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

Yang, Guoyue; Li, Yayue; Zhang, Hong

doi:10.1111/os.12543

Cited by 36 publications

(29 citation statements)

References 70 publications

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“…Pelvic tilt is the most important factor affecting cup anteversion. Several studies have reported that the degree of acetabular anteversion is related to pelvic tilt 10,21,30,31 . Lembeck reported that 1 of change in the pelvic tilt can lead to a change in the cup anteversion by approximately 0.7 31 .…”

Section: Pelvic Tilt Is the Only Contributor To Cup Anteversionmentioning

confidence: 99%

“…For example, a study concluded that the dislocation risk was 1.9 times higher if cup anteversion was not between 10 and 30 , which is different from the Lewinneck safe zone 9 . Moreover, many studies have also focused on the factors influencing implant orientation 5,10 . For instance, after analyzing numerous factors related to dislocation, Callanan found that surgical approach, surgeon volume, and obesity (body mass index, BMI > 30 kg/m 2 ) were independent factors related to mal-positioned cups 5 .…”

Section: Introductionmentioning

confidence: 99%

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A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach

Zhang

Lin

et al. 2020

Orthopaedic Surgery

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Objective To determine the implant orientation, especially the combined anteversion measurements in total hip arthroplasty (THA) using lateral approach, and to compare with implant orientation using posterior‐lateral (P‐L) approach. The secondary goal was to identify the factors associated with implant orientation. Methods Five hundred and one patients (545 hips) who underwent primary THA with the modified Hardinge approach between January 2016 and November 2019 by one senior surgeon in our department in a retrospective study were followed up. A survey to inquire about the history of dislocation of the hip after THA was designed and responses were gathered by telephone, WeChat software, and outpatient follow‐up. The mean age of the patients was 61.97 ± 11.72 years, and there were 254 males and 247 females. The average follow‐up time was 25.2 ± 13.7 months (range, 3.2–49.7 months). Among the patients who were followed up, 97 patients (104 hips) underwent computed tomography (CT) scans from L4 to the tuberosity of the tibia. The implant orientation, including the anteversion and inclination of the cup, anteversion of the stem, combined anteversion, and pelvic tilt were measured based on CT scans of these patients. The results were compared with the implant orientation reported in previous reports measured by CT. Factors that may be associated with implant orientation were investigated, including the patient's age, sex, body mass index (BMI), and diagnosis; size of the cup; diameter of the femoral head component; and pelvic tilt. Data and statistical analyses were performed using SPSS 20.0. Results No cases of dislocation were found in the 501 patients (545 hips) who underwent primary THA during this period. The mean inclination and anteversion of the cups were 38.83° ± 5.04° (24.5°–53.1°) and 9.26° ± 11.19° (−15°–48°), respectively. The mean anteversion of the stem was 13.83° ± 10.7° (−10.2°–42.3°). The combined anteversion was 23.1° ± 13.4° (−7.4°–54.6°). Compared with the reported combined anteversion and anteversion of the cup, the mean anteversion of the cup and combined anteversion using the lateral approach were much lower than the reported values in the literature using the P‐L approach. Pelvic tilt was found to be the only independent factor for cup anteversion. Factors including age, sex, BMI, diagnosis, cup size, and diameter of the femoral head component were not associated with implant orientation. Conclusion THA using the lateral approach yields smaller cup anteversion and combined anteversion values than using the P‐L approach. Pelvic tilt is the only predictor for cup anteversion.

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Section: Pelvic Tilt Is the Only Contributor To Cup Anteversionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach

Zhang

Lin

et al. 2020

Orthopaedic Surgery

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“…However, the acetabular orientation is not a static parameter; it is related to the pelvic movement in the sagittal plane that changes the acetabular functional version and inclination during activities of daily living [ 8 ]. It has been reported that the pelvis normally rotates posteriorly moving between supine, standing and sitting positions thus increasing the anterior opening of the acetabulum [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

The Accuracy of Patient-Specific Instrumentation with Laser Guidance in a Dynamic Total Hip Arthroplasty: A Radiological Evaluation

