Does It Matter: Total Hip Arthroplasty or Lumbar Spinal Fusion First? Preoperative Sagittal Spinopelvic Measurements Guide Patient-Specific Surgical Strategies in Patients Requiring Both

Parilla, Frank W; Shah, Rohan J.; Gordon, Alexander; Mardjetko, Steven; Cipparrone, Nancy; Goldstein, Wayne M.; Goldstein, Jonathan

doi:10.1016/j.arth.2019.05.053

Cited by 25 publications

(36 citation statements)

References 18 publications

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“…Most surgeons would opt to treat the condition that causes highest degree persistent pain, disability, and decreased quality of life, but there are no established guidelines on this matter. 17,[35][36][37] Although our study found no differences in dislocation rates between patients who received an LSF before THA and those who received an LSF after THA, the low total number of dislocations makes impossible to draw any conclusions about the effect of timing of LSF versus THA. Studies published in the literature have reported conflicting results.…”

Section: Discussioncontrasting

confidence: 65%

Stability in Direct Lateral vs Direct Anterior Total Hip Arthroplasty in the Context of Lumbar Spinal Fusion

Goyal

Divi

Vaccaro

et al. 2022

J Am Acad Orthop Surg

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Introduction: Lumbar spinal fusion (LSF) may increase the risk of dislocation in patients who have undergone total hip arthroplasty (THA), especially when the LSF was done before the THA. Most publications evaluated patients who had undergone THA using a posterior approach to the hip, yet there are little data on the influence of other surgical approaches. The goal of this study was to evaluate the risk of THA dislocation with anterior supine-based surgical approaches to the hip in patients who have undergone surgical management of concurrent hip and spine pathology. Methods: Patients older than 18 years who underwent an LSF and THA using a supine approach-either direct anterior (DA) or direct lateral (DL)-between 2000 and 2018 were identified. Only standard bearings (28-32-36-40 mm) were used. The dislocation rate was determined in this cohort. A subsequent analysis was conducted, stratifying patients based on the order in which they received the LSF or THA. Results: A total of 582 surgical hip-spine patients were retrospectively identified and included in the cohort. Of total, 332 patients (57.0%) received an LSF before the THA; 250 (43.0%) had the fusion after a primary hip replacement. There were 143 patients (24.6%) in the DA group and 439 (75.4%) in the DL group. Overall, there were five dislocations (0.9%) in the entire cohort. Conclusions: In patients with simultaneous degenerative hip and lumbar spine pathology, anterior supine-based approaches demonstrate a low (,1%) risk of instability. Given the small number of total dislocation events (n = 5), additional analysis is warranted to assess the effect of different anterior approaches (DA versus DL) or timing of lumbar spinal surgery (before or after THA).

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Section: Discussioncontrasting

confidence: 65%

Stability in Direct Lateral vs Direct Anterior Total Hip Arthroplasty in the Context of Lumbar Spinal Fusion

Goyal

Divi

Vaccaro

et al. 2022

J Am Acad Orthop Surg

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“… 70 In clinical and radiological analysis, Parilla et al emphasized the importance of the difficult decision of performing lumbar spine fusion due to PT changes in patients with THA. 71 Despite this, they did not find significant differences in the order of procedures. The authors suggested that THA would be better performed one year after lumbar spine fusion, since PT changes are minimal and predictable.…”

