Pelvic motion during total hip arthroplasty with translateral and posterolateral approaches

Ezoe, Masamitsu; Naito, Masatoshi; Asayama, Isao; Ishiko, Toshiyuki; Fujisawa, Michiko

doi:10.1007/s00776-004-0880-6

Cited by 23 publications

(17 citation statements)

References 13 publications

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“…We therefore recommend that surgeons consider having at least two supports anteriorly, thereby achieving three-point stabilisation and increasing pelvic constraint. Like Ezoe et al, 15 we identified significantly more intra-operative movement with the posterior approach (mean 9°) than with the lateral approach (mean 4°) in THR. During the posterior approach, the intact strong anterior capsule and iliofemoral ligament, coupled with the strong retraction and the leg-twisting manoeuvre, probably apply an increased torque to the pelvis.…”

Section: Discussionsupporting

confidence: 77%

Pelvic position and movement during hip replacement

Grammatopoulos

Pandit

Assuncao³

et al. 2014

The Bone & Joint Journal

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The orientation of the acetabular component is influenced not only by the orientation at which the surgeon implants the component, but also the orientation of the pelvis at the time of implantation. Hence, the orientation of the pelvis at set-up and its movement during the operation, are important. During 67 hip replacements, using a validated photogrammetric technique, we measured how three surgeons orientated the patient's pelvis, how much the pelvis moved during surgery, and what effect these had on the final orientation of the acetabular component. Pelvic orientation at set-up, varied widely (mean (± 2, standard deviation (sd))): tilt 8° (2sd ± 32), obliquity -4° (2sd ± 12), rotation -8° (2sd ± 14). Significant differences in pelvic positioning were detected between surgeons (p < 0.001). The mean angular movement of the pelvis between set-up and component implantation was 9° (sd 6). Factors influencing pelvic movement included surgeon, approach (posterior > lateral), procedure (hip resurfacing > total hip replacement) and type of support (p < 0.001). Although, on average, surgeons achieved their desired acetabular component orientation, there was considerable variability (2sd ± 16) in component orientation. We conclude that inconsistency in positioning the patient at set-up and movement of the pelvis during the operation account for much of the variation in acetabular component orientation. Improved methods of positioning and holding the pelvis are required.

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Section: Discussionsupporting

confidence: 77%

Pelvic position and movement during hip replacement

Grammatopoulos

Pandit

Assuncao³

et al. 2014

The Bone & Joint Journal

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“…The more common surgical approaches require that the patient be positioned in the lateral decubitus position which may result in tilting of the pelvis anteriorly during surgery [11, 12]. This anterior pelvic tilt if unrecognized intraoperatively may result in placement of the acetabular cup with inadequate anteversion, thus predisposing to posterior dislocation.…”

Section: Discussionmentioning

confidence: 99%

Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

Alexandrov

Ahlmann

Menendez

2014

Advances in Orthopedics

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We present a retrospective review of the early results and complications in a series of 35 consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%), femur fracture (2%), greater trochanteric fracture (12%), postoperative periprosthetic intertrochanteric fracture (2%), femoral nerve palsy (5%), hematoma (2%), and postoperative iliopsoas avulsion (2%). Radiographic analysis revealed average cup anteversion of 19.6° ± 6.6, average cup abduction angle of 48.4° ± 7, stem varus of 0.9° ± 2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery.

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“…[14][15][16] In one study, we observed a maximum pelvic rotation of 31°and maximum obliquity of 9°, 14 confirming similar findings from other authors who also found extreme examples of patient movement. 17,18 Intraoperative movement to this degree threatens to affect the ability of the surgeon to accurately place the cup component. As such, several authors [19][20][21][22] have investigated the relationship between intraoperative patient movement and cup position.…”

mentioning

confidence: 99%

“…In one of the few available studies, no association between rotation and cup position was noted, although pelvic obliquity and tilt were found to affect cup position. 20 The lack of evidence outlining the relationship between intraoperative pelvic rotation and its effect on cup position is curious, and the magnitude of rotation recorded in various studies 14,17,18 warrants investigation.…”

mentioning

confidence: 99%

Undetected Intraoperative Pelvic Movement Can Lead to Inaccurate Acetabular Cup Component Placement during Total Hip Arthroplasty: A Mathematical Simulation Estimating Change in Cup Position

et al. 2017

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Intraoperative patient movement is a common but underappreciated phenomenon in total hip arthroplasty (THA). Such movement can significantly affect the accuracy with which the acetabular cup component is implanted. To evaluate the effect of intraoperative movement on cup position, we performed a study using mathematical modeling to simulate intraoperative movement. Mathematical simulations were used to simulate pelvic movements during THA. Pelvic axial rotation, tilt, and obliquity were simulated, and the resulting changes in intended cup position were calculated. The rate of change of inclination and anteversion per degree of pelvic movement was calculated, establishing a ratio relating cup angle sensitivity to pelvic movement. These sensitivities were used to construct nomograms showing the per-degree effect of pelvic movement on cup position. The effect of pelvic movement on cup position was multifactorial and dependent on the intended cup orientation. For a cup intended to be inserted at 15° anteversion and 40° inclination, each degree of pelvic rotation induced changes of 0.64° and –0.20°, respectively. For this same cup orientation, each degree of pelvic tilt induced changes of 0.77° for anteversion and 0.17° for inclination. Pelvic obliquity was associated with a 1:1 ratio with inclination, with each degree of obliquity inducing 1° of change in inclination. Anteversion was unaffected by changes in pelvic obliquity. This study demonstrates the consequences of undetected pelvic movement on cup position, including the increased risk of the acetabular component being placed in an orientation that could increase wear or the likelihood of impingement and dislocation.

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Pelvic motion during total hip arthroplasty with translateral and posterolateral approaches

Cited by 23 publications

References 13 publications

Pelvic position and movement during hip replacement

Pelvic position and movement during hip replacement

Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

Undetected Intraoperative Pelvic Movement Can Lead to Inaccurate Acetabular Cup Component Placement during Total Hip Arthroplasty: A Mathematical Simulation Estimating Change in Cup Position

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