Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Spinopelvic Motion: A Simplified Approach to a Complex Subject

  • Cale A. Pagan (Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery) ;
  • Theofilos Karasavvidis (Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery) ;
  • Jonathan M. Vigdorchik (Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery) ;
  • Charles A. DeCook (Arthritis and Total Joint Specialists)
  • Received : 2023.10.02
  • Accepted : 2024.04.01
  • Published : 2024.06.01
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Abstract

Knowledge of the relationship between the hip and spine is essential in the effort to minimize instability and improve outcomes following total hip arthroplasty (THA). A detailed yet straightforward preoperative imaging workup can provide valuable information on pelvic positioning, which may be helpful for optimum placement of the acetabular cup. For a streamlined preoperative assessment of THA candidates, classification systems with a capacity for providing a more personalized approach to performance of THA have been introduced. Familiarity with these systems and their clinical application is important in the effort to optimize component placement and reduce the risk of instability. Looking ahead, the principles of the hip-spine relationship are being integrated using emerging innovative technologies, promising further streamlining of the evaluation process.

Keywords

References

  1. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018;100:1455-60. https://doi.org/10.2106/JBJS.17.01617
  2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780-5. https://doi.org/10.2106/JBJS.F.00222
  3. Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: future projections to 2020- 2040 using the national inpatient sample. J Rheumatol. 2019;46:1134-40. https://doi.org/10.3899/jrheum.170990
  4. Park JW, Won SH, Moon SY, Lee YK, Ha YC, Koo KH. Burden and future projection of revision Total hip Arthroplasty in South Korea. BMC Musculoskelet Disord. 2021;22:375. https://doi.org/10.1186/s12891-021-04235-3
  5. Gwam CU, Mistry JB, Mohamed NS, et al. Current epidemiology of revision Total Hip Arthroplasty in the United States: national inpatient sample 2009 to 2013. J Arthroplasty. 2017;32:2088-92. https://doi.org/10.1016/j.arth.2017.02.046
  6. Bourne RB, Maloney WJ, Wright JG. An AOA critical issue. The outcome of the outcomes movement. J Bone Joint Surg Am. 2004;86:633-40. https://doi.org/10.2106/00004623-200403000-00026
  7. Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, Bohler N, Labek G. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty. 2013;28:1329-32. https://doi.org/10.1016/j.arth.2013.01.012
  8. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217-20. https://doi.org/10.2106/00004623-197860020-00014
  9. Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW. What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position. Clin Orthop Relat Res. 2016;474:386-91. https://doi.org/10.1007/s11999-015-4432-5
  10. Miki H, Kyo T, Kuroda Y, Nakahara I, Sugano N. Risk of edge-loading and prosthesis impingement due to posterior pelvic tilting after total hip arthroplasty. Clin Biomech (Bristol, Avon). 2014;29:607-13. https://doi.org/10.1016/j.clinbiomech.2014.05.002
  11. Ike H, Dorr LD, Trasolini N, Stefl M, McKnight B, Heckmann N. Spine-pelvis-hip relationship in the functioning of a total hip replacement. J Bone Joint Surg Am. 2018;100:1606-15. https://doi.org/10.2106/JBJS.17.00403
  12. Vigdorchik JM, Sharma AK, Madurawe CS, Elbuluk AM, Bare JV, Pierrepont JW. Does prosthetic or bony impingement occur more often in total hip arthroplasty: a dynamic preoperative analysis. J Arthroplasty. 2020;35:2501-6. https://doi.org/10.1016/j.arth.2020.05.009
  13. Langston J, Pierrepont J, Gu Y, Shimmin A. Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty. Bone Joint J. 2018;100-B:845-52. https://doi.org/10.1302/0301-620X.100B7.BJJ-2017-1599.R1
  14. Buckland AJ, Fernandez L, Shimmin AJ, Bare JV, McMahon SJ, Vigdorchik JM. Effects of sagittal spinal alignment on postural pelvic mobility in total hip arthroplasty candidates. J Arthroplasty. 2019;34:2663-8. https://doi.org/10.1016/j.arth.2019.06.036
  15. Pierrepont J, Hawdon G, Miles BP, et al. Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. Bone Joint J. 2017;99-B:184-91. https://doi.org/10.1302/0301-620X.99B2.BJJ-2016-0098.R1
  16. Maratt JD, Esposito CI, McLawhorn AS, Jerabek SA, Padgett DE, Mayman DJ. Pelvic tilt in patients undergoing total hip arthroplasty: when does it matter? J Arthroplasty. 2015;30:387-91. https://doi.org/10.1016/j.arth.2014.10.014
