Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Change of Sacral Slope according to the Surgical Position in Total Hip Arthroplasty

  • Shobit Deshmukh (Department of Orthopaedic Surgery, Busan Bumin Hospital) ;
  • Nirav Gupta (Department of Orthopaedic Surgery, Busan Bumin Hospital) ;
  • Ki Seong Heo (Department of Orthopaedic Surgery, Busan Bumin Hospital) ;
  • Won Yong Shon (Department of Orthopaedic Surgery, Busan Bumin Hospital) ;
  • Se Myoung Jo (Department of Orthopaedic Surgery, Busan Bumin Hospital) ;
  • Anshul Pancholiya (Department of Orthopaedic Surgery, Busan Bumin Hospital)
  • Received : 2023.10.29
  • Accepted : 2024.02.24
  • Published : 2024.09.01
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Abstract

Purpose: Pelvis tilting in sagittal plane influences the acetabular cup position. Majority of total hip arthroplasty (THA) are performed in lateral decubitus surgical position. This study is to assess whether there is any difference in sacral slope between standing and lateral decubitus position and influence of this variation in planning acetabular cup anteversion. Materials and Methods: This is a prospective study including 50 patients operated between January 2020 to March 2022. Preoperative radiograph included lumbosacral spine lateral X-ray in standing, supine and lateral decubitus positions to calculate the sacral slope for assessment of anterior or posterior pelvic tilting. In our study, we determined the position of the acetabular cup based on changes in sacral slope between standing and lateral decubitus postures. For patients whose sacral slope increased from lateral decubitus to standing, we implanted the acetabular component with a higher degree of anteversion. Conversely, for patients with reverse phenomenon, the cup was inserted at lower anteversion. Results: Twenty-four patients (48.0%) had increase in sacral slope from lateral decubitus to standing whereas 26 patients (52.0%) had decrease in sacral slope. There was linear correlation between difference in preoperative sacral slope and postoperative cross table lateral cup anteversion. Harris hip scores improved from 40.78 to 85.43. There was no subluxation or dislocation in any patient at minimum 2-year follow-up. Conclusion: Individualized acetabular cup placement is important for better functional outcome in THA. Evaluation of pelvic tilting in lateral decubitus position is necessary for better positioning of acetabular cup and avoid postoperative complications.

