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李 博, 李 龙, 张 衡. [Feasibility study on measuring anteversion angle of acetabular prosthesis after total hip arthroplasty using arbitrary point method]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2025; 39:420-424. [PMID: 40240036 PMCID: PMC12011510 DOI: 10.7507/1002-1892.202501009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 03/28/2025] [Accepted: 03/28/2025] [Indexed: 04/18/2025]
Abstract
Objective To explore the reliability and accuracy of the arbitrary point method for measuring the anteversion angle of acetabular prosthesis after total hip arthroplasty (THA) based on pelvic X-ray films. Methods The clinical data of 23 patients (25 hips) who underwent THA between December 2018 and September 2023 and met the selection criteria were retrospectively analyzed. Among them, there were 16 males and 7 females, with an average age of 57.6 years (range, 34-81 years); 13 hips had THA on the left side and 12 on the right side. There were 19 cases (21 hips) of osteonecrosis of the femoral head, 2 cases (2 hips) of femoral neck fractures, 1 case (1 hip) of developmental dysplasia of the hip, and 1 case (1 hip) of osteoarthritis. After THA, all patients underwent X-ray examination and CT scan. Three physicians measured the anteversion angle of acetabular prosthesis using the arbitrary point method and the CT measurement method respectively, and repeated the measurements three times. The results of the two measurement methods were compared, and the intraclass correlation coefficient (ICC) was employed to assess the reproducibility of the methods. Results The anteversion angles of acetabular prosthesis were (15.87±7.73)° measured by the arbitrary point method, and (15.31±7.89)° measured by CT measurement method. There was no significant difference between the two methods ( t=1.515, P=0.143). The ICC of the measurement results by the arbitrary point method for the three physicians were 0.97 ( P<0.001), 0.96 ( P<0.001), and 0.96 ( P<0.001), respectively; and the ICC of the measurement results by CT method were 0.93 ( P<0.001), 0.93 ( P<0.001), and 0.94 ( P<0.001), respectively. Conclusion The arbitrary point method for measuring the anteversion angle of acetabular prosthesis after THA based on pelvic X-ray film is easy to operate, accurate, and has high reproducibility.
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Affiliation(s)
- 博闻 李
- 蚌埠医科大学第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233004)Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233004, P. R. China
| | - 龙源 李
- 蚌埠医科大学第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233004)Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233004, P. R. China
| | - 衡 张
- 蚌埠医科大学第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233004)Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233004, P. R. China
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Qi H, Zhao Z, Zu F, Wang C, Wang C, Zhang Z, Wang S, Yang S, Niu H, Xue R, Hou Z, Chen W, Zhang D. The role of pelvic coronal parameters in determining sagittal balance: a prospective radiographic analysis of pelvic spinopelvic alignment in Chinese asymptomatic Han adolescents. Front Pediatr 2025; 13:1565338. [PMID: 40297555 PMCID: PMC12034641 DOI: 10.3389/fped.2025.1565338] [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: 02/06/2025] [Accepted: 03/26/2025] [Indexed: 04/30/2025] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spinal deformity where sagittal alignment significantly influences clinical outcomes. This study aims to analyze spinopelvic balance parameters in asymptomatic adolescents without scoliosis, examining the correlation between pelvic coronal parameters and sagittal balance parameters to validate their use as preliminary indicators in assessing pelvic rotation. Methods A prospective study was conducted involving 354 adolescents (199 females, 155 males) aged 6-18 years who underwent full-length anteroposterior (AP) and lateral spine radiographs at The Third Hospital of Hebei Medical University between October 2022 and December 2023. Ethical approval and informed consent were obtained. Radiographic assessments included measuring pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), pelvic sacral angle (PSA), and other related parameters. Statistical analysis was performed using SPSS software. Results Significant gender differences were observed in Risser sign distribution and pelvic tilt, with females exhibiting more advanced skeletal maturity. Positive correlations were found between pelvic incidence and pelvic tilt (r = 0.41), and pelvic incidence and sacral slope (r = 0.57), while negative correlations were noted between pelvic incidence and pelvic sacral angle (r = -0.43). Strong correlations between sagittal parameters and newly introduced coronal parameters, such as sacral-femoral-pubic angle and Pubo-Hilgenreiner Distance, were also identified. Conclusion The study demonstrates that parameters like Iliac tilt, Pelvic sacral angle, Sacral-femoral-pubic angle, and Pubo-Hilgenreiner Distance correlate well with traditional spinopelvic parameters and can be used to assess pelvic sagittal balance in clinical settings. Future research should focus on longitudinal studies to further validate these findings.
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Affiliation(s)
- Hao Qi
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - ZengHui Zhao
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Feiyu Zu
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Chenchen Wang
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Chenxi Wang
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Zuzhuo Zhang
- Department of Radiology, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Siyuan Wang
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Shuo Yang
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Haiyun Niu
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
- Department of Joint Surgery, Hebei Medical University Third Hospital, Shijiazhuang city, Hebei, China
| | - Rui Xue
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Zhiyong Hou
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang City, China
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Wei Chen
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang City, China
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
| | - Di Zhang
- Department of Spine Surgery, Hebei Medical University Third Hospital, Shijiazhuang City, Hebei, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang City, China
- Department of Orthopaedic Surgery, Tiemenguan People's Hospital, Tiemenguan City, Xinjiang, China
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Youm T. Editorial Commentary: Spine Pathology May Improve or Worsen Outcomes After Hip Arthroscopy: Patient Evaluation and Indications Are Critical. Arthroscopy 2025; 41:235-238. [PMID: 39366434 DOI: 10.1016/j.arthro.2024.09.046] [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: 09/11/2024] [Revised: 09/15/2024] [Accepted: 09/26/2024] [Indexed: 10/06/2024]
Abstract
Compared with total hip arthroplasty, hip arthroscopy is a relatively new procedure, and as such, hip-spine syndrome in young adults is an emerging topic of research. In the past decade, our understanding of spinopelvic alignment has improved the stability and survivorship of hip replacements in patients with prior lumbar fusions. Obviously, the hip affects the spine and the spine affects the hip. In terms of hip arthroscopy, just as older patients and patients with cartilage damage have inferior outcomes, patients with spine pathology are at risk for postoperative worsening spinal symptoms, including sciatica. In addition, back and radicular pain may limit postoperative hip rehabilitation. Yet other patients show resolution of back symptoms after hip arthroscopy. Today, surgeons indicating hip arthroscopy must first investigate patient sagittal balance, which includes pelvis tilt, pelvic incidence, and sacral slope. When properly indicated, hip-spine pain patients show greater percentage improvement with no increased failure risk compared with patients with isolated FAIS. Exceptions include patients with concomitant lumbar stenosis or lumbar fusion. Rate of revision hip arthroscopy and conversion to total hip replacement is 2-fold compared with controls if patients had prior 1-2 level fusion and 3-fold if 3 or more levels are fused. Our understanding of hip-spine patients with regard to arthroscopy outcomes continues to develop. In addition to a comprehensive spine exam, the patient's spine surgical history and current spine symptoms must be investigated to predict the efficacy of hip arthroscopy. If patients have both hip and spine symptoms, a diagnostic hip injection to determine the prime pain generator is essential. If the hip is the source of pain, patients should be counseled that back symptoms will likely improve after hip arthroscopy but not in all cases. EOS imaging to measure sagittal balance may allow the surgeon to predict if impingement measurements on hip radiographs may be underestimated in the setting of a stiff spine. If the patient has multiple risk factors for poor outcomes such as advancing age, articular cartilage damage, borderline dysplasia, or hypermobility, on top of a history of multilevel lumbar fusion or spinal deformity, hip arthroscopy may not be ideal, and hip arthroplasty should be considered. Clearly, the spine may not be ignored in patients with femoroacetabular impingement.
