Can the sagittal pelvic tilt be estimated from anteroposterior pelvic radiographs in patients awaiting hip arthroplasty? A prospective, diagnostic study

Abstract Background Intraoperative pelvic tilt changes that occurs during total hip arthroplasty (THA) in the supine position affects cup placement and sometimes causes malalignment. The relationship between body mass index (BMI) and pelvic movement has been reported for some procedures, but not the direct anterior approach (DAA). The purpose of this study was to investigate intraoperative pelvic tilt changes that occurs during DAA. Methods In this single-center, retrospective study, we reviewed 200 hips that underwent primary THA via DAA in the supine position using an accelerometer-based navigation system. Intraoperative changes in pelvic tilt and axial rotation from the start of surgery to cup placement were assessed using the navigation system. Preoperative clinical factors that increased pelvic tilt and axial rotation toward the surgical side by > 10° were analyzed via univariate and multiple logistic regression analyses. Results The mean pelvic tilt value increased by 7.6° ± 3.8° (95% confidence interval [CI], 7.1–8.2; range, − 5.0–19.0) intraoperatively, and the axial rotation increased by 3.2° ± 2.7° (95% CI, 2.7–3.7; range, − 13.0–12.0). Univariate analysis revealed that the group with increased pelvic tilt showed significantly greater range of abduction and internal rotation, and significantly lower BMI than the group with no increased tilt. Pre-incisional pelvic tilt was significantly greater in the group with increased axial rotation than in the group with no increased rotation. On logistic regression analysis, BMI (odds ratio [OR], 0.889; 95% CI, 0.809–0.977; p = 0.014) and the range of internal rotation (OR, 1.310; 95% CI, 1.002–1.061; p = 0.038) were predictors of large increases in pelvic tilt. No predictors of large increases in axial rotation were identified. Conclusion Significant forward pelvic tilt was observed in patients with a low BMI values and high ranges of internal rotation via THA using the DAA. Findings indicated that surgeons should pay attention to intraoperative pelvic movements, which may help identify patients with significant pelvic tilt changes.

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Small Random Angular Variations in Pelvic Tilt and Lower Extremity Can Cause Error in Static Image-Based Preoperative Hip Arthroplasty Planning: A Computer Modeling Study

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000002106 ◽

2022 ◽

Vol Publish Ahead of Print ◽

Author(s):

Aidin Eslam Pour ◽

Jean Yves Lazennec ◽

Kunj P. Patel ◽

Manan P. Anjaria ◽

Paul E. Beaulé ◽

...

Keyword(s):

Lower Extremity ◽

Computer Modeling ◽

Hip Arthroplasty ◽

Pelvic Tilt ◽

Static Image ◽

Modeling Study

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Does obesity affect acetabular cup position, spinopelvic function and sagittal spinal alignment? A prospective investigation with standing and sitting assessment of primary hip arthroplasty patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02716-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Henryk Haffer ◽

Zhen Wang ◽

Zhouyang Hu ◽

Luis Becker ◽

Maximilian Müllner ◽

...

Keyword(s):

Hip Arthroplasty ◽

Pelvic Tilt ◽

Obese Group ◽

Sagittal Imbalance ◽

Obese Patients ◽

Spinal Alignment ◽

Acetabular Cup ◽

Sagittal Spinal Alignment ◽

Hip Motion ◽

Cup Position

Abstract Background Total hip arthroplasty (THA) instability is influenced by acetabular component positioning, spinopelvic function and sagittal spinal alignment. Obesity is considered as a risk factor of THA instability, but the causal relationship remains unknown. This study aimed to investigate the influence of BMI on (1) spinopelvic function (lumbar flexibility, pelvic mobility and hip motion), (2) sagittal spinal alignment pre- and postoperatively and (3) acetabular cup position postoperatively in primary THA patients in a prospective setting. Methods One hundred ninety patients receiving primary total hip arthroplasty were enrolled in a prospective cohort study and retrospectively analysed. All patients received stereoradiography (EOS) in standing and relaxed sitting position pre-and postoperatively. C7-sagittal vertical axis (C7-SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), anterior plane pelvic tilt (APPT), and pelvic femoral angle (PFA) were assessed. Key parameters of the spinopelvic function were defined as lumbar flexibility (∆ LL = LLstanding − LLsitting), pelvic mobility (∆ PT = PTstanding − PTsitting) and hip motion (∆ PFA = PFAstanding − PFAsitting). Pelvic mobility was further defined based on ∆ PT as stiff, normal and hypermobile (∆ PT < 10°; 10°–30°; > 30°). The patients were stratified to BMI according to WHO definition: normal BMI ≥ 18.5–24.9 kg/m2 (n = 68), overweight ≥ 25.0–29.9 kg/m2 (n = 81) and obese ≥ 30–39.9 kg/m2 (n = 41). Post-hoc analysis according to Hochberg's GT2 was applied to determine differences between BMI groups. Results Standing cup inclination was significant higher in the obese group compared to the normal BMI group (45.3° vs. 40.1°; p = 0.015) whereas standing cup anteversion was significantly decreased (22.0° vs. 25.3°; p = 0.011). There were no significant differences for spinopelvic function key parameter lumbar flexibility (∆ LL), pelvic mobility (∆ PT) and hip motion (∆ PFA) in relation to BMI stratified groups. The obese group demonstrated significant enhanced pelvic retroversion compared to the normal BMI group (APPT − 1.8° vs. 2.4°; p = 0.028). The preoperative proportion of stiff pelvic mobility was decreased in the obese group (12.2%) compared to normal (25.0%) and overweight (27.2%) groups. Spinal sagittal alignment in C7-SVA and PI-LL mismatch demonstrated significantly greater imbalance in the obese group compared to the normal BMI group (68.6 mm vs. 42.6 mm, p = 0.002 and 7.7° vs. 1.2°, p = 0.032, respectively) The proportion of patients with imbalanced C7-SVA was higher in the obese (58.5%) than in the normal BMI group (44.1%). Conclusions The significantly increased spinal sagittal imbalance with altered pelvic mechanics is a potential cause for the reported increased risk of THA dislocations in obese patients. Consequently, the increased spinal sagittal imbalance in combination with normal pelvic mobility need to be taken into account when performing THA in obese patients.

