Pelvic motion the key to understanding spine–hip interaction

Pizones, Javier; García-Rey, Eduardo

doi:10.1302/2058-5241.5.200032

Cited by 25 publications

(21 citation statements)

References 70 publications

(88 reference statements)

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“…An increased lumbar lordosis, in turn, may also require increased thoracic and sacral kyphosis (outward curvature). These geometric relationships between spinal curvature and pelvic form are well-documented by the correlations between AP pelvic dimensions, pelvic orientation and lumbar lordosis reported in orthopaedic studies [ 54 – 57 ]. In late pregnancy, lumbar lordosis is even further increased to balance the additional abdominal weight [ 58 ].…”

Section: Discussionmentioning

confidence: 73%

The evolution of pelvic canal shape and rotational birth in humans

et al. 2021

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Background The human foetus typically needs to rotate when passing through the tight birth canal because of the complex shape of the pelvis. In most women, the upper part, or inlet, of the birth canal has a round or mediolaterally oval shape, which is considered ideal for parturition, but it is unknown why the lower part of the birth canal has a pronounced anteroposteriorly oval shape. Results Here, we show that the shape of the lower birth canal affects the ability of the pelvic floor to resist the pressure exerted by the abdominal organs and the foetus. Based on a series of finite element analyses, we found that the highest deformation, stress, and strain occur in pelvic floors with a circular or mediolaterally oval shape, whereas an anteroposterior elongation increases pelvic floor stability. Conclusions This suggests that the anteroposterior oval outlet shape is an evolutionary adaptation for pelvic floor support. For the pelvic inlet, by contrast, it has long been assumed that the mediolateral dimension is constrained by the efficiency of upright locomotion. But we argue that the mediolateral elongation has evolved because of the limits on the anteroposterior diameter imposed by upright posture. We show that an anteroposteriorly deeper inlet would require greater pelvic tilt and lumbar lordosis, which compromises spine health and the stability of upright posture. These different requirements of the pelvic inlet and outlet likely have led to the complex shape of the pelvic canal and to the evolution of rotational birth characteristic of humans.

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Section: Discussionmentioning

confidence: 73%

The evolution of pelvic canal shape and rotational birth in humans

et al. 2021

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“…The preferred surgical approach of the studies included, was not taken into consideration. Although most patients in this review were operated on via a posterolateral approach, use of the anterior or anterolateral approach influences the orientation of the components [ 40 ], which can influence the dislocation rate too. This influences the outcomes of this review, since the dislocation mechanism is different in the direct anterior and anterolateral approach and that anterior dislocations occur more frequent, instead of posterior dislocations, compared to the posterolateral approach [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

The role of the femoral component orientation on dislocations in THA: a systematic review

Erp

Snijders

Weinans

et al. 2021

Arch Orthop Trauma Surg

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Introduction Dislocation remains a major complication in total hip arthroplasty (THA), in which femoral component orientation is considered a key parameter. New imaging modalities and definitions on femoral component orientation have been introduced, describing orientation in different planes. This study aims to systematically review the relevance of the different orientation parameters on implant stability. Methods A systematic review was performed according to the PRISMA guidelines to identify articles in the PubMed and EMBASE databases that study the relation between any femoral component orientation parameters and implant stability in primary THA. Results After screening for inclusion and exclusion criteria and quality assessment, nine articles were included. Definitions to describe the femoral component orientation and methodologies to assess its relevance for implant stability differed greatly, with lack of consensus. Seven retrospective case–control studies reported on the relevance of the transversal plane orientation: Low femoral- or low combined femoral and acetabular anteversion was statistical significantly related with more posterior dislocations, and high femoral- or combined femoral and acetabular anteversion with anterior dislocations in two studies. There were insufficient data on sagittal and coronal component orientation in relation to implant stability. Conclusion Because of incomparable definitions, limited quality and heterogeneity in methodology of the included studies, there is only weak evidence that the degree of transverse component version is related with implant stability in primary THA. Recommendations about the optimal orientation of the femoral component in all three anatomical planes cannot be provided. Future studies should uniformly define the three-dimensional orientation of the femoral component and systematically describe implant stability.

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“…An increase in AP length of the pelvis requires re-balancing this system by forward rotating the sacrum and increasing lumbar lordosis (Fig. 4) [38][39][40][41] . The amount of lordosis, however, is limited by the size, strength and wedging of the vertebral bodies as well as by necessary adaptations within the spinal musculature.…”

Section: Discussionmentioning

confidence: 99%

The evolution of pelvic canal shape and rotational birth in humans

Stansfield

Fischer

Mitterœcker

2021

Preprint

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The human foetus needs to rotate when passing through the tight birth canal because of the complex shape of the pelvis. In most women the upper part, or inlet, of the birth canal has a round or mediolaterally oval shape, which is considered ideal for parturition, but it is unknown why the lower part, or outlet, of the birth canal has a pronounced anteroposteriorly oval shape. Here we show that the shape of the lower birth canal affects the ability of the pelvic floor to resist pressure exerted by the abdominal organs and the foetus. Based on a series of finite element analyses, we found that the highest deformation, stress and strain occur in pelvic floors with a circular or mediolaterally oval shape, whereas an anteroposterior elongation increases pelvic floor stability. This suggests that the anteroposterior oval outlet shape is an evolutionary adaptation for pelvic floor support. For the pelvic inlet, by contrast, it has long been assumed that the mediolateral dimension is constrained by the efficiency of upright locomotion. But we argue that upright stance limits the anteroposterior dimension of the inlet. A deeper inlet requires greater pelvic tilt and lumbar lordosis, which compromises spine health and the stability of upright posture. These different requirements on the pelvic inlet and outlet have led to the complex shape of the human pelvic canal and to the evolution of rotational birth.

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Pelvic motion the key to understanding spine–hip interaction

Cited by 25 publications

References 70 publications

The evolution of pelvic canal shape and rotational birth in humans

The evolution of pelvic canal shape and rotational birth in humans

The role of the femoral component orientation on dislocations in THA: a systematic review

The evolution of pelvic canal shape and rotational birth in humans

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