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Affiliation(s)
- Thomas Youm
- New York University Langone Orthopaedic Hospital
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Du H, Qiao H, Zhai ZJ, Zhang JW, Li HW, Mao YQ, Zhu ZA, Zhao J, Yu DG, Zhao CQ. Acetabular component position significantly influences the rebalancing of pelvic sagittal inclination following total hip arthroplasty in patients with Crowe type III/IV developmental dysplasia of the hip. Bone Joint J 2025; 107-B:149-156. [PMID: 39889760 DOI: 10.1302/0301-620x.107b2.bjj-2024-0485.r1] [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: 02/03/2025]
Abstract
Aims Sagittal lumbar pelvic alignment alters with posterior pelvic tilt (PT) following total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The individual value of pelvic sagittal inclination (PSI) following rebalancing of lumbar-pelvic alignment is unknown. In different populations, PT regresses in a linear relationship with pelvic incidence (PI). PSI and PT have a direct relationship to each other via a fixed individual angle ∠γ. This study aimed to investigate whether the new PI created by acetabular component positioning during THA also has a linear regression relationship with PT/PSI when lumbar-pelvic alignment rebalances postoperatively in patients with Crowe type III/IV DDH. Methods Using SPINEPARA software, we measured the pelvic sagittal parameters including PI, PT, and PSI in 61 patients with Crowe III/IV DDH. Both PSI and PT represent the pelvic tilt state, and the difference between their values is ∠γ (PT = PSI + ∠γ). The regression equation between PI and PT at one year after THA was established. By substituting ∠γ, the relationship between PI and PSI was also established. The Bland-Altman method was used to evaluate the consistency between the PSI calculated by the linear regression equation (ePSI) and the actual PSI (aPSI) measured one year postoperatively. Results The mean PT and PSI changed from preoperative values of 7.0° (SD 6.5°) and -8.0° (SD 6.7°), respectively, to 8.4° (SD 5.5°) and -4.5° (SD 5.9°) at one year postoperatively. This change shows that the pelvis tilted posteriorly following THA. In addition, when lumbar-pelvic alignment rebalanced, the linear regression equation between PI and PT was PT = 0.45 × PI - 10.5°, and PSI could be expressed as PSI = 0.45 × PI - 10.5° - ∠γ. The absolute difference between ePSI and aPSI was less than 5° in 55 of 61 patients (90.16%). Conclusion The new PI created by the positioning of the acetabular component significantly affects the PSI when lumbar-pelvic alignment changes and rebalances after THA in patients with Crowe III/IV DDH.
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Affiliation(s)
- Han Du
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Qiao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zan-Jing Zhai
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing-Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui-Wu Li
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan-Qing Mao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen-An Zhu
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - De-Gang Yu
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Qing Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hambrecht J, Köhli P, Chiapparelli E, Zhu J, Guven AE, Evangelisti G, Burkhard MD, Tsuchiya K, Duculan R, Altorfer FCS, Shue J, Sama AA, Cammisa FP, Girardi FP, Mancuso CA, Hughes AP. The spinopelvic alignment in patients with prior knee or hip arthroplasty undergoing elective lumbar surgery. Spine J 2025; 25:45-54. [PMID: 39278271 DOI: 10.1016/j.spinee.2024.08.025] [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: 05/06/2024] [Revised: 07/18/2024] [Accepted: 08/24/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND CONTEXT Concurrent degeneration of the lumbar spine, hip, and knee can cause significant disability and lower quality of life. Osteoarthritis in the lower extremities can lead to movement limitations, possibly requiring total knee arthroplasty (TKA) or total hip arthroplasty (THA). These procedures often impact spinal posture, causing alterations in spinopelvic alignment and lumbar spine degeneration. It is unclear if patients with a history of prior total joint arthroplasty (TJA) have different spinopelvic alignment compared to patients without. PURPOSE To assess the relationship between a history of previous THA or TKA, as well as combined THA and TKA, and the spinopelvic alignment in patients undergoing elective lumbar surgery for degenerative conditions. STUDY DESIGN A retrospective analysis was conducted on patients who underwent lumbar surgery for degenerative conditions. The patients were stratified based on a history of TKA, THA, or both TKA and THA. PATIENT SAMPLE A total of 632 patients (63% female) with an average age of 64±11 years and an average BMI of 30±6 kg/m2 were included. OUTCOME MEASURES Patients were stratified based on a history of THA, TKA, or combined THA and TKA. Spinopelvic parameters (lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were assessed. The relationship between spinopelvic alignment and prior TKA, THA or TKA and THA was analyzed. METHODS The data was tested for normal distribution using the Shapiro-Wilk test. We analyzed the relationship between the spinopelvic parameters and the different arthroplasty groups. Differences in scores between groups were examined using ANOVA. Tukey's Honestly Significant Difference test was used for pairwise comparison for significant ANOVA test results. Multivariable linear regression was applied, adjusted for age, sex and BMI. RESULTS A total of 632 patients (63% female) were included in the study. Of these patients, 74 (12%) had a history of isolated TKA, 40 (6%) had prior isolated THA, and 15 (2%) had TKA and THA prior to lumbar surgery. Patients with prior arthroplasty were predominantly female (59%) and significantly older (68±7 years vs 63±12 years, p<.001) with a significantly higher BMI (31±6 kg/m2 vs 29±6 kg/m2, p<.001). The LL was significantly lower (45.0°±13 vs 50.9°±14 p=.011) in the arthroplasty group compared to the nonarthroplasty group. A history of isolated TKA was significantly associated with lower LL (Est=-3.8, 95% CI -7.3 to -0.3, p=.031) and SS (Est=-2.6, 95% CI -5.0 to -0.2, p=.012) compared to patients without TJA. Prior combined THA and TKA was found to be significantly associated with a higher PT compared to the nonarthroplasty group (Est=5.1, 95% CI 0.4-9.8, p=.034). CONCLUSIONS The spinopelvic alignment differs between patients with and without prior TJA who undergo elective lumbar surgery. The study shows that a history of TKA is significantly associated with a lower LL and SS. The combination of THA and TKA was associated with a significantly higher PT. These findings highlight the complex relationship between the hip, spine, and knee. Moreover, the results could aid in enhancing preoperative planning of lumbar surgery in patients with known TJA.
