sitting, -88.3̊±5.1̊ [-99.3̊; -78.7̊] and -87.9̊±5.9̊ [-97.6̊; -72.4̊] (p=0.6106) when lying supine, respectively. There was no significant difference in the pelvic tilt before and 6 months after THA procedure. Variations of±5̊; ±5-10̊; ±10-15̊ and 15-20̊ were found in 72% (18); 20% (5); 4% (1) and 4% (1) of patients when lying supine, 56% (14); 36% (9); 8% (2); 0% (0) of patients when standing and 76% (19); 24% (6); 0% (0); 0% (0) when sitting. The mean variation for each patient between the preoperative and 6 months postoperative measurement was 4.8±3.4̊ [0.8̊; 10.4̊] (p=0.4129), 3.5±2.3̊ [0.2̊; 9.1̊] (p=0.5760), and 4.6̊±3.2̊ [1.2̊; 15.4̊] (p=0.6106) for the standing, sitting and lying positions respectively. CONCLUSION The pelvic tilt does not significantly change 6 months after THA. Taking into account the various positions used in everyday life may help to optimize the implant position. We have described the use of an affordable, accurate and non-irradiating device that provides fast and easy measurements of pelvic tilt in various positions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jean-Philippe Pluchon
- Service de chirurgie orthopédique et traumatologique, hôpital d'instruction des Armées Clermont-Tonnerre, 29200 Brest, France; Laboratoire de traitement de l'information médicale (LaTIM, UMR1101), bâtiment IBRBS, 22, avenue Camille-Desmoulins, 29200 Brest, France
| | - Romain Gérard
- Laboratoire de traitement de l'information médicale (LaTIM, UMR1101), bâtiment IBRBS, 22, avenue Camille-Desmoulins, 29200 Brest, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier privé Brestois, clinique Pasteur-Lanroze, 29200 Brest, France
| | - Eric Stindel
- Laboratoire de traitement de l'information médicale (LaTIM, UMR1101), bâtiment IBRBS, 22, avenue Camille-Desmoulins, 29200 Brest, France; Service de chirurgie orthopédique et traumatologique, CHRU de la Cavale Blanche, 29200 Brest, France
| | - Christian Lefèvre
- Laboratoire de traitement de l'information médicale (LaTIM, UMR1101), bâtiment IBRBS, 22, avenue Camille-Desmoulins, 29200 Brest, France
| | - Hoel Letissier
- Laboratoire de traitement de l'information médicale (LaTIM, UMR1101), bâtiment IBRBS, 22, avenue Camille-Desmoulins, 29200 Brest, France; Service de chirurgie orthopédique et traumatologique, CHRU de la Cavale Blanche, 29200 Brest, France.
| | - Guillaume Dardenne
- Laboratoire de traitement de l'information médicale (LaTIM, UMR1101), bâtiment IBRBS, 22, avenue Camille-Desmoulins, 29200 Brest, France
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Pour AE, Innmann MM, Reichel F, Schaper B, Renkawitz T, Merle C, Grammatopoulos G. How Do Spinopelvic Characteristics Change Post-Total Hip Arthroplasty? A Longitudinal Assessment Raising Awareness of the Postoperative Period. J Arthroplasty 2024:S0883-5403(24)00199-2. [PMID: 38460739 DOI: 10.1016/j.arth.2024.02.079] [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: 12/13/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Spinopelvic characteristics, including sacral slope (SS), are commonly evaluated in different positions pre-total hip arthroplasty (THA). This study aimed to: 1) investigate the change in spinopelvic parameters at 7 days (early) and 1-year post-THA; and 2) identify patient characteristics associated with a change in SS of more than 7° post-THA. METHODS We prospectively studied 250 patients who underwent unilateral THA [132 women, age 66 years (range, 32 to 88)] and underwent biplanar images preoperatively and at 7 days and 1-year post-THA. Parameters measured included pelvic incidence, standing lumbar lordosis, SS, and proximal femoral angle (PFA). A SS change ≥ 7° was considered the threshold as it would result in more than a 5° change in cup orientation. RESULTS Early post-THA SSstanding remained within ± 6º from preoperative measurements in 75% of patients, reduced by ≥ 7° in 9%, and increased by ≥ 7° in 16%. Those that showed a reduction in SS had the lowest PFA and the highest SS pre-THA (P = .028, .107, and < 0.001, respectively). From 7 days until the 1-year mark, pelvic tilt increased, SS reduced (mean: -4º, range: -29 to 17º, P < .001), and patients stood with greater hip extension ΔPFAstanding (mean 7°, range: -34 to 37°, P < .001). At 1 year, SSseated had remained within ± 6º, relative to the pre-THA value, in 49% of patients. CONCLUSIONS Standing spinopelvic characteristics, especially SSstanding, remain within ±6° in three-quarters of patients both early- and at 1-year post-THA. In the remaining cases, pelvic tilt changes significantly. In 9% of cases, SS reduces ≥ 7° early THA, probably due to the alleviation of fixed-flexion contractures. The SSseated changes by ≥ ± 7° in almost 50% of cases in this study, and its clinical value as a preoperative planning tool should be questioned. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Aidin E Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut
| | - Moritz M Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ontario, Canada; Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Bibiane Schaper
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christian Merle
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ontario, Canada; Diakonie Klinikum Stuttgart, Stuttgart, Germany
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Vasiljeva K, Lunn D, Chapman G, Redmond A, Wang L, Thompson J, Williams S, Wilcox R, Jones A. Dynamic Acetabular Cup Orientation during Gait: A Study of Fast- and Slow-Walking Total Hip Replacement Patients. Bioengineering (Basel) 2024; 11:151. [PMID: 38391637 PMCID: PMC10885924 DOI: 10.3390/bioengineering11020151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
The dynamic orientation of total hip replacement acetabular cups during walking may vary substantially from their assumed position at surgical implantation and may vary between individuals. The scale of this effect is of interest for both pre-clinical device testing and for pre-operative surgical planning. This work aimed to evaluate (1) patient variation in dynamic cup orientation; (2) whether walking speed was a candidate proxy measure for the dynamic cup orientation; and (3) the relationships between dynamic cup orientation angles and planar pelvic angles. Pelvic movement data for patients with fast (20 patients) and slow (19 patients) self-selected walking speeds were used to calculate acetabular cup inclination and version angles through gait. For aim 1, the range and extremes of acetabular cup orientation angles were analysed for all patients. A large patient-to-patient variation was found in the ranges of both inclination angle (1° to 11°) and version angle (4° to 18°). The version angle was typically retroverted in comparison to the implantation position (greatest deviation 27°). This orientation is substantially different to the static, 0° version, simplifying assumptions in pre-clinical 'edge loading' testing. For aim 2, the cup orientation angles were compared between the fast- and slow-walking groups using statistical parametric mapping. The only significant differences observed were for cup version angle, during ~12% of the gait cycle before toe-off (p < 0.05). Therefore, self-selected walking speed, in isolation, is not a sufficient proxy measure for dynamic acetabular orientation. For aim 3, correlations were recorded between the acetabular cup orientation angles and the planar pelvic angles. The cup inclination angle during gait was strongly correlated (Spearman's coefficient -1) with pelvic obliquity alone, indicating that simple planar assessment could be used to anticipate inclination angle range. The cup version angle was correlated with both pelvic rotation and tilt (Spearman's coefficient 0.8-1), indicating that cup version cannot be predicted directly from any single pelvic movement. This complexity, along with the interaction between inclination angle and range of version angle, supports the use of computational tools to aid clinical understanding.
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Affiliation(s)
- Ksenija Vasiljeva
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - David Lunn
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds LS7 4SA, UK
| | - Graham Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Anthony Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds LS7 4SA, UK
| | - Lin Wang
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
- DePuy Synthes Joint Reconstruction, Leeds LS11 8DT, UK
| | - Jonathan Thompson
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
- DePuy Synthes Joint Reconstruction, Leeds LS11 8DT, UK
| | - Sophie Williams
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Ruth Wilcox
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Alison Jones
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
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McIntosh EI, Sarpong NO, Steele JR, Davis E, Muir JM, Canoles HG, Vigdorchik JM. The Hip-spine Assessment of a Novel Surgical Planning Software Provides Acetabular Component Targets That Are Reliable and in Agreement With Current Clinical Recommendations. Arthroplast Today 2024; 25:101288. [PMID: 38292149 PMCID: PMC10825230 DOI: 10.1016/j.artd.2023.101288] [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: 07/31/2023] [Revised: 10/11/2023] [Accepted: 11/04/2023] [Indexed: 02/01/2024] Open
Abstract
Background Spinopelvic immobility has been reported to increase dislocation risk following total hip arthroplasty. Surgically placing acetabular components in a functional orientation has been shown to mitigate risk. The aim of this study was to evaluate the validity and reliability of novel surgical planning software to generate clinically recommended cup targets. Methods Hip-spine assessments were performed retrospectively on 40 patients. Five reviewers, including 3 arthroplasty-trained surgical fellows and 2 clinical research scientists performed the assessments. Hip-spine assessments consisted of measuring anterior pelvic plane tilt, sacral slope, pelvic incidence, and lumbar lordosis on standing anteroposterior pelvis and lateral standing and seated hip-spine images. Generated cup targets and a control group (40°/20° relative to the anterior pelvic plane) were compared to clinically recommended cup targets. Agreement was defined as a cup position within the recommended range or within 3° of a specific target (eg, 40° inclination) when no range was provided. Intraclass correlation coefficients were used to assess interrater and intrarater reliability, and McNemar's chi-square test was used to measure success relative to the control group. Results The intraclass correlation coefficient was 0.88 for delta sacral slope and 0.92 for pelvic incidence-lumbar lordosis mismatch. For patients with spinopelvic risk factors, the generated targets matched the clinical recommendations in 81% of patients compared to only 16% in the control group. Conclusions Excellent interrater and intrarater reliability was achieved using the novel surgical planning software. The resultant target values agreed with clinical recommendations to a greater extent than the control group.
