Prosthetic Dislocation and Revision After Primary Total Hip Arthroplasty in Lumbar Fusion Patients: A Propensity Score Matched-Pair Analysis

Perfetti, Dean C.; Schwarzkopf, Ran; Buckland, Aaron J.; Paulino, Carl B.; Vigdorchik, Jonathan M.

doi:10.1016/j.arth.2016.11.029

Cited by 144 publications

(100 citation statements)

References 25 publications

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“…When patients have a limited ROM in the lumbar spine, the risk of dislocation and need for revision after THA increases markedly./ Based on a 12-month follow-up, Perfetti et al reported that, compared to the controls, the THA patients with prior spinal fusion were 7 times more likely to dislocate their prostheses (p < 0.01) and 4 times more likely to need revisions (p < 0.01), [10]. Sing et al reported that the dislocation rate was 2.4% for THA patients without prior spinal fusion, 4.3% for patients with 1 to 2 levels fused, and 7.5% for patients with 3 to 5 levels fused [11].…”

Section: Discussionmentioning

confidence: 99%

“…McGregor et al (1997) reported that patients with a degenerative lumbar spine or disc prolapse have an approximately 10°decrease in flexion and extension compared to the age-matched controls [9]. Lumbar spine movement reduction results in greater risk of dislocation and revision after THA [10,11]. Elucidation and measurement of the effects of lumbar disc degeneration on spinopelvic movement are, thus, essential when preparing patients for THA.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Furthermore, the comparison between the two groups revealed a significant increase in the revision rate after THA in the group with a history of lumbar fusion. Perfetti et al . included a total of 934 patients who underwent THA and had a history of lumbar fusion, while another 934 patients underwent THA and did not present any history of lumbar fusion.…”

Section: Effects Of Spinal Diseases On Thamentioning

confidence: 99%

“…The pelvis is usually tilted backward extremely for patients with ankylosing spondylitis in the standing position due to malformation of the sagittal plane of the spine (thoracic kyphosis increases and lumbar lordosis decreases). Interestingly, the acetabular anteversion increases as the pelvis is tilted backward. In 2000, Tang et al .…”

Section: Effects Of Spinal Diseases On Thamentioning

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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“…[4] This motion is necessary to avoid anterior impingement of the femoral neck in the flexed and internally rotated hip while in the seated position. It is often altered in patients with coexisting hip-spine pathology and corresponds with a seven-fold increase in the risk of dislocation within 12 months from an index THA compared to those with no spine pathology [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Pelvic Tilt Cannot Be Accurately Predicted Using Anteroposterior Radiographs

Cizmic¹,

Gabor²,

Eftekhary³

et al.

EPiC Series in Health Sciences

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INTRODUCTION: Pelvic positioning during total hip arthroplasty (THA) can affect the functional position of the acetabular component. A comprehensive understanding of pelvic orientation prior to THA is necessary to allow for proper cup positioning and mitigate the risks of complications associated with component malpositioning. Measurements using anteroposterior (AP) radiographs have been described as an effective means of accurately predicting pelvic functional orientation. The purpose of our study was to describe the accuracy of assessing pelvic tilt using AP radiographs alone.METHODS: An online survey was created and sent to a cohort of fellowship-trained adult reconstruction surgeons. The survey consisted of 65 standing AP pelvis radiographs. Participants were asked to score each radiograph as 1) anterior pelvic tilt > 10 degrees, 2) posterior pelvic tilt > 10 degrees, or 3) neutral. Responses were then compared to measurements of pelvic tilt made on lateral standing pelvic radiographs. Categorical and continuous variables were compared using chi-squared, unpaired, two-tailed student’s T tests, and ANOVA.RESULTS: 135 surgeons completed the survey. The average correct predictive value of pelvic tilt between all surgeons was 53.2%. 51.2% of responding surgeons performed greater than 100 cases per year. 50% of surgeons reported that they were “not so familiar” or “somewhat familiar” with the principles of spinopelvic mobility. 43.5% of surgeons reported that they did not routinely use spinopelvic mobility principles in THA planning.DISCUSSION: The standing AP pelvis radiograph is poorly predictive of pelvic tilt. Pre-operative evaluation of spinopelvic parameters requires AP and lateral pelvic views for detailed assessment and accurate pre-operative planning.

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Prosthetic Dislocation and Revision After Primary Total Hip Arthroplasty in Lumbar Fusion Patients: A Propensity Score Matched-Pair Analysis

Cited by 144 publications

References 25 publications

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

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

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

Pelvic Tilt Cannot Be Accurately Predicted Using Anteroposterior Radiographs

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