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Affiliation(s)
- Jan Hambrecht
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Paul Köhli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Gisberto Evangelisti
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Marco D Burkhard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Koki Tsuchiya
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Roland Duculan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Franziska C S Altorfer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Carol A Mancuso
- Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
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Khalifa AA, Abdelaal AM. Does the placement of acetabular cups differ between right and left sides for a right-handed surgeon operating through a direct lateral approach? A comparative study. ARTHROPLASTY 2024; 6:58. [PMID: 39497213 PMCID: PMC11536924 DOI: 10.1186/s42836-024-00278-8] [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: 07/01/2024] [Accepted: 09/03/2024] [Indexed: 11/07/2024] Open
Abstract
PURPOSE Although many factors were suggested to affect acetabular cup positioning during primary total hip arthroplasty, the effect of surgeon handedness was rarely evaluated. We aimed primarily to assess the difference in cup positioning (inclination and anteversion) between the right and left sides during primary THA. Secondly, to check the difference in the percentages of cups positioned in the safe zone for inclination and anteversion and if there will be a difference in cup positioning according to the type of cup fixation (cemented vs. cementless). METHODS Cup inclination and anteversion of 420 THAs were radiographically evaluated retrospectively. THAs were performed by a senior right-handed surgeon, who operated through a direct lateral approach in a lateral decubitus position using manual instruments and freehand technique for cup placement. Patients were assigned to two groups: Group A (right, or dominant side), and Group B (left, or non-dominant side), with equal cases of THAs (n = 210) in each group. RESULTS No difference was found in patients' basic characteristics, preoperative diagnosis, and cup fixation (54.3% cemented and 45.7% cementless) between the two groups. There was a significant difference in cup inclination between Groups A and Group B (40.1° ± 6.3° vs. 38.2° ± 6.1°) (P = 0.002). No significant difference was revealed in anteversion between the two groups (11.7° ± 4.4° vs. 11.8° ± 4.7°) (P = 0.95). The percentage of cups located within the safe zone in terms of both inclination and anteversion was 85.2% vs. 83.8% and 69% vs. 73.3% for Group A and Group B, according to Lewinnek and Callahan's safe zones, respectively. There existed a significant difference in the cemented cup inclination between Group A and Group B (40.8° ± 6.4° vs. 38.3° ± 6.3°) (P = 0.004). CONCLUSION Cup inclination is affected by the surgeon's handedness when operating through a direct lateral approach and using a freehand technique, while anteversion is less affected. Furthermore, the difference is greater with cemented cups.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopaedic Department, Qena University Hospital, Qena, 83523, Egypt
| | - Ahmed M Abdelaal
- Department of Orthopedic Surgery and Traumatology, Assiut University Hospital, Assiut, 71515, Egypt.
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Wu J, Lin C, Zhuang X, He L, Wang J, Zhou X, Xu N, Xie H, Lv H, Ye H, Zhang R. How does the position of the pelvis and femur influence the selection of prosthesis size during 2D preoperative planning for total hip arthroplasty? BMC Musculoskelet Disord 2024; 25:845. [PMID: 39448960 PMCID: PMC11515560 DOI: 10.1186/s12891-024-07955-4] [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: 08/24/2023] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open
Abstract
PURPOSE Total Hip Arthroplasty (THA) is the primary treatment for hip diseases today. Nevertheless, total hip arthroplasty has its challenges, and one of these challenges is the potential for incorrect execution of the preoperative planning process. Such errors can lead to complications such as loosening and instability of the prosthesis and leg length discrepancy. In this study, we used human phantoms to investigate the influence of pelvic and femoral factors on prosthesis size selection in the preoperative planning of total hip arthroplasty and to provide a reference standard for clinical imaging in preoperative planning of total hip arthroplasty. METHODS In this experiment, we utilised a custom-made experimental device that enabled us to manipulate the movement of the pelvis and femur in various directions. The device also incorporated sensors to control the angle of movement. By obtaining X-rays from different positions and angles, we were able to determine the size of the prosthesis based on the 2D preoperative planning generated by the mediCAD software. RESULTS When the pelvis was in a nonneutral position, the size of the acetabular cup varied within a range of three sizes. Similarly, when the femur was in a nonneutral position, the size of the femoral stem varied within a range of two sizes. The movement of the pelvis and femur in the coronal plane, relative to the neutral position, did not impact the selection of the prosthesis size. However, the motion of the pelvis and femur in the sagittal and transverse planes had a notable effect. CONCLUSION The selection of the prosthesis size for preoperative planning can be significantly influenced by specific positions of the pelvis and femur. It is crucial for the radiographer to ensure that the pelvis and femur maintain a standard neutral position, particularly in the sagittal and transverse planes, during the image acquisition process.
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Affiliation(s)
- Junzhe Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Chaohui Lin
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Xunrong Zhuang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Lijiang He
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Jiawei Wang
- Department of Emergency surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Xinzhe Zhou
- The Second Clinical Medical College, Fujian Medical University, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China
| | - Nanjie Xu
- The Second Clinical Medical College, Fujian Medical University, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China
| | - Huating Xie
- The Second Clinical Medical College, Fujian Medical University, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China
| | - Hanzhang Lv
- The Second Clinical Medical College, Fujian Medical University, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China
| | - Hui Ye
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, Fujian, China.
| | - Rongmou Zhang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, Fujian, China.
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Khalifa AA, Hassan AA. Surgeon handedness affects the acetabular cup positioning during primary total hip arthroplasty regardless of the surgical approach. a systematic review and metanalysis. BMC Musculoskelet Disord 2024; 25:792. [PMID: 39375663 PMCID: PMC11460204 DOI: 10.1186/s12891-024-07868-2] [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: 07/01/2024] [Accepted: 09/11/2024] [Indexed: 10/09/2024] Open
Abstract
PURPOSE The aim was to investigate the effect of surgeon handedness on acetabular cup positioning, functional outcomes, and dislocation incidence during primary THA. METHODS A systematic review was conducted according to the PRISMA guidelines. Studies published in English were searched in three databases (PubMed, Embase, and Scopus). A dominant side is a right-handed (RHD) or left-handed (LHD) surgeon who operates on the right or left hip, respectively. The opposite is considered to be the non-dominant side. We used odds ratios for dichotomous data and mean differences for continuous data, with 95% confidence intervals for quantitative data synthesis. Heterogeneity was assessed using the I² test, with outcomes graphically represented in a forest plot and a p-value of < 0.05 considered statistically significant; analyses were performed using Review Manager 5.4 (RevMan 5.4.1). >. RESULT Four observational studies were included out of 98 articles. Ten experienced surgeons participated (8 RHD and 2 LHD) and operated on 822 patients (1484 hips), divided equally between dominant and non-dominant sides, and the posterolateral approach was utilized in 80.9% of THAs. RHD surgeons operated on 1404 (94.6%) THAs. The pooled synthesis for inclination indicated no significant difference between either side [MD: 0.10 (95% CI -2.10 to 2.30, P = 0.93, I² = 91%)]. While the difference was significant for anteversion [MD: -2.37 (95% CI -3.82 to -0.93, P = 0.001, I² = 31%)]. The functional outcome was better on the dominant side [MD: 1.44 (95% CI 0.41 to 2.48, P = 0.006, I² = 0%)], and the dislocation incidence was significantly higher on the non-dominant side [OR: 0.45 (95% CI 0.25 to 0.81, P = 0.008, I² = 0%)]. CONCLUSION Surgeon handedness and whether operating on the dominant or non-dominant side could affect the acetabular cup positioning and outcomes during primary THAs, even in the hands of high-volume surgeons.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Abdelazim Hassan
- Orthopaedic and Traumatology Department, Assiut University School of Medicine, Assuit, 71515, Egypt.