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Affiliation(s)
- Emily I. McIntosh
- Department of Clinical Research, Intellijoint Surgical Inc, Kitchener, ON, Canada
| | - Nana O. Sarpong
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - John R. Steele
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth Davis
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey M. Muir
- Department of Clinical Research, Intellijoint Surgical Inc, Kitchener, ON, Canada
| | - Haley G. Canoles
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Shao H, Huang Y, Yang D, Deng W, Wu XD, Zhou Y. Variety of femoral anteversion and its measurement in cementless total hip arthroplasty: Does robotic technology improve accuracy? J Orthop Surg Res 2024; 19:47. [PMID: 38195511 PMCID: PMC10775668 DOI: 10.1186/s13018-024-04527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND High-performance total hip arthroplasty (THA) depends on the accurate position of components. However, femoral anteversion is variable, and current studies only used traditional instruments to evaluate it, such as protractor and spirit level with limited cases. This study aimed to identify the variability in the measured femoral native anteversion and intraoperative stem anteversion under different measurement methods, including intraoperative robotic method. We hypothesized that robotic technology was more accurate than traditional instruments for femoral anteversion evaluation. METHODS This study included 117 hips of patients who underwent robotic-assisted THA between November 2019 and March 2021. Preoperative native femoral anteversion was measured using a robotic system. Intraoperative femoral stem anteversion was evaluated visually, and then measured with a goniometer and a robotic system, respectively. Variability in the measured femoral native anteversion and intraoperative femoral stem anteversion was calculated and compared. Intraclass correlation coefficient (ICC) and Pearson correlation analysis were used to assess the consistency and correlation of anteversion of different measurements and postoperative CT-measured stem anteversion, respectively. RESULTS The result of measurement for preoperative native femoral anteversion was more variable than the intraoperative robotic-measured stem anteversion. Intraoperative robotic-measured stem version showed the highest correlation with postoperative CT measurement of stem version (r = 0.806, P < 0.001), while intraoperative surgeon estimation had the lowest correlation coefficient (r = 0.281, P = 0.025). As for the consistency with postoperative CT measurement of femoral stem anteversion, the intraoperative robotic-measured femoral stem version also had the highest value (ICC = 0.892, P < 0.001). CONCLUSION Native femoral anteversion was variable preoperatively. Using cementless stems, anteversion was also highly variable. Robotic assessment for stem anteversion during surgery was more consistent with the final position than the preoperative assessment and conventional intraoperative estimation.
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Affiliation(s)
- Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Xiang-Dong Wu
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China.
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LaCour M, Nguyen TD, Nachtrab J, Bonnin M, Komistek R. Alignment and mechanics evaluation for a compaction broach stem versus a blade style proximal press fit stem using 3-Dimensional planning. J Biomech 2024; 163:111950. [PMID: 38237494 DOI: 10.1016/j.jbiomech.2024.111950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/06/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
Three-dimensional (3D) preoperative planning tools can be used to help plan and compare component alignment scenarios for different total hip arthroplasty systems to ultimately improve postoperative outcomes and patient satisfaction. The objective of this study is to use 3D preoperative planning tools based on patient-specific bone models to compare two different stem designs, specifically a compaction broach stem and a proximal press fit stem. The planner uses patient-specific proximal femoral bone morphology to suggest a specific implant size and placement. The planner then allows for preoperative predictions of component head positioning, stem fit within the canal, and potential cortical bone reaming that must be done, as well as postoperative predictions of stability and mechanics. The stems were evaluated to determine the accuracy of stem placement, the theoretical volumetric bone removal/reaming required to achieve a desired fit, and the associated postoperative mechanics. This study demonstrated that there was a difference in component alignment and predicted postoperative mechanics between a compaction broach stem and a press fit stem, with the compaction broach stem allowing for more accurate alignment with less required bone removal, resulting in improved postoperative stability and mechanics. This study also demonstrated that much of the stem misalignment for both systems occurred in the anterior/posterior direction. Overall, 3D preoperative planning offers significant benefits and novel intraoperative insight, and the industry should continue to enhance their THA preoperative planning tools.
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Innmann M, Verhaegen J, Renkawitz T, Merle C, Grammatopoulos G. How to Screen for Lumbar Spine Stiffness in Patients Awaiting Total Hip Arthroplasty. J Arthroplasty 2024; 39:124-131. [PMID: 37567351 DOI: 10.1016/j.arth.2023.08.006] [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: 12/01/2022] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This study aimed to (1) define the prevalence of spinopelvic abnormalities among patients who have hip osteoarthritis (OA) and controls (asymptomatic volunteers) and (2) identify factors that reliably predict the presence of lumbar spine stiffness. METHODS This is a prospective, cross-sectional, case-cohort study of patients who have end-stage primary hip OA, who underwent primary total hip arthroplasty (THA). Patients were compared with a cohort of asymptomatic volunteers, matched for age, sex, and body mass index (BMI), serving as a control group. Spinopelvic pathologies were defined as: lumbar spine flatback deformity (difference of 10 or more degrees for pelvic incidence minus lumbar lordosis angle), a standing sagittal pelvic tilt of 19° or more and lumbar spine stiffness (lumbar flexion of less than 20° between both postures). RESULTS The prevalence of spinopelvic pathologies was similar between patients and controls (flatback deformity: 16% versus 10%, P = .209; standing pelvic tilt >19°: 17% versus 24%, P = .218; lumbar spine stiffness: 6% versus 5%, P = .827). Age over 65 years-old and standing lumbar lordosis angle less than 45° were associated with high sensitivity and specificity for identifying lumbar spine stiffness (age >65 years: 82% and 66%; standing lumbar lordosis angle <45°: 85% and 73%). CONCLUSION The presence of end-stage hip osteoarthritis was not associated with increased prevalence of adverse spinopelvic characteristics compared to matched, asymptomatic volunteers. Age and LLstanding are the strongest predictors of lumbar spine flexion and can guide clinical practice on when to obtain additional radiographs for patients who have hip OA before arthroplasty to identify at-risk patients. LEVEL OF EVIDENCE II (prospective, cohort study).
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Affiliation(s)
- Moritz Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada; Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jeroen Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada; Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Merle
- Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany; Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, Ottawa, Ontario, Canada
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Cha MJ, Xi Y, Chhabra A, Pierrepont J, Jones T, Hohman D, Wells J. Variation in Functional Pelvic Tilt in Female Patients Undergoing Total Hip Arthroplasty With Acetabular Dysplasia. J Arthroplasty 2023; 38:2623-2629. [PMID: 37279848 DOI: 10.1016/j.arth.2023.05.062] [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: 12/27/2022] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND As the pelvis is a dynamic structure, the quantification of pelvic tilt (PT) should be done in different hip positions prior to total hip arthroplasty (THA). We sought to investigate functional PT in young female patients undergoing THA and explore the correlation of PT with the extent of acetabular dysplasia. Additionally, we aimed to define the PS-SI (pubic symphysis-sacroiliac joint) index as a PT quantifier on AP pelvis X-ray. METHODS Pre-THA female patients under the age of 50 years (n = 678) were investigated. Functional PT in 3 positions (supine, standing, and sitting) were measured. Hip parameters including lateral center-edge angle (LCEA), Tönnis angle, head extrusion index (HEI), and femoro-epiphyseal acetabular roof (FEAR) index were correlated to PT values. The PS-SI/SI-SH (sacroiliac joint-sacral height) ratio was also correlated to PT. RESULTS From the 678 patients, 80% were classified as having acetabular dysplasia. Among these patients, 50.6% were bilaterally dysplastic. The mean functional PT of the entire patient group was 7.4°, 4.1°, and -1.3° in the supine, standing and seated positions. The mean functional PT of the dysplastic group was 7.4°, 4.0°, and -1.2° in the supine, standing and seated positions. The PS-SI/SI-SH ratio was found to be correlated to PT. CONCLUSION Most of the pre-THA patients had acetabular dysplasia and exhibited anterior PT in the supine and standing positions, most pronounced in the standing position. PT values were comparable between the dysplastic and non-dysplastic group without change with worsening dysplasia. PS-SI/SI-SH ratio can be used to easily characterize PT.
