Total Hip Arthroplasty in the Spinal Deformity Population: Does Degree of Sagittal Deformity Affect Rates of Safe Zone Placement, Instability, or Revision?

DelSole, Edward M.; Vigdorchik, Jonathan M.; Schwarzkopf, Ran; Errico, Thomas J.; Buckland, Aaron J.

doi:10.1016/j.arth.2016.12.039

Cited by 193 publications

(165 citation statements)

References 31 publications

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“…The study by DelSole et al . revealed that lumbar back deformity and the decompensated state of the sagittal plane of the spine affect the stability of the prosthesis after THA. The sagittal deformity caused by spinal diseases is compensated by the change in the pelvic tilt to achieve the sagittal balance of the limbs.…”

Section: Effects Of Spinal Diseases On Thamentioning

confidence: 99%

The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis

Yang

Zhang

2019

Orthopaedic Surgery

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The concept of the “safe area” of the acetabular prosthesis has a long history and has been recognized by many scholars. It is generally believed that postoperative hip dislocation rate is low, when the acetabular anteversion angle is placed in the range of 15° ± 10°. Despite this, hip dislocation is a common complication after total hip arthroplasty. In recent years, more and more scholars have paid attention to the influence of pelvic tilt on the acetabular anteversion angle. The concept of acetabular anteversion changes as the pelvic tilt changes, and is challenging the traditional acetabular prosthesis “safe area.” This study summarized the potential influencing factors of pelvic tilt and discussed the influence of the phenomenon on the anteversion angle of total hip arthroplasty (THA) acetabular prosthesis based on the literature review. We conclude that from the supine position to standing, followed by sitting, the pelvis tends to move backward. Pelvic sagittal activity, lumbar disease (ankylosing spondylitis), lumbar fusion (lumbar fusion, spine‐pelvic fusion), and other factors related to the tilt are THA risk factors for postoperative dislocation and revision. With the change of body position, the degree of acetabular anteversion is directly related to the degree of pelvic tilt. The acetabular anteversion varies greatly, which leads to increased hip prosthesis wear and even hip dislocation. The lateral X‐ray of the spine and pelvis is recommended in supine, standing, and sitting positions before THA. In addition, the pelvic tilt should be regarded as a reference of the acetabular prosthesis in the preoperative planning of THA.

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Section: Effects Of Spinal Diseases On Thamentioning

confidence: 99%

The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis

Yang

Zhang

2019

Orthopaedic Surgery

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“…Furthermore, in Li's series spinal sagittal balance and its complex multifactorial relationship with the coronal plane has not been considered, nor the resultant effects that restoration of LLD may produce. The implication for acetabular component anteversion is well documented (9,11,12), and similar considerations with regard to the hip-spine relationship as addressed with the coronal plane, are merited in the sagittal plane. For complex reconstructive cases where significant correction of leg lengths will have an impact on the spine, we recommend a careful multidisciplinary approach with pre-operative planning performed by both hip and spinal specialists working in concert.…”

Section: Editorialmentioning

confidence: 99%

Editorial review: Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-IV developmental dysplasia of the hip

Berstock¹,

Torrie

Whitehouse³

2018

Ann. Joint

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“…In addition, cup anteversion and inclination have been shown to be dynamic variables related to patient position and spino‐pelvic alignment and mobility . The contribution of spino‐pelvic biomechanics to the risk of instability after THA has been a topic of increased interest in the literature . Altered spino‐pelvic biomechanics may be caused by lumbar degenerative disc disease (DDD) or surgical spinal fusion.…”

mentioning

confidence: 99%

“…5 The contribution of spino-pelvic biomechanics to the risk of instability after THA has been a topic of increased interest in the literature. [6][7][8] Altered spino-pelvic biomechanics may be caused by lumbar degenerative disc disease (DDD) or surgical spinal fusion. Upright sagittal balance in the setting of decreased lumbar lordosis is maintained by compensatory posterior pelvic tilt, which subsequently results in increased acetabular cup anteversion and inclination.…”

mentioning

confidence: 99%

In Vivo analysis of spinopelvic kinematics and peak head‐cup contact in total hip arthroplasty patients with lumbar degenerative disc disease

Limmahakhun

Box

Arauz

et al. 2019

Journal Orthopaedic Research

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Anterior instability after total hip arthroplasty (THA) has been described in patients with thoracolumbar kyphotic deformity. Although compensatory posterior pelvic tilt with subsequent increased functional anteversion has been described as the mechanism, there is a paucity of in vivo data. The purpose of our study was to compare pelvic tilt, anteversion, inclination, and position of head‐cup contact points in patients with lumbar degenerative disc disease (DDD) and a matched patient cohort without DDD. A total of 50 THA, 18 hips with lumbar DDD and 32 hips without DDD, underwent CT imaging for 3D hip reconstruction. Component orientations and in vivo hip gait kinematics was quantified using a validated dual fluoroscopic imaging system. Hip kinematics and head‐cup contact points were compared. Patients with lumbar DDD demonstrated decreased maximum (5.9° ± 4.2° vs. 9.3° ± 5.4°, p = 0.02) and minimum (2.4° ± 4.1° vs. 6.2° ± 5.6°, p = 0.01) anterior pelvic tilt, and increased maximum cup anteversion (29.3° ± 8.7° vs. 25.1° ± 8.1°, p = 0.05). The peak head‐cup contact points were shifted closer to the anterior edge of the polyethylene (7.8 ± 1.7 mm vs. 9.6 ± 2.2 mm, p = 0.02). Patients with lumbar degenerative disc disease demonstrated increased posterior pelvic tilt, functional acetabular anteversion, inclination as well as shifting of the peak head‐cup contact pattern significantly closer to an anterior edge, suggesting sagittal spinopelvic deformity may predispose to anterior instability in THA patients during upright activities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Total Hip Arthroplasty in the Spinal Deformity Population: Does Degree of Sagittal Deformity Affect Rates of Safe Zone Placement, Instability, or Revision?

Cited by 193 publications

References 31 publications

The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis

The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis

Editorial review: Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-IV developmental dysplasia of the hip

In Vivo analysis of spinopelvic kinematics and peak head‐cup contact in total hip arthroplasty patients with lumbar degenerative disc disease

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