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Influence of pelvic sagittal tilt on 3-dimensional bone coverage in total hip arthroplasty: a simulation analysis

Hip International ◽

10.1177/1120700019868780 ◽

2019 ◽

Vol 30 (3) ◽

pp. 288-295

Author(s):

Takuro Ueno ◽

Tamon Kabata ◽

Yoshitomo Kajino ◽

Tomoharu Takagi ◽

Takaaki Ohmori ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Pelvic Tilt ◽

Orientation Angle ◽

Acetabular Coverage ◽

3 Dimensional ◽

Total Hip ◽

Sagittal Tilt ◽

Posterior Tilt ◽

3D Coverage

Background: In total hip arthroplasty with computer navigation assistance, cup orientation is generally determined according to the coordinate system relative to the functional pelvic plane (FPP). However, there is a large difference in the cup anteversion between a posterior pelvic tilt relative to the computed tomography (CT) table in the sagittal plane and anterior pelvic tilt, even when the cup is set at the same orientation angle according to each FPP. The present study analysed this difference from the viewpoint of 3-dimensional (3D) coverage of the acetabular component (3D coverage) to determine how the 3D acetabular coverage is altered with changes in pelvic sagittal tilt. Methods: We analysed 3D-simulated acetabular coverage measured in 3D pelvic models reconstructed from the preoperative CT data of 50 patients. In each patient, we created 5 pelvic models with a sagittal tilt of 10° increments between 20° anterior tilt and 20° posterior tilt relative to the CT table. Results: We found that 3D coverage decreased as the pelvis tilted posteriorly. Particularly, there were significant differences between the pelvis with 20° anterior tilt and that with neutral tilt ( p < 0.001). There was also a difference between the pelvis with neutral tilt and that with a 20° posterior tilt ( p < 0.01). The mean decrease in 3D coverage between the pelvis with neutral tilt and that with 20° posterior tilt was 7.2 ± 1.6%. Conclusions: We found that 3D coverage differed among pelvis with different sagittal tilts when the cup orientation angle was determined according to FPP.

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Predictability of Pelvic Tilt During Total Hip Arthroplasty Using a Traction Table

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.03.018 ◽

2018 ◽

Vol 33 (8) ◽

pp. 2556-2559

Author(s):

Paul S. Roettges ◽

Jack R. Hannallah ◽

Jordan L. Smith ◽

John T. Ruth

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Pelvic Tilt ◽

Total Hip

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Posterior pelvic tilt evolution in patients undergoing total hip arthroplasty. A minimum 5-years follow-up clinico-radiological study

Revista Española de Cirugía Ortopédica y Traumatología (English Edition) ◽

10.1016/j.recote.2021.08.008 ◽

2021 ◽

Vol 65 (6) ◽

pp. 401-407

Author(s):

B. García-Maya ◽

J. Gómez Luque ◽

E. García Rey

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Pelvic Tilt ◽

Radiological Study ◽

Total Hip

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Axial pelvic tilt in direct anterior Total hip Arthroplasty using a traction table

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03837-7 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

A. Aichmair ◽

M. Dominkus ◽

J. G. Hofstaetter

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Supine Position ◽

Pelvic Tilt ◽

Patient Positioning ◽

Direct Anterior Approach ◽

Operating Table ◽

Inclusion Criteria ◽

Single Institution ◽

Total Hip

Abstract Background Direct anterior approach total hip arthroplasty may be undertaken on a traction table, but the effects that patient positioning can have on axial pelvic tilt (aPT) are unknown. The aim of this study was to assess the degree of error from patient positioning on the traction table during anterior minimally-invasive surgery (AMIS) THA. Methods Patients were included who underwent direct anterior THA via the AMIS technique at a single institution between 11/2018 and 03/2019. Axial pelvic tilt was measured (a) in the supine position on the operating table, and (b) after positioning on the traction table, by the same consultant surgeon in all cases. Results In the above-mentioned study period, 50 patients (F: 32; M: 18) with an average age of 60.6 ± 13.6 (range: 26.5 to 88.3) years, and an average BMI of 27.2 ± 5.0 (range: 17.9 to 41.5) kg/m2 met the inclusion criteria. When measured in supine position, the average aPT was − 0.2 ± 1.7 (range: − 5.6 to 3.8) degrees. After positioning on the traction table, the average aPT was − 3.5 ± 2.1 (− 8.5 to 1.6) degrees (p < 0.001). In patients with an aPT of more than 5 degrees, the caput-collum-diaphyseal (CCD) angle was significantly lower (125 ± 11° vs. 134 ± 8°, p = 0.007). Conclusion This study raises awareness for the potential risk of aPT during positioning of the patient on the traction table, commonly used during direct anterior THA via the AMIS technique.

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