Preoperative planning for implant placement with consideration of pelvic tilt in total hip arthroplasty: postoperative efficacy evaluation

Inaba, Yutaka; Kobayashi, Naomi; Suzuki, Hideharu; Ike, Hiroyuki; So, KF; Saito, T.

doi:10.1186/s12891-016-1120-x

Cited by 33 publications

(27 citation statements)

References 28 publications

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“…In most patients, the coronal plane in the supine position can act as the FPP for planning of the cup angle [9]. THA patients with small lumbo-lordotic angle have tendency of time course change of posterior pelvic tilt after surgery [1,3]. In this case, because the patient had a reduced-lumbar lordosis, postoperative posterior pelvic change was expected and then, the change was considered in preoperative planning of cup positioning [1,3].…”

Section: Discussionmentioning

confidence: 99%

“…CT showed that the anteversion angle of the stem on the femoral table top plane was 16 degrees. Based on a previously published method of calculation [2,3], we planned radiographic cup positioning angle to be 40 degrees of inclination and 26 degrees of anteversion relative to the functional pelvic plane (FPP), which was defined as the coronal plane passing through the bilateral ASIS in the supine position. The anatomic cup positioning angle was planned to be 37.3 degrees of inclination and − 8.3 degrees of anteversion, whereas the radiographic cup positioning angle was planned to be 37 degrees of inclination and − 5 degrees of anteversion and the operative cup positioning angle was planned to be 36.8 degrees of inclination and − 6.3 degrees of anteversion, relative to the APP based on a previously published method [4].…”

Section: Case Presentationmentioning

confidence: 99%

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Utility of CT-based navigation in revision total hip arthroplasty for a patient with severe posterior pelvic tilt-case report-

Watanabe

Choe

Kobayashi

et al. 2020

BMC Musculoskelet Disord

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Background: Hip dislocation after total hip arthroplasty (THA) or hemi-arthroplasty is a rare but serious complication. Dislocation may be prevented by appropriate positioning of the cup angle of inclination and anteversion. Case presentation: This report describes a 66-year-old woman who underwent revision THA using a computer tomography (CT)-based navigation system to treat an anterior dislocation after hemi-arthroplasty due to a severe posterior pelvic tilt. At initial presentation, her sagittal pelvic tilt angle, measured as anterior pelvic plane (APP) in the supine position, was 38 degrees posterior to the coronal plane. Owing to the posterior pelvic tilt, revision THA was performed using CT-based navigation, while dual mobility was utilized to reduce the risk of re-dislocation. Postoperatively, her sagittal pelvic tilt angle showed further progression over time, with an APP of 66 degrees posterior to the coronal plane in the standing position 3 years after revision THA. Simulation with the Zed Hip system showed that the risk of implant-to-implant impingement was much higher posteriorly than anteriorly. Gait analysis demonstrated hyperextension of the hip joint while walking, although hip joint function required for daily activity was maintained. Conclusions: Preoperative planning of implant orientation, based on posterior progression of pelvic tilt and accurate placement of components, is important to prevent dislocation in patients with severe posterior pelvic tilt. A dual mobility cup may also improve hip function in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Utility of CT-based navigation in revision total hip arthroplasty for a patient with severe posterior pelvic tilt-case report-

Watanabe

Choe

Kobayashi

et al. 2020

BMC Musculoskelet Disord

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“…Y. Inaba et al [8] investigated the efficacy of preoperative planning for implant placement with consideration of pelvic tilt in THA, and the accuracy of a CT based computer navigation for implant positioning. The research found that the Mean absolute error of combined anteversion between preoperative planning and post-operative measurement was 5° with use of the CT based navigation.…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary Communication in Orthopedic Surgical Planning

Kostevšek¹,

Drstvenšek²,

Balič³

et al. 2018

J. Prod. Eng.

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The paper describes a process of 3D planning of replacement of an acetabular component on a case of a defect with a huge bone loss estimated at level IIIa according to Paprosky. The planning was based on CT scans of the affected area and performed in interdisciplinary cooperation among surgeons and mechanical engineers. This cooperation combined surgical experiences and knowledge of surgeons with knowledge of engineers in using 3D design tools and mechanical calculation. The cooperation resulted in a virtual 3D plan and 3D printed communication models that enabled flawless communication among the team members. This lead to a definition of optimal hip parameters (centre of rotation, inclination and version angles) in a virtual computer space. To transfer the virtually planned parameters and shapes into a real environment surgical equipment were custom made for the particular patient. These were surgical guides used to help the surgeon resect the femoral neck and to hold and guide the reamer while reshaping the acetabular cave. This way the centre of rotation, inclination and version angles were precisely transferred from a virtual computer space into the patient's hip. The implementation of the described procedure required some changes in the surgical process. To that purpose special documentation has been prepared that enables the surgeon to approve the surgical plan. Additionally, a user's guide was written that lists and describes all patient specific instruments and their use to enable a flawless surgical process.

