Sagittal spinal alignment after total hip arthroplasty for neglected high hip dysplasia: does changing the distorted mechanics of the hip normalize spinal alignment?

Çağlar, Ömür; Isik, Samet; Kaymakoğlu, Mehmet; Demirkiran, H. Gokhan; Atılla, Bülent; Tokgözoğlu, Mazhar; Yazıcı, Muharrem

doi:10.1007/s43390-020-00204-3

Cited by 4 publications

(10 citation statements)

References 30 publications

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“…Interestingly, previous authors have reported a decrease in LL and an increase in standing pelvic tilt, but without a statistically significant difference after THA for patients with high dislocation dysplasia. 14,15 However, we found a mixture of types B1 (n = 8; 40%), B2 (n = 1; 5%), B3 (n = 2; 10%), and C (n = 9; 45%) among the 20 patients reported by Calgar et al, 14 explaining the absence of statistical significance in their data. In particular, they stated that some patients had a compensatory decrease of the excessive pelvic tilt and lordosis after THA, which is consistent with type C patients as evidenced by their data and radiographs.…”

Section: Discussionmentioning

confidence: 50%

“…6,8,13 Although the mean change in pelvic tilt after THA has been reported to be small, the patientspecific change may be considerably larger. 11,12,[14][15][16] Pour et al 17 reported a change in pelvic tilt of > 10° after THA in 34 (14.4%) of 237 primary THAs. Ishida et al 11 found that patients with severely abnormal posture had a large change in pelvic tilt postoperatively.…”

Section: Introductionmentioning

confidence: 99%

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A patient-specific algorithm for predicting the standing sagittal pelvic tilt one year after total hip arthroplasty

Tang,

Guo,

et al. 2024

Bone Joint J

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AimsThe aim of this study was to evaluate the reliability and validity of a patient-specific algorithm which we developed for predicting changes in sagittal pelvic tilt after total hip arthroplasty (THA).MethodsThis retrospective study included 143 patients who underwent 171 THAs between April 2019 and October 2020 and had full-body lateral radiographs preoperatively and at one year postoperatively. We measured the pelvic incidence (PI), the sagittal vertical axis (SVA), pelvic tilt, sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis to classify patients into types A, B1, B2, B3, and C. The change of pelvic tilt was predicted according to the normal range of SVA (0 mm to 50 mm) for types A, B1, B2, and B3, and based on the absolute value of one-third of the PI-LL mismatch for type C patients. The reliability of the classification of the patients and the prediction of the change of pelvic tilt were assessed using kappa values and intraclass correlation coefficients (ICCs), respectively. Validity was assessed using the overall mean error and mean absolute error (MAE) for the prediction of the change of pelvic tilt.ResultsThe kappa values were 0.927 (95% confidence interval (CI) 0.861 to 0.992) and 0.945 (95% CI 0.903 to 0.988) for the inter- and intraobserver reliabilities, respectively, and the ICCs ranged from 0.919 to 0.997. The overall mean error and MAE for the prediction of the change of pelvic tilt were -0.3° (SD 3.6°) and 2.8° (SD 2.4°), respectively. The overall absolute change of pelvic tilt was 5.0° (SD 4.1°). Pre- and postoperative values and changes in pelvic tilt, SVA, SS, and LL varied significantly among the five types of patient.ConclusionWe found that the proposed algorithm was reliable and valid for predicting the standing pelvic tilt after THA.Cite this article: Bone Joint J 2024;106-B(1):19–27.

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Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

A patient-specific algorithm for predicting the standing sagittal pelvic tilt one year after total hip arthroplasty

Tang,

Guo,

et al. 2024

Bone Joint J

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“…There is a considerable amount of current clinical research that focuses on the relationship between spinopelvic positioning and disorders of the hip and pelvis 6,19–22 . Being able to accurately and precisely measure pelvic tilt and rotation is key to advancing our understanding of hip and pelvis disease.…”

Section: Discussionmentioning

confidence: 99%

Measurement of pelvic tilt and rotation on AP radiographs using HipRecon: Validation and comparison to other parameters

