Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty: When Does it Matter?

Maratt, Joseph D.; Esposito, Christina; McLawhorn, Alexander S.; Jerabek, Seth A.; Padgett, Douglas E.; Mayman, David J.

doi:10.1016/j.arth.2014.10.014

Cited by 186 publications

(181 citation statements)

References 26 publications

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“…An increase in functional anteversion of the acetabular component is thought to be protective against posterior dislocation in the sitting position, because it provides more posterior coverage of the prosthetic head [19] and reduces the likelihood of anterior impingement of the prosthetic femoral neck on the edge of the acetabular cup or bone [12]. Our study patients experienced a mean increase in posterior pelvic tilt of 22°from standing to sitting position, which is similar to values reported in previous studies [19,25,35], and this increase in posterior pelvic tilt would increase the functional anteversion of the acetabular component by approximately 15° [29,31]. It might be important to consider the outliers, which include 3% of patients (with and without DDD) who actually rotated their pelvises forward (more anterior tilting pelvises) from standing to sitting position.…”

Section: Discussionsupporting

confidence: 85%

“…The patient's inability to accommodate postural changes through the lumbar spine after spine surgery, with limited change in pelvic tilt during functional activities, may explain the reported dislocation event. Pelvic tilt affects the functional orientation of acetabular components in patients undergoing THA, such that increasing posterior pelvic tilt increases functional acetabular inclination and anteversion, while decreasing pelvic tilt will result in the loss of functional inclination and anteversion [31]. Previous studies have shown that preoperative pelvic tilt from standing to sitting position can be used to reliably predict postoperative THA cup orientation with standing and sitting lateral radiographs [19,23].…”

Section: Discussionmentioning

confidence: 99%

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Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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201

177

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Background Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbarpelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized. Therefore, we measured standing and sitting lumbar-pelvic-femoral alignment in patients with radiographic signs of DDD and in patients with no radiographic signs of spine arthrosis.Questions/purposes We asked: (1) Is there a difference in standing and sitting lumbar-pelvic-femoral alignment before surgery among patients undergoing THA who have no radiographic signs of spine arthrosis compared with those with preexisting lumbar DDD? (2) Do patients with lumbar DDD experience less spine flexion moving from a standing to a sitting position and therefore compensate with more femoroacetabular flexion compared with patients who have no radiographic signs of arthrosis? Methods Three hundred twenty-five patients undergoing primary THA had preoperative low-dose EOS spine-toankle lateral radiographs in standing and sitting positions. Eighty-three patients were excluded from this study for scoliosis (39 patients), spondylolysis (15 patients), not having five lumbar vertebrae (7 patients), surgical or disease fusion (11 patients), or poor image quality attributable to high BMI (11 patients). In the remaining 242 of 325 patients (75%), two observers categorized the lumbar spine as either without radiographic arthrosis or having DDD based on defined radiographic criteria. Sacral slope, lumbar lordosis, and proximal femur angles were measured, and these angles were used to calculate lumbar spine flexion and femoroacetabular flexion in standing and sitting positions. Patients were aligned in a standardized sitting position so that their femurs were parallel to the floor to achieve approximately 90°of apparent hip flexion. Results After controlling for age, sex, and BMI, we found patients with DDD spines had a mean of 5°more posterior pelvic tilt (95% CI, À2°to À8°lower sacral slope angles; p \0.01) and 7°less lumbar lordosis (95% CI, À10°to À3°; p \ 0.01) in the standing position compared with patients without radiographic arthrosis. However, in the sitting position, patients with DDD spines had 4°less posterior pelvic tilt (95% CI, 1°-7°higher sacral slope angles; p = 0.02). From standing to sitting position, patients with DDD

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

Self Cite

201

177

View full text Add to dashboard Cite

show abstract

“…showed that every 1° increase in anterior pelvic tilt would result in a reduction of acetabular anteversion by 0.7°–0.8°. Other studies also obtained similar conclusions.…”

Section: Effects Of Pelvic Tilt On Acetabular Anteversionsupporting

confidence: 75%

“…LL was proposed to be directly affected by SS, and the two were positively correlated. The changes in the pelvic tilt need to be compensated by changes in the LL, eventually reaching the balance of the sagittal plane. Different compensation mechanisms might be activated when the spine is deformed: the spinal segments on both sides of the deformed parts can be compensated in the case of adequate spinal flexibility.…”

Section: Correlation Between Sagittal Morphology Of the Spine And Pelmentioning

confidence: 99%

The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis

Yang

Zhang

2019

Orthopaedic Surgery

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The concept of the “safe area” of the acetabular prosthesis has a long history and has been recognized by many scholars. It is generally believed that postoperative hip dislocation rate is low, when the acetabular anteversion angle is placed in the range of 15° ± 10°. Despite this, hip dislocation is a common complication after total hip arthroplasty. In recent years, more and more scholars have paid attention to the influence of pelvic tilt on the acetabular anteversion angle. The concept of acetabular anteversion changes as the pelvic tilt changes, and is challenging the traditional acetabular prosthesis “safe area.” This study summarized the potential influencing factors of pelvic tilt and discussed the influence of the phenomenon on the anteversion angle of total hip arthroplasty (THA) acetabular prosthesis based on the literature review. We conclude that from the supine position to standing, followed by sitting, the pelvis tends to move backward. Pelvic sagittal activity, lumbar disease (ankylosing spondylitis), lumbar fusion (lumbar fusion, spine‐pelvic fusion), and other factors related to the tilt are THA risk factors for postoperative dislocation and revision. With the change of body position, the degree of acetabular anteversion is directly related to the degree of pelvic tilt. The acetabular anteversion varies greatly, which leads to increased hip prosthesis wear and even hip dislocation. The lateral X‐ray of the spine and pelvis is recommended in supine, standing, and sitting positions before THA. In addition, the pelvic tilt should be regarded as a reference of the acetabular prosthesis in the preoperative planning of THA.

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“…[1] about the role of pelvic sagittal alignment in the functional orientation of the acetabular cup in total hip arthroplasty (THA).…”

mentioning

confidence: 99%

Letter to the Editor: Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty: When Does it Matter?

Pierannunzii

2016

The Journal of Arthroplasty

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Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty: When Does it Matter?

Cited by 186 publications

References 26 publications

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis

Letter to the Editor: Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty: When Does it Matter?

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