Changes of acetabular anteversion according to pelvic tilt on sagittal plane under various acetabular inclinations

Song, Suk Kyoon; Choi, Won-Kee; Jung, Suk Han; Kim, Hee Chan; Kim, Tae Hoon; Cho, Michael

doi:10.1002/jor.24790

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…In our case, the anterior tilted pelvi along with the angles of the femur in the heel strike simulations distributed the load anteriorly and superiorly compared to posterior tilt, thus agreeing with Henak and colleagues' findings [51]. Our results suggest that patients may experience higher contact stress on the femoral head cartilage during gait, especially in patients with excess posterior pelvic tilt [8,49,[51][52][53]. Along with higher femoral head contact stress, patients with posterior pelvic tilt may be more prone to slip due to higher shear stresses at the growth plate.…”

Section: Discussionsupporting

confidence: 91%

Biomechanical Implications of Spinopelvic Alignment on Femoral Head Cartilage and the Proximal Femoral Physis in Slipped Capital Femoral Epiphysis: A Theoretical Finite Element Analysis

Kumaran,

Mumtaz,

Quatman

et al. 2024

Preprint

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Background Slipped capital femoral epiphysis (SCFE) is a prevalent pediatric hip disorder. Recent studies suggest the spine's sagittal profile may influence the proximal femoral growth plate's slippage, an aspect not extensively explored. This study utilizes finite element analysis to investigate how different spinopelvic alignments affect shear stress and potential slippage at the growth plate. Methods A finite element model was developed from CT scans of a healthy adult male lumbar spine, pelvis, and femurs. The model was subjected to various sagittal alignments through rotational boundary conditions. Simulations of two-leg stance, one-leg stance, walking heel strike, ascending stairs heel strike, and descending stairs heel strike were conducted. Parameters measured included hip joint contact area, stress, and maximum Tresca (shear) stress on the growth plate. Findings Posterior pelvic tilt cases indicated larger shear stresses compared to the anterior pelvic tilt variants except in two leg stance. Two leg stance resulted in decreases in the posterior tilted pelvi variants compared to anterior tilted pelvi, however a combination of posterior pelvic tilt and high pelvic incidence indicated larger shear stresses on the growth plate. One leg stance and heal strike resulted in higher shear stress on the growth plate in posterior pelvic tilt variants compared to anterior pelvic tilt, with a combination of posterior pelvic tilt and high pelvic incidence resulting in the largest shear stress. Interpretation Our findings suggest that posterior pelvic tilt and high pelvic incidence can lead to increased shear stress at the growth plate. Activities performed in patients with these alignments may predispose to biomechanical loading that shears the growth plate, potentially causing slippage.

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Section: Discussionsupporting

confidence: 91%

Biomechanical Implications of Spinopelvic Alignment on Femoral Head Cartilage and the Proximal Femoral Physis in Slipped Capital Femoral Epiphysis: A Theoretical Finite Element Analysis

Kumaran,

Mumtaz,

Quatman

et al. 2024

Preprint

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“…Anterior pelvic plane inclination (APPI) was the most significant factor affecting acetabular cup anteversion (Figure 7). Many previous studies have revealed that the pelvic tilt angle affects the degree of acetabular cup anteversion 34–36 . We found that APPI was an important factor affecting the acetabular cup anteversion without considering what kind of surgical approach to use (Table 3).…”

Section: Discussionmentioning

confidence: 84%

“…Many previous studies have revealed that the pelvic tilt angle affects the degree of acetabular cup anteversion. 34 , 35 , 36 We found that APPI was an important factor affecting the acetabular cup anteversion without considering what kind of surgical approach to use (Table 3 ). When surgical approach was considered, we found that APPI remained an important factor influencing acetabular cup anteversion, and that its size was positively correlated with acetabular cup anteversion (Tables 4 and 5 ).…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Radiographic Outcomes after Total Hip Arthroplasty between the Direct Lateral Approach and Posterior Lateral Approach with EOS 2D/3D X‐Ray Imaging System