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Affiliation(s)
- Myung-Jin Cha
- University of Texas Rio Grande Valley, UT Southwestern Medical School, Dallas, Texas
| | - Yin Xi
- Department of Radiology and Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Avneesh Chhabra
- Department of Radiology and Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | | | | | - Don Hohman
- Department of Orthopaedic Surgery, Medical City Dallas Texas, UT Southwestern Medical Center, Dallas, Texas
| | - Joel Wells
- Baylor Scott & White Comprehensive Hip Center and Hip Preservation Center, Texas A&M School of Medicine, Bryan, Texas
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21
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Jarrett DY, Stamoulis C, Shore BJ, Tsai A. Pelvis radiographs in children with cerebral palsy: effects of patient positioning on calculating migration percentages. Pediatr Radiol 2023; 53:2662-2671. [PMID: 37833504 DOI: 10.1007/s00247-023-05783-7] [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: 06/26/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Hip displacement in children with cerebral palsy (CP) is monitored by measuring migration percentage on anteroposterior pelvis radiographs. However, proper positioning for radiography in children with spasticity is difficult. The reliability and accuracy of migration percentage as a function of patient positioning is unknown. OBJECTIVE To determine the effects of patient positioning on migration percentage measurements in children with CP. MATERIALS AND METHODS We identified children with CP (≤18-year-old) with pelvis CT and anteroposterior pelvis radiograph obtained <6 months apart (10/2018-11/2021). Digitally reconstructed radiographs were generated from each pelvis CT, to simulate nine different patient positions: neutral; 10° and 20° lordosis and kyphosis; and 10° and 20° right rotation and left rotation. Two radiologists measured migration percentages from the simulated and real pelvis radiographs. We used Spearman's rho to assess inter-rater reliability, and Wilcoxon signed rank test to determine statistical significance. RESULTS We studied sixty-three children (male=41; median age=8 years; range=4-18 years). The two radiologists' migration percentage measurements were highly correlated with each other across all simulated and real radiographs (Spearman's rho=0.86-0.99, P<0.01). For both readers and hips, migration percentages measured from real radiographs were significantly different from those measured from neutral simulated radiographs (P<0.01), with median absolute difference=5-6 percentage points (PP) and interquartile range (IQR)=9-12 PP. When comparing migration percentage measurements from neutral simulated radiographs to those in kyphosis/lordosis and right/left rotations, median absolute differences were 2-4 PP (IQR=3-8 PP) and 4-15 PP (IQR=6-17 PP), respectively. CONCLUSION Inter-rater reliability of measured migration percentages is high, but accuracy decreases with patient positional changes.
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Affiliation(s)
- Delma Y Jarrett
- Divisions of Pediatric Radiology and Musculoskeletal Radiology, Weill Cornell Medical School, New York, NY, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Catherine Stamoulis
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin J Shore
- Department of Orthopedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andy Tsai
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
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22
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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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23
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Grosso MJ, Plaskos C, Pierrepont J, Saxena A. Increased Cup Anteversion May Not Prevent Posterior Dislocation in Patients With Abnormal Spinopelvic Characteristics in Total Hip Arthroplasty. Arthroplast Today 2023; 23:101192. [PMID: 37745968 PMCID: PMC10517262 DOI: 10.1016/j.artd.2023.101192] [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: 05/17/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
Background The aims of this study were to (1) assess the degree of variation in acetabular component placement and combined anteversion in a large cohort of dislocating total hip arthroplasties; (2) assess the spinopelvic characteristics of the cohort; and (3) examine the association between cup anteversion and reported direction of instability. Methods A commercial database of 245 dislocating total hip arthroplasties referred for postoperative computed tomography and functional radiographic imaging and analysis were reviewed. Spinopelvic parameters and cup and stem positions were measured in the supine, standing, flex-seated, and anterior pelvic plane (APP) positions. Spinopelvic characteristics were stratified by high, neutral, and low cup anteversion using thresholds of >35° and <15° anteversion in standing, respectively. Results In the dislocation cohort, 62%, 45%, and 42% of cups were within the safe zone in supine, standing, and the APP, respectively (P < .001). Patients with high vs neutral or low cup anteversion had significantly stiffer spines, more posterior pelvic tilt in standing, greater changes in pelvic tilt, and higher sagittal imbalance. Of the 45 patients with high cup anteversion and reported instability direction, 60% and 40% were reported to have posterior and anterior instability, respectively, with no differences in spinopelvic characteristics. Conclusions In this dislocating cohort, there is a decreased percentage of cups within the safe zone in the APP and standing position compared to the supine reference. In addition, we found that patients having poor spinopelvic characteristics and high cup anteversion can still dislocate, suggesting that adjusting cup anteversion alone may not be sufficient for preventing instability.
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Affiliation(s)
| | | | | | - Arjun Saxena
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
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24
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Ramkumar PN, Pang M, Vigdorchik JM, Chen AF, Iorio R, Lange JK. Patient-Specific Safe Zones for Acetabular Component Positioning in Total Hip Arthroplasty: Mathematically Accounting for Spinopelvic Biomechanics. J Arthroplasty 2023; 38:1779-1786. [PMID: 36931359 DOI: 10.1016/j.arth.2023.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/26/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Despite a growing understanding of spinopelvic biomechanics in total hip arthroplasty (THA), there is no validated approach for executing patient-specific acetabular component positioning. The purpose of this study was to (1) validate quantitative, patient-specific acetabular "safe zone" component positioning from spinopelvic parameters and (2) characterize differences between quantitative patient-specific acetabular targets and qualitative hip-spine classification targets. METHODS From 2,457 consecutive primary THA patients, 22 (0.88%) underwent revision for instability. Spinopelvic parameters were measured prior to index THA. Acetabular position was measured following index and revision arthroplasty. Using a mathematical proof, we developed an open-source tool translating a surgeon-selected, preoperative standing acetabular target to a patient-specific safe zone intraoperative acetabular target. Difference between the patient-specific safe zone and the actual component position was compared before and after revision. Hip-spine classification targets were compared to patient-specific safe zone targets. RESULTS Of the 22 who underwent revision, none dislocated at follow-up (4.6 [range, 1 to 6.9]). Patient-specific safe zone targets differed from prerevision acetabular component position by 9.1 ± 4.2° inclination/13.3 ± 6.7° version; after revision, the mean difference was 3.2 ± 3.0° inclination/5.3 ± 2.7° version. Differences between patient-specific safe zones and the median and extremes of recommended hip-spine classification targets were 2.2 ± 1.9° inclination/5.6 ± 3.7° version and 3.0 ± 2.3° inclination/7.9 ± 3.5° version, respectively. CONCLUSION A mathematically derived, patient-specific approach accommodating spinopelvic biomechanics for acetabular component positioning was validated by approximating revised, now-stable hips within 5° version and 3° inclination. These patient-specific safe zones augment the hip-spine classification with prescriptive quantitative targets for nuanced preoperative planning.
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Affiliation(s)
- Prem N Ramkumar
- Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts; Long Beach Orthopaedic Institute, Long Beach, California
| | - Michael Pang
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Antonia F Chen
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
| | - Richard Iorio
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
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25
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Kamihata S, Ando W, Takao M, Hamada H, Uemura K, Sugano N. Effect of hip flexion contracture on the pelvic sagittal tilt in the supine position: A retrospective case-series study. Mod Rheumatol 2023; 33:1052-1057. [PMID: 36083017 DOI: 10.1093/mr/roac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The functional pelvic plane, which adopts the natural pelvic sagittal tilt in the supine position, is a good reference for determining the cup angle in total hip arthroplasty. However, hip flexion contracture may change pelvic tilt postoperatively by the release of contracture. This study investigated the influence of hip flexion contracture on pelvic sagittal tilt in the supine position. METHODS This study included 300 patients who underwent primary unilateral total hip arthroplasty. We divided the participants into two groups: with a preoperative hip extension angle of <0° (hip flexion contracture group) and without (non-contracture group). The pelvic sagittal tilt and femoral flexion angle were investigated using computed tomography or pelvic radiographs performed preoperatively and postoperatively. RESULTS The femoral flexion angle had significantly reduced postoperatively in the hip flexion contracture group but remained unchanged in the non-contracture group. The preoperative and postoperative pelvic sagittal tilt showed no significant differences between the two groups up to 1 year postoperatively. CONCLUSIONS The influence of hip flexion contracture on the pelvic sagittal tilt in the supine position was minimal. The functional pelvic plane in the supine position could be a good reference to ascertain the cup orientation, even in hip flexion contracture cases.
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Affiliation(s)
- Satoshi Kamihata
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
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26
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Jones AC, Stewart TD, Maher N, Holton C. Can a Computational Model Predict the Effect of Lesion Location on Cam-type Hip Impingement? Clin Orthop Relat Res 2023; 481:1432-1443. [PMID: 36724209 PMCID: PMC10263218 DOI: 10.1097/corr.0000000000002565] [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] [Received: 07/05/2022] [Accepted: 01/03/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Warwick consensus defined femoroacetabular impingement syndrome as a motion-related clinical disorder of the hip with a triad of symptoms, clinical signs, and imaging findings representing symptomatic premature contact between the proximal femur and acetabulum. Several factors appear to cause labral and cartilage damage, including joint shape and orientation and patient activities. There is a lack of tools to predict impingement patterns in a patient across activities. Current computational modeling tools either measure pure ROM of the joint or include complexity that reduces reliability and increases time to achieve a solution. QUESTIONS/PURPOSES The purpose of this study was to examine the efficacy of a low computational cost approach to combining cam-type hip shape and multiple hip motions for predicting impingement. Specifically, we sought to determine (1) the potential to distinguish impingement in individual hip shapes by analyzing the difference between a cam lesion at the anterior femoral neck and one located at the superior femoral neck; (2) sensitivity to three aspects of hip alignment, namely femoral neck-shaft angle, femoral version angle, and pelvic tilt; and (3) the difference in impingement measures between the individual activities in our hip motion dataset. METHODS A model of the shape and alignment of a cam-type impinging hip was created and used to describe two locations of a cam lesion on the femoral head-neck junction (superior and anterior) based on joint shape information available in prior studies. Sensitivity to hip alignment was assessed by varying three aspects from a baseline (typical alignment described in prior studies), namely, femoral neck-shaft angle, femoral version, and pelvic tilt. Hip movements were selected from an existing database of 18 volunteers performing 13 activities (10 male, eight female; mean age 44 ± 19 years). A subset was selected to maximize variation in the range of joint angles and maintain a consistent number of people performing each activity, which resulted in nine people per activity, including at least three of each sex. Activities included pivoting during walking, squatting, and golf swing. All selected hip motion cases were applied to each hip shape model. For the first part of the study, the number of motion cases in which impingement was predicted was recorded. Quantitative analyses of the depth of penetration of the cam lesion into the acetabular socket and qualitative observations of impingement location were made for each lesion location (anterior and superior). In the second part of the study, in which we aimed to test the sensitivity of the findings to hip joint orientation, full analysis of both cam lesion locations was repeated for three modified joint orientations. Finally, the results from the first part of the analysis were divided by activity to understand how the composition of the activity dataset affected the results. RESULTS The two locations of cam lesion generated impingement in a different percentage of motion cases (anterior cam: 56% of motion cases; superior cam: 13% of motion cases) and different areas of impingement in the acetabulum, but there were qualitatively similar penetration depths (anterior cam: 6.8° ± 5.4°; superior cam: 7.9° ± 5.8°). The most substantial effects of changing the joint orientation were a lower femoral version angle for the anterior cam, which increased the percentage of motion cases generating impingement to 67%, and lower neck-shaft angle for the superior cam, which increased the percentage of motion cases generating impingement to 37%. Flexion-dominated activities (for example, squatting) only generated impingement with the anterior cam. The superior cam generated impingement during activities with high internal-external rotation of the joint (for example, the golf swing). CONCLUSION This work demonstrated the capability of a simple, rapid computational tool to assess impingement of a specific cam-type hip shape (under 5 minutes for more than 100 motion cases). To our knowledge, this study is the first to do so for a large set of motion cases representing a range of activities affecting the hip, and could be used in planning surgical bone removal. CLINICAL RELEVANCE The results of this study imply that patients with femoroacetabular impingement syndrome with cam lesions on the superior femoral head-neck junction may experience impinging during motions that are not strongly represented by current physical diagnostic tests. The use of this tool for surgical planning will require streamlined patient-specific hip shape extraction from imaging, model sensitivity testing, evaluation of the hip activity database, and validation of impingement predictions at an individual patient level.