Ferretti

Iannotti

Proietti

et al. 2021

Sensors

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The functional positioning of components in a total hip arthroplasty (THA) and its relationship with individual lumbopelvic kinematics and a patient’s anatomy are being extensively studied. Patient-specific kinematic planning could be a game-changer; however, it should be accurately delivered intraoperatively. The main purpose of this study was to verify the reliability and accuracy of a patient-specific instrumentation (PSI) and laser-guided technique to replicate preoperative dynamic planning. Thirty-six patients were prospectively enrolled and received dynamic hip preoperative planning based on three functional lateral spinopelvic X-rays and a low dose CT scan. Three-dimensional (3D) printed PSI guides and laser-guided instrumentation were used intraoperatively. The orientation of the components, osteotomy level and change in hip length and offset were measured on postoperative CT scans and compared with the planned preoperative values. The length of surgery was compared with that of a matched group of thirty-six patients who underwent a conventional THA. The mean absolute deviation from the planned inclination and anteversion was 3.9° and 4.4°, respectively. In 92% of cases, both the inclination and anteversion were within +/− 10° of the planned values. Regarding the osteotomy level, offset change and limb length change, the mean deviation was, respectively, 1.6 mm, 2.6 mm and 2 mm. No statistically significant difference was detected when comparing the planned values with the achieved values. The mean surgical time was 71.4 min in the PSI group and 60.4 min in the conventional THA group (p < 0.05). Patient-specific and laser-guided instrumentation is safe and accurately reproduces dynamic planning in terms of the orientation of the components, osteotomy level, leg length and offset. Moreover, the increase in surgical time is negligible.

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“… 20 , 21 SS and PT are dynamic parameters defined as postural angles, and they change through the different pelvic positions (standing and sitting). 14 The sacral slope (SS) is represented by the angle between the tangent of the S1 endplate and the horizontal line. It measures on average 40° in standing position and decreases to 20° in sitting position (range, 20°-65°).…”

Section: Sagittal Spinopelvic Anglesmentioning

confidence: 99%

“… 52 Acetabular anteversion changes in relation to the pelvic tilt, which challenges the concept of acetabular “safe zone” as defined by Lewinnek et al , with 40±10° inclination and 15±10° anteversion (LSZ). 12 , 14 This has been widely used as reference point for nearly 40 years, but recent studies have demonstrated that cups positioned within this range did not effectively reduce the dislocation rate. 53 , 54 In order to further understand the pathophysiology of prosthetic dislocation, it has been introduced the concept of functional acetabular orientation related to pelvic and lumbar mobility.…”

Section: Spine Disorders and Total Hip Arthroplastymentioning

confidence: 99%

Surgical implications of the hip-spine relationship in total hip arthroplasty

et al. 2020

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Total hip arthroplasty (THA) is considered the most successful orthopedic surgical procedure of the last century with excellent survivorship up to 20-years. However, instability remains a major issue representing the most common reason for revision after THA. Hip-spine relationship has gained progressive interest between arthroplasty surgeons and its understanding is crucial in order to identify high-risk patients for postoperative dislocation. Spinal deformity and abnormal spinopelvic mobility have been associated with increased risk for instability, dislocation and revision THA. Preoperative workup begins with standing anteroposterior pelvis x-ray and lateral spinopelvic radiographs in the standing and sitting position. Hip-spine stiffness needs to be addressed before THA in consideration of adapting the preoperative planning to the patient’s characteristics. Acetabular component should be implanted with different anteversion and inclination angles according to the pattern of hip-spine motion in order to reduce the risk of impingement and consequent dislocation. Different algorithmic approaches have been proposed in case of concomitant hip-spine disease and in case of altered sagittal balance and pelvic mobility. The aim of this review is to investigate and clarify the hip-spine relationships and evaluate the impact on modern total hip arthroplasty.

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

Cited by 36 publications

References 70 publications

A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach

A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach

The Accuracy of Patient-Specific Instrumentation with Laser Guidance in a Dynamic Total Hip Arthroplasty: A Radiological Evaluation

Surgical implications of the hip-spine relationship in total hip arthroplasty

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