Xie

Huang

et al. 2023

Orthopaedic Surgery

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Objective The classical approaches for total hip arthroplasty (THA) are the direct lateral approach (DLA) and posterior lateral approach (PLA). There are few studies comparing implant orientation with these two approaches, and the impact of surgical approaches on implant orientation remains controversial. With the rise of the EOS imaging system, we aimed to use it to identify the differences between and factors associated with implant orientation after THA using DLA and PLA. Methods In our department from January 2019 to December 2021, 321 primary unilateral THAs that used PLA and DLA were enrolled. A total of 201 patients who received PLA and 120 patients who received DLA were included in this study. Two blinded observers measured each case using EOS imaging data. Postoperative imaging metrics and other relevant influencing factors of the two surgical approaches were compared. Postoperative imaging metrics, including the anteversion and inclination of the cup, anteversion of the stem, and combined anteversion were measured based on EOS. Other relevant influencing factors included age, approach, gender, laterality, BMI, anterior pelvic plane inclination, femoral head diameter, femoral offset, lateral pelvic tilt, pelvic incidence, pelvis axial rotation, sacral slope, sagittal pelvic tilt, and surgery time. Multiple linear regression analyses were performed to identify the predictors of acceptability for each imaging data point. Results No dislocation was found in the 321 patients who underwent primary THA during this period. The mean anteversion and combined anteversion of the cups using the DLA were 21.33° ± 17.31° (−51.7°–60.8°) and 33.71° ± 20.85° (−38.8°–77.6°) and PLA were 25.34° ± 12.76° (−5.5°–57.0°) and 42.37° ± 18.85° (−8.7°–84.7°), respectively. The DLA group had smaller anteversion ( p = 0.038) and combined anteversion ( p < 0.001). We found that surgical approach ( p < 0.05), anterior pelvic plane inclination ( p < 0.001), gender ( p < 0.001), and femoral head diameter ( p < 0.001) were important factors affecting acetabular cup anteversion ( R 2 = 0.375) and combined anteversion ( R 2 = 0.525). Conclusions In total hip arthroplasty, different prosthesis installation directions should be made according to different surgical approaches. Compared with the direct lateral approach, the acetabular anteversion can be intentionally enlarged when using the posterolateral approach. Surgical approach, anterior pelvic plane inclination (APPI), gender, and femoral head diameter were significant predictors of prosthesis orientation. The anterior pelvic plane inclination may be a useful standard for assessing the position of the prosthesis using EOS.

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“…The anteversion angles of the cup were measured using axial computed tomography (CT) scans (Fig. 2 B) [ 17 ], whereas the anteversion angles of the femoral component were measured using axial CT scans (Fig. 2 -C) [ 18 ] with a picture archiving and communication system (PACS; GE Healthcare, Chicago, Illinois, USA).…”

Section: Methodsmentioning

confidence: 99%

Insufficient stem antetorsion and lower cup abduction is a combined risk factor for posterior hip dislocation in patients undergoing THA for femoral neck fractures: a retrospective analysis

Li,

Yang,

Guo

et al. 2024

BMC Musculoskelet Disord

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Background The role of acetabular and femoral component positions with respect to the risk of post-operative instability and dislocation remains debated. In this study, we aimed to identify potential risk factors for early dislocation following primary total hip arthroplasty (THA) for displaced intracapsular femoral neck fractures (FNF) using radiological measurements. Methods We retrospectively analyzed data for patients who underwent cementless primary THA for FNF using a posterolateral approach between January 2018 and December 2021. Follow-up duration, age, sex, affected side, and mean time from THA to dislocation were recorded. Leg-length inequality, abductor lever arm, vertical and horizontal femoral offsets, vertical and horizontal hip centers of rotation, abduction, anteversion of the acetabulum and femoral prosthesis, and combined anteversion were measured. Results The study sample included 17 men and 34 women, with 21 and 30 patients undergoing left- and right-hip operations, respectively. The mean patient age was 70.18 ± 7.64 years, and the mean follow-up duration was 27.73 ± 13.52 months. The mean time between THA and dislocation was 1.58 ± 0.79 months. Seven patients (13.73%) sustained posterior dislocation of the hip. The abduction angle (36.05 ± 6.82° vs. 45.68 ± 8.78°) (p = 0.008) and anteversion of the femoral prosthesis (8.26 ± 4.47° vs. 19.47 ± 9.01°) (p = 0.002) were significantly lower in the dislocation group than in the control group. There were no significant differences in other parameters. Conclusions Insufficient stem antetorsion combined with lower abduction angle of the acetabular component were associated with a high risk of dislocation, especially in patients with deep flexion or internal rotation of the flexed hip joint and knees, or in patients with a stiff spine or anterior pelvic tilt, impingement may then occur in the neck of the prosthesis and cup component, ultimately resulting in posterior dislocation. These findings could remind surgeons to avoid simultaneous occurrence of both in THA surgery. These results provide new insight into risk factors for hip dislocation in patients undergoing primary THA for FNF and may aid in reducing the risk of instability and dislocation. Level of evidence Prospective comparative study Level II.

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Changes of acetabular anteversion according to pelvic tilt on sagittal plane under various acetabular inclinations

Cited by 6 publications

References 37 publications

Biomechanical Implications of Spinopelvic Alignment on Femoral Head Cartilage and the Proximal Femoral Physis in Slipped Capital Femoral Epiphysis: A Theoretical Finite Element Analysis

Biomechanical Implications of Spinopelvic Alignment on Femoral Head Cartilage and the Proximal Femoral Physis in Slipped Capital Femoral Epiphysis: A Theoretical Finite Element Analysis

A Comparison of Radiographic Outcomes after Total Hip Arthroplasty between the Direct Lateral Approach and Posterior Lateral Approach with EOS 2D/3D X‐Ray Imaging System

Insufficient stem antetorsion and lower cup abduction is a combined risk factor for posterior hip dislocation in patients undergoing THA for femoral neck fractures: a retrospective analysis

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