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Affiliation(s)
- Alison C. Jones
- Leeds Institute of Medical and Biological Engineering, University of Leeds, UK
| | - Todd D. Stewart
- Leeds Institute of Medical and Biological Engineering, University of Leeds, UK
| | - Niall Maher
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Colin Holton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- National Institute for Health Research Leeds Biomedical Research Centre, Leeds, UK
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27
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Bradley MP, Muir JM, Wang S. Computer-Assisted Navigation Accurately Delivers Preoperative Targets for Acetabular Component Orientation During Direct Anterior Approach Total Hip Arthroplasty. Orthopedics 2023; 46:218-223. [PMID: 36719422 DOI: 10.3928/01477447-20230125-03] [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: 02/01/2023]
Abstract
Despite its success, total hip arthroplasty (THA) remains associated with potentially significant complications associated with component malposition. Preoperative planning can mitigate some of these potential concerns; however, the accurate intraoperative delivery of preoperative targets can be challenging. Computer-assisted navigation may assist with intraoperative target delivery, although the integration of these two technologies is relatively uncommon. We retrospectively reviewed cases of THA planned with a computed tomography-based preoperative planning software and performed with the use of an imageless, computer-assisted navigation system. Postoperative acetabular component orientation from radiographs was compared with preoperative targets and intraoperative navigation measurements. A total of 76 patients were included in the analysis. The mean anteversion target (20.0°±3.1°) did not differ significantly from the mean intraoperative navigation measurement (20.5°±3.3°; P=.30; mean difference, 2.2°±2.3°). The mean radiographic measurement (26.6°±6.5°) differed from the target by a mean of 7.5°±6.1° (P<.001). The mean inclination target (38.4°±1.9°) did not differ significantly from the mean intra-operative measurement (38.0°±1.5°; P=.20; mean difference, 1.3°±1.7°) but differed from the radiographic measurement by a mean of 5.2°±4.2° (41.8°±5.6°; P<.001). No adverse events were reported in the 90-day period following the index procedure. Our study demonstrated that an imageless navigation system can accurately deliver computed tomography-derived preoperative targets for acetabular component orientation. Differences noted on radiographs may be due to the difference in patient positioning for the postoperative imaging (standing) as compared with preoperative imaging or surgery itself (supine). [Orthopedics. 2023;46(4):218-223.].
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28
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Murphy MP, Killen CJ, Winfrey SR, Schmitt DR, Hopkinson WJ, Wu K, Brown NM. Artificial Intelligence Autonomously Measures Cup Orientation, Corrects for Pelvis Orientation, and Identifies Retroversion From Antero-Posterior Pelvis Radiographs. J Arthroplasty 2023; 38:S319-S323. [PMID: 36893991 DOI: 10.1016/j.arth.2023.02.076] [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: 11/30/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Measuring cup orientation is time consuming and inaccurate, but orientation influences the risk of impingement and dislocation following total hip arthroplasty (THA). This study designed an artificial intelligence (AI) program to autonomously determine cup orientation, correct for pelvis orientation, and identify cup retroversion from an antero-posterior pelvic radiographs. METHODS There were 2,945 patients between 2012 and 2019 identified to have 504 computed tomographic (CT) scans of their THA. A 3-dimensional (3D) reconstruction was performed on all CTs, where cup orientation was measured relative to the anterior pelvic plane. Patients were randomly allocated to training (4,000 x-rays), validation (511 x-rays), and testing (690 x-rays) groups. Data augmentation was applied to the training set (n = 4,000,000) to increase model robustness. Statistical analyses were performed only on the test group in their accuracy with CT measurements. RESULTS AI predictions averaged 0.22 ± 0.03 seconds to run on a given radiograph. Pearson correlation coefficient was 0.976 and 0.984 for AI measurements with CT, while hand measurements were 0.650 and 0.687 for anteversion and inclination, respectively. The AI measurements more closely represented CT scans when compared to hand measurements (P < .001). Measurements averaged 0.04 ± 2.21°, 0.14 ± 1.66°, -0.31 ± 8.35°, and 6.48° ± 7.43° from CT measurements for AI anteversion, AI inclination, hand anteversion, and hand inclination, respectively. AI predictions identified 17 radiographs as retroverted with 100.0% accuracy (total retroverted, n = 45). CONCLUSION The AI algorithms may correct for pelvis orientation when measuring cup orientation on radiographs, outperform hand measurements, and may be implemented in a timely fashion. This is the first method to identify a retroverted cup from a single AP radiograph.
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Affiliation(s)
- Michael P Murphy
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Cameron J Killen
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Sara R Winfrey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Daniel R Schmitt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - William J Hopkinson
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Karen Wu
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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29
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Pour AE, Green JH, Christensen TH, Muthusamy N, Schwarzkopf R. Is It Necessary to Obtain Lateral Pelvic Radiographs in Flexed Seated Position for Preoperative Total Hip Arthroplasty Planning? Arthroplast Today 2023; 21:101133. [PMID: 37234599 PMCID: PMC10206860 DOI: 10.1016/j.artd.2023.101133] [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: 08/19/2022] [Revised: 02/06/2023] [Accepted: 03/08/2023] [Indexed: 05/28/2023] Open
Abstract
Background Many of the current total hip arthroplasty (THA) planning tools only consider sagittal pelvic tilt in the standing and relaxed sitting positions. Considering that the risk of postoperative dislocation is higher when bending forward or in sit-to-stand move, sagittal pelvic tilt in the flexed seated position may be more relevant for preoperative planning. We hypothesized that there was a significant difference in sagittal pelvic tilt between the relaxed sitting and flexed seated positions as measured by the sacral slope in preoperative and postoperative full-body radiographs. Methods This was a multicenter retrospective analysis of the preoperative and postoperative simultaneous biplanar full-body radiographs of 93 primary THA patients in standing, relaxed sitting, and flexed seated positions. The sagittal pelvic tilt was measured using the sacral slope relative to the horizontal line. Results The mean difference between the preoperative sacral slope in the relaxed sitting position and the flexed seated position was 11.3° (-13° to 43°) (P < .0001). This difference was >10° in 52 patients (56%) and >20° in 18 patients (19.4%). The mean difference between the postoperative sacral slope in a relaxed sitting position and the sacral slope in a flexed seated position was 11.3° (P < .0001). This difference was >10° in 51 patients (54.9%) and >30° in 14 patients (15.1%) postoperatively. Conclusions There was a significant difference in sagittal pelvic tilt between the relaxed and flexed seated positions. A flexed seated view provides valuable information that might be more relevant for preoperative THA planning in order to prevent postoperative THA instability.
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Affiliation(s)
- Aidin Eslam Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Jordan H. Green
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas H. Christensen
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Nishanth Muthusamy
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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30
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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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31
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Dennis DA, Smith GH, Phillips J, Ennis H, Jennings JM, Plaskos C, Pierrepont JW. Does Individualization of Cup Position Affect Prosthetic or Bone Impingement Following THA? J Arthroplasty 2023:S0883-5403(23)00387-X. [PMID: 37100096 DOI: 10.1016/j.arth.2023.04.031] [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: 11/21/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Spinopelvic (SP) mobility patterns during postural changes affect three-dimensional acetabular component position, the incidence of prosthetic impingement, and total hip arthroplasty (THA) instability. Surgeons have commonly placed the acetabular component in a similar "safe zone" for most patients. Our purpose was to determine the incidence of bone and prosthetic impingement with various cup orientations and determine if a preoperative SP analysis with individualized cup orientation lessens impingement. METHODS A preoperative SP evaluation of 78 THA subjects was performed. Data was analyzed using a software program to determine the prevalence of prosthetic and bone impingement with a patient individualized cup orientation versus six commonly selected cup orientations. Impingement was correlated with known SP risk factors for dislocation. RESULTS Prosthetic impingement was least with the individualized choice of cup position (9%) vs. preselected cup positions (18 to 61%). The presence of bone impingement (33%) was similar in all groups and not affected by cup position. Factors associated with impingement in flexion were age, lumbar flexion, pelvic tilt (stand to flexed seated), and functional femoral stem anteversion. Risk factors in extension included standing pelvic tilt, standing SP tilt, lumbar flexion, pelvic rotation (supine to stand and stand to flexed seated), and functional femoral stem anteversion. CONCLUSION Prosthetic impingement is reduced with individualized cup positioning based on SP mobility patterns. Bone impingement occurred in one-third of patients and is a noteworthy consideration in preoperative THA planning. Known SP risk factors for THA instability correlated with the It dependspresence of prosthetic impingement in both flexion and extension.
