Pelvic Tilt Displacement Before and After Artificial Hip Joint Replacement Surgery

Nishiwaki, Toru; Hata, Ryosuke; Oya, Akihito; Nakamura, Masaya; Matsumoto, Morio; Kanaji, Arihiko

doi:10.1016/j.arth.2017.10.014

Cited by 12 publications

(12 citation statements)

References 16 publications

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“…Whether PT differs before and after total hip arthroplasty is controversial. In most studies, PT did not change 16-19 . However, it has been reported that in specific groups of patients, PT changed.…”

Section: Discussionmentioning

confidence: 88%

Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia

Okuzu

Goto

Okutani

et al. 2019

JBJS OA

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Background: Hip-spine syndrome was originally described by Offierski and MacNab, who argued that the flexion deformity of the hip rotated the pelvis forward, causing the spine symptoms. We additionally hypothesized that in patients who have osteoarthritis (OA) of the hip, the pelvis is tilted anteriorly to compensate for the anterior acetabular coverage defect. We investigated the hip factors associated with anterior pelvic tilt (PT) in patients who had OA of the hip due to acetabular dysplasia. Methods: We retrospectively reviewed the medical records of patients who had undergone total hip arthroplasty between January 2009 and December 2017 to identify those who had unilateral secondary OA due to acetabular dysplasia. Patients who had spinal imbalance, a history of spinal or lower limb fracture or surgery, bilateral OA of the hip, or a severely subluxated hip were excluded, leaving 100 eligible patients. We defined the indicators of an anterior acetabular coverage defect, flexion deformity of the hip, and anterior PT as the acetabular anteversion angle (AAA), extension range of motion (ROM), and anterior tilt of the pelvis, respectively. We measured hip factors and spinal parameters on radiographs and the standardized axial and coronal planes on 3-dimensional computed tomography with reference to the anterior pelvic plane. Hip factors associated with PT were investigated. Results: Univariate analysis showed a significant correlation between PT and both AAA (r = –0.389, p < 0.001) and combined anteversion angle (r = –0.272, p = 0.03). Multivariate regression analysis identified AAA (β = –0.385, p < 0.001) and extension ROM (β = 0.212, p = 0.0496) as independent factors associated with PT. Lumbar lordosis and pelvic incidence minus lumbar lordosis were significantly correlated with AAA, but sagittal vertical axis was not. Conclusions: When treating patients who have acetabular dysplasia, surgeons should recognize the relationship between the anterior acetabular coverage and anterior PT. Correcting hyperlordosis of the lumbar spine can induce progression of hip OA because it may decrease the acetabular anterior coverage.

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Section: Discussionmentioning

confidence: 88%

Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia

Okuzu

Goto

Okutani

et al. 2019

JBJS OA

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“…Ideally, a prosthesis system should come with recommended prosthesis-specific (technical) targets provided by the distributor because the prosthesis’ design determines the kinematic performance of a prosthesis system. Then it would be at the surgeon’s discretion to adapt these targets to patient-specific factors, such as changes in pelvic tilt [ 3 , 20 , 26 , 45 , 48 , 54 , 61 , 69 , 74 , 101 ], changes because of limitations in the lower spine [ 8 , 13 , 30 , 32 , 34 , 38 , 47 , 62 , 71 , 79 , 84 ], incidental pelvic reorientation after THA [ 11 , 47 , 51 , 61 , 68 ], and other changes after surgery [ 65 , 83 , 87 ]. However, to our knowledge, no prosthesis-specific targets have been published.…”