Section: The Fate Of Total Hip Arthroplasty and Lumbar Spine Disordermentioning

confidence: 86%

Pelvic motion the key to understanding spine–hip interaction

Pizones

García-Rey

2020

EFORT Open Reviews

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Pelvic motion acting as a hinge between the spine and hips is essential to maintain proper balance during bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment occurs. This pelvic rotation can affect functional acetabular orientation, and consequently functional cup positioning if a total hip arthroplasty (THA) is needed. Pelvic retroversion, frequently associated with degenerative spinal changes, implies an increase of acetabular version. Patients with flexible lumbar spines (spine users) protect the hip joint. Patients with stiff, degenerated or fused lumbar spines (hip users) demand higher hip mobility, placing the THA at risk. Pelvises in retroversion place the THA at risk for anterior dislocation when standing. In contrast, pelvises in anteversion or with low pelvic incidence (PI) can place THA at risk for posterior dislocation when sitting. Try to set the cup in an anatomic position. However, bear in mind that low PI pelvises may need more acetabular ante-inclination, and high PI pelvises more acetabular retroversion. If surgery is needed, start first by addressing the hip, except in patients with compensation (high pelvic retroversion), who may need spine surgery first to place the pelvis, and consequently the acetabulum, in a proper position. Cite this article: EFORT Open Rev 2020;5:522-533. DOI: 10.1302/2058-5241.5.200032

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“…PI could be used to predict the adaptability of PT and SS regarding their changes in sitting and standing positions, which was not readily recognized by hip surgeon [ 14 , 32 ]. The change of PT and SS is essential in that they determine the hip-spine relationship between different positions and that they are essential to the management of acetabular cup [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…The change of PT and SS is essential in that they determine the hip-spine relationship between different positions and that they are essential to the management of acetabular cup [ 33 ]. For example, a large PI-LL mismatch or large SS or LL loss could negatively affect the functional anteversion ranges at different positions [ 32 ]. Furthermore, Imai et al compared the PI between women with normal hips and female patients with DDH Crowe I, and they showed that PI and anatomical-pelvic tilt were significantly greater in patients with DDH Crowe I [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

The severity of developmental dysplasia of the hip does not correlate with the abnormality in pelvic incidence

Cheng

Huang

Kernkamp

et al. 2020

BMC Musculoskelet Disord

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Background The purpose of this study was to investigate the association between the severity of Developmental dysplasia of the hip (DDH) and the abnormality in pelvic incidence (PI). Methods This was a retrospective study analyzing 53 DDH patients and 53 non-DDH age-matched controls. Computed tomography images were used to construct three-dimensional pelvic model. The Crowe classification was used to classify the severity of DDH. The midpoint of the femoral head centers and sacral endplates were projected to the sagittal plane of the pelvis. The PI was defined as the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting this point to the axis of the femoral heads. Independent sample t-tests were used to compare the differences between the PI of DDH group and the non-DDH controls group. Kendall’s coefficient of concordance was used to determine the correlation between the severity of DDH and PI. Results Patients with DDH had a significantly (p = 0.041) higher PI than the non-DDH controls (DDH 47.6 ± 8.2°, normal 44.2 ± 8.8°). Crowe type I patients had a significantly (p = 0.038) higher PI (48.2 ± 7.6°) than the non-DDH controls. No significant difference between the PI in Crowe type II or III patients and the PI in non-DDH controls were found (Crowe type II, 50.2 ± 9.6°, p = 0.073; Crowe type III, 43.8 ± 7.2°, p = 0.930). No correlation was found between the severity of DDH and the PI (r = 0.091, p = 0.222). Conclusions No correlation was found between the severity of DDH and the PI. The study confirmed that the PI in DDH (Crowe type I) group was higher than that of the non-DDH control group, while the PI does not correlate with the severity of DDH.

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Does It Matter: Total Hip Arthroplasty or Lumbar Spinal Fusion First? Preoperative Sagittal Spinopelvic Measurements Guide Patient-Specific Surgical Strategies in Patients Requiring Both

Cited by 25 publications

References 18 publications

Stability in Direct Lateral vs Direct Anterior Total Hip Arthroplasty in the Context of Lumbar Spinal Fusion

Stability in Direct Lateral vs Direct Anterior Total Hip Arthroplasty in the Context of Lumbar Spinal Fusion

Pelvic motion the key to understanding spine–hip interaction

The severity of developmental dysplasia of the hip does not correlate with the abnormality in pelvic incidence

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