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

Pour, Aidin Eslam; Schwarzkopf, Ran; Patel, K; Anjaria, Manan P; Lazennec, Jean Yves; Dorr, Lawrence D.

doi:10.1002/jor.25022

Cited by 10 publications

(13 citation statements)

References 31 publications

(91 reference statements)

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“…These movements are likely important, as previous computer simulations have shown the effect of these variables on prosthetic impingement. [17][18][19] Lastly, aggregated estimates from published papers were used to simulate the additional positions of daily life. Although these estimates were reported by experienced orthopaedic surgeons and averaged for each position, these numbers do not necessarily represent how a particular patient may move, but still constitute level V evidence.…”

Section: Discussionmentioning

confidence: 99%

Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling

et al. 2023

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AimsComputer-assisted 3D preoperative planning software has the potential to improve postoperative stability in total hip arthroplasty (THA). Commonly, preoperative protocols simulate two functional positions (standing and relaxed sitting) but do not consider other common positions that may increase postoperative impingement and possible dislocation. This study investigates the feasibility of simulating commonly encountered positions, and positions with an increased risk of impingement, to lower postoperative impingement risk in a CT-based 3D model.MethodsA robotic arm-assisted arthroplasty planning platform was used to investigate 11 patient positions. Data from 43 primary THAs were used for simulation. Sacral slope was retrieved from patient preoperative imaging, while angles of hip flexion/extension, hip external/internal rotation, and hip abduction/adduction for tested positions were derived from literature or estimated with a biomechanical model. The hip was placed in the described positions, and if impingement was detected by the software, inspection of the impingement type was performed.ResultsIn flexion, an overall impingement rate of 2.3% was detected for flexed-seated, squatting, forward-bending, and criss-cross-sitting positions, and 4.7% for the ankle-over-knee position. In extension, most hips (60.5%) were found to impinge at or prior to 50° of external rotation (pivoting). Many of these impingement events were due to a prominent ischium. The mean maximum external rotation prior to impingement was 45.9° (15° to 80°) and 57.9° (20° to 90°) prior to prosthetic impingement. No impingement was found in standing, sitting, crossing ankles, seiza, and downward dog.ConclusionThis study demonstrated that positions of daily living tested in a CT-based 3D model show high rates of impingement. Simulating additional positions through 3D modelling is a low-cost method of potentially improving outcomes without compromising patient safety. By incorporating CT-based 3D modelling of positions of daily living into routine preoperative protocols for THA, there is the potential to lower the risk of postoperative impingement events.Cite this article: Bone Jt Open 2023;4(6):416–423.

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Section: Discussionmentioning

confidence: 99%

Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling

et al. 2023

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“…Such movement can result in a 10 change in the acetabular anteversion angle, which may place the acetabular prosthesis outside the "safe zone" and cause postoperative dislocation. 21,22 Uemura et al 23 reported that the changes in pelvic sagittal inclination (PSI) from a supine to a standing position would exceed 10 in 8% to 19% of patients with end-stage OA. Abdel et al 24 found that in the majority of cases where dislocation occurred, the cup was positioned in the safety zone, and he suggested that the traditional safety zone may no longer be applicable.…”

Section: Discussionmentioning

confidence: 99%

“…A change in the posterior pelvic tilt of more than 13° from a supine position to standing is defined as adverse pelvic mobility. Such movement can result in a 10° change in the acetabular anteversion angle, which may place the acetabular prosthesis outside the “safe zone” and cause postoperative dislocation 21,22 . Uemura et al 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Such movement can result in a 10° change in the acetabular anteversion angle, which may place the acetabular prosthesis outside the “safe zone” and cause postoperative dislocation. 21 , 22 Uemura et al . 23 reported that the changes in pelvic sagittal inclination (PSI) from a supine to a standing position would exceed 10° in 8% to 19% of patients with end‐stage OA.…”

Section: Discussionmentioning

confidence: 99%

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Does the Dual Mobility Cup Reduce Dislocation After Primary Total Hip Arthroplasty in Elderly Patients at High Risk of Dislocation?

Chen

Takahashi

Kaneuji

et al. 2022

Orthopaedic Surgery

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Objective The dual mobility cup (DMC) is designed to extend the longevity of the prosthesis by improving stability, enhancing the range of motion, and decreasing impingement without increasing wear. We hypothesized that DMC would reduce the risk of dislocation in elderly patients. This study aimed to investigate the clinical and radiographic outcomes of DMC‐total hip arthroplasty (THA) in elderly patients at high risk of dislocation. Methods From June 2016 to March 2020, 94 patients with a mean age of 77.7 years (97 hips) who underwent a posterolateral approach for DMC‐THA in our department were followed up for at least one year. Preoperative and postoperative pelvic tilt angles (PTA) and DMC orientation were prospectively collected for all patients. Intraoperative and postoperative complications were recorded. A parametric test was used for normal distribution, and a non‐parametric test was used for non‐normal distribution. Results Abduction and anteversion angles of the cup were 42.4 and 18.0° in the supine position immediately postoperative. The average PTA for patients in the supine and standing positions were 26.5 and 34.5°, respectively. When moving from the supine to the standing position, patients experienced a mean posterior pelvic tilt of 9°. No intraoperative acetabular‐related complications were recorded. Postoperative complications included early infection in one patient (1.0%) and dislocation in one patient (1.0%). Conclusion Our study demonstrates that DMC‐THA provides satisfactory short‐term outcomes in elderly patients at a high risk of dislocation, regardless of the change in PTA resulting from postural transition.

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“…It has been shown that patients who underwent THA without spine disorder had more changes in acetabular implant orientation due to greater adaptability of the spinopelvic junction than patients who had spine fusion, who might be at risk of posterior dislocation because of less femoral head coverage and less acetabular anteversion. Additionally, the more fused levels, the more acetabular anteversion and inclination decrease (about 1° for each fused group for each value) [ 70 ]. Therefore, it has been proposed by Lazennec et al to evaluate lumbosacral junction using standing and sitting EOS imaging or radiographs in patients with spine fusion in THA planning and follow-up [ 71 , 72 , 73 ], but this attitude is not yet officially recommended.…”

Section: Imaging Follow-up Of Hamentioning

confidence: 99%

Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy

Lombard¹,

Gillet

Germain³

et al. 2022

JCM

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Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects.

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

Cited by 10 publications

References 31 publications

Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling

Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling

Does the Dual Mobility Cup Reduce Dislocation After Primary Total Hip Arthroplasty in Elderly Patients at High Risk of Dislocation?

Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy

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