The Current Knowledge on Spinopelvic Mobility

Lum, Zachary C.; Coury, John G.; Cohen, Jonathan; Dorr, Lawrence D.

doi:10.1016/j.arth.2017.08.013

Cited by 113 publications

(128 citation statements)

References 27 publications

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“…As the kyphotic thoracic spine forms a cage in combination with the ribs and respiratory muscles, a minimal sagittal ROM (0.1°) is present, as reported by Ochi et al [8] This cage provides a stable base for the cervical spine and head. Below L1, the lumbar spine, pelvis, and femur rotate in a chain-like manner to distribute the flexion of the spinofemoral movement [21]. Spinofemoral flexion is the combination of intrinsic motion of the acetabular-femur joint and extrinsic lumbar spine movements.…”

Section: Discussionmentioning

confidence: 99%

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

Feng

et al. 2020

BMC Musculoskelet Disord

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Background: Limitations in the lumbar spine movement reduce lumbar vertebral motion and affect spinopelvic kinematics. We studied the influence of lumbar intervertebral disc degeneration on spinofemoral movement, from standing to sitting, in patients undergoing total hip arthroplasty (THA). Methods: Of 138 consecutive patients scheduled for THA due to unilateral avascular necrosis (AVN) of the femoral head, those with ≥3 discs with University of California at Los Angeles (UCLA) disc degeneration score > 1 were defined as the lumbar degenerative disc disease (LDD) group, and the remaining patients constituted d the control group. Full body anteroposterior and lateral EOS images in the standing and sitting positions were obtained. Pelvic incidence (PI), L1 slope (L1 s), lumbar lordosis angle (LL), pelvic tilt (PT), sacral slope (SS), femoral slope (Fs), sagittal vertical axis (SVA), hip flexion, lumbar spine flexion, and total spinofemoral flexion were measured on the images and compared between groups. Results: No significant between-group differences were observed in the height, weight, body mass index, AVN staging, or PI, SS, and Fs on standing. The LDD group included more females and older patients, had 5°lesser LL, 5°g reater PT, and larger SVA. From standing to sitting, the PI remained constant in both groups. Total spinofemoral flexion was 7°less, lumbar spine flexion 16°less, L1 slope change 6°less, and SS change 8°less, and hip flexion was 7°more in the LDD than in the control group. The spine/hip flexion ratio was significantly lower in the LDD group (0.3 versus 0.7; p < 0.001). On regression analysis, the LDD group (p < 0.001) and older age (p = 0.048) but not sex, weight, or height were significant univariate predictors of decreased spine/hip ratio. Conclusions: Patients with LDD leant more forward and had a larger pelvis posterior tilt angle on standing and a decreased lumbar spine/hip flexion ratio, with more hip joint flexion, on sitting, to compensate for reduced lumbar spine flexion. Surgeons should be aware that elderly patients with multiple LDD have significantly different spinofemoral movements and increased risk of posterior dislocation post-THA. Preoperative patient identification, intraoperative surgical technique modification, and individualized rehabilitation protocols are necessary.

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Section: Discussionmentioning

confidence: 99%

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

Feng

et al. 2020

BMC Musculoskelet Disord

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“…Improvements in our understanding of femoral morphology and anteversion and their influence on implant impingement and dislocation have caused surgeons to re-evaluate component positioning during THA [26]. Several studies have examined stem anteversion during THA [18,27].…”

Section: Discussionmentioning

confidence: 99%

A simple angle-measuring instrument for measuring cemented stem anteversion during total hip arthroplasty

Mitsutake

Tanino

Nishida

et al. 2020

BMC Musculoskelet Disord

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Background: During total hip arthroplasty (THA), the accurate placement of the femoral components is an important determinant of the success of the procedure. This study assessed the accuracy of cemented stem placement using a new angle-measuring instrument. The primary objective was to investigate the accuracy of the intraoperative measurements of cemented stem anteversion obtained using the angle-measuring instrument. Our secondary objective was to evaluate the accuracy of stem positioning performed using the angle-measuring instrument. Methods: We compared the intraoperative stem anteversion measurements obtained using the angle-measuring instrument with postoperative stem anteversion measurements obtained using computed tomography in 149 hips (measurement accuracy). We also compared the target angle and postoperative stem anteversion in 105 hips (implantation accuracy). Results: The mean amount of intraoperative stem anteversion was 37.9°± 10.1°, and the mean amount of postoperative stem anteversion was 37.0°± 10.4°. The mean measurement accuracy was 0.9°± 6.1°, and the absolute measurement accuracy was 4.9°± 3.7°. The correlation coefficient for the relationship between the intraoperative and postoperative stem anteversion measurements was 0.824 (p = 0.000). The mean amount of target angle was 37.4°± 7.6°, and the mean amount of postoperative stem anteversion was 35.9°± 9.1°. The mean implantation accuracy was 1.4°± 5.6°, and the mean absolute implantation accuracy was 4.3°± 3.6°. The correlation coefficient for the relationship between the target angle and postoperative stem anteversion was 0.795 (p = 0.000). Conclusions: The angle-measuring instrument measured intraoperative stem anteversion accurately, and cemented stem was implanted accurately during THA with the angle-measuring instrument.

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“…This helps accommodate the flexed position of the femur and prevents impingement with subsequent dislocation. 44 Patients with rigid spines or prior spinopelvic fusions lack this compensatory pelvic motion, and this imbalance may predispose for impingement and instability. Patients who experience dislocation after THA have significantly less spine flexion, less change in pelvic tilt, and less functional anteversion in the sitting position compared with nondislocators.…”

Section: Altered Spinopelvic Dynamicsmentioning

confidence: 99%

The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty

et al. 2018

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The concept of dual mobility (DM) bearings in total hip arthroplasty was first introduced by Professors Gilles Bousquet and Andre Rambert in France in 1974 with the goal of enhancing hip stability. Although DM did not receive U.S. Food and Drug Administration approval for commercial use in the United States until 2009, there has been a surge in popularity of DM implants over the past several years, evidenced by the American Joint Replacement Registry data. The enthusiasm for DM stems from a growing body of literature that supports its use across a range of patient populations, most notably revision hip arthroplasty and high-risk primary scenarios. DM has been shown to effectively reduce the risk of dislocation while also exhibiting excellent survivorship. DM does incur some unique risks, namely, intraprosthetic dissociation, but many of the early concerns with DM have not been realized in the literature and do not seem to negatively impact its long-term survivorship. The exact indications for DM have yet to be defined and remain a matter of debate. It should be considered as an alternative for any primary or revision hip arthroplasty at high risk for postoperative instability. In this article, the authors review the current literature regarding the clinical success of DM implants for a variety of indications, all of which predispose to hip instability. The history, basic biomechanics, modern designs, and unique complications are also discussed.

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The Current Knowledge on Spinopelvic Mobility

Cited by 113 publications

References 27 publications

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

A simple angle-measuring instrument for measuring cemented stem anteversion during total hip arthroplasty

The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty

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