Hip spine relationships: application to total hip arthroplasty

Lazennec, Jean-Yves; Riwan, A.; Gravez, F.; Rousseau, Marc-Antoine; Mora, Nancy; Gorin, Michael A.; Lasne, A.; Catonné, Yves; Saillant, G

doi:10.5301/hip.2008.1228

Cited by 80 publications

(71 citation statements)

References 51 publications

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“…Degenerative changes of end-stage arthritis in the hip and spine can significantly alter body kinematics and therefore lumbar-pelvic-femoral alignment [24,36,42]. There is evidence that lumbar-pelvic-femoral mobility affects the risk of dislocation after THA, with a case report of late posterior hip dislocation after lumbar spinopelvic fusion [33].…”

Section: Discussionmentioning

confidence: 99%

“…First, static imaging in standing and sitting may not fully represent the patient's pelvic orientation during the dynamic motion of sitting down on a stool. During activities of daily living, sacral slope can go from very high in a supine position with the legs in extension to null or negative sacral slope when in a crouching position [24]. Second, we do not know how much pelvic tilt is clinically relevant or whether the presented preoperative information is representative of what happens postoperatively; however, we are following these patients prospectively for complications including dislocation and analyzing postoperative imaging for comparison.…”

Section: Discussionmentioning

confidence: 99%

“…This may not replicate how patients sit comfortably during their daily activities. However, previous studies used the same method [22,24].…”

Section: Discussionmentioning

confidence: 99%

“…Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement. Although some studies have described pelvic tilt during postural changes [11,41], few have considered pelvic tilt as a function of the hip-spine relationship [23,24], because it is difficult to view the entire lumbar spine (L1-S1) and hips on a conventional lateral radiograph.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

185

177

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Background Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbarpelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized. Therefore, we measured standing and sitting lumbar-pelvic-femoral alignment in patients with radiographic signs of DDD and in patients with no radiographic signs of spine arthrosis.Questions/purposes We asked: (1) Is there a difference in standing and sitting lumbar-pelvic-femoral alignment before surgery among patients undergoing THA who have no radiographic signs of spine arthrosis compared with those with preexisting lumbar DDD? (2) Do patients with lumbar DDD experience less spine flexion moving from a standing to a sitting position and therefore compensate with more femoroacetabular flexion compared with patients who have no radiographic signs of arthrosis? Methods Three hundred twenty-five patients undergoing primary THA had preoperative low-dose EOS spine-toankle lateral radiographs in standing and sitting positions. Eighty-three patients were excluded from this study for scoliosis (39 patients), spondylolysis (15 patients), not having five lumbar vertebrae (7 patients), surgical or disease fusion (11 patients), or poor image quality attributable to high BMI (11 patients). In the remaining 242 of 325 patients (75%), two observers categorized the lumbar spine as either without radiographic arthrosis or having DDD based on defined radiographic criteria. Sacral slope, lumbar lordosis, and proximal femur angles were measured, and these angles were used to calculate lumbar spine flexion and femoroacetabular flexion in standing and sitting positions. Patients were aligned in a standardized sitting position so that their femurs were parallel to the floor to achieve approximately 90°of apparent hip flexion. Results After controlling for age, sex, and BMI, we found patients with DDD spines had a mean of 5°more posterior pelvic tilt (95% CI, À2°to À8°lower sacral slope angles; p \0.01) and 7°less lumbar lordosis (95% CI, À10°to À3°; p \ 0.01) in the standing position compared with patients without radiographic arthrosis. However, in the sitting position, patients with DDD spines had 4°less posterior pelvic tilt (95% CI, 1°-7°higher sacral slope angles; p = 0.02). From standing to sitting position, patients with DDD

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…This may not replicate how patients sit comfortably during their daily activities. However, previous studies used the same method [22,24].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

185

177

View full text Add to dashboard Cite

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“…Some authors have also raised the role of sacropelvic morphology and balance in the pathogenesis and surgical treatment of hip osteoarthritis [21][22][23][24]. As a basis for comparison, it is therefore important to document the sacropelvic balance and morphology in the normal population.…”

Section: Introductionmentioning

confidence: 99%

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

et al. 2011

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Introduction Many studies suggest the importance of the sagittal sacropelvic balance and morphology in spinal and hip disorders. This study describes the normal age-and sex-related changes in sacropelvic morphology and balance in a prospective cohort of asymptomatic adults without spinal disorder. Materials and methods A prospective cohort of 709 asymptomatic adults without spinal pathology was recruited. There were 354 males and 355 females aged 37.9 ± 14.7 and 35.7 ± 13.9 years, respectively. For each subjects, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured from standing lateral radiographs. Ratios of SS to PI (SS/PI), PT to PI (PT/PI), and PT to SS (PT/SS) were also calculated. Results There was no significant difference in PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt), PT/PI, SS/PI, or PT/SS between males and females. The mean ± 2 standard deviations (SD) range was 32°-74°, 0°-27°, and 24°-55°for PI, PT and SS, respectively. The mean ± 2 SD range was greater than 0.5 for SS/PI and less than 0.5 for PT/PI. PI was not related to age in either sex group. PT, SS, PT/PI, SS/PI, and PT/SS presented only weak correlation coefficients (r B 0.21) with respect to age. Conclusion The current study presents the largest cohort of asymptomatic adults in the literature dedicated to the evaluation of sagittal sacropelvic morphology and balance. The range of values corresponding to the mean ± 2 SD can provide invaluable information to clinicians about the normal range of values expected in 95% of the normal population.

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Assessment of the acetabular version in relation to sagittal sacropelvic parameters

Baker

Robertson

2022

Clinical Anatomy

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The relationship between acetabular orientation and the sacropelvic parameters is of interest to both hip and spine surgeons as it is increasingly clear disease in one area can affect the other, including the outcome of surgical procedures. The aim of this study was to further clarify the relationship between measures of acetabular orientation and sacropelvic parameters. This study utilized a trauma CT database. A total of 100 scans on adult patients without overt hip or spinal disease were included. Measures of acetabular orientation included the acetabular sagittal angle (ASA) which uses the anterior pelvic plane as a reference and sacroacetabular angle which uses the sacral endplate as a reference (SA); spinopelvic parameters include the pelvic incidence (PI), sacral anatomic orientation (SAO) and pelvic thickness (PTH). Mean age 48.2 years (SD 18.0), 62% male. Mean values were: PI 50.5, SAO 50.7, PTH 106.4 mm, ASA-right 62.1, ASA-left 64.0, SA-right 67.2, and SA-left 65.4. There was substantial correlation between PI and SA (r = 0.628-0.630) and also between SAO and SA (À0.657 to À0.692). Liner regression determined SA was best predicted by the model: SA = 81 Â SAO + 0.36 Â PI. When using the anterior pelvic plane as a reference to define acetabular orientation, there does not appear to be any significant relationship between the sagittal orientation of the acetabulum and sacropelvic parameters. Using the sacrum as a common point of reference allows some further understanding of the interplay between pelvic parameters and the orientation of the acetabulum.

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Hip spine relationships: application to total hip arthroplasty

Cited by 80 publications

References 51 publications

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults

Assessment of the acetabular version in relation to sagittal sacropelvic parameters

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