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Xu Z, Chai S, Chen D, Wang W, Dai J, Zhang X, Qin J, Song K, Li X, Han J, Chang Q, Zhang M, Xue C, Lu J, Wu L, Yao Y, Li L, Jiang Q. The LANCET robotic system can improve surgical efficiency in total hip arthroplasty: A prospective randomized, multicenter, parallel-controlled clinical trial. J Orthop Translat 2024; 45:247-255. [PMID: 38601198 PMCID: PMC11004624 DOI: 10.1016/j.jot.2023.12.004] [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: 09/19/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 04/12/2024] Open
Abstract
Objective To evaluate the accuracy and safety of the LANCET robotic system, a robot arm assisted operation system for total hip arthroplasty via a multicenter clinical randomized controlled trial. Methods A total of 116 patients were randomized into two groups: LANCET robotic arm assisted THA group (N = 58) and the conventional THA group (N = 58). General information about the patients was collected preoperatively. Operational time and bleeding were recorded during the surgery. The position of the acetabular prosthesis was evaluated by radiographs one week after surgery and compared with preoperative planning. Harris score, hip mobility, prosthesis position and angle and complications were compared between the two groups at three months postoperatively. Results None of the 111 patients who ultimately completed the 3-month follow-up experienced adverse events such as hip dislocation and infection during follow-up. In the RAA group, 52 (92.9 %) patients were located in the Lewinnek safe zone and 49 (87.5 %) patients were located in the Callanan safe zone. In the control group were 47 (85.5 %) and 44 (80.0 %) patients, respectively. In the RAA group, 53 (94.6 %) patients had a postoperative acetabular inclination angle and 51 (91.1 %) patients had an acetabular version angle within a deviation of 5° from the preoperative plan. These numbers were significantly higher than those of the control group, which consisted of 42 (76.4 %) and 34 (61.8 %) patients respectively. There were no significant differences between the two groups of subjects in terms of general condition, intraoperative bleeding, hip mobility, and adverse complications. Conclusion The results of this prospective randomized, multicenter, parallel-controlled clinical study demonstrated that the LANCET robotic system leads conventional THA surgery in accuracy of acetabular cup placement and does not differ from conventional THA surgery in terms of postoperative hip functional recovery and complications. The translational potential of this article In the past, the success rate of total hip arthroplasty (THA) relied heavily on the surgeon's experience. As a result, junior doctors needed extensive training to become proficient in this technique. However, the introduction of surgical robots has significantly improved this situation. By utilizing robotic assistance, both junior and senior doctors can perform THA quickly and efficiently. This advancement is crucial for the widespread adoption of THA, as patients can now receive surgical treatment in local facilities instead of overwhelming larger hospitals and straining medical resources. Moreover, the development of surgical robots with fully independent intellectual property rights holds immense value in overcoming the limitations of high-end medical equipment. This aligns with the objectives outlined in the 14th Five Year Plan for National Science and Technology Strategy.
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Affiliation(s)
- Zhihong Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Senlin Chai
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Dongyang Chen
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Weijun Wang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jin Dai
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaofeng Zhang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jianghui Qin
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Kai Song
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinhua Li
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jing Han
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing Chang
- Sports Medicine Center, Department of Orthopaedic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Miaofeng Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Chenxi Xue
- Department of Orthopedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jun Lu
- Sports Medicine Center, Department of Orthopaedic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Lidong Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yunfeng Yao
- Department of Orthopedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
| | - Lan Li
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Itthipanichpong T, Menta SV, Ranawat AS. Editorial Commentary: Restrictions in Spinal Motion Result in Lower Outcome Scores After Hip Arthroscopy. Arthroscopy 2023; 39:1855-1856. [PMID: 37400169 DOI: 10.1016/j.arthro.2023.04.004] [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: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 07/05/2023]
Abstract
The critical consideration in determining the efficacy of hip surgery is patient-reported outcomes, specifically the achievement of the clinical threshold. Several studies examined the achievement of the clinical threshold following hip arthroscopy (HA) in the presence of coexisting lumbar spine disease. The condition related to the spine receiving a lot of focus in recent research is the lumbosacral transitional vertebrae (LSTV). However, this condition could be just the tip of the iceberg. To forecast the outcomes of HA, it is far more important to comprehend spinopelvic motion. Since higher-grade LSTV is associated with less lumbar spine flexibility and reduces the ability to antevert acetabulum, it is possible that LSTV severity or grading could be one of the indicators of less effective operation "especially in "hip users"' (hip users are defined as patents who are more dependent on on hip motion than spinal motion). In light of this, lower-grade LSTV ought to have a less significant impact on surgical outcomes than higher-grade LSTV.
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Affiliation(s)
- Thun Itthipanichpong
- New York, New York, USA. (T.I., S.V.M., A.S.R.); Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand (T.I.)
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11
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Feingold JD, Srikumar S, Vaswani R, White AE, Swartwout EL, Ranawat AS. The Outcome of Hip Arthroscopy in the Setting of Lumbar Spine Disease Is Beneficial, Yet Limited: A Systematic Review of Existing Evidence. Arthroscopy 2023; 39:1568-1583. [PMID: 36191731 DOI: 10.1016/j.arthro.2022.09.014] [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: 12/30/2021] [Revised: 09/04/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To compare hip arthroscopy outcomes in femoroacetabular impingement (FAI) patients with concurrent symptomatic lumbar spine disease to the outcomes of arthroscopic FAI patients without spine disease. METHODS A systematic review was performed according to PRISMA guidelines via PubMed, Cochrane, Embase, and Google Scholar databases. Studies were valid for inclusion if they had an average follow-up ≥12 months and compared patient-reported outcome measures (PROMs) in hip arthroscopy patients with and without concurrent spinal disease. Data collected included study characteristics, patient demographics, follow-up intervals, surgical indications, spinal pathology, PROMs, and reoperation rates. RESULTS Twelve studies were included in this systematic review. 3,107 patients who underwent hip arthroscopy were evaluated: 1,056 with coexisting lumbar spine disease (spine cohort) and 2,051 control subjects without spine disease (control cohort). The average follow-up period was 24 months. Across included studies, there were 35 instances wherein postoperative PROM scores reported by each cohort were compared. In all 35 instances, the spine cohort reported inferior postoperative PROM scores with the difference being significant (P < .05) on 23 PROMs. Collectively, 23 cases were available contrasting the proportion of each cohort to achieve the minimal clinically important difference (MCID). In 22 (95.65%) of these cases, the spine cohort achieved the MCID at a lower rate than the control cohort. There were 14 PROMs, wherein intragroup analyses were reported that compared the preoperative and postoperative score reported by the spine cohort. On all 14 PROMs, the spine cohort reported significant (P < .05) improvement after arthroscopic intervention. CONCLUSION FAI patients with coexisting lumbar spine pathology experience significant improvement from baseline state after arthroscopic intervention. However, the postoperative outcomes reported are inferior, and the improvement from arthroscopy was limited when compared to surgical control subjects with FAI and normal spinal anatomy. LEVEL OF EVIDENCE Level IV: systematic review of Level II, III, and IV studies.
