Surgical implications of the hip-spine relationship in total hip arthroplasty

Abstract

Total hip arthroplasty (THA) is considered the most successful orthopedic surgical procedure of the last century with excellent survivorship up to 20-years. However, instability remains a major issue representing the most common reason for revision after THA. Hip-spine relationship has gained progressive interest between arthroplasty surgeons and its understanding is crucial in order to identify high-risk patients for postoperative dislocation. Spinal deformity and abnormal spinopelvic mobility have been associated with increased risk for instability, dislocation and revision THA. Preoperative workup begins with standing anteroposterior pelvis x-ray and lateral spinopelvic radiographs in the standing and sitting position. Hip-spine stiffness needs to be addressed before THA in consideration of adapting the preoperative planning to the patient’s characteristics. Acetabular component should be implanted with different anteversion and inclination angles according to the pattern of hip-spine motion in order to reduce the risk of impingement and consequent dislocation. Different algorithmic approaches have been proposed in case of concomitant hip-spine disease and in case of altered sagittal balance and pelvic mobility. The aim of this review is to investigate and clarify the hip-spine relationships and evaluate the impact on modern total hip arthroplasty.

Comparison of the accuracy of 2D and 3D templating methods for planning primary total hip replacement: a systematic review and meta-analysis

“…This means that their value changes with body position (31), which must be taken into account when planning total hip arthroplasty. Spinal deformity and abnormal pelvic mobility have been associated with an increased risk of instability, dislocation and revision (32), and as such, patients with suspected spino-pelvic mobility pathology should be identified prior to performing THA and have a comprehensive radiographic examination, which should include a weight-bearing AP pelvic view as well as sitting and standing lateral projections (33), which would not be possible using CT-based 3D templating.…”

Spinopelvic Relationship and Its Impact on Total Hip Arthroplasty

“…and Mancino et al. recommend that prior to THA, all patients must undergo standing, supine, and sitting lateral radiographs of the pelvis and the lumbar spine [ 47 , 48 ]. The views should ideally include L1 or, at the least, the level of L3, as most of the lumbar motion happens between L3 and L5 [ 47 , 48 ].…”

Functional safe zone for THA considering the patient‐specific pelvic tilts: An ultrasound‐based approach

“…Therefore, a lumbar stiffness will have to be compensated by more hip flexion when sitting and conversely, hip stiffness will require more lumbar flexion 8 . For this reason, many authors suggested to adjust the orientation of the hip implant according to spino‐pelvic mobility categories to compensate for possible stiffness and limit the risks of dislocation or impingement 4,9–14 . Yet, there is still today no consensus in the literature about the exact definition of these categories and their associated recommendations 15 …”