Importance of the spinopelvic factors on the pelvic inclination from standing to sitting before total hip arthroplasty

Ochi, Hironori; Baba, Tomonori; Homma, Yasuhiro; Matsumoto, M; Nojiri, Hidetoshi; Kaneko, Kazuo

doi:10.1007/s00586-015-4217-2

Cited by 68 publications

(53 citation statements)

References 44 publications

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“…In general, PT changes posteriorly from supine to standing position. Preoperative assessment with a dynamic evaluation in the standing and sitting or supine position reduces the risk of complications. Second, PT changes posteriorly over the years after THA.…”

Section: Discussionmentioning

confidence: 99%

“…Cup inclination and anteversion angles were targeted at 35°–45° and 15°–25°. Cup orientation is affected by the pelvic tilt (PT), and several studies have demonstrated the postural change in PT between sitting, supine and standing position. Postoperative change in PT is important for accurate preoperative planning of acetabular cup angles.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

Kanto

Maruo

Tachibana

et al. 2019

Orthopaedic Surgery

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Objective To evaluate the impact of spinopelvic parameters and hip contracture on change in the pelvic tilt (PT) after Total hip arthroplasty (THA). Methods One hundred patients (15 male and 85 female) who underwent THA were included in this prospective study. Radiographic data were obtained preoperatively and 1 year after THA. Radiographic parameters included sagittal anterior pelvic plane (APP), sagittal vertical axis (SVA), sacral slope (SS), pelvic inclination (PI), and lumbar lordosis angle (LL). The APP was defined as the angle between the anterior pelvic plane and the vertical plane. A positive value indicates pelvic retroversion. Postoperative changes in PT were divided into three groups: the PA group (pelvic anteversion, ΔAPP < −5°), the PR group (pelvic retroversion, ΔAPP > 5°), and the PT group (minimal change, ΔAPP ≤ ± 5°). The Kruskal–Wallis test and the Steel–Dwass test were used to compare the preoperative and postoperative spinopelvic parameters among the three groups. The Spearman's rank correlation coefficient was used to evaluate the correlation between ΔAPP and spinopelvic parameters. Results Minimal change in pelvic tilt was observed in 59% of patients, while pelvic anteversion was observed in 16% of patients and pelvic retroversion was observed in 25% of patients. There were no significant changes in the spinopelvic parameters, including TK, LL, SVA, LL, SS, and APP after THA. The Femoral angle (FA) was significantly decreased after THA (P < 0.001). Preoperative APP was significantly more retroverted in the PA group than the PR group, and the PT group (6.8 ± 12.2, 0.2 ± 9.9, −8.3 ± 8.3, P < 0.001). Preoperative SS, PI‐LL, and PI were significantly smaller in the PA group than the PT group and the PR group. A significant negative correlation was identified between preoperative APP and ΔAPP (r = −0.418, P < 0.001). Conclusion Approximately 60% of the patients did not have any marked change in PT after THA. Preoperative APP was the only predictive factor associated with marked anterior or posterior change in PT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

Kanto

Maruo

Tachibana

et al. 2019

Orthopaedic Surgery

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“…Previous studies reported that patients with hip osteoarthritis demonstrated abnormal hip kinematics during daily activity [7,8]. Moreover, other studies reported that spinal fusion may alter the adaptation of the spinopelvic junction [9,10]. This can result in less than optimal acetabular implant anteversion and inclination in standing and sitting positions, leading to potential dislocations or subluxations after total hip arthroplasty (THA) [3].…”

Section: Introductionmentioning

confidence: 99%

Stand-to-Sit Kinematics of the Pelvis Is Not Always as Expected: Hip and Spine Pathologies Can Have an Impact