Heimann

Schwab

Popa

et al. 2023

Journal Orthopaedic Research

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In this paper, we present and evaluate HipRecon, a noncommercial software package that simultaneously calculates pelvic tilt and rotation from an anteroposterior pelvis radiograph. We asked: What is the (1) accuracy and precision, (2) robustness, and (3) intra‐/interobserver reliability/reproducibility of HipRecon to analyze both pelvic tilt and rotation on conventional AP pelvis radiographs? (4) How does the prediction of pelvic tilt on AP pelvis radiographs using HipRecon compare to established measurement methods? We compared the actual pelvic tilt of 20 adult human cadaveric pelvises with the calculated pelvic orientation based on an AP pelvis radiograph using HipRecon software. The pelvises were mounted on a radiolucent fixture and a total of 380 AP pelvis radiographs with different configurations were acquired. In addition, we investigated the correlation between actual tilt and the tilt calculated using HipRecon and seven other established measurement methods. The calculated software accuracy was 0.2 ± 2.0° (−3.6–4.1) for pelvic tilt and 0.0 ± 1.2° (−2.2–2.3, p = 0.39) for pelvic rotation. The Bland–Altman analysis showed values that were evenly and randomly spread in both directions. HipRecon showed excellent consistency for the measurement of pelvic tilt and rotation (intraobserver intraclass‐correlation coefficient [ICC]: 0.99 [95% CI: 0.99–0.99] and interobserver ICC 0.99 [95% CI: 0.99–0.99]). Of all eight analyzed methods, the highest correlation coefficient was found for HipRecon (r = 0.98, p < 0.001). In the future, HipRecon could be used to detect changes in patient‐specific pelvic orientation, helping to improve clinical understanding and decision‐making in pathologies of the hip.

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“…However, reports are scarce owing to the rarity of this disease. [6][7][8] Morimoto et al • Medicine (2024) Medicine…”

Section: Introductionmentioning

confidence: 99%

“…1A). [6,10] Although the PI can be measured after S-THA with an HDH, these measurements may be compromised due to difficulties in placing the THA cup in true acetabulum, difficulties in measuring the hip axis from the THA ball, and soft tissue imbalance (Fig. 1B).…”

Section: Introductionmentioning

confidence: 99%

Sagittal-spinopelvic alignment improves in patients with bilateral highly dislocated hip (Crowe type IV) after subtrochanteric shortening total hip arthroplasty: A retrospective radiographic study

Morimoto,

Kobayashi,

Tsukamoto

et al. 2024

Medicine

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In patients with bilateral highly dislocated hips (HDHs), total hip arthroplasty with subtrochanteric shortening osteotomy (S-THA) is a viable option for achieving adequate reconstruction with restoration of the anatomical hip center. This procedure has the potential to improve sagittal spinopelvic alignment (SSPA). However, reports are scarce owing to the rarity of this disease. The objective of this study is to investigate pre- and post-operative SSPA in patients with HDHs who had undergone S-THA. This retrospective radiographic study included 55 patients (54 females and 1 male; average age, 63.1 ± 6.9 years) who underwent S-THA. Lateral spine radiographs in the standing position were obtained pre- and post-operatively. The SSPA included lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), and intervertebral disc (ID) angle of L1/2–L5/S. The SSPA pre- and post-S-THA was compared using a paired t test. Pearson correlation coefficient was used to assess the relationships between parameters. The mean pre- and post-operative LL and SS values were 62° and 49° (LL) and 50° and 39° (SS), respectively (P < .001). The ID angle was significantly reduced post-operatively at all levels (P < .001). The correlation coefficients between preoperative LL and SS and postoperative LL and PI were 0.81 and 0.38, respectively (P < .01). The preoperative SSPA of Crowe type IV HDHs revealed excessive pelvic anteversion and lumbar hyperlordosis, with a high correlation between LL and SS, suggesting that these alterations were compensatory changes to maintain body balance. Furthermore, in patients with HDHs and residual spinal flexibility, restoring the original pelvic morphology with S-THA may contribute to improved SSPA.

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Sagittal spinal alignment after total hip arthroplasty for neglected high hip dysplasia: does changing the distorted mechanics of the hip normalize spinal alignment?

Cited by 4 publications

References 30 publications

A patient-specific algorithm for predicting the standing sagittal pelvic tilt one year after total hip arthroplasty

A patient-specific algorithm for predicting the standing sagittal pelvic tilt one year after total hip arthroplasty

Measurement of pelvic tilt and rotation on AP radiographs using HipRecon: Validation and comparison to other parameters

Sagittal-spinopelvic alignment improves in patients with bilateral highly dislocated hip (Crowe type IV) after subtrochanteric shortening total hip arthroplasty: A retrospective radiographic study

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