  17. Lazennec JY, Riwan A, Gravez F, et al. Hip spine relationships: application to total hip arthroplasty. Hip Int. 2007;17 Suppl 5:S91-104. https://doi.org/10.1177/112070000701705S12
  18. Philippot R, Wegrzyn J, Farizon F, Fessy MH. Pelvic balance in sagittal and Lewinnek reference planes in the standing, supine and sitting positions. Orthop Traumatol Surg Res. 2009;95:70-6. https://doi.org/10.1016/j.otsr.2008.01.001
  19. Blizzard DJ, Sheets CZ, Seyler TM, et al. The impact of lumbar spine disease and deformity on total hip arthroplasty outcomes. Orthopedics. 2017;40:e520-5. https://doi.org/10.3928/01477447-20170327-03
  20. Esposito CI, Carroll KM, Sculco PK, Padgett DE, Jerabek SA, Mayman DJ. Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation. J Arthroplasty. 2018;33:1449-54. https://doi.org/10.1016/j.arth.2017.12.005
  21. Esposito CI, Miller TT, Kim HJ, et al. Does degenerative lumbar spine disease influence femoroacetabular flexion in patients undergoing total hip arthroplasty? Clin Orthop Relat Res. 2016;474:1788-97. https://doi.org/10.1007/s11999-016-4787-2
  22. Lazennec JY, Clark IC, Folinais D, Tahar IN, Pour AE. What is the impact of a spinal fusion on acetabular implant orientation in functional standing and sitting positions? J Arthroplasty. 2017;32:3184-90. https://doi.org/10.1016/j.arth.2017.04.051
  23. Barry JJ, Sing DC, Vail TP, Hansen EN. Early outcomes of primary total hip arthroplasty after prior lumbar spinal fusion. J Arthroplasty. 2017;32:470-4. https://doi.org/10.1016/j.arth.2016.07.019
  24. Phan D, Bederman SS, Schwarzkopf R. The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty. Bone Joint J. 2015;97-B:1017-23. https://doi.org/10.1302/0301-620X.97B8.35700
  25. Bedard NA, Martin CT, Slaven SE, Pugely AJ, Mendoza-Lattes SA, Callaghan JJ. Abnormally high dislocation rates of total hip arthroplasty after spinal deformity surgery. J Arthroplasty. 2016;31:2884-5. https://doi.org/10.1016/j.arth.2016.07.049
  26. Gausden EB, Parhar HS, Popper JE, Sculco PK, Rush BNM. Risk factors for early dislocation following primary elective total hip arthroplasty. J Arthroplasty. 2018;33:1567-71.e2. https://doi.org/10.1016/j.arth.2017.12.034
  27. Luthringer TA, Vigdorchik JM. A preoperative workup of a "hip-spine" total hip arthroplasty patient: a simplified approach to a complex problem. J Arthroplasty. 2019;34(7S):S57-70. https://doi.org/10.1016/j.arth.2019.01.012
  28. Iyer S, Sheha E, Fu MC, et al. Sagittal spinal alignment in adult spinal deformity: an overview of current concepts and a critical analysis review. JBJS Rev. 2018;6:e2. https://doi.org/10.2106/JBJS.RVW.17.00117
  29. Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop. 2005;76:517-23. https://doi.org/10.1080/17453670510041501
  30. Buckland AJ, Puvanesarajah V, Vigdorchik J, et al. Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion. Bone Joint J. 2017;99-B:585-91. https://doi.org/10.1302/0301-620X.99B5.BJJ-2016-0657.R1
  31. DelSole EM, Vigdorchik JM, Schwarzkopf R, Errico TJ, Buckland AJ. Total hip arthroplasty in the spinal deformity population: does degree of sagittal deformity affect rates of safe zone placement, instability, or revision? J Arthroplasty. 2017;32:1910-7. https://doi.org/10.1016/j.arth.2016.12.039
  32. Buckland AJ, Ayres EW, Shimmin AJ, Bare JV, McMahon SJ, Vigdorchik JM. Prevalence of sagittal spinal deformity among patients undergoing total hip arthroplasty. J Arthroplasty. 2020;35:160-5. https://doi.org/10.1016/j.arth.2019.08.020
  33. Sariali E, Lazennec JY, Khiami F, Gorin M, Catonne Y. Modification of pelvic orientation after total hip replacement in primary osteoarthritis. Hip Int. 2009;19:257-63. https://doi.org/10.1177/112070000901900312
  34. Nam D, Riegler V, Clohisy JC, Nunley RM, Barrack RL. The impact of total hip arthroplasty on pelvic motion and functional component position is highly variable. J Arthroplasty. 2017;32:1200-5. https://doi.org/10.1016/j.arth.2016.11.008
  35. Vigdorchik JM, Sharma AK, Buckland AJ, et al. 2021 Otto Aufranc Award: a simple Hip-Spine Classification for total hip arthroplasty: validation and a large multicentre series. Bone Joint J. 2021;103-B(7 Supple B):17-24. https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-2448.R2
  36. Eftekhary N, Shimmin A, Lazennec JY, et al. A systematic approach to the hip-spine relationship and its applications to total hip arthroplasty. Bone Joint J. 2019;101-B:808-16. https://doi.org/10.1302/0301-620X.101B7.BJJ-2018-1188.R1