Youngwoo

Vergari

Girinon

et al. 2019

The Journal of Arthroplasty

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Introduction; Stand to sit pelvis kinematics is commonly considered as a rotation around the bicoxofemoral axis. However, abnormal kinematics could occur for patients with musculoskeletal disorders affecting the hip-spine complex. The aim of this study is to perform a quantitative analysis of the stand to sit pelvis kinematics using 3D reconstruction from biplanar x-rays. Material & Methods; Thirty volunteers as a control group (C), 30 patients with hip pathology (Hip) and 30 patients with spine pathology (Spine) were evaluated. All subjects underwent standing and sitting full-body bi-planar x-rays. 3D reconstruction was performed in each configuration and then translated such as the middle of the line joining the center of each acetabulum corresponds to the origin. Rigid registration quantified the finite helical axis (FHA) describing the transition between standing and sitting with two specific parameters. The orientation angle (OA) is the signed 3D angle between FHA and bicoxofemoral axis and the rotation angle (RA) represents the signed angle around FHA. Results; Mean OA was-1.8° for C group, 0.3° for Hip group and-2.4° for Spine group. There was no significant difference in mean OA between groups. However, variability was higher for Spine group with a standard deviation of 16.4° compared to 10.8° in C group and 12.3° in Hip group. Mean RA in C group was 18.1° (SD 9.1°). There was significant difference in RA between Hip and Spine groups (21.1° SD 8.0°) and 16.4° (SD 10.8°), respectively) (p=0.04). Conclusion; Hip and spine pathologies affect stand to sit pelvic kinematics.

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“…During sitting, the L1 slope change was relatively small (4.7°). As the kyphotic thoracic spine forms a cage in combination with the ribs and respiratory muscles, a minimal sagittal ROM (0.1°) is present, as reported by Ochi et al [8] This cage provides a stable base for the cervical spine and head. Below L1, the lumbar spine, pelvis, and femur rotate in a chain-like manner to distribute the flexion of the spinofemoral movement [21].…”

Section: Discussionmentioning

confidence: 69%

“…The functional angles of the acetabular component in THA patients may change according to the body posture [5][6][7][8]. Studies have reported a 22.3-28.7°posterior pelvic tilt change from standing to sitting [6][7][8]. Babisch et al (2008) reported that for every 1°change in the pelvic tilt, the cup inclination and anteversion changed by approximately 0.3°and 0.8°, respectively [5].…”

Section: Introductionmentioning

confidence: 99%

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

Feng

et al. 2020

BMC Musculoskelet Disord

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Background: Limitations in the lumbar spine movement reduce lumbar vertebral motion and affect spinopelvic kinematics. We studied the influence of lumbar intervertebral disc degeneration on spinofemoral movement, from standing to sitting, in patients undergoing total hip arthroplasty (THA). Methods: Of 138 consecutive patients scheduled for THA due to unilateral avascular necrosis (AVN) of the femoral head, those with ≥3 discs with University of California at Los Angeles (UCLA) disc degeneration score > 1 were defined as the lumbar degenerative disc disease (LDD) group, and the remaining patients constituted d the control group. Full body anteroposterior and lateral EOS images in the standing and sitting positions were obtained. Pelvic incidence (PI), L1 slope (L1 s), lumbar lordosis angle (LL), pelvic tilt (PT), sacral slope (SS), femoral slope (Fs), sagittal vertical axis (SVA), hip flexion, lumbar spine flexion, and total spinofemoral flexion were measured on the images and compared between groups. Results: No significant between-group differences were observed in the height, weight, body mass index, AVN staging, or PI, SS, and Fs on standing. The LDD group included more females and older patients, had 5°lesser LL, 5°g reater PT, and larger SVA. From standing to sitting, the PI remained constant in both groups. Total spinofemoral flexion was 7°less, lumbar spine flexion 16°less, L1 slope change 6°less, and SS change 8°less, and hip flexion was 7°more in the LDD than in the control group. The spine/hip flexion ratio was significantly lower in the LDD group (0.3 versus 0.7; p < 0.001). On regression analysis, the LDD group (p < 0.001) and older age (p = 0.048) but not sex, weight, or height were significant univariate predictors of decreased spine/hip ratio. Conclusions: Patients with LDD leant more forward and had a larger pelvis posterior tilt angle on standing and a decreased lumbar spine/hip flexion ratio, with more hip joint flexion, on sitting, to compensate for reduced lumbar spine flexion. Surgeons should be aware that elderly patients with multiple LDD have significantly different spinofemoral movements and increased risk of posterior dislocation post-THA. Preoperative patient identification, intraoperative surgical technique modification, and individualized rehabilitation protocols are necessary.

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Importance of the spinopelvic factors on the pelvic inclination from standing to sitting before total hip arthroplasty

Abstract: The change in pelvic inclination from standing to sitting is strongly related to the mobility of the lumbar spine in patients with hip diseases.

Cited by 68 publications

References 44 publications

Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

Stand-to-Sit Kinematics of the Pelvis Is Not Always as Expected: Hip and Spine Pathologies Can Have an Impact

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

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