Applying the hip-spine relationship in total hip arthroplasty

Wiznia, Daniel H.; Buchalter, Daniel B.; Kirby, David J.; Buckland, Aaron J.; Long, William J.; Schwarzkopf, Ran

doi:10.1177/1120700020949837

Cited by 11 publications

(7 citation statements)

References 47 publications

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“…This difference can lead to greater relative hip use with aging and might render the hip at risk for dislocation and adverse biomechanics. Increasing lumbar spinal stiffness during aging is a concern in patients treated with THA, as it can increase the risk of dislocation (for the same reason that patients with lumbar fusion have a higher risk of dislocation) 1,2,30 .…”

Section: Discussionmentioning

confidence: 99%

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Defining “Normal” Static and Dynamic Spinopelvic Characteristics

et al. 2022

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Background: Spinopelvic characteristics influence the hip's biomechanical behavior. However, there is currently little knowledge regarding what "normal" characteristics are. This study aimed to determine how static and dynamic spinopelvic characteristics change with age, sex, and body mass index (BMI) among well-functioning volunteers.Methods: This was a cross-sectional cohort study of 112 asymptomatic volunteers (age, 47.4 ± 17.7 years; 50.0% female; BMI, 27.3 ± 4.9 kg/m 2 ). All participants underwent lateral spinopelvic radiography in the standing and deepseated positions to determine maximum hip and lumbar flexion. Lumbar flexion (change in lumbar lordosis, ΔLL), hip flexion (change in pelvic-femoral angle, ΔPFA), and pelvic movement (change in pelvic tilt, DPT) were determined. The hip user index, which quantifies the relative contribution of the hip to overall sagittal movement, was calculated asResults: There were decreases of 4.5°(9%) per decade of age in lumbar flexion (rho, 20.576; p < 0.001) and 3.6°(4%) per decade in hip flexion (rho, 20.365; p < 0.001). ΔLL could be predicted by younger age, low standing PFA, and high standing LL. Standing spinopelvic characteristics were similar between sexes. There was a trend toward men having less hip flexion (90.3°± 16.4°versus 96.4°± 18.1°; p = 0.065) and a lower hip user index (62.9% ± 8.2% versus 66.7% ± 8.3%; p = 0.015). BMI weakly correlated with ΔLL (rho, 20.307; p = 0.011) and ΔPFA (rho, 20.253; p = 0.039).Conclusions: Spinopelvic characteristics were found to be age, sex, and BMI-dependent. The changes in the lumbar spine during aging (loss of lumbar lordosis and flexion) were greater than the changes in the hip, and as a result, the hip's relative contribution to overall sagittal movement increased. Men had a greater change in posterior pelvic tilt when moving from a standing to a deep-seated position in comparison with women, secondary to less hip flexion. The influence of BMI on spinopelvic parameters was low.T he relationship among the hip, pelvis, and spine has recently received great interest, as patients with spinopelvic pathology have been shown to have higher rates of complications, including dislocation, following total hip arthroplasty (THA) [1][2][3][4] . The position of the lumbar spine affects the pelvic position, which in turn influences acetabular orientation 5,6 , an important determinant of hip biomechanics in native 4,7,8 and replaced hips 9,10 . In patients with hip osteoarthritis, femoroacetabular flexion is reduced, which is associated with an increased posterior pelvic tilt (PT) in the seated position and corresponding compensation in the lumbar spine (reduction in lordosis angle) 11 . This compensatory mechanism is reversed after THA in individuals without a history of spinal fusion 12 .Changes in spinopelvic parameters during aging might be different between asymptomatic and symptomatic individuals, because the latter may have developed altered motion due to the underlying pathology 13 . In order to better understand the role of ...

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Section: Discussionmentioning

confidence: 99%

“…The decrease in lumbar flexion (∆LL) with age can be explained by intervertebral disc and facet joint degeneration, which is associated with a reduction in lumbar curvature and range of motion 13,30 . Overall, ∆LL decreased by 4.5° per decade of age, which equates to approximately a 9% relative decrease in lumbar flexion per decade.…”

Section: Discussionmentioning

confidence: 99%

Defining “Normal” Static and Dynamic Spinopelvic Characteristics

et al. 2022

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“…With this work-up, one could differentiate within the spectrum between so-called “hip users” and “spine users.” 35,39 Early recognition of patients at the ends of this spectrum will lead to more realistic patient expectations regarding the risk of THA dislocation. Furthermore, it could help to improve the preoperative work-up in terms of optimal implant selection (dual-mobility articulation, high-offset stem, or large femoral head) 40 and patient-specific implant orientation.…”

