Chronological Changes in Functional Cup Position at 10 Years after Total Hip Arthroplasty

Okanoue, Yusuke; Ikeuchi, Masahiko; Takaya, Shogo; Izumi, Masashi; Aso, Koji; Kawakami, Toru

doi:10.5301/hipint.5000487

Cited by 17 publications

(18 citation statements)

References 36 publications

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“…Preoperative pelvic tilt has been reported to be a predictive parameter for postoperative change in PT. Lumbar spine degenerative conditions and vertebral fractures are also associated with the change in PT after THA. In the current study, preoperative spinopelvic parameters did not affect the change in PT after THA, except for preoperative PT.…”

Section: Discussioncontrasting

confidence: 44%

“…Preoperative assessment with a dynamic evaluation in the standing and sitting or supine position reduces the risk of complications. Second, PT changes posteriorly over the years after THA. In our study, the 1‐year follow‐up period may not have been long enough to assess the chronological change in PT.…”

Section: Discussionmentioning

confidence: 88%

“…Numerous studies have demonstrated that no significant difference has been observed between preoperative and postoperative PT. Pelvic retroversion has generally been observed over the years after THA. In addition, the chronological changes in PT in standing position were larger than the supine position at 5 years after THA.…”

Section: Discussionmentioning

confidence: 97%

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Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

Kanto

Maruo

Tachibana

et al. 2019

Orthopaedic Surgery

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Objective To evaluate the impact of spinopelvic parameters and hip contracture on change in the pelvic tilt (PT) after Total hip arthroplasty (THA). Methods One hundred patients (15 male and 85 female) who underwent THA were included in this prospective study. Radiographic data were obtained preoperatively and 1 year after THA. Radiographic parameters included sagittal anterior pelvic plane (APP), sagittal vertical axis (SVA), sacral slope (SS), pelvic inclination (PI), and lumbar lordosis angle (LL). The APP was defined as the angle between the anterior pelvic plane and the vertical plane. A positive value indicates pelvic retroversion. Postoperative changes in PT were divided into three groups: the PA group (pelvic anteversion, ΔAPP < −5°), the PR group (pelvic retroversion, ΔAPP > 5°), and the PT group (minimal change, ΔAPP ≤ ± 5°). The Kruskal–Wallis test and the Steel–Dwass test were used to compare the preoperative and postoperative spinopelvic parameters among the three groups. The Spearman's rank correlation coefficient was used to evaluate the correlation between ΔAPP and spinopelvic parameters. Results Minimal change in pelvic tilt was observed in 59% of patients, while pelvic anteversion was observed in 16% of patients and pelvic retroversion was observed in 25% of patients. There were no significant changes in the spinopelvic parameters, including TK, LL, SVA, LL, SS, and APP after THA. The Femoral angle (FA) was significantly decreased after THA (P < 0.001). Preoperative APP was significantly more retroverted in the PA group than the PR group, and the PT group (6.8 ± 12.2, 0.2 ± 9.9, −8.3 ± 8.3, P < 0.001). Preoperative SS, PI‐LL, and PI were significantly smaller in the PA group than the PT group and the PR group. A significant negative correlation was identified between preoperative APP and ΔAPP (r = −0.418, P < 0.001). Conclusion Approximately 60% of the patients did not have any marked change in PT after THA. Preoperative APP was the only predictive factor associated with marked anterior or posterior change in PT.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 88%

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Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

Kanto

Maruo

Tachibana

et al. 2019

Orthopaedic Surgery

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“…It is worth remembering that spinopelvic mobility progressively decreases. Tamura et al reported on these changes in a 10-year follow-up after THA, noting an increase of posterior pelvic tilt (posterior APPt, referred to as PSI (pelvic sagittal inclination) in this study) in standing position [ 47 , 48 ]. Decreasing spinopelvic mobility can be a considerable factor, especially in late-occurring dislocations (more than 1 year) after THA, as one study reported that 90% of late THA dislocations involved a spinopelvic imbalance [ 33 ].…”