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“…According to these reports, the PT cannot be ignored during spinal surgery procedures performed after THA if we want to avoid that the change in PT angle could induce a THA dislocation [9e11]. Inaba et al [12], in a recent prospective study, underline that the risk of THA displacement is very low if the preoperative plans are made with consideration of preoperative PT.We applaud the authors for raising the problem of THA dislocation in patients with concomitant THA and spinopelvic fusion; however, we believe readers should be aware that the THA dislocation rate could not be related to spinal fusion surgery without any consideration to PT.Correction of sagittal malalignment will decrease acetabular anteversion by its effect on reducing PT increasing the risk of posterior dislocation.In patients with coexisting spinal pathologies and hip arthrosis, when performing THA before spinal correction, it is important to understand the PT and the implications of future spinal correction on it when planning acetabular orientation.…”

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confidence: 99%

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Letter to the Editor on “Abnormally High Dislocation Rates of Total Hip Arthroplasty After Spinal Deformity Surgery”

Piazzolla

Solarino

Bizzoca

et al. 2017

The Journal of Arthroplasty

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We read with great interest the study by Bedard et al [1] regarding the high dislocation rates of total hip arthroplasty (THA) in patients with concurrent spinopelvic fusion but we believe that some limitations cannot be overlooked.The evaluation of spinopelvic alignment is gaining an increasing importance, not only in spinal surgery but also in THA [2e4]. Although pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis, and sagittal vertical axis parameters have recognized importance in spinal sagittal alignment, they have largely been neglected in THA. The concept of PT is defined differently between spine and hip surgeons. PT measured for hip navigation is a deviation of the anterior pelvic plane from the global coronal axis of the body. When measured as a spinopelvic parameter, PT is a measure of the relative position of the sacrum to the center of the femoral heads when compared with the vertical axis and the patient is in the standing position.PI is a constant morphologic parameter dependent upon the position of the hip center and the obliquity of the sacrum relative to the ilium. Its normal value must be between 35 and 85 and is unchangeable during the life.PT and SS are positional parameters, strongly related to the PI, according to the formula PI ¼ PT þ SS, and to the ability of the pelvis to rotate around the femoral heads, following the bicoxofemoral axis [5,6]. An intimate relationship exists between PI, PT, SS, and lumbar lordosis. When the pelvis rotates backward (retroversion), PT increases whereas when the pelvis rotates forward (anteversion), PT decreases. This is the best mechanisms of regulation of sagittal balance. Achieving a postoperative PT of <20 is an important aim of the spinal corrective surgical procedure. Obviously, patients with a small PI have a small capacity to compensate their sagittal imbalance through pelvis retroversion. In recent years, the correlation between PT and acetabular anteversion changes, and the effect of PT on acetabular cup positioning have attracted several authors [5,7e11].Lembeck et al [9] reported that acetabular cup anteversion in THA must be 0.7 Â PT.Babisch et al [10] confirmed this evidence adding that cup inclination must be 0.3 Â PT. According to these reports, the PT cannot be ignored during spinal surgery procedures performed after THA if we want to avoid that the change in PT angle could induce a THA dislocation [9e11]. Inaba et al [12], in a recent prospective study, underline that the risk of THA displacement is very low if the preoperative plans are made with consideration of preoperative PT.We applaud the authors for raising the problem of THA dislocation in patients with concomitant THA and spinopelvic fusion; however, we believe readers should be aware that the THA dislocation rate could not be related to spinal fusion surgery without any consideration to PT.Correction of sagittal malalignment will decrease acetabular anteversion by its effect on reducing PT increasing the risk of posterior dislocation.In patients with coexi...

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Preoperative planning for implant placement with consideration of pelvic tilt in total hip arthroplasty: postoperative efficacy evaluation

Cited by 33 publications

References 28 publications

Utility of CT-based navigation in revision total hip arthroplasty for a patient with severe posterior pelvic tilt-case report-

Utility of CT-based navigation in revision total hip arthroplasty for a patient with severe posterior pelvic tilt-case report-

Interdisciplinary Communication in Orthopedic Surgical Planning

Letter to the Editor on “Abnormally High Dislocation Rates of Total Hip Arthroplasty After Spinal Deformity Surgery”

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