Section: Discussionmentioning

confidence: 99%

Current Evidence for Spinopelvic Characteristics Influencing Total Hip Arthroplasty Dislocation Risk

et al. 2022

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Background: Decreased pelvic mobility and pelvic retroversion may result from spinal degeneration and lead to changes in the orientation of the acetabular implant after total hip arthroplasty (THA). While multiple patient and surgery-related factors contribute to THA dislocations, there is increasing evidence that sagittal spinopelvic dynamics are relevant for THA stability. The aim of this systematic review was to assess the relationship between previously described sagittal spinopelvic characteristics and implant dislocations after primary THA.Methods: A comprehensive literature search in the PubMed and Embase databases was conducted for studies reporting on spinopelvic morphology, alignment, pathology, or surgery and THA dislocations. Risk of bias was assessed using the MINORS criteria. Because of high heterogeneity in study methodology, a synthesis of best evidence was performed. Odds ratios (ORs), relative risks (RRs), and effect sizes (g) were calculated.Results: Fifteen studies (1,007,900 THAs) with quality scores of 15 to 23 out of 24 were included. Nine different spinopelvic alignment parameters (8 studies, g 5 0.14 to 2.02), spinal pathology (2 studies, OR 5 1.9 to 29.2), and previous spinal fusion surgery (8 studies, OR 5 1.59 to 23.7, RR 5 3.0) were found to be related to THA dislocation. Conflicting results were found for another sagittal pelvic morphology parameter, pelvic incidence.Conclusions: Several sagittal spinopelvic patient characteristics were found to be related to THA dislocation, and the associated risks were greater than for other patient and surgery-related factors. Future research is needed to determine which of those characteristics and parameters should be taken into account in patients undergoing primary THA.

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Section: Introductionmentioning

confidence: 99%

“…The relationship between the hip and lumbar spine continues to garner interest from clinicians as the interplay between hip function and spinal alignment can influence the outcome of surgery in either region (Ike et al, 2018 ; Vigdorchik et al, 2019 ; Wiznia et al, 2021 ). Understanding determinants of the relationship between the acetabulum and spine are essential as hip surgeons aim to antevert the acetabular component appropriate to the individual patient to minimize the risk of dislocation and avoid problems such as impingement (Lazennec et al, 2007 ; Lewinnek et al, 1978 ).…”

Section: Introductionmentioning

confidence: 99%

Assessment of the acetabular version in relation to sagittal sacropelvic parameters

Baker

Robertson

2022

Clinical Anatomy

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The relationship between acetabular orientation and the sacropelvic parameters is of interest to both hip and spine surgeons as it is increasingly clear disease in one area can affect the other, including the outcome of surgical procedures. The aim of this study was to further clarify the relationship between measures of acetabular orientation and sacropelvic parameters. This study utilized a trauma CT database. A total of 100 scans on adult patients without overt hip or spinal disease were included. Measures of acetabular orientation included the acetabular sagittal angle (ASA) which uses the anterior pelvic plane as a reference and sacroacetabular angle which uses the sacral endplate as a reference (SA); spinopelvic parameters include the pelvic incidence (PI), sacral anatomic orientation (SAO) and pelvic thickness (PTH). Mean age 48.2 years (SD 18.0), 62% male. Mean values were: PI 50.5, SAO 50.7, PTH 106.4 mm, ASA-right 62.1, ASA-left 64.0, SA-right 67.2, and SA-left 65.4. There was substantial correlation between PI and SA (r = 0.628-0.630) and also between SAO and SA (À0.657 to À0.692). Liner regression determined SA was best predicted by the model: SA = 81 Â SAO + 0.36 Â PI. When using the anterior pelvic plane as a reference to define acetabular orientation, there does not appear to be any significant relationship between the sagittal orientation of the acetabulum and sacropelvic parameters. Using the sacrum as a common point of reference allows some further understanding of the interplay between pelvic parameters and the orientation of the acetabulum.

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Applying the hip-spine relationship in total hip arthroplasty

Cited by 11 publications

References 47 publications

Defining “Normal” Static and Dynamic Spinopelvic Characteristics

Defining “Normal” Static and Dynamic Spinopelvic Characteristics

Current Evidence for Spinopelvic Characteristics Influencing Total Hip Arthroplasty Dislocation Risk

Assessment of the acetabular version in relation to sagittal sacropelvic parameters

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