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Affiliation(s)
- Douglas A Dennis
- Colorado Joint Replacement, Denver, CO, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN.
| | - Gerard H Smith
- Corin Group, Cirencester, Gloucestershire, United Kingdom
| | | | | | - Jason M Jennings
- Colorado Joint Replacement, Denver, CO, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO
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Sharma AK, Grammatopoulos G, Pierrepont JW, Madurawe CS, Innmann MM, Vigdorchik JM, Shimmin AJ. Sacral Slope Change From Standing to Relaxed-Seated Grossly Overpredicts the Presence of a Stiff Spine. J Arthroplasty 2023; 38:713-718.e1. [PMID: 35588904 DOI: 10.1016/j.arth.2022.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several authors propose that a change in sacral slope of ≤10° between the standing and relaxed-seated positions (ΔSSstanding→relaxed-seated) identifies a patient with a stiff lumbar spine and has suggested the use of dual-mobility bearings for such patients undergoing a total hip arthroplasty (THA). The aim of this study was to assess how accurately ΔSSstanding→relaxed-seated can identify patients with a stiff spine. METHODS A prospective, multicentre, consecutive cohort series of 312 patients had standing, relaxed-seated, and flexed-seated lateral radiographs prior to THA. ΔSSstanding→relaxed-seated was determined by the change in sacral slope between the standing and relaxed-seated positions. Lumbar flexion (LF) was defined as the difference in lumbar lordotic angle between standing and flexed-seated. LF ≤20° was considered a stiff spine. The predictive value of ΔSSstanding→relaxed-seated for characterizing a stiff spine was assessed. RESULTS A weak correlation between ΔSSstanding→relaxed-seated and LF was identified (r2 = 0.13). Eighty six patients (28%) had ΔSSstanding→relaxed-seated ≤10° and 19 patients (6%) had a stiff spine. Of the 86 patients with ΔSSstanding→relaxed-seated ≤10°, 13 had a stiff spine. The positive predictive value of ΔSSstanding→relaxed-seated ≤10° for identifying a stiff spine was 15%. CONCLUSION In this cohort, ΔSSstanding→relaxed-seated ≤10° was not correlated with a stiff spine. Using this simplified approach could lead to a 7-fold overprediction of patients with a stiff lumbar spine and abnormal spinopelvic mobility, unnecessary use of dual-mobility bearings, and incorrect component alignment targets. Referring to patients with ΔSSstanding→relaxed-seated ≤10° as being stiff is misleading. The flexed-seated position should be used to effectively assess a patient's spine mobility prior to THA.
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Affiliation(s)
- Abhinav K Sharma
- Department of Orthopaedic Surgery, University of California, Irvine, School of Medicine, Orange, California
| | | | | | | | - Moritz M Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
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LeBrun DG, Ondeck NT, Nessler JP, Marchand RC, Illgen RL, Westrich GH. Variability of pre-operative functional pelvic tilt in total hip arthroplasty patients. INTERNATIONAL ORTHOPAEDICS 2023; 47:1243-1247. [PMID: 36864185 DOI: 10.1007/s00264-023-05748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Pelvic tilt (PT) is important to consider when planning total hip arthroplasty (THA) due to its dynamic impact on acetabular orientation. The degree of sagittal pelvic rotation varies during functional activities and can be difficult to measure without proper imaging. The purpose of this study was to evaluate PT variation in the supine, standing, and seated positions. METHODS A multi-centre cross-sectional study was performed that included 358 THA patients who had preo-perative PT measured from supine CT scan and standing and upright seated lateral radiographs. Supine, standing, and seated PT and associated changes between functional positions were evaluated. Anterior PT was assigned a positive value. RESULTS In the supine position, mean PT was 4° (range, -35° to 20°), where 23% had posterior PT and 69% anterior PT. In the standing position, mean PT was 1° (range, -23° to 29°), where 40% had posterior PT and 54% anterior PT. In the seated position, mean PT was -18° (range, -43° to 47°), where 95% had posterior PT and 4% anterior PT. From standing to seated, the pelvis rotated posteriorly in 97% of cases (maximum 60°) with 16% of cases considered stiff (change ≤ 10°) and 18% of cases considered hypermobile (change ≥ 30°). CONCLUSION Patients undergoing THA have marked PT variation in the supine, standing, and seated positions. There was wide variability in PT change from standing to seated, with 16% of patients considered stiff and 18% considered hypermobile. Functional imaging should be performed on patients prior to THA to allow for more accurate planning.
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Affiliation(s)
- Drake G LeBrun
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA.
| | - Nathaniel T Ondeck
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA
| | - Joseph P Nessler
- St. Cloud Orthopedics, 1901 Connecticut Ave S, MN, 56377, Sartell, USA
| | - Robert C Marchand
- Ortho Rhode Island, 285 Promenade Street, RI, 02908, Providence, USA
| | - Richard L Illgen
- University of Wisconsin-Madison, 4602 Eastpark Blvd, Madison, WI, 53706, USA
| | - Geoffrey H Westrich
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA
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Haffer H, Hu Z, Wang Z, Müllner M, Hardt S, Pumberger M. Association of age and spinopelvic function in patients receiving a total hip arthroplasty. Sci Rep 2023; 13:2589. [PMID: 36788270 PMCID: PMC9929091 DOI: 10.1038/s41598-023-29545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Restricted spinopelvic mobility received attention as a contributing factor for total hip arthroplasty (THA) instability. However, it is still unknown, how the spinopelvic function is influenced by age. In identifying the patients at highest risk for altered spinopelvic mechanics the study aimed to determine the association of age on the individual segments of the spinopelvic complex and global spinal sagittal alignment in patients undergoing THA. 197 patients were included in the prospective observational study conducting biplanar stereoradiography (EOS) in standing and sitting position pre-and postoperatively. Two independent investigators assessed C7-sagittal vertical axis (C7-SVA), cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), anterior plane pelvic tilt (APPT), and pelvic femoral angle (PFA). Key segments of the spinopelvic complex are defined as lumbar flexibility (∆ LL = LLstanding - LLsitting), pelvic mobility (∆ SS = SSstanding - SSsitting) and hip motion (∆ PFA = PFAstanding - PFAsitting). Pelvic mobility was further defined based on ∆ SS = SSstanding - SSsitting as stiff (∆ SS < 10°), normal (∆ SS ≥ 10°-30°) and hypermobile (∆ SS > 30°). The patient collective was classified into three groups: (1) < 60 years (n = 56), (2) ≥ 60-79 years (n = 112) and (3) ≥ 80 years (n = 29). Lumbar flexibility (∆ LL) was decreased with increasing age between all groups (36.1° vs. 23.1° vs. 17.2°/p1+2 < 0.000, p2+3 = 0.020, p1+3 < 0.000) postoperatively. Pelvic mobility (∆ SS) was decreased in the groups 2 and 3 compared to group 1 (21.0° and 17.9° vs. 27.8°/p1+2 < 0.000, p2+3 = 0.371, p1+3 = 0.001). Pelvic retroversion in standing position (APPT) was higher in group 2 and 3 compared to group 1 (1.9° and - 0.5° vs 6.9°/p1+2 < 0.000, p2+3 = 0.330, p1+3 < 0.000). Global sagittal spinal balance (C7-SVA) showed more imbalance in groups 2 and 3 compared to group 1 (60.4 mm and 71.2 mm vs. 34.5 mm/p1+2 < 0.000, p2+3 = 0.376, p1+3 < 0.000) postoperatively. The preoperative proportion of patients with stiff pelvic mobility in group 1 was distinctly lower than in group 3 (23.2% vs. 35.7%) and declined in group 1 to 1.8% compared to 20.7% in group 3 after THA. Changes after THA were reported for groups 1 and 2 representing spinopelvic complex key parameter lumbar flexibility (∆ LL), pelvic mobility (∆ SS) and hip motion (∆ PFA), but not for group 3. This is the first study to present age-adjusted normative values for spinopelvic mobility. The subgroups with increased age were identified as risk cohort for altered spinopelvic mechanics and enhanced sagittal spinal imbalance and limited capacity for improvement of mobility after THA. This valuable information serves to focus in the preoperative screening on the THA candidates with the highest risk for abnormal spinopelvic function.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Zhouyang Hu
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Zhen Wang
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maximilian Müllner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Aubert T, Bouche PA. Combined kinematic cup alignment reduces the rate of impingement and edge loading compared to mechanical and anatomical alignment. An in-vitro case-control study. Orthop Traumatol Surg Res 2023; 109:103468. [PMID: 36441035 DOI: 10.1016/j.otsr.2022.103468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In recent years, different alignments have been described for acetabular components in total hip arthroplasty (THA), to reduce the risk of impingement and edge loading. Currently there are 3 main options: mechanical (40° inclination/15° anteversion relative to the anterior pelvic plane), anatomic (40° inclination/anteversion parallel to the transverse ligament) and combined kinematic (according to spinal-pelvic parameters). There are no studies comparing all three in terms of impingement and edge loading. We therefore performed a retrospective case-control in-vitro study comparing risk of impingement and edge loading between the three alignments. HYPOTHESIS The study hypothesis was that combined kinematic alignment incurs significantly less risk of impingement and edge loading than do the other two types of alignment. METHODS Using a THA planning system, we simulated the 3 alignments for 90 patients undergoing THA with a ceramic-on-ceramic bearing between November 2019 and January 2022; for each simulation, we recorded any prosthetic impingement or edge loading. The study endpoint was the rate of prosthetic impingement or edge loading between the 3 alignments. RESULTS With the mechanical alignment, 31% of patients (28/90) showed risk of impingement and 22% (20/90) risk of edge loading. With the anatomic alignment, 31% of patients (28/90) showed risk of impingement and 23.3% (21/90) risk of edge loading. With the combined kinematic alignment, 12.2% of patients (11/90) showed risk of impingement and 8.9% (8/90) risk of edge loading. Pairwise comparison showed that the combined kinematic alignment was associated with significantly less impingement and edge loading than the mechanical alignment (respectively, p=0.03 and p=0.022) or the anatomic alignment (respectively, p=0.03 and p=0.014), while the mechanical and anatomic alignments did not differ. CONCLUSION A combined kinematic cup alignment in THA significantly reduced the risk of impingement and edge loading compared to mechanical and anatomic alignments. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Thomas Aubert
- Orthopaedic Department, Croix Saint Simon Hospital, 125 Rue d'Avron, 75020 Paris, France
| | - Pierre-Alban Bouche
- Orthopaedic Department, Croix Saint Simon Hospital, 125 Rue d'Avron, 75020 Paris, France; Orthopaedic Department, Lariboisière Hospital, APHP, 2 Rue Ambroise Paré, 75010 Paris, France.
