Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates

Buckland, Aaron J.; Fernandez, Laviel; Shimmin, A; Baré, Jonathan; McMahon, Stephen; Vigdorchik, Jonathan M.

doi:10.1016/j.arth.2019.06.036

Cited by 41 publications

(49 citation statements)

References 18 publications

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“…In fact, only 12% of our patients were men; therefore, our results cannot be generalised to other implant types, approaches, or ethnicities [4,12,30] (Table 1). Third, the analyses cannot be performed for dynamic changes with the patient in the sitting or supine position [7]. Lastly, our follow-up period was relatively short [14,16].…”

Section: Discussionmentioning

confidence: 99%

“…To identify independent risk factors for the residual disability group, logistic regression analyses were performed. Factors, such as age, sex, body height, body mass index, spinopelvic parameters, and surgeon experience, were analysed using an exploratory univariate analysis followed by a multivariate analysis [1,4,7,13,[15][16][17]21]. Surgeons were trichotomised into the following groups: orthopaedic specialists <8 years', 8-15 years', and ≥15 years' experience after certi cation [15].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…This is seen in approximately 20%-44% of patients undergoing THA [5,6]. 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].…”

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…We would like to acknowledge the importance that native hip anatomy has on the development of hip osteoarthritis. It has been previously reported that structural abnormalities of the hip joint lead to premature early failure [1]. These structural abnormalities include femoroacetabular impingement, avascular necrosis, acetabular dysplasia, among others.…”

mentioning

confidence: 99%

Letter to the Editor Regarding “Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates”

Kobayashi

Morimoto

Mawatari

2020

The Journal of Arthroplasty

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To the Editor Considerable attention was given to the study by Buckland et al [1] on postural changes in the pelvis based on pelvic incidence (PI)e lumbar lordosis (LL), which are as follows: >10 (flat back), À10 to 10 (balanced sagittal alignment), and <À10 (hyperlordosis). They concluded that patients with hyperlordosis likely utilize their spines, whereas patients with flat back use their hips. Definitions of "physiological" and "nonphysiological" spinopelvic conditions should be considered. Physiological states are defined based on the anatomical parameters of PI and anatomical acetabular anteversion angle (AAA) [2]. A small PI and high anatomical AAA are associated with a low LL and small sagittal pelvic range of motion during sitting or squatting, making patients use more of each hip's cone of mobility (physiological hip users) [2]. However, patients with a large PI and small anatomical AAA are likely to have a high LL and large sagittal pelvic range of motion using more of the flexible spine during postural changes (physiological spine users) [2]. Therefore, as shown by Buckland et al [1], balanced sagittal alignment may be "physiological states." Considering the lumbopelvic complex, nonphysiological states are determined through positional parameters: LL and positional AAA [3]. Patients having very small PI and acetabular undercoverage are considered to have a "pathoanatomy" and are likely to have a fixed flexion deformity of the hip resulting in decreased positional AAA [4]; therefore, pelvic anteversion and its associated increased LL (nonphysiological spine users) are required. In patients with high PI and stiff degenerated spine, decreased LL and its associated pelvic retroversion are noted, resulting in high positional AAA (nonphysiological hip users) [3]. Therefore, as described by Buckland et al [1], the spine users with hyperlordosis and hip users due to flat back may be in "nonphysiological states." In conclusion, future research should focus not only on sagittal spinopelvic kinematics but also on AAA to further understand hip anatomy and its relation to the development of hip osteoarthritis.

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How much change in pelvic sagittal tilt can result in hip dislocation due to prosthetic impingement? A computer simulation study

Pour

Schwarzkopf

Patel

et al. 2021

Journal Orthopaedic Research

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Developing spinal pathologies and spinal fusion after total hip arthroplasty (THA) can result in increased pelvic retroversion (e.g., flat back deformity) or increased anterior pelvic tilt (caused by spinal stenosis, spinal fusion or other pathologies) while bending forward. This change in sagittal pelvic tilt (SPT) can result in prosthetic impingement and dislocation. Our aim was to determine the magnitude of SPT change that could lead to prosthetic impingement. We hypothesized that the magnitude of SPT change that could lead to THA dislocation is less than 10° and it varies for different hip motions. Hip motion was simulated in standing, sitting, sit‐to‐stand, bending forward, squatting and pivoting in Matlab software. The implant orientations and SPT angle were modified by 1° increments. The risk of prosthetic impingement in pivoting caused by increased pelvic retroversion (reciever operating characteristic [ROC] threshold as low as 1–3°) is higher than the risk of prosthetic impingement with increased pelvic anteversion (ROC threshold as low as 16–18°). Larger femoral heads decrease the risk of prosthetic impingement (odds ratio {OR}: 0.08 [932 mm head]; OR: 0.01 [36 mm head]; OR: 0.002 [40 mm head]). Femoral stems with a higher neck‐shaft angle decrease the prosthetic impingement due to SPT change in motions requiring hip flexion (OR: 1.16 [132° stem]; OR: 4.94 [135° stem]). Our results show that overall, the risk of prosthetic impingement due to SPT change is low. In particular, this risk is very low when a larger diameter head is used and femoral offset and length are recreated to prevent bone on bone impingement.

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Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates

Cited by 41 publications

References 18 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

Letter to the Editor Regarding “Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates”

How much change in pelvic sagittal tilt can result in hip dislocation due to prosthetic impingement? A computer simulation study

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