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Affiliation(s)
| | | | - Ravi Vaswani
- Hospital for Special Surgery, New York, New York, USA
| | - Alex E White
- Hospital for Special Surgery, New York, New York, USA
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Xie R, Huang J, Wu Q, Qian Y, Jiang D, Li L, Huang L. A Comparison of Radiographic Outcomes after Total Hip Arthroplasty between the Direct Lateral Approach and Posterior Lateral Approach with EOS 2D/3D X-Ray Imaging System. Orthop Surg 2023; 15:1312-1324. [PMID: 37076774 PMCID: PMC10157717 DOI: 10.1111/os.13726] [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: 09/30/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE The classical approaches for total hip arthroplasty (THA) are the direct lateral approach (DLA) and posterior lateral approach (PLA). There are few studies comparing implant orientation with these two approaches, and the impact of surgical approaches on implant orientation remains controversial. With the rise of the EOS imaging system, we aimed to use it to identify the differences between and factors associated with implant orientation after THA using DLA and PLA. METHODS In our department from January 2019 to December 2021, 321 primary unilateral THAs that used PLA and DLA were enrolled. A total of 201 patients who received PLA and 120 patients who received DLA were included in this study. Two blinded observers measured each case using EOS imaging data. Postoperative imaging metrics and other relevant influencing factors of the two surgical approaches were compared. Postoperative imaging metrics, including the anteversion and inclination of the cup, anteversion of the stem, and combined anteversion were measured based on EOS. Other relevant influencing factors included age, approach, gender, laterality, BMI, anterior pelvic plane inclination, femoral head diameter, femoral offset, lateral pelvic tilt, pelvic incidence, pelvis axial rotation, sacral slope, sagittal pelvic tilt, and surgery time. Multiple linear regression analyses were performed to identify the predictors of acceptability for each imaging data point. RESULTS No dislocation was found in the 321 patients who underwent primary THA during this period. The mean anteversion and combined anteversion of the cups using the DLA were 21.33° ± 17.31° (-51.7°-60.8°) and 33.71° ± 20.85° (-38.8°-77.6°) and PLA were 25.34° ± 12.76° (-5.5°-57.0°) and 42.37° ± 18.85° (-8.7°-84.7°), respectively. The DLA group had smaller anteversion (p = 0.038) and combined anteversion (p < 0.001). We found that surgical approach (p < 0.05), anterior pelvic plane inclination (p < 0.001), gender (p < 0.001), and femoral head diameter (p < 0.001) were important factors affecting acetabular cup anteversion (R2 = 0.375) and combined anteversion (R2 = 0.525). CONCLUSIONS In total hip arthroplasty, different prosthesis installation directions should be made according to different surgical approaches. Compared with the direct lateral approach, the acetabular anteversion can be intentionally enlarged when using the posterolateral approach. Surgical approach, anterior pelvic plane inclination (APPI), gender, and femoral head diameter were significant predictors of prosthesis orientation. The anterior pelvic plane inclination may be a useful standard for assessing the position of the prosthesis using EOS.
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Affiliation(s)
- Rui Xie
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Jun Huang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Qian Wu
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Yu‐fan Qian
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Dinghua Jiang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Lisong Li
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Lixin Huang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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Lukas KJ, Verhaegen JCF, Livock H, Kowalski E, Phan P, Grammatopoulos G. The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review. Bone Joint Res 2023; 12:231-244. [PMID: 37051815 PMCID: PMC10065848 DOI: 10.1302/2046-3758.124.bjr-2022-0335.r1] [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] [Indexed: 04/03/2023] Open
Abstract
Spinopelvic characteristics influence the hip's biomechanical behaviour. However, to date there is little knowledge defining what 'normal' spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction. When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: -1.5° (SD 0.3°), -1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: -1.3° (SD 0.3°) to -0.5° (SD 1.3°), -1.2° (SD 0.2°) to -0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively. Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI.
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Affiliation(s)
- Kenneth J. Lukas
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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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: 4] [Impact Index Per Article: 1.3] [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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Kim K, Wei R, Kim YH. Reliability in measurement of three-dimensional anterior pelvic plane orientation by registration with an inertial measurement unit. Front Surg 2022; 9:1011432. [DOI: 10.3389/fsurg.2022.1011432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/03/2022] [Indexed: 12/02/2022] Open
Abstract
It is strongly challenging to obtain functional movement of the pelvis based on the three-dimensional (3D) dynamic anterior pelvic plane (APP) orientation information. This study provided the 3D APP orientation measurement technique by registration with an inertial measurement unit (IMU), and its reliability was tested. The local coordinate systems of the APP and the IMU sensor were registered using two images of the pelvic part from the frontal and left sagittal views in a neutral standing posture. Then, the measurement errors in the APP orientation were analyzed by comparing the values obtained from manually measured four points in the IMU sensor and the known exact values in 10 different postures. Moreover, the errors between values obtained from manually measured three anatomical points and the known exact values were also compared. The average errors were quite small (less than 0.6°) when measuring from three anatomical points and were acceptable (1.6°–3.4°) when measuring from four points in the IMU sensor. These results indicate that the measurement of APP direction using four points in the IMU sensor could be considered reliable in terms of intra-participant and inter-participant. The present technique to register the IMU sensor position and the APP direction by taking X-ray images from the frontal and sagittal directions can be fundamental information to measure the APP direction during dynamic motion when the IMU position is obtained from the IMU sensor data instead of the four-point location information.
