Sacral Slope Change From Standing to Relaxed-Seated Grossly Overpredicts the Presence of a Stiff Spine

Sharma, Abhinav K.; Grammatopoulos, George; Pierrepont, J; Madurawe, C; Innmann, Moritz M.; Vigdorchik, Jonathan M.; Shimmin, A

doi:10.1016/j.arth.2022.05.020

Cited by 11 publications

(10 citation statements)

References 33 publications

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“…Thus, the postoperative lumbar and pelvic mobility was decreased without spinal degeneration and the improvement of hip mobility affected this lumbar and pelvic mobility. A recent study supports our result that ∆SS standing/relaxed-seated ≥ −10 • was not correlated with a stiff spine and overpredicted the presence of stiff spine [26]. Our results suggest that spinopelvic assessment using only ∆SS might be not sufficient, and hip mobility in the relaxed-and flexed-seated position should also be assessed before THA.…”

Section: Discussionsupporting

confidence: 85%

The Impact of Hip Mobility on Lumbar and Pelvic Mobility before and after Total Hip Arthroplasty

Youngwoo

Vergari

Shimizu

et al. 2022

JCM

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Hip arthrosis and total hip arthroplasty (THA) can alter a patient’s balance and spinopelvic mobility. In this study, we hypothesized that lumbar, pelvic, and hip mobility and their inter-relations are affected by THA and that their study could give an insight in our understanding of postoperative balance and mobility. A total of 165 patients with hip arthrosis and with an indication for THA were included in this single-center prospective cohort. Sagittal radiographs were acquired in four positions: free-standing, standing extension, relaxed-seating and flexed-seating preoperatively and at 6 and 12 months. Spinopelvic parameters were measured (pelvic tilt and incidence, sacral slope, lumbar lordosis, pelvic-femoral angle). Standing spinopelvic parameters did not significantly change postoperatively. However, the postural changes occurring between positions were significantly altered after THA. In particular, pelvic and lumbar mobility was significantly reduced postoperatively, while hip mobility was increased. Correlations were observed between the changes in lumbar, pelvic and hip mobility before and after THA. This study confirmed that there is a relationship between lumbar, pelvic and hip mobility in osteoarthritis, and that this relationship is modified by the postoperative compensation mechanisms deployed by the patient in dynamic postures. Hence, surgeons should consider these relationships when planning surgery, in order to obtain a physiological pelvic tilt postoperatively and to account for the potential increased risk of impingement and dislocation with hip hypermobility.

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Section: Discussionsupporting

confidence: 85%

The Impact of Hip Mobility on Lumbar and Pelvic Mobility before and after Total Hip Arthroplasty

Youngwoo

Vergari

Shimizu

et al. 2022

JCM

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“…This is of significant relevance for the study of the hip–spine interaction. The deep-flexed-seated radiograph has superior sensitivity-, specificity, and negative and positive predictive values in identifying spinal stiffness and thus the presence of abnormal spinopelvic characteristics relative to the relaxed-seated radiographs, and it should thus be the radiograph of choice if quasi-static radiographs are to be used ( 57 ). Furthermore, radiographic measurements of the spinopelvic complex (with standing and deep seated radiographs) have been shown to correlate with axial- and coronal- plane kinematics during daily tasks as assessed in a motion analysis laboratory ( 58 ).…”

Section: Evaluation: Clinical and Radiographicmentioning

confidence: 99%

“…A change in sPT between 10° and 30 is considered normal, whilst a pelvis with less than 10° of change in tilt is considered stiff and one with greater than 30° of change is considered hypermobile. However, the change in SS measures the change in PT but provides no direct measure of spinal stiffness ( 57 ). Only 15% of ‘stiff’ hips as measured by the relaxed seated would truly exhibit spinal stiffness as per deep-seated assessments.…”

Section: Evaluation: Clinical and Radiographicmentioning

confidence: 99%

“…Only 15% of ‘stiff’ hips as measured by the relaxed seated would truly exhibit spinal stiffness as per deep-seated assessments. Thus, the relaxed-seated assessment is likely to lead to overestimation of hips at risk ( 57 ). Furthermore, about ≈20% of hips with osteoarthritis pre-THA would have features of spinopelvic hypermobility, due to the arthritic hip, lacking movement and tilting the pelvis posteriorly when adopting a relaxed-seated position as a compensatory manoeuver ( 42 , 46 , 49 ).…”

Section: Evaluation: Clinical and Radiographicmentioning

confidence: 99%

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Spinopelvic challenges in primary total hip arthroplasty

et al. 2023

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There is no universal safe zone for cup orientation. Patients with spinal arthrodesis or a degenerative lumbar spine are at increased risk of dislocation. The relative contributions of the hip (femur and acetabulum) and of the spine (lumbar spine) in body motion must be considered together. The pelvis links the two and influences both acetabular orientation (i.e. hip flexion/extension) and sagittal balance/lumbar lordosis (i.e. spine flexion/extension). Examination of the spino-pelvic motion can be done through clinical examination and standard radiographs or stereographic imaging. A single, lateral, standing spinopelvic radiograph would be able to providemost relevant information required for screening and pre-operative planning. A significant variability in static and dynamic spinopelvic characteristics exists amongst healthy volunteers without known spinal or hip pathology. The stiff, arthritic, hip leads to greater changes in pelvic tilt (changes are almost doubled), with associated obligatory change in lumbar lordosis to maintain upright posture (lumbar lordosis is reduced to counterbalance for the reduction in sacral slope). Following total hip arthroplasty and restoration of hip flexion, spinopelvic characteristics tend to change/normalize (to age-matched healthy volunteers). The static spinopelvic parameters that are directly associated with increased risk of dislocation are lumbo-pelvic mismatch (pelvic incidence – lumbar lordosis angle >10°), high pelvic tilt (>19°), and low sacral slope when standing. A high combined sagittal index (CSI) when standing (>245°) is associated with increased risk of anterior instability, whilst low CSI when standing (<205°) is associated with increased risk of posterior instability. Aiming to achieve an optimum CSI when standing within 205–245° (with narrower target for those with spinal disease) whilst ensuring the coronal targets of cup orientation targets are achieved (inclination/version of 40/20 ±10°) is our preferred method.

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“…Behery et al 16 have suggested that the flexed seated position might give a more accurate representation of compensatory actions in patients with disorders of the spine and hip. Sharma et al 17 have suggested that spinal stiffness might be over-predicted when the patient is in the relaxed seated position.…”

mentioning

confidence: 99%

A leap towards personalized orthopaedic surgery and the prediction of spinopelvic mechanics in total hip arthroplasty

Fontalis,

Haddad

2024

Bone Joint J

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Sacral Slope Change From Standing to Relaxed-Seated Grossly Overpredicts the Presence of a Stiff Spine

Cited by 11 publications

References 33 publications

The Impact of Hip Mobility on Lumbar and Pelvic Mobility before and after Total Hip Arthroplasty

The Impact of Hip Mobility on Lumbar and Pelvic Mobility before and after Total Hip Arthroplasty

Spinopelvic challenges in primary total hip arthroplasty

A leap towards personalized orthopaedic surgery and the prediction of spinopelvic mechanics in total hip arthroplasty

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