Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty

Langston, Joseph R.; Pierrepont, J; Gu, Yolanda; Shimmin, A

doi:10.1302/0301-620x.100b7.bjj-2017-1599.r1

Cited by 98 publications

(81 citation statements)

References 29 publications

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“…The horizontal axis of the APP was set as a line connecting bilateral ASIS. PSI was defined as the angle between the APP and the vertical line of the body on the sagittal plane of the pelvis, as described previously 4,8,9 . Anterior rotation of the pelvis was set as a positive PSI whereas a posterior rotation was set as a negative PSI (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Uemura

Atkins

Okamoto

et al. 2020

Journal Orthopaedic Research

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Pelvic sagittal inclination (PSI) is often evaluated in patients with hip pathology using lateral radiographs. However, it would be useful if PSI could be predicted from an anteroposterior radiograph since this film is ubiquitous in the evaluation of hip pathology. Herein, computer‐modeling was applied to predict PSI from radiographic measurements assessed in the anteroposterior plane. Three‐dimensional surface models of the pelvis, femur, and sacrum were reconstructed from computed tomography images of 50 women with hip dysplasia. This study cohort was selected as changes in PSI alter femoral head coverage, which is relevant to the diagnosis and treatment of hip dysplasia, a known cause of hip osteoarthritis. Five radiographic parameters commonly used to independently estimate PSI were evaluated after bone surfaces were projected to an anteroposterior plane, including the symphysis to sacrococcygeal joint distance (S‐S distance), the pelvic foramen aspect ratio (PF ratio), the distance between the symphysis and a line connecting the femoral head centers (S‐H distance), the sacro‐femoral‐pubic angle (SFP angle), and the pelvic vertical ratio (PVR). Regression models determined the ability of these parameters to predict PSI from −20° to 20° at 1° increment. All five parameters showed a strong correlation with the PSI (all r > 0.9). From the regression models, PSI was estimated with a median (maximum) absolute error of 3.6° (18.4°), 3.8° (17.7°), 5.2° (17.9°), 5.8° (28.8°), and 3.2° (23.5°) for the S‐S distance, PF ratio, S‐H distance, SFP angle, and PVR, respectively. The regression model for S‐S distance had a mean slope of 2.18 that ranged from 1.98 to 2.41 when the sacrococcygeal joint was located superior to the symphysis. Results indicated that substantial errors occur when estimating the actual value of PSI from an anteroposterior radiograph. However, the change in PSI could be estimated from the S‐S distance, which may aid surgeons to successfully increase head coverage through periacetabular osteotomy and to locate the acetabular cup in a functional position for total hip arthroplasty.

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Section: Methodsmentioning

confidence: 99%

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Uemura

Atkins

Okamoto

et al. 2020

Journal Orthopaedic Research

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show abstract

“…While an anteriorly tilted pelvis increases, a posteriorly tilted pelvis decreases the anteversion angle of the cup [ 8 ]. At the same time, the hip range of motion and the range of motion of the lumbar spine influence the degree of pelvic tilt too [ 9 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Pelvic Tilt Angle Differences Between Symptom-Free Young Subjects and Elderly Patients Scheduled for THA: The Rationale for Tilt-Adjusted Acetabular Cup Implantation

Marques¹,

Martín²,

Kochman³

et al. 2018

TOORTHJ

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Background:The question whether Pelvic Tilt (PT) angles measured in the supine position are adequate for the alignment of the acetabular cup without an adjustment for anatomical differences between patients is of clinical importance. The aim of this work was to test for factors that can significantly affect PT angles.Methods:In the present retrospective cohort comparison, the PT angles of 12 Symptom-Free Young Subjects (SFYS) and 45 patients scheduled for Total Hip Arthroplasty (THA) were compared. The data was collected during two studies with the use of a novel smartphone-based navigated ultrasound measurement system. Multi-factorial analysis of variance was run to determine which factors significantly affect PT.Results:Body position (F= 126.65; P< 0.001) and group (SFYS vs. THA patients) (F= 17.52; P< 0.001) had significant main effects on PT. There was also a significant interaction between body position and group (F= 25.59; P< 0.001). The mean PT increased by 8.1° from an interiorly to a neutral tilted position (P< 0.001) and 21.4° from a neutral to a posteriorly tilted position (P< 0.001) with the transition from the supine into the upright position for the SFYS and THA patients, respectively.Conclusion:In both groups, PT changed significantly with a transition from the supine to the upright position. A position-dependent mean PT increase in the patient group showed that acetabular cup alignment based on PT in the supine position is not reliable without taking into consideration the inclination of the pelvis in standing position. This may lead to instability and dislocations.

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“…Type III was pelvis of high mobility (14%) with the mobility of >35°. Langston et al . speculated that the change in the sagittal pelvic tilt >13° is defined as poor pelvic activity as it can cause a 10° change in the acetabular anteversion, thereby possibly placing the acetabular prosthesis outside the safety zone.…”

Section: Effects Of Body Position On the Pelvic Tiltmentioning

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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Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty

Cited by 98 publications

References 29 publications

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Pelvic Tilt Angle Differences Between Symptom-Free Young Subjects and Elderly Patients Scheduled for THA: The Rationale for Tilt-Adjusted Acetabular Cup Implantation

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

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