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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: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [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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Vaswani R, White AE, Feingold J, Ranawat AS. Hip-Spine Syndrome in the Nonarthritic Patient. Arthroscopy 2022; 38:2930-2938. [PMID: 35550420 DOI: 10.1016/j.arthro.2022.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
Hip-spine syndrome refers to concurrent hip and spine pathology with overlapping symptoms. Most of the literature has studied it in relation to total hip arthroplasty literature and has been shown to increase dislocation risk. Lumbar spine and pelvic mobility have been studied less frequently in relation to nonarthritic pathologic hip states. Understanding the biomechanical relationship between the lumbar spine, pelvis, and hip can help elucidate how hip-spine syndrome affects the nonarthritic hip and how it impacts outcomes of hip arthroscopy. Changes in lumbar spine motion may be the reason certain predisposed patients develop symptomatic femoroacetabular impingement (FAI) or ischiofemoral impingement. Some athletes may be "hip users" with a low pelvic incidence, making them more reliant on hip motion due to less-intrinsic lumbopelvic motion. When these patients have FAI morphology, their increased reliance on hip motion makes them prone to experiencing femoroacetabular contact and concurrent symptoms. Other athletes may be "spine users," with larger pelvic incidence and more baseline lumbopelvic motion, making them less reliant on hip motion and therefore less prone to experiencing hip impingement even with hip FAI morphology. Hip-spine syndrome also appears to have an impact on patient selection, role of nonoperative treatment, and hip arthroscopy surgical outcomes. Identifying patients with concurrent pathology may allow surgeons to recommend targeted physical therapy or counsel patients better on their expectations after surgery.
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Affiliation(s)
- Ravi Vaswani
- Hospital for Special Surgery, New York, New York, U.S.A; Hospital for Special Surgery Sports Medicine Institute, New York, New York, U.S.A.
| | | | | | - Anil S Ranawat
- Hospital for Special Surgery, New York, New York, U.S.A; Hospital for Special Surgery Sports Medicine Institute, New York, New York, U.S.A
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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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19
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Huang H, Chen Y, Chen Z, Zhao C. Reliability and Validity Analysis of Pelvic Sagittal Inclination Calculated by Inverse Cosine Function Method on Pelvic Anteroposterior Radiographs. Orthop Surg 2022; 14:2721-2729. [PMID: 36102214 PMCID: PMC9531102 DOI: 10.1111/os.13488] [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: 12/13/2021] [Revised: 05/12/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Evaluation of sagittal pelvic tilt is significant for hip surgeons. However, the accurate measurement of pelvic sagittal inclination (PSI) is still a challenge. The objective of this study is to propose a new method for measurement of PSI from pelvic anteroposterior radiograph based on the inverse cosine function obtained from individualized pelvic model. Methods Collecting the imaging data of 30 patients with both pelvic CT and full‐length spine radiographs. Establishing pelvic model by customized 3D reconstruction software. The length of three groups of longitudinal and transverse line segments (A′p and B′) were measured from full‐length spine anteroposterior radiographs. The corresponding anatomical parameters, including A, B, b, ∠α, ∠γ, were measured and calculated on the same patient's pelvic model. The estimated PSI (ePSI) based on three groups of anatomical landmarks, including ePSI‐1, ePSI‐2, and ePSI‐3, were calculated by equation, ePSI=arccosA′pb*B′−∠α, and compared with the actual PSI (aPSI) measured by Surgamap software. For the reliability and validation evaluation, three observers measured these parameters in two rounds. Intra‐class correlation and inter‐class correlation were both calculated. Bland–Altman method was used to evaluate the consistency between the estimated PSI (ePSI) and the actual PSI (aPSI). Results ePSI‐1 and ePSI‐2 showed excellent intra‐observer reliability (0.921–0.997, p < 0.001) and inter‐observer reliability (0.801–0.977, p < 0.001). ePSI‐3 had a fair inter‐observer reliability (0.239–0.823, p < 0.001). ePSI‐1 showed the strongest correlation with aPSI (r = 0.917, p < 0.001). Mean (maximum) absolute difference of ePSI‐1, ePSI‐2, and ePSI‐3 is 2.62° (7.42°), 4.23° (13.78°), and 7.74° (31.47°), respectively. The proportion of cases with absolute difference less than 5° in three groups were 86.7% (ePSI‐1), 66.7% (ePSI‐2), 56.7% (ePSI‐3). Conclusion This new method based on inverse cosine function has good reliability and validity when used in the evaluation of PSI on pelvic anteroposterior radiographs.
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Affiliation(s)
- Hao‐han Huang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yan Chen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Zhao‐xun Chen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chang‐qing Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
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20
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Bartolotta RJ, Ha AS. Current Imaging Concepts in Shoulder and Hip Arthroplasty. Radiol Clin North Am 2022; 60:669-678. [DOI: 10.1016/j.rcl.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Iturriaga CR, Jung B, Mont MA, Rasquinha VJ, Boraiah S. Variability in Acetabular Component Position in Patients Undergoing Direct Anterior Approach Total Hip Arthroplasty Who Have Concomitant Spine Pathology. J Arthroplasty 2022; 37:501-506.e1. [PMID: 34822930 DOI: 10.1016/j.arth.2021.11.025] [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: 03/19/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip instability following total hip arthroplasty (THA) can be a major cause of revision surgery. Physiological patient position impacts acetabular anteversion and abduction, and influences the functional component positioning. Osteoarthritis of the spine leads to abnormal spinopelvic biomechanics and motion, but there is no consensus on the degree of component variability for THAs performed by anterior approach. Therefore, we sought to present guidelines for changes in acetabular component positioning between supine and standing positions for patients undergoing primary THA by a uniform anterior approach. METHODS Perioperative patient radiographs of the pelvis and lumbar spine were collected. Images were used to determine acetabular component positioning and degree of coexisting spinal pathology, categorized as a Lane Grade (LG). Final analysis of variance was performed on a sample size of 643 anterior primary THAs. RESULTS From supine to standing position, as the severity of lumbar pathology increased the change in anteversion also increased (LG:0 = -0.11° ± 4.65°, LG:1 = 2.02° ± 4.09°, LG:2-3 = 5.78° ± 5.72°, P < .001). The mean supine anteversion in patients with absent lumbar pathology was 19.72° ± 5.05° and was lower in patients with worsening lumbar pathology (LG:1 = 18.25° ± 4.81°, LG:2-3 = 16.73° ± 5.28°, P < .001). CONCLUSION Patients undergoing primary THA by anterior approach with worsening spinal pathology have larger increases in component anteversion when transitioning from supine to standing positions. Consideration should be given to this expected variability when placing the patient's acetabular component.
