How do global sagittal alignment and posture change after total hip arthroplasty?

Youngwoo, Kim; Pour, Aidin Eslam; Lazennec, Jean Yves

doi:10.1007/s00264-019-04363-5

Cited by 24 publications

(30 citation statements)

References 33 publications

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“…11 Another study by Kim et al also showed decrease in SVA after THA, and in particular, found the SVA changes to present in the low and medium PI patients but not the high PI patients. 12 The present study was unable to demonstrate a difference between PI groups and change in global alignment parameters. This seemingly conflicting finding can be attributed to the fact that Kim et al did not perform any comparison in alignment parameters between PI groups, and thus could not conclude that PI significantly influenced alignment changes.…”

Section: Discussioncontrasting

confidence: 76%

The Impact of Global Spinal Alignment on Standing Spinopelvic Alignment Change After Total Hip Arthroplasty

Jain

Vigdorchik

Abotsi

et al. 2021

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: The interactions between hip osteoarthritis (OA) and spinal malalignment are poorly understood. The purpose of this study was to assess the influence of total hip arthroplasty (THA) on standing spinopelvic alignment. Methods: In this retrospective cohort study, patients undergoing THA for OA with pre-and postoperative full-body radiographs were included. Standing spinopelvic parameters were measured. Contralateral hip was graded on the Kellgren-Lawrence scale. Pre-and postoperative alignment parameters were compared by paired t-test. The severity of preoperative thoracolumbar deformity was measured using TPA. Linear regression was performed to assess the impact of preoperative TPA and changes in spinal alignment. Patients were separated into low and high TPA (<20 or >/=20 deg) and change in parameters were compared between groups by t-test. Similarly, the influence of K-L grade, age, and PI were also tested. Results: 95 patients were included (mean age 58.6 yrs, BMI 28.7 kg/m2, 48.2% F). Follow-up radiographs were performed at mean 220 days. Overall, the following significant changes were found from pre-to postoperative: SPT (14.2 vs. 16.1, P = 0.021), CL (−8.9 vs. −5.3, P = .001), TS-CL (18.2 vs. 20.5, P = .037) and SVA (42.6 vs. 32.1, P = .004). Preoperative TPA was significantly associated with the change in PI-LL, SVA, and TPA. High TPA patients significantly decreased SVA more than low TPA patients. There was no significant impact of contralateral hip OA, PI, or age on change in alignment parameters. Conclusion: Spinopelvic alignment changes after THA, evident by a reduction in SVA. Preoperative spinal sagittal deformity impacts this change. Level of evidence: III.

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Section: Discussioncontrasting

confidence: 76%

The Impact of Global Spinal Alignment on Standing Spinopelvic Alignment Change After Total Hip Arthroplasty

Jain

Vigdorchik

Abotsi

et al. 2021

Global Spine Journal

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“…Type 1 was defined as "neutral" with -1 cm < SSPT <1 cm for sagittal balance. As previously described in the literature, patients were categorized into 3 groups based on the PI: low PI < 45 , 45 < average PI < 65 , or high PI > 65 [24].…”

Section: Study Variablesmentioning

confidence: 99%

Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA

et al. 2020

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Background: Sagittal spinopelvic translation (SSPT) is the horizontal distance from the hip center to the C7 plumb line (C7PL). SSPT is an important variable showing the overall patient balance in different functional positions which could affect the rate of hip instability. This study investigates the SSPT modification in patients who underwent total hip arthroplasty (THA). Methods: A total of 120 patients were assessed preoperatively and postoperatively on standing and sitting acquisitions (primary unilateral THA without complication). SSPT is zero when the C7PL goes through the center of the femoral heads and positive when the C7PL is posterior to the hips' center (negative if anterior). Three subgroups were defined based on the pelvic incidence (PI): low PI <45 , 45 < normal PI <65 , or high PI >65. Results: The overall mean preoperative SSPT change from standing to sitting was 2.2 cm ([-7.2 to 17.4]) (P < .05). The overall mean postoperative SSPT change from standing to sitting was 1.2 cm ([-14.2 to 22.4]) (P < .05). In low-and normal-PI groups, standing to sitting SSPT and preoperative to postoperative changes in standing SSPT were increased significantly after surgery with the C7PL behind the hips' center (P < .05). In the high-PI group, standing to sitting SSPT was increased postoperatively (P ¼ .034) (no significant changes from preoperative to postoperative status in standing and sitting). Conclusions: Adaptation from standing to sitting positions combines pelvic tilt and anteroposterior pelvic translation. THA implantation induces significant changes in SSPT mainly for low-and standard-PI patients. This is an important variable to consider when investigating the causes of THA subluxation or dislocation.

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“…The importance of the preoperative sagittal pelvic tilt (SPT) assessment and its effect on the risk of total hip arthroplasty (THA) dislocation has been previously shown 1‐12 . The magnitude of the SPT during different daily activities is personalized based on the patients' functional anatomy 1,3‐5,10,13‐17 . SPT changes with spinal pathologies as well as spinal surgeries, but there is limited evidence regarding the magnitude of SPT change that can increase the risk for postoperative THA dislocation.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] The magnitude of the SPT during different daily activities is personalized based on the patients' functional anatomy. 1,[3][4][5]10,[13][14][15][16][17] SPT changes with spinal pathologies as well as spinal surgeries, but there is limited evidence regarding the magnitude of SPT change that can increase the risk for postoperative THA dislocation. The criteria that is known is the spinal stiffness (SPT change less than 10°) that can increase the risk of dislocation.…”

Section: Introductionmentioning

confidence: 99%

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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How do global sagittal alignment and posture change after total hip arthroplasty?

Cited by 24 publications

References 33 publications

The Impact of Global Spinal Alignment on Standing Spinopelvic Alignment Change After Total Hip Arthroplasty

The Impact of Global Spinal Alignment on Standing Spinopelvic Alignment Change After Total Hip Arthroplasty

Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA

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

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