2018 Frank Stinchfield Award: Spinopelvic Hypermobility Is Associated With an Inferior Outcome After THA: Examining the Effect of Spinal Arthrodesis

Grammatopoulos, George; Gofton, Wade; Jibri, Zaid; Coyle, Matthew J.; Dobransky, Johanna; Kreviazuk, Cheryl; Kim, Paul R.; Beaulé, Paul E.

doi:10.1097/corr.0000000000000367

Cited by 72 publications

(77 citation statements)

References 54 publications

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“…Previous studies that have evaluated sagittal spinopelvic parameters on THA outcomes have employed dislocation and revision as the study end-points [4,9,11]. Other studies have focused on evaluating measures of alignment obtained in sitting and standing postures as dynamic risk factors for dislocation [8,10]. Only a few studies have retrospectively evaluated the effect of pre-operative sagittal spinopelvic alignment on outcomes after THA [22,29].…”

Section: Discussionmentioning

confidence: 99%

“…However, little is known about how sagittal spinal alignment affects THA outcomes, especially that of patient disability [4,[9][10][11]. The key to successful THA necessitates a further comprehensive analysis of the in uence of sagittal spinopelvic interactions.…”

Section: Introductionmentioning

confidence: 99%

“…A greater understanding of the association between sagittal spinopelvic alignment and outcomes is also thought to minimise instances of cumbersome dislocation or revision [7,8]. However, little is known about how sagittal spinal alignment affects THA outcomes, especially that of patient disability [4,[9][10][11]. The key to successful THA necessitates a further comprehensive analysis of the in uence of sagittal spinopelvic interactions.…”

Section: Introductionmentioning

confidence: 99%

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Association of global sagittal deformity with functional disability two years after total hip arthroplasty

Okamoto

Wakama

Okayoshi

et al. 2021

Preprint

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Introduction: The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. We aimed to determine whether global sagittal deformity was associated with post-operative disability.Materials and methods: This prospective analysis was based on 208 THAs that were followed up for 2 years. The Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR) ranging from a scale of 0 (complete joint disability) to 100 (perfect joint health) was utilised to divide eligible patients into two groups with and without disability, using 70 as the threshold. Multivariate analysis was performed to evaluate the factors associated with disability. To identify the cut-off value of the parameters for predicting disability (HOOS-JR <70/100), we used the receiver-operating characteristic curve.Results: The disability (30 hips) and control (178 hips) groups showed a significant difference in body height (p = 0.020), pre-operative T1 pelvic angle divided by pelvic incidence (T1PA/PI) (p = 0.018), pelvic incidence minus lumbar lordosis (p = 0.027), post-operative HOOS-JR (p = 0.010), and satisfaction (p = 0.033). On multivariate analysis, the following factors were associated with persistent disability: T1PA/PI >0.2 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.19–4.14; p < 0.001) and height <148 cm (OR, 1.26; 95% CI, 1.09–1.48; p = 0.011). The cut-off value of pre-operative T1PA/PI was >0.19 with a sensitivity of 95% and specificity of 85%. Post-operative satisfaction (p < 0.001) and HOOS-JR (p = 0.023) differed between the two groups when the pre-operative cut-off value was chosen as 0.2.Conclusions: A T1PA/PI >0.2 was associated with greater disability after THA. Clinicians should be aware that patient-related factors, including global spinal deformities, particularly in patients with a short stature, can influence THA outcomes at 2 years postoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of global sagittal deformity with functional disability two years after total hip arthroplasty

Okamoto

Wakama

Okayoshi

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous studies that have evaluated sagittal spinopelvic parameters on THA outcomes have employed dislocation and revision as the study end-points [ 4 , 9 , 11 ]. Other studies have focused on evaluating measures of alignment obtained in sitting and standing postures as dynamic risk factors for dislocation [ 8 , 10 ]. Only a few studies have retrospectively evaluated the effect of the pre-operative sagittal spinopelvic alignment on outcomes after THA [ 23 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Association of global sagittal spinal deformity with functional disability two years after total hip arthroplasty