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References

  1. Weber M, Grifka J, Renkawitz T. Patient-specific restoration of biomechanics in total hip arthroplasty. Z Orthop Unfall. 2019;157:292-9. https://doi.org/10.1055/a-0725-8527 
  2. D'Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell CW Jr. The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am. 2000;82:315-21. https://doi.org/10.2106/00004623-200003000-00003 
  3. Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty. 1998;13:530-4. https://doi.org/10.1016/s0883-5403(98)90052-3 
  4. Kummer FJ, Shah S, Iyer S, DiCesare PE. The effect of acetabular cup orientations on limiting hip rotation. J Arthroplasty. 1999;14:509-13. https://doi.org/10.1016/s0883-5403(99)90110-9 
  5. 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 
  6. Otero JE, Fehring KA, Martin JR, Odum SM, Fehring TK. Variability of pelvic orientation in the lateral decubitus position: are external alignment guides trustworthy? J Arthroplasty. 2018;33:3496-501. https://doi.org/10.1016/j.arth.2018.07.021 
  7. Aguilera-Bohorquez B, Corea P, Siguenza C, Gerstner-Saucedo J, Carvajal A, Cantor E. Relationship between spinopelvic parameters and hip function in patients with femoroacetabular impingement at diagnosis: a cross-sectional study. Hip Pelvis. 2023;35:6-14. https://doi.org/10.5371/hp.2023.35.1.6 
  8. Shon WY, Gupta S, Biswal S, et al. Validation of a simple radiographic method to determine variations in pelvic and acetabular cup sagittal plane alignment after total hip arthroplasty. Skeletal Radiol. 2008;37:1119-27. https://doi.org/10.1007/s00256-008-0550-4 
  9. Tezuka T, Heckmann ND, Bodner RJ, Dorr LD. Functional safe zone is superior to the Lewinnek safe zone for total hip arthroplasty: why the Lewinnek safe zone is not always predictive of stability. J Arthroplasty. 2019;34:3-8. https://doi.org/10.1016/j.arth.2018.10.034 
  10. Dorr LD, Callaghan JJ. Death of the Lewinnek "Safe Zone". J Arthroplasty. 2019;34:1-2. https://doi.org/10.1016/j.arth.2018.10.035 
  11. Brown NM, McDonald JF 3rd, Sershon RA, Hopper RH Jr. The effect of intraoperative radiographs on component position and leg length during routine posterior approach total hip arthroplasty. Hip Pelvis. 2021;33:128-39. https://doi.org/10.5371/hp.2021.33.3.128 
  12. Niemeier TE, Wills BW, Theiss SM, Strom SF. Sagittal pelvic kinematics in hip arthroplasty. Curr Rev Musculoskelet Med. 2020;13:240-6. https://doi.org/10.1007/s12178-020-09628-w 
  13. Lazennec JY, Charlot N, Gorin M, et al. Hip-spine relationship: a radio-anatomical study for optimization in acetabular cup positioning. Surg Radiol Anat. 2004;26:136-44. https://doi.org/10.1007/s00276-003-0195-x 
  14. Mayr E, Kessler O, Prassl A, Rachbauer F, Krismer M, Nogler M. The frontal pelvic plane provides a valid reference system for implantation of the acetabular cup: spatial orientation of the pelvis in different positions. Acta Orthop. 2005;76:848-53. https://doi.org/10.1080/17453670510045471 
  15. 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 
  16. Kittanakere SR, Kohli R, Shah HM, Shetty N, Bhonsle RP, Sivakanthan A. Factors affecting demonstration of intraoperative Co-planar test in Total Hip Arthoplasty. J Kar Orth Assoc. 2018;6:35-8. 
  17. Shon WY, Sharma V, Keon OJ, Moon JG, Suh DH. Can pelvic tilting be ignored in total hip arthroplasty? Int J Surg Case Rep. 2014;5:633-6. https://doi.org/10.1016/j.ijscr.2014.07.015 
  18. Lee SH, Lim CW, Choi KY, Jo S. Effect of spine-pelvis relationship in total hip arthroplasty. Hip Pelvis. 2019;31:4-10. https://doi.org/10.5371/hp.2019.31.1.4 
  19. 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 
  20. McCarthy TF, Alipit V, Nevelos J, Elmallah RK, Mont MA. Acetabular cup anteversion and inclination in hip range of motion to impingement. J Arthroplasty. 2016;31(9 Suppl):264-8. https://doi.org/10.1016/j.arth.2016.01.067 
  21. DiGioia AM, Jaramaz B, Blackwell M, et al. The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res. 1998;(355):8-22. https://doi.org/10.1097/00003086-199810000-00003 
  22. Meermans G, Grammatopoulos G, Innmann M, Beverland D. Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics. EFORT Open Rev. 2022;7:365-74. https://doi.org/10.1530/EOR-22-0025 
  23. McCollum DE, Gray WJ. Dislocation after total hip arthroplasty. Causes and prevention. Clin Orthop Relat Res. 1990;(261):159-70. 
  24. Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469:319-29. https://doi.org/10.1007/s11999-010-1487-1 
  25. Lazennec JY, Brusson A, Rousseau MA. Lumbar-pelvic-femoral balance on sitting and standing lateral radiographs. Orthop Traumatol Surg Res. 2013;99(1 Suppl):S87-103. https://doi.org/10.1016/j.otsr.2012.12.003 
  26. Uemura K, Takao M, Otake Y, et al. Change in pelvic sagittal inclination from supine to standing position before hip arthroplasty. J Arthroplasty. 2017;32:2568-73. https://doi.org/10.1016/j.arth.2017.03.015 
  27. Chevillotte T, Coudert P, Cawley D, et al. Influence of posture on relationships between pelvic parameters and lumbar lordosis: comparison of the standing, seated, and supine positions. A preliminary study. Orthop Traumatol Surg Res. 2018;104:565-8. https://doi.org/10.1016/j.otsr.2018.06.005 
  28. Watanabe S, Choe H, Kobayashi N, Ike H, Kobayashi D, Inaba Y. Prediction of pelvic mobility using whole-spinal and pelvic alignment in standing and sitting position in total hip arthroplasty patients. J Orthop Surg (Hong Kong). 2021;29:23094990211019099. https://doi.org/10.1177/23094990211019099 
  29. Sun Z, Zhou S, Jiang S, Zou D, Yu M, Li W. Variations of sagittal alignment in standing versus sitting positions under the Roussouly classification in asymptomatic subjects. Global Spine J. 2022;12:772-9. https://doi.org/10.1177/2192568220962436 
  30. 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 
  31. Sari-Ali E, Lazennec J, Morin M, Saillant G. [Comparative study of sagittal lumbo-pelvic balance values between the standing and seated positions. The lumbo-pelvic complex]. Sauramps; 2005. 35-46. French. 
  32. Eddine TA, Migaud H, Chantelot C, Cotten A, Fontaine C, Duquennoy A. Variations of pelvic anteversion in the lying and standing positions: analysis of 24 control subjects and implications for CT measurement of position of a prosthetic cup. Surg Radiol Anat. 2001;23:105-10. https://doi.org/10.1007/s00276-001-0105-z 
  33. Hepinstall MS, Coden G, Salem HS, Naylor B, Matzko C, Mont MA. Consideration of pelvic tilt at the time of preoperative planning improves standing acetabular position after robotic-arm assisted total hip arthroplasty. Hip Int. 2023;33:47-52. https://doi.org/10.1177/11207000211038670