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Affiliation(s)
- Cesar R Iturriaga
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY; Department of Orthopaedic Surgery, Plainview Hospital, Northwell Health, Plainview, NY
| | - Byeongho Jung
- Donald and Barbara Zucker School of Medicine, Hofstra University, Hempstead, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Vijay J Rasquinha
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY
| | - Sreevathsa Boraiah
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY
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22
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The Accuracy of Patient-Specific Instrumentation with Laser Guidance in a Dynamic Total Hip Arthroplasty: A Radiological Evaluation. SENSORS 2021; 21:s21124232. [PMID: 34203107 PMCID: PMC8234047 DOI: 10.3390/s21124232] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 01/13/2023]
Abstract
The functional positioning of components in a total hip arthroplasty (THA) and its relationship with individual lumbopelvic kinematics and a patient’s anatomy are being extensively studied. Patient-specific kinematic planning could be a game-changer; however, it should be accurately delivered intraoperatively. The main purpose of this study was to verify the reliability and accuracy of a patient-specific instrumentation (PSI) and laser-guided technique to replicate preoperative dynamic planning. Thirty-six patients were prospectively enrolled and received dynamic hip preoperative planning based on three functional lateral spinopelvic X-rays and a low dose CT scan. Three-dimensional (3D) printed PSI guides and laser-guided instrumentation were used intraoperatively. The orientation of the components, osteotomy level and change in hip length and offset were measured on postoperative CT scans and compared with the planned preoperative values. The length of surgery was compared with that of a matched group of thirty-six patients who underwent a conventional THA. The mean absolute deviation from the planned inclination and anteversion was 3.9° and 4.4°, respectively. In 92% of cases, both the inclination and anteversion were within +/− 10° of the planned values. Regarding the osteotomy level, offset change and limb length change, the mean deviation was, respectively, 1.6 mm, 2.6 mm and 2 mm. No statistically significant difference was detected when comparing the planned values with the achieved values. The mean surgical time was 71.4 min in the PSI group and 60.4 min in the conventional THA group (p < 0.05). Patient-specific and laser-guided instrumentation is safe and accurately reproduces dynamic planning in terms of the orientation of the components, osteotomy level, leg length and offset. Moreover, the increase in surgical time is negligible.
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23
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Flintham K, Alzyoud K, England A, Hogg P, Snaith B. Comparing the supine and erect pelvis radiographic examinations: an evaluation of anatomy, image quality and radiation dose. Br J Radiol 2021; 94:20210047. [PMID: 33989034 DOI: 10.1259/bjr.20210047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared supine and erect radiographic examinations for anatomical features, radiation dose and image quality. METHODS 60 patients underwent pelvis radiography in both supine and erect positions at the same examination appointment. Measures of body mass index and sagittal diameter were obtained. Images were evaluated using visual grading analysis and pelvic tilt was compared. Dose-area product values were recorded and inputted into the CalDose_X software to estimate effective dose (ED). The CalDose_X software allowed comparisons using data from the erect and supine sex-specific phantoms (MAX06 & FAX06). RESULTS Patient sagittal diameter was greater on standing with an average 20.6% increase at the iliac crest (median 30.0, interquartile range [26.0 to 34.0] cm), in comparison to the supine position [24.0 (22.3 to 28.0) cm; p < 0.001]. 57 (95%) patients had posterior pelvic tilt on weight-bearing. Erect image quality was significantly decreased with median image quality scores of 78% (69 to 85) compared to 87% for the supine position [81 to 91] (p < 0.001). In the erect position, the ED was 47% higher [0.17 (0.13 to 0.33) mSv vs 0.12 (0.08 to 0.18) mSv (p < 0.001)], influenced by the increased sagittal diameter. 42 (70%) patients preferred the standing examination. CONCLUSION Patient diameter and pelvic tilt were altered on weightbearing. Erect images demonstrated an overall decrease in image quality with a higher radiation dose. Optimal acquisition parameters are required for erect pelvis radiography as the supine technique is not directly transferable.
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Affiliation(s)
| | - Kholoud Alzyoud
- Hashemite University, Zarqa, Jordan.,University of Salford, Salford, UK
| | - Andrew England
- University of Salford, Salford, UK.,University of Keele, Newcastle, UK
| | | | - Beverly Snaith
- Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.,University of Bradford, Bradford, UK
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24
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Snijders TE, Schlösser TPC, van Stralen M, Castelein RM, Stevenson RP, Weinans H, de Gast A. The Effect of Postural Pelvic Dynamics on the Three-dimensional Orientation of the Acetabular Cup in THA Is Patient Specific. Clin Orthop Relat Res 2021; 479:561-571. [PMID: 33009235 PMCID: PMC7899699 DOI: 10.1097/corr.0000000000001489] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sagittal pelvic dynamics mainly consist of the pelvis rotating anteriorly or posteriorly while the hips flexes, and this affects the femoroacetabular or THA configuration. Thus far, it is unknown how the acetabular cup of the THA in the individual patient reorients with changing sagittal pelvic dynamics. QUESTIONS/PURPOSES The aim of this study was to validate a method that establishes the three-dimensional (3-D) acetabular cup orientation with changing sagittal pelvic dynamics and describe these changes during functional pelvic dynamics. METHODS A novel trigonometric mathematical model, which was incorporated into an easy-to-use tool, was tested. The model connected sagittal tilt, transverse version, and coronal inclination of the acetabular cup during sagittal pelvic tilt. Furthermore, the effect of sagittal pelvic tilt on the 3-D reorientation of acetabular cups was simulated for cups with different initial positions. Twelve pelvic CT images of patients who underwent THA were taken and rotated around the hip axis to different degrees of anterior and posterior sagittal pelvic tilt (± 30°) to simulate functional pelvic tilt in various body positions. For each simulated pelvic tilt, the transverse version and coronal inclination of the cup were manually measured and compared with those measured in a mathematical model in which the 3-D cup positions were calculated. Next, this model was applied to different acetabular cup positions to simulate the effect of sagittal pelvic dynamics on the 3-D orientation of the acetabular cup in the coronal and transverse plane. After pelvic tilt was applied, the intraclass correlation coefficients of 108 measured and calculated coronal and transverse cup orientation angles were 0.963 and 0.990, respectively, validating the clinical use of the mathematical model. RESULTS The changes in 3-D acetabular cup orientation by functional pelvic tilt differed substantially between cups with different initial positions; the change in transverse version was much more pronounced in cups with low coronal inclination (from 50° to -29°) during functional pelvic tilt than in cups with a normal coronal inclination (from 39° to -11°) or high coronal inclination (from 31° to 2°). However, changes in coronal inclination were more pronounced in acetabular cups with high transverse version. CONCLUSION Using a simple algorithm to determine the dynamic 3-D reorientation of the acetabular cup during functional sagittal pelvic tilt, we demonstrated that the 3-D effect of functional pelvic tilt is specific to the initial acetabular cup orientation and thus per THA patient. CLINICAL RELEVANCE Future studies concerning THA (in)stability should not only include the initial acetabular cup orientation, but also they need to incorporate the effect of sagittal pelvic dynamics on the individual 3-D acetabular cup orientation. Clinicians can also use the developed tool, www.3d-hip.com, to calculate the acetabular cup's orientation in other instances, such as for patients with spinopelvic imbalance.