Okamoto

Wakama

Okayoshi

et al. 2021

BMC Musculoskelet Disord

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Background The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. Therefore, our aim was to assess the effect of global sagittal spinal deformity on post-operative disability. Methods This analysis was based on 208 cases of THA, with functional disability measured at a follow-up of 2 years. The Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR), ranging from a scale of 0 (complete joint disability) to 100 (perfect joint health), was used to divide eligible patients into two groups, namely with and without disability, using a score of 70 as the cut-off. The following factors were compared between the two groups using multivariate analysis: age, sex, body height, body mass index, spinopelvic parameters, and surgeon experience. To identify the cut-off value of the parameters for predicting disability (HOOS-JR < 70/100), we used the receiver-operating characteristic curve. Results The disability (30 hips) and control (178 hips) groups showed a significant difference in pre-operative body height (p = 0.020), T1 pelvic angle divided by pelvic incidence (T1PA/PI; p = 0.018), PI minus lumbar lordosis (p = 0.027), post-operative HOOS-JR (p = 0.010), patient satisfaction (p = 0.033), and the modified Harris Hip Score (p = 0.038). On multivariate analysis, the following factors were associated with persistent disability: T1PA/PI > 0.2 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.19–4.14; p < 0.001) and height < 148 cm equivalent to legal standards as short stature (OR, 1.26; 95% CI, 1.09–1.48; p = 0.011). The cut-off value of pre-operative T1PA/PI was > 0.19, with a sensitivity of 95% and specificity of 85%. Post-operative satisfaction (p < 0.001), HOOS-JR (p = 0.023), and EuroQol 5-Dimension (p = 0.041) differed between the two groups when the pre-operative cut-off value was chosen as 0.2. Conclusions A T1PA/PI > 0.2 was associated with greater disability after THA. Clinicians should be aware that patient-related factors, including global spinal deformities, particularly in patients with a short stature, can influence THA outcomes at 2 years postoperatively.

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“…[ 25 ] have recently called into question the so-called “safe zone” for hip abduction and anteversion. They demonstrated that most hip dislocations (58%) occur within this “safe zone.” Numerous studies have demonstrated increased instability in patients with spinopelvic disease ranging from prior lumbosacral fusions to hypermobility [ [26] , [27] , [28] ]. Although spinopelvic relationships certainly can impact hip stability, traditional targets in implant positioning have not changed drastically.…”

Section: Discussionmentioning

confidence: 99%

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy

2020

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Background: Total hip arthroplasty (THA) has demonstrated excellent results regardless of the surgical approach. However, the approach used may be a factor in final positioning of implants. We hypothesized that the direct anterior approach (DAA) with fluoroscopy would be associated with more anatomic implant positioning than the posterior approach (PA). Methods: A retrospective review of 200 patients was performed. One hundred patients underwent THA utilizing the PA, and 100 patients, with the DAA. All patients had an anterior-posterior pelvis radiograph preoperatively and postoperatively with a magnification marker present to standardize each radiograph. Exclusion criteria included contralateral THA or any pelvic or femoral deformity. Results: Preoperative radiographs demonstrated identical cohorts with respect to leg length, femoral offset, and total offset. Postoperatively, the DAA achieved more accurate anatomic restoration of leg length (1.6 mm vs 5.5 mm; P < .0001), femoral offset (4.8 mm vs 9.3 mm; P < .0001), and total offset (0.5 mm vs 4.7 mm; P < .0001) compared with the PA. Ideal cup abduction and anteversion were significantly superior to the DAA (96% vs 78%, P ¼ .0002, and 69% vs 24%, P < .0001, respectively). Conclusions: This study is the first to compare anatomic implant positioning between patients undergoing THA with these 2 approaches. All parameters were significantly closer to anatomic implant positioning with the DAA. There are at least 2 potential explanations for this: (1) The DAA implant positioning was performed under fluoroscopic guidance, whereas the PA was not. (2) The PA disrupts the posterior capsule and external rotators, and therefore, increased offset or leg length may be necessary to achieve comparable hip stability with the DAA.

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2018 Frank Stinchfield Award: Spinopelvic Hypermobility Is Associated With an Inferior Outcome After THA: Examining the Effect of Spinal Arthrodesis

Cited by 72 publications

References 54 publications

Association of global sagittal deformity with functional disability two years after total hip arthroplasty

Association of global sagittal deformity with functional disability two years after total hip arthroplasty

Association of global sagittal spinal deformity with functional disability two years after total hip arthroplasty

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy

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