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Verhaegen JC, Alves Batista N, Horton I, Rakhra K, Beaulé PE, Michielsen J, Stratton A, Grammatopoulos G. Prevalence of Lumbosacral Transitional Vertebral Anomalies Among Healthy Volunteers and Patients with Hip Pathology: Association with Spinopelvic Characteristics. JB JS Open Access 2023; 8:e22.00095. [PMID: 37908325 PMCID: PMC10614646 DOI: 10.2106/jbjs.oa.22.00095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
A lumbosacral transitional vertebra (LSTV) has been reported to be prevalent among patients with hip dysplasia. The aims of this study were to determine the (1) prevalence of an LSTV in young patients presenting with hip pain and a group of asymptomatic volunteers, (2) effect of an LSTV on spinopelvic characteristics, and (3) presence of low back pain among patients with an LSTV. Methods This cross-sectional study included 102 patients with hip pathology and 51 asymptomatic volunteers (mean age, 33.9 ± 7.3 years; mean body mass index, 26.0 ± 5.0 kg/m2; 57.5% female). Participants underwent radiographic assessment of the lumbar spine and pelvis in standing and deep-seated positions. LSTV occurrence was classified according to the Castellvi system. Spinopelvic characteristics included lumbar lordosis (including segmental lumbar angles), pelvic tilt, and hip flexion (pelvic-femoral angle). Differences between standing and deep-seated values were calculated. Low back pain was assessed using the Oswestry Disability Index. Results The prevalence of LSTV type ≥II was 8.5%, with no difference between patients and volunteers (p = 0.386). Individuals with an LSTV had a greater standing L1-L5 angle (mean, 51.6° ± 11.7° versus 38.9° ± 9.3°; p < 0.001). The overall spinal flexion (change in L1-S1 angle between the standing and deep-seated positions) in individuals with an LSTV was similar to that in individuals without an LSTV; restricted L5-S1 mobility was compensated for at L1-L2 (10.2° ± 5.8° in those with versus 8.4° ± 4.1° in those without an LSTV; p = 0.070). No significant difference in the presence of low back pain was found (p = 0.250). Conclusions An LSTV was found in 8.5% of young adults, with no difference between patients with hip pathology and controls. Individuals with an LSTV have greater standing lumbar lordosis, with altered mechanics at the cephalad adjacent level, which may predispose these individuals to degenerative changes at this level. Level of Evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeroen C.F. Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- University Hospital Antwerp, Edegem, Belgium
| | - Nuno Alves Batista
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabel Horton
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kawan Rakhra
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E. Beaulé
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Alexandra Stratton
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Guezou-Philippe A, Dardenne G, Letissier H, Yvinou A, Burdin V, Stindel E, Lefèvre C. Anterior pelvic plane estimation for total hip arthroplasty using a joint ultrasound and statistical shape model based approach. Med Biol Eng Comput 2023; 61:195-204. [PMID: 36342596 DOI: 10.1007/s11517-022-02681-2] [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: 09/14/2021] [Accepted: 09/21/2022] [Indexed: 11/09/2022]
Abstract
Orienting properly the prosthetic cup in total hip arthroplasty is key to ensure the postoperative stability. Several navigation solutions have been developed to assist surgeons in orienting the cup regarding the anterior pelvic plane (APP), defined by both anterior superior iliac spines (ASIS) and the pubic symphysis. However acquiring the APP when the patient is ready for surgery, i.e., mainly in lateral decubitus, is difficult due to the contralateral ASIS being against the operating table. We propose a method to determine the APP from both (1) alternative anatomical landmarks which are easy to acquire with a navigated ultrasound probe and (2) a Statistical Shape Model (SSM) of the pelvis. After creating a pelvic SSM from 40 data, a SSM-based morphometric analysis has been carried out to identify the best anatomical landmarks allowing the easy determination of the APP. The proposed method has then been assessed with both in silico and in vivo experiments on respectively forty synthetic data, and five healthy volunteers. The in silico experiment shows the feasibility to determine the APP with an average error of 4.7∘ by only acquiring the iliac crest, the anterior superior iliac spine, the anterior inferior iliac spine, and the pubic symphysis. The average in vivo error using the ultrasound modality was 7.3∘ with an estimated impact on both the cup anteversion and inclination of 4.0∘ and 1.7∘ respectively. The proposed method shows promising results that could allow the determination of the APP in lateral decubitus with a clinically acceptable impact on the computation of the cup orientation.
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Affiliation(s)
- Aziliz Guezou-Philippe
- Latim INSERM UMR 1101, Brest, France. .,CHU, Brest, France. .,University of Western Brittany, Brest, France.
| | | | - Hoel Letissier
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Agathe Yvinou
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Valérie Burdin
- Latim INSERM UMR 1101, Brest, France.,IMT Atlantique, Brest, France
| | - Eric Stindel
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Christian Lefèvre
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
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How does corrective fusion surgery for adult spinal deformities affect pelvic inclination in the supine position as the reference plane for THA? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:143-150. [PMID: 34825988 DOI: 10.1007/s00590-021-03166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the changes in pelvic inclination in the supine and standing positions after spinal corrective surgery, and to identify the most predictive factor for changes in pelvic inclination with the supine position as the reference plane for total hip arthroplasty. METHODS We retrospectively analysed the data of 124 patients who underwent spinal corrective fusion surgery for adult spinal deformity between 2012 and 2016 at our institution. Spinal parameters were assessed preoperatively and postoperatively using whole spine radiographs in the standing position. The sacral slope (SS) was measured using spine and pelvis computed tomography. Differences between the preoperative and postoperative SS values in each position were calculated as Δsupine SSpre post and Δstanding SSpre post, respectively. We statistically analysed the correlations between Δsupine SS pre post and preoperative spinal parameters to determine the most useful predictor of Δ supine SSpre post. RESULTS The mean Δsupine SSpre post of 10.5°(-13°-50°) was significantly smaller than the mean Δstanding SSpre post of 13.2° (-19°-44°) (p = 0.02). Moreover, 21 patients (17%) had Δsupine SSpre post > 20°. The Δsupine SS pre post was correlated with preoperative LL (r = -0.34 p < 0.01), PT (r = 0.42 p < 0.01), and SVA (r = 0.37 p < 0.01). Preoperative supine SS (r = -0.54, p < 0.01) had the highest correlation with Δsupine SSpre post, whereas preoperative standing SS showed no correlation (r = -0.14 p = 0.12). CONCLUSION Preoperative supine SS is the most useful predictive factor for changes in supine pelvic inclination, and low preoperative values should be noted. This information should be considered for the management of patients with hip-spine syndrome.
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Vayalapra S, Wang X, Qureshi A, Vepa A, Rahman U, Palit A, Williams MA, King R, Elliott MT. Repeatability of Inertial Measurement Units for Measuring Pelvic Mobility in Patients Undergoing Total Hip Arthroplasty. SENSORS (BASEL, SWITZERLAND) 2022; 23:s23010377. [PMID: 36616975 PMCID: PMC9823306 DOI: 10.3390/s23010377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 06/12/2023]
Abstract
Consideration of pelvic mobility when positioning implants for total hip arthroplasty (THA) has been shown to reduce the risk of complications such as dislocation, squeaking and excessive wear. We aim to test the repeatability of pelvic tilt measurements taken between three positions (standing, flexed-seated and step-up) by an inertial measurement unit (IMU) and hence, evaluate their reliability in screening for high pelvic mobility in patients undergoing THA. The repeated IMU measurements of pelvic tilt were analysed for consistency and compared with measures taken by x-ray analysis. Our study showed greater variation in measures taken by the IMU particularly in the flexed-seated position. The patient's pelvic tilt in this position negatively correlated with their mid-back angle, suggesting the posture of the patient is a source of variation in the flexed-seated position if not kept consistent during assessments. IMUs were overall able to produce accurate and reliable measurements of pelvic tilt; however, protocols will need to be adjusted to factor in a patient's mid-back angle when taking future readings.