Section: Introductionmentioning

confidence: 99%

The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components

Widmer

2020

Clin Orthop Relat Res

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Background Lewinnek’s recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. Questions/purposes (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. Methods A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation referencing to body planes was used: cups were abducted from 20° to 70°, and anteverted from -10° to 40°. Stems were rotated from -10° to 40° anteversion, neck-shaft angles varied from 115° to 143°, and head sizes varied from 28 to 40 mm. Hip movements up to the point of prosthetic impingement were tested, including simple flexion/extension, internal/external rotation, ab/adduction, combinations of these, and activities of daily living that were known to trigger dislocation. For each combination of parameters, the impingement-free combined target zone was determined. Maximizing the size of the combined target zone was the optimization criterion. Results The combined target zones for impingement-free cup orientation had polygonal boundaries. Their size and position in the diagram changed with stem anteversion, neck-shaft angle, head size, and target ROM. The largest target zones were at neck-shaft angles from 125° to 127°, at stem anteversions from 10° to 20°, and at radiographic cup anteversions between 17° and 25°. Cup anteversion and stem anteversion were inverse-linearly correlated supporting the combined-anteversion concept. The range of impingement-free cup inclinations depended on head size, stem anteversion, and neck-shaft angle. For a 127°-neck-shaft angle, the lowest cup inclinations that fell within the target zone were 42° for the 28-mm and 35° for the 40-mm head. Cup anteversion and combined version depended on neck-shaft angle. For head size 32-mm cup, anteversion was 6° for a 115° neck-shaft angle and 25° for a 135°-neck-shaft angle, and combined version was 15° and 34° respectively. Conclusions The shape, size, and location of the combined target zones were dependent on design and implantation parameters of both components. Changing the prosthesis design or changing implantation parameters also changed the combined target zone. A maximized combi...

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“…Most of the studies agree that pelvic position shows a high interindividual variability and cup position should be adjusted accordingly (Table 3). 2,3,6,7,15,16,18,28–32 In contrast, the discussion about the change after THA is controversial. While some studies describe a relatively fixed position of the pelvis pre‐ to postoperatively, 15,16,28 others studies have reported a significant change of pelvic tilt 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…However, this has been discussed controversially in literature. Whilst some studies describe the position of the pelvis as steady 15,16 others report relevant pelvic displacements after THA up to 21.7° 17,18 . In addition, activities of daily living reflect dynamic movement sequences including a range of motion of the pelvis.…”

Section: Introductionmentioning

confidence: 99%

Kinematic pelvic tilt during gait alters functional cup position in total hip arthroplasty

Weber¹,

Suess

Jerabek

et al. 2021

Journal Orthopaedic Research

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Static pelvic tilt impacts functional cup position in total hip arthroplasty (THA). In the current study we investigated the effect of kinematic pelvic changes on cup position. In the course of a prospective controlled trial postoperative 3D‐computed tomography (CT) and gait analysis before and 6 and 12 months after THA were obtained in 60 patients. Kinematic pelvic motion during gait was measured using Anybody Modeling System. By fusion with 3D‐CT, the impact of kinematic pelvic tilt alterations on cup anteversion and inclination was calculated. Furthermore, risk factors correlating with high pelvic mobility were evaluated. During gait a high pelvic range of motion up to 15.6° exceeding 5° in 61.7% (37/60) of patients before THA was found. After surgery, the pelvis tilted posteriorly by a mean of 4.0 ± 6.6° (p < .001). The pelvic anteflexion led to a mean decrease of −1.9 ± 2.2° (p < .001) for cup inclination and −15.1 ± 6.1° (p < .001) for anteversion in relation to the anterior pelvic plane (APP). Kinematic pelvic changes resulted in a further change up to 2.3° for inclination and up to 12.3° for anteversion. In relation to the preoperative situation differences in postoperative cup position ranged from −4.4 to 4.6° for inclination and from −7.8 to 17.9° for anteversion, respectively. Female sex (p < .001) and normal body weight (p < .001) correlated with high alterations in pelvic tilt. Kinematic pelvic changes highly impact cup anteversion in THA. Surgeons using the APP as reference should aim for a higher anteversion of about 15° due to the functional anteflexion of the pelvis during gait.

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Pelvic Tilt Displacement Before and After Artificial Hip Joint Replacement Surgery

Cited by 12 publications

References 16 publications

Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia

Hip-Spine Syndrome: Acetabular Anteversion Angle Is Associated with Anterior Pelvic Tilt and Lumbar Hyperlordosis in Patients with Acetabular Dysplasia

The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components

Kinematic pelvic tilt during gait alters functional cup position in total hip arthroplasty

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