What is the Impact of a Spinal Fusion on Acetabular Implant Orientation in Functional Standing and Sitting Positions?

Lazennec, Jean Yves; Clark, Ian C.; Folinais, D.; Tahar, I. Nid; Pour, Aidin Eslam

doi:10.1016/j.arth.2017.04.051

Cited by 72 publications

(46 citation statements)

References 27 publications

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“…It has been considered for several decades that the cup should be oriented within a safe zone defined as 15° ± 10° of anteversion and 40° ± 10° of inclination according to the anterior pelvic plane (APP) . Some authors mentioned that this safe zone is not suitable because of the extreme interindividual variation of the pelvic kinematics . During daily activities such as in the sitting, standing, and supine positions, the pelvic tilt varies substantially to modify the functional orientation of the acetabulum and to adjust the range of motion of the hip according to these different positions.…”

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confidence: 99%

“…5 Some authors mentioned that this safe zone is not suitable because of the extreme interindividual variation of the pelvic kinematics. [9][10][11][12] During daily activities such as in the sitting, standing, and supine positions, the pelvic tilt varies substantially to modify the functional orientation of the acetabulum and to adjust the range of motion of the hip according to these different positions. When the pelvis posteriorly tilts, as, for instance, in the sitting position, the acetabular anteversion is increased to enable higher flexion but reducing extension at the same time.…”

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confidence: 99%

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Accuracy and Precision of an Ultrasound‐Based Device to Measure the Pelvic Tilt in Several Positions

Dardenne

Pluchon

Letissier

et al. 2019

J of Ultrasound Medicine

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Objectives A new ultrasound‐based device is proposed to measure the patient‐specific pelvic tilt in different daily positions. The aim of this study was to assess the accuracy of this device as well as the intraobserver and interobserver precisions. Methods The accuracy was assessed by performing several tilt measurements with the device on a testing mechanical bench. The error was defined as the difference between the tilt measured with the device and the tilt provided by this test bench. Three physicians, a novice, an intermediate, and an expert user, were also asked to perform 10 measurements on 3 healthy volunteers with low, medium, and high body mass indices to analyze the intraobserver and interobserver precisions. These 10 measurements were performed in the standing, sitting, and supine positions. Results The mean accuracy of the device ± SD was 1.1° ± 0.7° (range, 0°–4.0°). The interobserver and intraobserver precisions were excellent whatever the body mass index and good to excellent according to the positions. There was no learning curve, and the time required to complete the measurements was approximately 5 minutes. Conclusions This study presents an accurate and precise noninvasive device for measurement of the pelvic tilt in different positions.

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confidence: 99%

mentioning

confidence: 99%

Accuracy and Precision of an Ultrasound‐Based Device to Measure the Pelvic Tilt in Several Positions

Dardenne

Pluchon

Letissier

et al. 2019

J of Ultrasound Medicine

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“…Furthermore, we have demonstrated that cup anteversion differs between the static standing position as well as dynamic gait due to the pelvic loading, an aspect that should further be considered for surgical planning. Spinopelvic relations change relative to postural changes, muscle and soft tissue tensional strength, and progression of the sagittal spinal deformity . Therefore, when considering acetabular cup placement and anterior hip instability, patients should be assessed in the standing position rather than in the seated position.…”

Section: Discussionmentioning

confidence: 99%

“…Spinopelvic relations change relative to postural changes, muscle and soft tissue tensional strength, and progression of the sagittal spinal deformity. 23 Therefore, when considering acetabular cup placement and anterior hip instability, patients should be assessed in the standing position rather than in the seated position. The functional cup anteversion is dependent on pelvic tilt, and component orientation.…”

Section: Discussionmentioning

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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“…The loss of lordosis of the distal arch results in a reduction in disc height at level L4-S1 causing structural damage in distal lumbar degenerative disc disease. As well, isolated distal lumbar discopathy, with loss of disc height, can induce segmental lumbo-pelvic kyphosis [3,5,6]. One-or two-level anterior or lateral lumbar interbody fusions can alter segmental LL with or without modification of the lumbo-pelvic kinematic parameters [7]; however, whether this modification can be applied to the preoperative status is not clear.…”

Section: Introductionmentioning

confidence: 99%

Prospective Evaluation of Spino-Pelvic Parameters with Clinical Correlation in Patients Operated with an Anterior Lumbar Interbody Fusion

et al. 2020

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The goal of this study was to evaluate the impact of anterior lumbar interbody fusion (ALIF) on L5-S1 level for restitution of distal segmental lordosis and to investigate its consequences on spino-pelvic parameters and the global sagittal balance. Overview of Literature: Lumbar surgery must be adapted to the spinal morphology in order to restore an adequate relation between pelvic and spinal parameters and especially to the pelvic incidence. Methods: An observational, prospective study was conducted between January 2013 and May 2017. Eighty-six patients were treated by L5-S1 ALIF procedure regardless of disc replacement above L5-S1 level. Thirty-seven patients were included and subset analyses were performed on 25 patients operated on an isolated ALIF L5-S1 (group 1), and 12 patients with hybrid surgery consisting of an L5-S1 ALIF procedure and a L4-L5 lumbar disc replacement (group 2). Clinical parameters were analyzed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at M0 (preoperative) and M12 (12 months). Lumbo-pelvic parameters were assessed on a standing full-spine X-ray, preoperatively and at M12 after surgery. Results: We observed a significant evolution of L1-S1 lumbar lordosis (p<0.001) with a significant increase of the distal arch L4-S1 lordosis (p<0.001) and decrease of the proximal arch lordosis (p=0.03). Preoperatively, 27% of the patients were unbalanced. Significant variation in sagittal balance parameters was observed, with a decrease of the sagittal vertebral axis (p<0.001). VAS and ODI improved significantly but no correlation was found. An evolution in the same direction was found in the two subgroup analyses. Conclusions: ALIF procedure on L5-S1 level allowed a reconstruction of lumbosacral segmental lordosis, modification of global lordosis, without variation of spino-pelvic parameters except an improvement in sagittal balance.

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What is the Impact of a Spinal Fusion on Acetabular Implant Orientation in Functional Standing and Sitting Positions?

Cited by 72 publications

References 27 publications

Accuracy and Precision of an Ultrasound‐Based Device to Measure the Pelvic Tilt in Several Positions

Accuracy and Precision of an Ultrasound‐Based Device to Measure the Pelvic Tilt in Several Positions

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

Prospective Evaluation of Spino-Pelvic Parameters with Clinical Correlation in Patients Operated with an Anterior Lumbar Interbody Fusion

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