Section: Why We Should Take a Closer Lookmentioning

confidence: 61%

The Impact of Spinopelvic Mobility on Arthroplasty: Implications for Hip and Spine Surgeons

Haffer

Amini

Perka

et al. 2020

JCM

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Spinopelvic mobility represents the complex interaction of hip, pelvis, and spine. Understanding this interaction is relevant for both arthroplasty and spine surgeons, as a predicted increasing number of patients will suffer from hip and spinal pathologies simultaneously. We conducted a comprehensive literature review, defined the nomenclature, summarized the various classifications of spinopelvic mobility, and outlined the corresponding treatment algorithms. In addition, we developed a step-by-step workup for spinopelvic mobility and total hip arthroplasty (THA). Normal spinopelvic mobility changes from standing to sitting; the hip flexes, and the posterior pelvic tilt increases with a concomitant increase in acetabular anteversion and decreasing lumbar lordosis. Most classifications are based on a division of spinopelvic mobility based on ΔSS (sacral slope) into stiff, normal, and hypermobile, and a categorization of the sagittal spinal balance regarding pelvic incidence (PI) and lumbar lordosis (LL) mismatch (PI–LL = ± 10° balanced versus PI–LL > 10° unbalanced) and corresponding adjustment of the acetabular component implantation. When performing THA, patients with suspected pathologic spinopelvic mobility should be identified by medical history and examination, and a radiological evaluation (a.p. pelvis standing and lateral femur to L1 or C7 (if EOS (EOS imaging, Paris, France) is available), respectively, for standing and sitting radiographs) of spinopelvic parameters should be conducted in order to classify the patient and determine the appropriate treatment strategy. Spine surgeons, before planned spinal fusion in the presence of osteoarthritis of the hip, should consider a hip flexion contracture and inform the patient of an increased risk of complications with existing or planned THA.

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“…Lastly, we did not investigate the effect of THA on the pelvic tilt during long-term follow-up. Okanou et al 28 and Tamura et al 29 observed that the standing pelvic tilt decreases with time over 10 years follow-up after THA. However, it may be based on chronological changes and not as a result of THA.…”

Section: Discussionmentioning

confidence: 98%

Effect of pelvic tilt and rotation on cup orientation in standing anteroposterior radiographs

et al. 2019

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Background: Individual pelvic tilt and rotation have wide variability that can affect the measurement of cup orientation in anteroposterior (AP) radiographs. The purpose of this study was to analyse the effect of pelvic tilt and rotation on radiographic measurements of cup orientation. Methods: A total of 53 patients (63 hips) were included in this study. The patients underwent a computed tomography study with standing AP pelvis radiographs taken both preoperatively and approximately 3 months postoperatively. We used 2-dimensional/3-dimensional matching to measure the pelvic tilt and rotation, and the non-standardised and standardised cup orientation. Results: There was no difference in the pelvic tilt and rotation between the preoperative and postoperative radiographs. The distribution of the differences between the non-standardised and standardised cup anteversion exhibited a change within 5° in only 34/63 (54%) hips. The pelvic tilt correlated with the difference between the non-standardised and standardised cup anteversion, but the pelvic rotation did not. When all 63 hips were separated into the right and left sides, the pelvic rotation inversely correlated with the pelvic tilt-adjusted difference between the non-standardised and standardised cup anteversion of the right side but directly correlated with that of the left side. Conclusions: The current study demonstrated that the measurement of cup anteversion in standing AP radiographs is significantly affected by both the pelvic tilt and pelvic rotation. An improved understanding of the pelvic orientation may eventually allow for desired cup positioning on a patient-specific basis to potentially reduce complications associated with the malposition of the cup.

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Chronological Changes in Functional Cup Position at 10 Years after Total Hip Arthroplasty

Cited by 17 publications

References 36 publications

Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

The Impact of Spinopelvic Mobility on Arthroplasty: Implications for Hip and Spine Surgeons

Effect of pelvic tilt and rotation on cup orientation in standing anteroposterior radiographs

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