Current concepts in hip–spine relationships: making them practical for total hip arthroplasty

Zagra, Luigi; Benazzo, Francesco; Falez, Francesco; Solarino, Giuseppe; D’Apolito, Rocco; Castelli, Claudio

doi:10.1530/eor-21-0082

Cited by 19 publications

(12 citation statements)

References 51 publications

(73 reference statements)

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“…Additionally, there is an evident lack of standardization in terms, objectives, and therapeutic actions, making it challenging to address the problem systematically. Clinical recommendations often provide little practical guidance, failing to offer a simple and clear approach to the problem [ 69 , 70 ].…”

Section: Discussion and Treatment Algorithmmentioning

confidence: 99%

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Hip-spine relationship: clinical evidence and biomechanical issues

Di Martino,

Geraci,

Brunello

et al. 2024

Arch Orthop Trauma Surg

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The hip-spine relationship is a critical consideration in total hip arthroplasty (THA) procedures. While THA is generally successful in patient, complications such as instability and dislocation can arise. These issues are significantly influenced by the alignment of implant components and the overall balance of the spine and pelvis, known as spinopelvic balance. Patients with alteration of those parameters, in particular rigid spines, often due to fusion surgery, face a higher risk of THA complications, with an emphasis on complications in instability, impingement and dislocation. For these reasons, over the years, computer modelling and simulation techniques have been developed to support clinicians in the different steps of surgery. The aim of the current review is to present current knowledge on hip-spine relationship to serve as a common platform of discussion among clinicians and engineers. The offered overview aims to update the reader on the main critical aspects of the issue, from both a theoretical and practical perspective, and to be a valuable introductory tool for those approaching this problem for the first time.

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Section: Discussion and Treatment Algorithmmentioning

confidence: 99%

“…Functional patient evaluation during ambulation allows the clinician to understand pelvic position in space and functional pelvis plane orientation while standing. Unbalanced patients have more retroverted pelvis and require more anteverted cup placement [ 48 , 49 , 69 ].…”

Section: Discussion and Treatment Algorithmmentioning

confidence: 99%

Hip-spine relationship: clinical evidence and biomechanical issues

Di Martino,

Geraci,

Brunello

et al. 2024

Arch Orthop Trauma Surg

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“…Utilisation of dual mobility cups could also represent a practical solution in patients with a stiff spine and a bail-out option in cases where persistent impingement is evident [ 33 , 34 ]. It has been shown that they can minimise dislocations after primary THA [ 35 ] and a recent study from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has reported 99.1% survival at 14 months [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…While dual mobility articulations could help mitigate the dislocation risk, one should consider that a real benefit regarding ROM is seen with the larger acetabular cups. Furthermore, the long-term survivorship of this construct in younger patients with spinopelvic imbalance needs to be substantiated whereas another consideration is the potential for fretting and corrosion between the titanium shell and cobalt-chromium liner [ 33 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Functional implant positioning in total hip arthroplasty and the role of robotic-arm assistance

Fontalis

Raj

Kim

et al. 2022

International Orthopaedics (SICOT)

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Introduction Accurate implant positioning, tailored to the phenotype and unique biomechanics of each patient is the single most important objective in achieving stability in THA and maximise range of motion. The spine-pelvis-hip construct functions as a single unit adapting to postural changes. It is widely accepted in the literature that no universaltarget exists and variations in spinopelvic mobility mandate adjustments to the surgical plan; thus bringing to the fore the concept of personalised, functional component positioning. Methods This manuscript aims to outline the challenges posed by spinopelvic imbalance and present a reproducible, stepwise approach to achieve functional-component positioning. We also present the one-year functional outcomes and Patient Reported Outcome Measures of a prospective cohort operated with this technique. Results and Conclusion Robotic-arm assisted Total Hip Arthroplasty has facilitated enhanced planning based on the patient’s phenotype and evidence suggests it results in more reproducible and accurate implant positioning. Preservation of offset, avoiding leg-length discrepancy, accurate restoration of the centre of rotation and accomplishing the combinedversion target are very important parameters in Total Hip Arthroplasty that affect post-operative implant longevity, patient satisfaction and clinical outcomes.

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“…The weakness of this study is to be noted that most studies included in this network meta-analysis are from USA-based studies. Some European studies have focused on the issue but were mostly review articles, making the difficulty to compare the geographical and cultural differences in this issue [ 48 , 49 ]. The strength of this study is that we are given a large total number of 3,418,499 stiff spine patients from the existing literature.…”

Section: Discussionmentioning

confidence: 99%

Total hip arthroplasty has higher complication rates in stiff spine patients: a systematic review and network meta-analysis

et al. 2022

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Background Ankylosing spondylitis (AS) and spinal fusion (SF) classified as stiff spines have been associated with the increased rate of complications following total hip arthroplasty (THA). However, the differences between the two cohorts have inconsistent evidence. Methods We searched for studies comparing complications among stiff spine patients, including SF and AS, who underwent THA in PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus until March 2021. Studies detailing rates of mechanical complications, aseptic loosening, dislocation, infection, and revisions were included. We performed network meta-analyses using frequentist random-effects models to compare differences between cohorts. We used P-score to rank the better exposure with the lowest complications. Results Fourteen studies were included in the final analysis. A total of 740,042 patients were included in the systematic review and network meta-analysis. Mechanical complications were highest among SF patients (OR 2.33, 95% CI 1.86, 2.92, p < 0.05), followed by AS patients (OR 1.18, 95% CI 0.87, 1.61, p = 0.82) compared to controls. Long Spinal Fusions had the highest aseptic loosening (OR 2.33, 95% CI 1.83, 2.95, p < 0.05), dislocations (OR 3.25, 95% CI 2.58, 4.10, p < 0.05), infections (OR 2.14, 95% CI 1.73, 2.65, p < 0.05), and revisions (OR 5.25, 95% CI 2.23, 12.32, p < 0.05) compared to AS and controls. Our results suggested that SF with longer constructs may be associated with higher complications in THA patients. Conclusions THAs following SFs have higher mechanical complications, aseptic loosening, dislocations, and infections, especially with longer constructs. AS patients may have fewer complications compared to this cohort.

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Current concepts in hip–spine relationships: making them practical for total hip arthroplasty

Cited by 19 publications

References 51 publications

Hip-spine relationship: clinical evidence and biomechanical issues

Hip-spine relationship: clinical evidence and biomechanical issues

Functional implant positioning in total hip arthroplasty and the role of robotic-arm assistance

Total hip arthroplasty has higher complication rates in stiff spine patients: a systematic review and network meta-analysis

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