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Affiliation(s)
- Thom E Snijders
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Tom P C Schlösser
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Maartje van Stralen
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Renee M Castelein
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Rob P Stevenson
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Harrie Weinans
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Arthur de Gast
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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Do All Rigid and Unbalanced Spines Present the Same Risk of Dislocation After Total Hip Arthroplasty? A Comparison Study Between Patients With Ankylosing Spondylitis and History of Spinal Fusion. J Arthroplasty 2020; 35:3594-3600. [PMID: 32660797 DOI: 10.1016/j.arth.2020.06.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Spines with ankylosis or with a history of lumbosacral fusions have been collectively classified as rigid and unbalanced, and associated with an increased rate of dislocation after total hip arthroplasty (THA). It remains unknown whether the cause of spinal arthrodesis influences the dislocation rate. METHODS A retrospective study was conducted from January 2000 to December 2017, with an institutional review board's approval to identify 2 cohorts with a history of THA: one with ankylosing spondylitis (AS) involving the lumbosacral spine and another cohort with a history of lumbosacral spinal fusion (SF). A chart review was performed to collect demographic and surgical variables. Lumbar lordosis angle (LLA), acetabular anteversion, and inclination angle measurements were taken for each patient. Kaplan-Meier survivorship curves were constructed and multivariable Cox regression was performed for analysis. RESULTS The AS and SF cohorts consisted of 142 and 135 patients, respectively. The SF group had a greater mean LLA (34.18°) than the AS group (21°). A total of 16 patients (11.85%) suffered from dislocation after primary elective THA in the SF group, whereas 4 patients (2.82%) in the AS group. After multivariable Cox regression analysis, increasing LLA and hips outside of the Lewinnek safe zone were found to be associated with a higher hazard of dislocation after THA. CONCLUSION We found that the degree of lumbar spine curvature is more associated with dislocation after THA than the history of SF itself; specifically, an increase in lumbar lordosis angle of 1º increases the probability of dislocation by 13% among AS and SF patients.
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Wang X, Qureshi A, Vepa A, Rahman U, Palit A, Williams MA, King R, Elliott MT. A Sensor-Based Screening Tool for Identifying High Pelvic Mobility in Patients Due to Undergo Total Hip Arthroplasty. SENSORS 2020; 20:s20216182. [PMID: 33143034 PMCID: PMC7663251 DOI: 10.3390/s20216182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
There is increasing evidence that pelvic mobility is a critical factor to consider in implant alignment during total hip arthroplasty (THA). Here, we test the feasibility of using an inertial sensor fitted across the sacrum to measure change in pelvic tilt, and hence screen for patients with high pelvic mobility. Patients (n = 32, mean age: 57.4 years) due to receive THA surgery participated in the study. Measures of pelvic tilt were captured simultaneously using the device and radiograph in three functional positions: Standing, flexed-seated, and step-up. We found a strong correlation between the device and radiograph measures for the change in pelvic tilt measure from standing to flexed-seated position (R2 = 0.911); 75% of absolute errors were under 5 degrees. We demonstrated that the device can be used as a screening tool to rapidly identify patients who would benefit from more detailed surgical planning of implant positioning to reduce future risks of impingement and dislocation.
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Affiliation(s)
- Xueyang Wang
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Arham Qureshi
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Abhinav Vepa
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Usama Rahman
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Arnab Palit
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Mark A. Williams
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Richard King
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Mark T. Elliott
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
- Correspondence:
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27
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Li L, Zhang Y, Lin YY, Li ZX, Chen L, Chen DS, Fan P. A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach. Orthop Surg 2020; 12:1663-1673. [PMID: 32924261 PMCID: PMC7767786 DOI: 10.1111/os.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/27/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine the implant orientation, especially the combined anteversion measurements in total hip arthroplasty (THA) using lateral approach, and to compare with implant orientation using posterior-lateral (P-L) approach. The secondary goal was to identify the factors associated with implant orientation. METHODS Five hundred and one patients (545 hips) who underwent primary THA with the modified Hardinge approach between January 2016 and November 2019 by one senior surgeon in our department in a retrospective study were followed up. A survey to inquire about the history of dislocation of the hip after THA was designed and responses were gathered by telephone, WeChat software, and outpatient follow-up. The mean age of the patients was 61.97 ± 11.72 years, and there were 254 males and 247 females. The average follow-up time was 25.2 ± 13.7 months (range, 3.2-49.7 months). Among the patients who were followed up, 97 patients (104 hips) underwent computed tomography (CT) scans from L4 to the tuberosity of the tibia. The implant orientation, including the anteversion and inclination of the cup, anteversion of the stem, combined anteversion, and pelvic tilt were measured based on CT scans of these patients. The results were compared with the implant orientation reported in previous reports measured by CT. Factors that may be associated with implant orientation were investigated, including the patient's age, sex, body mass index (BMI), and diagnosis; size of the cup; diameter of the femoral head component; and pelvic tilt. Data and statistical analyses were performed using SPSS 20.0. RESULTS No cases of dislocation were found in the 501 patients (545 hips) who underwent primary THA during this period. The mean inclination and anteversion of the cups were 38.83° ± 5.04° (24.5°-53.1°) and 9.26° ± 11.19° (-15°-48°), respectively. The mean anteversion of the stem was 13.83° ± 10.7° (-10.2°-42.3°). The combined anteversion was 23.1° ± 13.4° (-7.4°-54.6°). Compared with the reported combined anteversion and anteversion of the cup, the mean anteversion of the cup and combined anteversion using the lateral approach were much lower than the reported values in the literature using the P-L approach. Pelvic tilt was found to be the only independent factor for cup anteversion. Factors including age, sex, BMI, diagnosis, cup size, and diameter of the femoral head component were not associated with implant orientation. CONCLUSION THA using the lateral approach yields smaller cup anteversion and combined anteversion values than using the P-L approach. Pelvic tilt is the only predictor for cup anteversion.
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Affiliation(s)
- Li Li
- Zhejiang Provincial Key Laboratory of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yu Zhang
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yuan-Yuan Lin
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Zhen-Xing Li
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Liang Chen
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Dao-Sen Chen
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Pei Fan
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
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Mancino F, Cacciola G, Di Matteo V, Perna A, Proietti L, Greenberg A, MA M, Sculco PK, Maccauro G, De Martino I. Surgical implications of the hip-spine relationship in total hip arthroplasty. Orthop Rev (Pavia) 2020; 12:8656. [PMID: 32913592 PMCID: PMC7459374 DOI: 10.4081/or.2020.8656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/28/2022] Open
Abstract
Total hip arthroplasty (THA) is considered the most successful orthopedic surgical procedure of the last century with excellent survivorship up to 20-years. However, instability remains a major issue representing the most common reason for revision after THA. Hip-spine relationship has gained progressive interest between arthroplasty surgeons and its understanding is crucial in order to identify high-risk patients for postoperative dislocation. Spinal deformity and abnormal spinopelvic mobility have been associated with increased risk for instability, dislocation and revision THA. Preoperative workup begins with standing anteroposterior pelvis x-ray and lateral spinopelvic radiographs in the standing and sitting position. Hip-spine stiffness needs to be addressed before THA in consideration of adapting the preoperative planning to the patient's characteristics. Acetabular component should be implanted with different anteversion and inclination angles according to the pattern of hip-spine motion in order to reduce the risk of impingement and consequent dislocation. Different algorithmic approaches have been proposed in case of concomitant hip-spine disease and in case of altered sagittal balance and pelvic mobility. The aim of this review is to investigate and clarify the hip-spine relationships and evaluate the impact on modern total hip arthroplasty.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d’Italia Franco Scalabrino, Ganzirri, Messina, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Greenberg
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Malahias MA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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