Changes in the spino-pelvic balance after hip replacement in patients with congenital hip dislocation

Objective. To analyze the influence of sagittal balance parameters on the risk of dislocations of the head of the femoral component of the hip joint endoprosthesis.Material and Methods. A retrospective analysis of medical records of 113 patients with idiopathic coxarthrosis who underwent unilateral total hip arthroplasty was performed. The study assessed the parameters characterizing the sagittal balance in patients without prosthetic femoral head dislocation in the postoperative period (Group 1; n = 60) and in patients treated for prosthetic femoral head dislocation (Group 2; n = 53). Comparison of indicators was carried out by non-parametric Mann – Whitney U-test, and identification of dislocation predictors – by building single- and multi-factor logistic regression models. Differences were considered statistically significant at the achieved significance level p < 0.05.Results. In Group 1, the type 3 sagittal balance according to Roussouly prevailed (48 %), in Group 2 – types 1, 2 and 4 (75 %). In patients with types 1 and 2 sagittal balance, the dislocations of the prosthetic femoral head occured 1.84 times more often than in patients with type 3, and that in patients with type 4 – 1.66 times more often.Conclusion. Patients with Roussouly type 3 sagittal balance have significantly lower risks of postoperative dislocation of the prosthetic femoral head, as compared with those with types 1, 2 and 4.

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The influence of spinopelvic relationships on late dislocation of the prosthetic femoral head after total hip arthroplasty

Peleganchuk

Turgunov

Mushkachev

et al. 2022

Hir. pozvonoč.

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Modeling the behavior of the acetabular axis and the axis of the ischial tuberosities during the transition from a standing to a sitting position

Peleganchuk,

Turgunov,

Mushkachev

et al. 2023

jour

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Introduction The success of the treatment of patients with degenerative diseases of the spine and concomitant damage to the hip joint depends on the understanding of the biomechanics of movements in the spinal-pelvic segment. After a thorough analysis of the biomechanical processes occurring in the spine-pelvis system during the transition from a standing to a sitting position, it becomes clear that the acetabular axis of rotation of the pelvis in space is not the only one.The purpose of the study was to develop and test a virtual model of the pelvis to study the kinematics of the movement of the spinal-pelvic complex with a description of the emergence of the iscial axis of rotation by changing the position from standing to sitting.Materials and methods The problem was solved using the finite element method. The bones were modeled as absolutely rigid bodies. The main ligaments and muscles were modeled using finite element springs: elastic fragments with specified rheological characteristics. The study of contact interaction was carried out for pairs: "femoral head – acetabulum" and "ischial tuberosities - chair surface".Results A new axis of rotation was revealed, the ischial axis, which corresponded to the points of initial contact of the ischial tuberosities with the surface of the chair. The axis of the acetabulum rotated by 7.1° relative to the ischial axis and at the final moment shifted in the horizontal direction relative to the acetabular axis by 8.83 mm. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm.Discussion The study shows that the pelvis rotates depending on the position around two axes: acetabular and ischial ones, hence it follows that the acetabular axis oscillates back and forth during ante- and retroversion, that is, it is non-static. Shortcomings of the model: 1) muscles and ligaments were modeled using FE springs, the end and beginning of which were set by two points, and the muscles and ligaments in the real body are attached along the entire surface of the bones; 2) soft tissues were not modeled in real volume. The merit of the study is the contact interaction of the pelvis with the chair and its rotation relative to the ischial axis, while other studies consider the rotation of the pelvis only relative to the acetabular axis.Conclusion A new axis of rotation arises due to the contact interaction of the pelvic bone with the surface of the chair when the skeleton moves from a standing position to a sitting position, the ischial axis. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm. It is advisable to conduct a clinical study.

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Surgical Correction of Trunk Balance in Spinal Deformities and in Instability of Hip Joints

Chelpachenko

Zherdev

Фисенко

et al. 2020

Russian Journal of Pediatric Surgery

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Introduction. Restoration of trunk balance is the basic task in surgical correction of spinal deformities and in hip joint instability of various etiology. Purpose. To analyze and to define the relevance of roentgen-anatomical parameters of spine-pelvis relationships for surgical correction of deformities in the thoracolumbar spine and of hip joint instability of dysplastic and neurogenic etiology. Material and methods. An X-ray analysis of parameters of the frontal and sagittal spine-pelvis balance was performed in 220 patients with dysplastic and neurogenic deformities of the thoracic and lumbar spine (n = 98) and with instability of hip joints (n = 122) but who were able to walk. They were operated in the neuro-orthopedic department with orthopedics in National Medical Research Center for Children’s Health. The reference group included 60 relatively healthy children without any scoliotic deformities of the spine and with stable hip joints. Dynamics of changes in X-ray parameters was analyzed using findings of orthostatic spondylograms from the indicated groups of children. The obtained data were compared with reference values. Results. The trial performed has revealed typical changes in spine-pelvis relationship parameters in patients with hip joint instability and spine deformities and in the reference group . The researchers also found out relations between various parameters of the trunk balance before and after surgical correction. Conclusion. While planning a surgical correction of trunk balance in spinal deformities, one should take into account parameters of spine-pelvis relationships, such as PI, SS, PT, SVA deviation and the mid-sacral line; and in case of hip joint instability - local roentgen-angulometric parameters of the femoral and acetabular components of instability. This is due to the fact that the lower the level of reconstructive surgical manipulation is located, the greater effect it has at the frontal and sagittal balance of the trunk.

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Changes in the spino-pelvic balance after hip replacement in patients with congenital hip dislocation

Cited by 3 publications

References 6 publications

The influence of spinopelvic relationships on late dislocation of the prosthetic femoral head after total hip arthroplasty

The influence of spinopelvic relationships on late dislocation of the prosthetic femoral head after total hip arthroplasty

Modeling the behavior of the acetabular axis and the axis of the ischial tuberosities during the transition from a standing to a sitting position

Surgical Correction of Trunk Balance in Spinal Deformities and in Instability of Hip Joints

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