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Affiliation(s)
- Sushanth Vayalapra
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Xueyang Wang
- WMG, University of Warwick, Coventry CV4 7AL, UK
| | - Arham Qureshi
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Abhinav Vepa
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Usama Rahman
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Arnab Palit
- WMG, University of Warwick, Coventry CV4 7AL, UK
| | | | - Richard King
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
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Cho E, Hisatome T, Oda S, Fujimaki H, Nakanishi K. Accuracy of acetabular cup placement during anterolateral supine total hip arthroplasty using intraoperative fluoroscopy: a retrospective study. J Orthop Surg Res 2022; 17:523. [PMID: 36471354 PMCID: PMC9720972 DOI: 10.1186/s13018-022-03422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In our institution, total hip arthroplasty (THA) is performed using the anterolateral supine (ALS) approach with intraoperative fluoroscopy. This study aimed to investigate and review the accuracy of acetabular cup placement in ALS-THA using intraoperative fluoroscopy. METHODS A total of 142 patients with 154 joints (mean age 64.3 years, 30 males and 112 females) underwent ALS-THA with intraoperative fluoroscopy at the same institution. The target angle of the cup position was set at 40° for radiographic inclination (RI) and 5°-25° for radiographic anteversion (RA) based on the functional pelvic plane according to the pelvic motion during individual postural changes. The cup position angle was measured using postoperative computed tomography, and the error in the target angle was investigated. RESULTS The target angle of RI was 40°, and the postoperative RI was 39.3° ± 4.3°. The target angle of the RA was 17° ± 2.6°, and the postoperative RA was 20.6° ± 3.7°. The absolute values of the error from the target angle were 3.6° ± 2.5° for RI and 4.2° ± 3.3° for RA. For RI and RA, 67.5% (104/154 joints) were within ± 5° of the target and 96.1% (148/154 joints) were within ± 10°. CONCLUSIONS The accuracy of cup positioning in ALS-THA using intraoperative fluoroscopy was good and appeared comparable to that of various navigation systems.
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Affiliation(s)
- Eiji Cho
- grid.495549.00000 0004 1764 8786Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takashi Hisatome
- grid.412178.90000 0004 0620 9665Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Shuhei Oda
- grid.412178.90000 0004 0620 9665Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Hirohisa Fujimaki
- grid.412178.90000 0004 0620 9665Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- grid.495549.00000 0004 1764 8786Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
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The Functional Mechanics of the Acetabular Component in Total Hip Arthroplasty. J Arthroplasty 2022; 37:2199-2207.e1. [PMID: 35643259 DOI: 10.1016/j.arth.2022.05.017] [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] [Received: 12/17/2021] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty functional safe zones match postural hip changes to dynamic positioning of the acetabular component. We studied integrating the Anteinclination (AI) cup angle into the spinopelvic environment, defining normative values for all parameters and calculating adjustments to AI for each degree of altered standing pelvic position and postural mobility from these values. A sagittal geometric model was employed to determine these values using established spinopelvic parameter angles. METHODS Theoretical normative Pelvic Incidence (PI) specific values were calculated using a triangular construct employing a linear equation describing the functional relationship between the pelvic parameters at a mobility producing an isosceles solution for normative acetabular angles. Individual optimal AI cup values for altered Sacral Slope (SS)/pelvic tilt (sPT) and mobility (dSS) were calculated using specific ratios of angular change between parameters correcting from these normative values. RESULTS A PI:SS:sPT ratio of angular change of 3:2:1 at dSS = 25° mobility creates an isosceles condition solving for PI specific theoretical normative values for all construct parameters. Individualized tilt correction applies to each posture a +0.25° AI alteration for each +1° sPT increase from this architectural value. Mobility correction applies a +0.5° standing AI and -0.5° sitting AI alteration for each -1° dSS < 25°, the opposite for each +1° dSS > 25°. The Sacroacetabular angle/Pelvic acetabular angle (SAA/PAA) index describes the underlying spinopelvic environment the cup functions within. CONCLUSION This model quantitatively integrates an implanted acetabular component into the host spinopelvic environment. Theoretical normative and individual optimal cup orientations are passively determined by these conditions of standing pelvic position and mobility.
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Schmidt-Braekling T, Coyle MJ, Dobransky J, Kreviazuk C, Gofton W, Phan P, Beaulé PE, Grammatopoulos G. Spinal pathology and outcome post-THA: does segment of arthrodesis matter? Arch Orthop Trauma Surg 2022; 142:3477-3487. [PMID: 34677633 DOI: 10.1007/s00402-021-04220-4] [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] [Received: 03/19/2021] [Accepted: 10/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The presence of lumbar spine arthrodesis (SA) is associated with abnormal spinopelvic characteristics and inferior outcome post total hip arthroplasty (THA). However, whether patients with upper segment SA are also at increased risk of complications is unknown. This study aims to (1) determine if upper segment SA is associated with inferior THA outcomes; (2) assess spino-pelvic characteristics; and (3) test whether static or dynamic spinopelvic characteristics correlate with outcome post-THA. MATERIALS AND METHODS In this retrospective, case-matched, cohort study from a tertiary referral centre, 40 patients (59 hips) that had undergone both THA and any level of spinal arthrodesis (49 THA-Lumb and 10 THA-Cerv) were compared with 41 patients (59 hips) who had THA-only without known spinal pathology. Spino-pelvic characteristics [including severity of Degenerative-Disc-Disease (DDD); spinal balance and stiffness] and outcome, including patient reported outcome measures (PROMs), at minimum of 1-year post-THA were assessed. RESULTS THA-Lumb and THA-Cerv groups had greater number of complications and inferior hip and spinal PROMs compared to THA-Only (p < 0.001). Similar spinopelvic characteristics were seen between the THA-Cerv and THA-Lumb, which were significantly different to the THA-only group. The presence of DDD and unbalanced or stiff spine was associated with increased dislocation and inferior PROMs in the whole cohort. CONCLUSIONS THA in the presence of SA, regardless of level, is associated with inferior outcomes and an increased risk for dislocation. The presence of a SA is associated with increased risk of adverse spinopelvic characteristics. Such characteristics were strongly associated with increased dislocation-risk and inferior PROMs. It is likely that these adverse characteristics are the most important adverse predictor, rather than segment of SA per se.
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Affiliation(s)
- Tom Schmidt-Braekling
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada.,Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Matthew J Coyle
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Johanna Dobransky
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Wade Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada.
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Tetsunaga T, Tetsunaga T, Akazawa H, Yamada K, Furumatsu T, Ozaki T. Evaluation of the labrum on postoperative magnetic resonance images: a predictor of acetabular development in developmental dysplasia of the hip. Hip Int 2022; 32:800-806. [PMID: 33829902 DOI: 10.1177/11207000211004917] [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
INTRODUCTION Residual acetabular dysplasia of the hip after open reduction can complicate the treatment of developmental dysplasia of the hip (DDH) due to the potential need for corrective surgery. This retrospective study aimed to determine the predictive factors for acetabular development using postoperative radiographs and magnetic resonance imaging (MRI). METHODS We retrospectively investigated 74 hips of patients with DDH who underwent open reduction after reaching walking age and were followed up radiologically until skeletal maturity. We evaluated the cartilaginous acetabulum and labrum using a new method that measures the cartilaginous and labral landmarks on coronal and axial MR T2*-weighted images in patients aged 5 years. The mean age at the time of surgery was 22 months and that at the final survey was 20 years. Severin classification was determined at the final follow-up. Groups with good (53 hips) and poor (21 hips) outcomes were compared using the postoperative radiographic and MRI parameters recorded at 5 years of age. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. RESULTS There were no significant differences in the bony-acetabular index (AI) and centre-edge (CE) angle between the good and poor outcome groups. However, the poor outcome group had significantly larger cartilaginous- and labral-AIs but significantly smaller cartilaginous- and labral-CE angles than the good outcome group (both p < 0.05). Multiple logistic regression analysis showed that labral-AI and labral-CE angle were predictors of acetabular development after open reduction for DDH, and their optimal cut-offs were 4° (77% sensitivity, 76% specificity) and 37° (68% sensitivity, 85% specificity), respectively. DISCUSSION Normal cartilaginous acetabulum development occurs in childhood, and evaluation using only radiographs is difficult. However, labral-AI ⩾4° and labral-CE angle <37° on MRI at 5 years of age offer useful indications for corrective surgery in patients with DDH.