  37. Vigdorchik JM, Sharma AK, Dennis DA, Walter LR, Pierrepont JW, Shimmin AJ. The majority of total hip arthroplasty patients with a stiff spine do not have an instrumented fusion. J Arthroplasty. 2020;35(6S):S252-4. https://doi.org/10.1016/j.arth.2020.01.031
  38. Vigdorchik JM, Sharma AK, Madurawe CS, Pierrepont JW, Dennis DA, Shimmin AJ. Prevalence of risk factors for adverse spinopelvic mobility among patients undergoing total hip arthroplasty. J Arthroplasty. 2021;36:2371-8. https://doi.org/10.1016/j.arth.2020.12.029
  39. Kanawade V, Dorr LD, Wan Z. Predictability of acetabular component angular change with postural shift from standing to sitting position. J Bone Joint Surg Am. 2014;96:978-86. https://doi.org/10.2106/JBJS.M.00765
  40. Stefl M, Lundergan W, Heckmann N, et al. Spinopelvic mobility and acetabular component position for total hip arthroplasty. Bone Joint J. 2017;99-B(1 Supple A):37-45. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0415.R1
  41. Vigdorchik JM, Sharma AK, Elbuluk AM, Carroll KM, Mayman DJ, Lieberman JR. High offset stems are protective of dislocation in high-risk total hip arthroplasty. J Arthroplasty. 2021;36:210-6. https://doi.org/10.1016/j.arth.2020.07.016
  42. Sharma AK, Vigdorchik JM. The hip-spine relationship in total hip arthroplasty: how to execute the plan. J Arthroplasty. 2021;36(7S):S111-20. https://doi.org/10.1016/j.arth.2021.01.008
  43. Vigdorchik JM, Muir JM, Buckland A, et al. Undetected intraoperative pelvic movement can lead to inaccurate acetabular cup component placement during total hip arthroplasty: a mathematical simulation estimating change in cup position. J Hip Surg. 2017;1:186-93. https://doi.org/10.1055/s-0038-1635103
  44. Dorr LD, Malik A, Wan Z, Long WT, Harris M. Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin Orthop Relat Res. 2007;465:92-9. https://doi.org/10.1097/BLO.0b013e3181560c51
  45. Patil S, Bergula A, Chen PC, Colwell CW Jr, D'Lima DD. Polyethylene wear and acetabular component orientation. J Bone Joint Surg Am. 2003;85-A Suppl 4:56-63. https://doi.org/10.2106/00004623-200300004-00007
  46. Meermans G, Van Doorn WJ, Koenraadt K, Kats J. The use of the transverse acetabular ligament for determining the orientation of the components in total hip replacement: a randomised controlled trial. Bone Joint J. 2014;96-B:312-8. https://doi.org/10.1302/0301-620X.96B3.32989
  47. Domb BG, El Bitar YF, Sadik AY, Stake CE, Botser IB. Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res. 2014;472:329-36. https://doi.org/10.1007/s11999-013-3253-7
  48. Wasterlain AS, Buza JA 3rd, Thakkar SC, Schwarzkopf R, Vigdorchik J. Navigation and robotics in total hip arthroplasty. JBJS Rev. 2017;5:e2. https://doi.org/10.2106/JBJS.RVW.16.00046
  49. VELYSTM Hip Navigation [Internet]. Raynham: DePuy Synthes [cited 2023 Aug 14]. Available from: https://www.jnjmedtech.com/en-US/products/digital-surgery/velys-hip-navigation.
  50. ONE Planner® Hip [Internet]. Warsaw: Zimmer Biomet [cited 2023 Aug 14]. Available from: https://www.zimmerbiomet.com/en/products-and-solutions/specialties/hip/one-planner-hip.html.
  51. Intellijoint VIEWTM [Internet]. Kitchener: Intellijoint Surgical [cited 2023 Aug 14]. Available from: https://www.intellijointsurgical.com/view/.
  52. Optimized Positioning SystemTM [Internet]. Cirencester: Corin Group [cited 2023 Aug 14]. Available from: https://www.coringroup.com/healthcare-professionals/solutions/optimized-positioning-system-ops/.
  53. Hip replacement with Mako robotic-arm assisted technology [Internet]. Kalamazoo: Stryker [cited 2023 Aug 14]. Available from: https://patients.stryker.com/hip-replacement/options/mako-robotic-arm-assisted.
  54. RI.HIP NAVIGATION Total Hip Arthroplasty [Internet]. London: Smith+Nephew [cited 2023 Aug 14]. Available from: https://www.smith-nephew.com/en/health-care-professionals/products/orthopaedics/ri-hip-navigation.
  55. Sicat CS, Buchalter DB, Luthringer TA, Schwarzkopf R, Vigdorchik JM. Intraoperative technology use improves accuracy of functional safe zone targeting in total hip arthroplasty. J Arthroplasty. 2022;37(7S):S540-5. https://doi.org/10.1016/j.arth.2022.02.038
  56. Parratte S, Argenson JN, Flecher X, Aubaniac JM. [Computer-assisted surgery for acetabular cup positioning in total hip arthroplasty: comparative prospective randomized study]. Rev Chir Orthop Reparatrice Appar Mot. 2007;93:238-46. French. https://doi.org/10.1016/s0035-1040(07)90245-7