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Affiliation(s)
| | - Tomoko Tetsunaga
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | - Hirofumi Akazawa
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan.,Department of Orthopaedic Surgery, Asahigawaso Children's Welfare and Medical Centre, Okayama, Japan
| | - Kazuki Yamada
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | | | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
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Fischer MCM, Tokunaga K, Okamoto M, Habor J, Radermacher K. Implications of the uncertainty of postoperative functional parameters for the preoperative planning of total hip arthroplasty. J Orthop Res 2022; 40:2656-2662. [PMID: 35266575 DOI: 10.1002/jor.25291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/23/2021] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
The functional parameters pelvic tilt (PT) and hip joint force (HJF) are required to calculate patient-specific target zones based on the range of motion (ROM) and implant loading for preoperative planning of total hip arthroplasty (THA). Both functional parameters may change after THA. The preoperative prediction of the postoperative PT and HJF is associated with a specific amount of uncertainty. The prediction uncertainty has to be considered in the preoperative planning process to avoid a suboptimal implantation. So far, very little attention has been paid to the necessary reduction of patient-specific target zones by the prediction uncertainties of postoperative functional parameters. Prediction models for the postoperative PT in standing position and for the HJF during one-leg stance as a surrogate for the peak force phase during level walking were used to quantify the reduction of the ROM- and load-based target zones of 196 Japanese THA patients. The prediction uncertainty was about 14° for the postoperative standing PT and ranged from 17% body weight to 37% body weight for the components of the HJF. On average, the prosthetic ROM-based target zone had to be significantly reduced by 43% and the load-based target zone by 39%. This led to a median reduction of the combined prosthetic ROM- and load-based target zone of 96%. The study sharpens the awareness for the substantial reduction of ROM- and load-based target zones by prediction uncertainties of the postoperative PT and HJF and highlights the importance of further research to improve prediction models for both functional parameters.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Hardwick-Morris M, Twiggs J, Kacker K, Miles B, Balakumar J. Functional Femoral Anteversion: Axial Rotation of the Femur and its Implications for Stem Version Targets in Total Hip Arthroplasty. Arthroplast Today 2022; 18:16-23. [PMID: 36267395 PMCID: PMC9576488 DOI: 10.1016/j.artd.2022.09.002] [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: 04/20/2022] [Revised: 08/13/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Acetabular and femoral component positioning are important considerations in reducing adverse outcomes after total hip arthroplasty (THA). Previous assessments of femoral anteversion examined anatomic femoral anteversion (AFA) referenced to anatomic landmarks. However, this does not provide a functional understanding of the femur's relationship to the hip. We investigate a new measurement, functional femoral anteversion (FFA), and sought to measure its variability across a large sample of patients undergoing THA. Methods A total of 1008 consecutive patients underwent THA surgery between September 2019 and July 2021. All patients were measured for supine and standing functional femoral rotation (FFR), AFA, and FFA. Results The mean standing FFA was 13.2° ± 12.2° (-27.8° to 52.3°). The mean change in FFR from supine to standing was -2.2° ± 11.8° (-43.0° to 41.9°). Of all, 161 (16%) patients had standing FFA version greater than 25°. Four hundred sixty (46%) patients had standing FFR (internal or external) greater than 10°. One hundred twenty-three (12%) patients exhibited an increase in external rotation from supine to standing of greater than 10°. A moderate, negative linear relationship was observed between AFA and standing external femoral rotation (P <<.001, R = -0.46), indicating people may externally rotate their femur as AFA decreases with age. Conclusions Functional alignment of the femur in patients requiring THA is understudied. It is now understood that the femur, like the pelvis, can rotate substantially between functional positions. Enhancing our understanding of FFA and FFR may improve both acetabular and femoral component positioning.
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Affiliation(s)
- Max Hardwick-Morris
- Flinders University, Adelaide, South Australia, Australia,360 Med Care, Sydney, New South Wales, Australia,Corresponding author. 360 Med Care, Suite 3, Building 1/20 Bridge Street, Pymble, New South Wales, Australia. Tel.: +61 406 937 050.
| | | | | | - Brad Miles
- 360 Med Care, Sydney, New South Wales, Australia
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Thomas C, Gupta V, Parsons H, Metcalfe A, Foguet P, King R. Does functional planning, 3D templating and patient-specific instrumentation improve accuracy in total hip replacement?- a randomized controlled trial. ARTHROPLASTY (LONDON, ENGLAND) 2022; 4:43. [PMID: 36183111 PMCID: PMC9526907 DOI: 10.1186/s42836-022-00143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/01/2022] [Indexed: 11/05/2022]
Abstract
AIMS Debate continues as to the optimal orientation of the acetabular component in total hip arthroplasty (THA) and how to reliably achieve this. The primary objective of this study was to compare functional CT-based planning and patient-specific instruments with conventional THA using 2D templating. METHODS A pragmatic single-center, patient-assessor blinded, randomized control trial of patients undergoing THA was performed. 54 patients (aged 18-70) were recruited to either Corin Optimized Positioning System (OPS) or conventional THA. All patients received a cementless acetabular component. All patients underwent pre- and postoperative CT scans, and four functional X-rays. Patients in the OPS group had a 3D surgical plan and bespoke guides made. Patients in the conventional group had a surgical plan based on 2D templating X-rays. The primary outcome measure was the mean error in acetabular anteversion as determined by postoperative CT scan. RESULTS There was no statistically significant difference in the mean error in angle of acetabular anteversion when comparing OPS and conventional THA. In the OPS group, the achieved acetabular anteversion was within 10° of the planned anteversion in 96% of cases, compared with only 76% in the conventional group. The clinical outcomes were comparable between the groups. CONCLUSION Large errors in acetabular orientation appear to be reduced when CT-based planning and patient-specific instruments are used compared to the standard technique but no significant differences were seen in the mean error.
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Affiliation(s)
- Christopher Thomas
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England ,grid.414081.80000 0004 0400 1166Present address: Dorset County Hospital, Williams Avenue, Dorchester, DT1 2JY UK
| | - Vatsal Gupta
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
| | - Helen Parsons
- grid.7372.10000 0000 8809 1613University of Warwick, Coventry, England
| | - Andrew Metcalfe
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England ,grid.7372.10000 0000 8809 1613University of Warwick, Coventry, England
| | - Pedro Foguet
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
| | - Richard King
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
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Louette S, Wignall A, Pandit H. Spinopelvic Relationship and Its Impact on Total Hip Arthroplasty. Arthroplast Today 2022; 17:87-93. [PMID: 36042938 PMCID: PMC9420424 DOI: 10.1016/j.artd.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
The dynamic, complex interaction among the spine, pelvis, and hip is often underappreciated, yet understanding it is vital for both arthroplasty and spinal surgeons. There is an increasing incidence of degenerative hip and spinal pathologies as a result of the ageing population. Furthermore, hip pathology can cause spine pathology and vice versa through “hip-spine” and “spine-hip syndrome.” Consequently, total hip arthroplasty (THA) and spinal fusion surgery, which both affect spinopelvic mobility, are also on the rise. Alteration in spinopelvic motion can affect the orientation of the acetabulum and, therefore, implant positioning in THA, leading to complications such as dislocation, impingement, aseptic loosening, and wear of components. This makes it imperative to assess spinopelvic motion and pelvic tilt prior to patients undergoing THA. In this paper, we explore how the surgeon should proceed to reduce risk of component malalignment, as well as the role of navigation systems in acetabular cup positioning.
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48
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Ma Z, Tang H, Zhou Y, Wang S, Yang D, Guo S. Assessing component orientation of total hip arthroplasty using the low-dose bi-planar radiographs. BMC Musculoskelet Disord 2022; 23:886. [PMID: 36154920 PMCID: PMC9511787 DOI: 10.1186/s12891-022-05835-3] [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: 06/19/2022] [Accepted: 09/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background Three-dimensional computed tomography (3D CT) reconstruction is the reference standard for measuring component orientation. However, functional cup orientation in standing position is preferable compared with supine position. The low-dose bi-planar radiographs can be used to analyze standing cup component orientation. We aimed to assess the validity and reliability of the component orientation using the low-dose bi-planar radiographs compared with the 3D CT reconstruction, and explore the differences between the functional cup orientation in standing radiographs and supine CT scans. Methods A retrospective study, including 44 patients (50 hips) with total hip arthroplasty (THA), was conducted. CT scans were taken 1 week after surgery and the low-dose bi-planar radiographs were taken in the follow-up 6 weeks later. Component orientation measurement was performed using the anterior pelvic plane and the radiographic coronal plane as reference, respectively. Results The study showed no significant difference in cup anteversion (p = 0.160), cup inclination (p = 0.486), and stem anteversion (p = 0.219) measured by the low-dose bi-planar radiographs and 3D reconstruction. The differences calculated by the Bland–Altman analysis ranged from − 0.4° to 0.6° for the three measured angles. However, the mean absolute error was 4.76 ± 1.07° for functional anteversion (p = 0.035) and 4.02 ± 1.08° for functional inclination (p = 0.030) measured by the bi-planar radiographs and supine CT scans. Conclusions The low-dose bi-planar radiographs are the same reliable and accurate as 3D CT reconstruction to assess post-THA patients’ component orientation, while providing more valuable functional component orientation than supine CT scans.
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Affiliation(s)
- Zhuyi Ma
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Hao Tang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China.
| | - Siyuan Wang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Dejin Yang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Shaoyi Guo
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
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Thummala AR, Xi Y, Middleton E, Kohli A, Chhabra A, Wells J. Does surgery change pelvic tilt? : an investigation in patients with osteoarthritis of the hip, dysplasia, and femoroacetabular impingement. Bone Joint J 2022; 104-B:1025-1031. [PMID: 36047020 DOI: 10.1302/0301-620x.104b9.bjj-2022-0095.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients. METHODS The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS). RESULTS The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05). CONCLUSION There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients.Cite this article: Bone Joint J 2022;104-B(9):1025-1031.
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Affiliation(s)
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Population Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emily Middleton
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ajay Kohli
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Abstract
AIMS Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. METHODS A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified. RESULTS The AOANJRR reported two revisions: one due to infection, and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan-Meier survival rate was 99.1% (95% confidence interval 98.3 to 100) at 14 months (number at risk 104). CONCLUSION In our cohort of patients undergoing primary THA with one or more factor associated with adverse SPM, DM bearings conferred stability at two years' follow-up. Cite this article: Bone Joint J 2022;104-B(7):820-825.
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Affiliation(s)
- Rohit Dhawan
- Melbourne Orthopaedic Group, Melbourne, Australia
| | | | - Andrew Shimmin
- Melbourne Orthopaedic Group, Melbourne, Australia.,Monash University, Melbourne, Australia
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