Good vs Poor Results After Total Hip Arthroplasty: An Analysis Method Using Implant and Anatomic Parameters With the EOS Imaging System

Purpose: Asymmetric gait patterns are known to persist in patients with unilateral total hip arthroplasty (THA). Little is known about the effect of gender on gait asymmetry. This study aimed to determine whether gait asymmetry differs between genders in unilateral THA patients and can be explained by component positioning. Methods: 23 female and 10 male unilateral THA patients were included. Asymmetric hip kinematics during gait and component positioning were quantified using a combined computed tomography-based modelling and dual fluoroscopic imaging system. Multiple regression was performed to examine the unique and mediated contribution of gender to observed gait asymmetry. Results: Female and male patients differed most significantly in frontal plane gait asymmetry ( p = 0.001) and bilateral difference of vertical femoral offset ( p = 0.048). Compared with the native hip, the implanted hip exhibited significantly increased adduction ( p = 0.007) in females but significantly increased abduction ( p = 0.001) in males. The stem head of the implanted hip was more superiorly positioned compared to the native femoral head in female but more inferiorly positioned in male. Gender accounted for 41.5% variance of frontal plane gait asymmetry and was partially mediated by the bilateral difference of vertical femoral offset. Conclusions: Female unilateral THA patients exhibited significantly increased adduction in the implanted hip compared to the native hip, which is partially attributable to a more superiorly positioned femoral stem centre of rotation. The understanding of gender-specific differences of kinematic patterns may benefit female patients through targeted preoperative planning and postoperative rehabilitation.

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EOS Imaging is Accurate and Reproducible for Preoperative Total Hip Arthroplasty Templating

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.09.051 ◽

2020 ◽

Author(s):

Leonard T. Buller ◽

Alexander S. McLawhorn ◽

Joseph D. Maratt ◽

Kaitlin M. Carroll ◽

David J. Mayman

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Total Hip ◽

Eos Imaging

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Prediction of pelvic mobility using whole-spinal and pelvic alignment in standing and sitting position in total hip arthroplasty patients

Journal of Orthopaedic Surgery ◽

10.1177/23094990211019099 ◽

2021 ◽

Vol 29 (2) ◽

pp. 230949902110190

Author(s):

Shintaro Watanabe ◽

Hyonmin Choe ◽

Naomi Kobayashi ◽

Hiroyuki Ike ◽

Daigo Kobayashi ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Significant Risk ◽

Sitting Position ◽

Factors Associated ◽

Total Hip ◽

Spinopelvic Alignment ◽

Eos Imaging ◽

Lumbar Alignment ◽

Preoperative Factors

Purpose: Dislocation is a major complication after total hip arthroplasty (THA), and pelvic stiffness is reportedly a significant risk factor for dislocation. This study aimed to investigate spinopelvic alignment, and identify preoperative factors associated with postoperative pelvic mobility. Methods: We enrolled 78 THA patients with unilateral osteoarthritis. The sagittal spinopelvic alignment in the standing and sitting position was measured using an EOS imaging system before and 3 months after THA. We evaluated postoperative pelvic mobility, and defined cases with less than 10° of sacral slope change as pelvic stiff type. The preoperative characteristics of those with postoperative stiff type, and preoperative factors associated with risk of postoperative stiff type were evaluated. Results: Sagittal spinopelvic alignment except for lumbar alignment were significantly changed after THA.A total of 13 patients (17%) were identified as postoperative pelvic stiff type. Preoperative lower pelvic and lumbar mobility were determined as significant factors for prediction of postoperative pelvic stiff type. Among these patients, nine patients (69%) did not have pelvic stiffness before THA. Preoperative factor associated with the risk of postoperative pelvic stiff type in those without preoperative stiffness was lower lumbar lordosis in standing position by multivariate regression analysis. Conclusion: Spinopelvic alignments except lumber alignment was significantly changed after THA. The lower pelvic mobility and lumbar alignment were identified as the preoperative predictive factors for postoperative pelvic mobility. Evaluation of preoperative lumbar alignment may be especially useful for the prediction in patients with hip contractures, for these patients may possibly experience the extensive perioperative change in pelvic mobility.

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Preoperative factors improving the prediction of the postoperative sagittal orientation of the pelvis in standing position after total hip arthroplasty

Scientific Reports ◽

10.1038/s41598-020-72782-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Maximilian C. M. Fischer ◽

Kunihiko Tokunaga ◽

Masashi Okamoto ◽

Juliana Habor ◽

Klaus Radermacher

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Planning Process ◽

Standing Position ◽

Harris Hip Score ◽

Patient Specific ◽

Total Hip ◽

Eos Imaging ◽

Sagittal Orientation ◽

Preoperative Factors

Abstract The aims of this study were to investigate if the sagittal orientation of the pelvis (SOP) in the standing position changes after total hip arthroplasty (THA) and evaluate what preoperative factors may improve the prediction of the postoperative standing SOP in the context of a patient-specific functional cup orientation. 196 primary THA patients from Japan were retrospectively selected for this study. Computed tomography imaging of the pelvis, EOS imaging of the lower body and lateral radiographs of the lumbar spine in the standing position were taken preoperatively. Common biometrics and preoperative Harris Hip Score were recorded. The EOS imaging in the standing position was repeated three months following THA. A 3D/2.5D registration process was used to determine the standing SOP. Thirty-three preoperative biometric, morphological and functional parameters were measured. Important preoperative parameters were identified that significantly improve the prediction of the postoperative standing SOP by using multiple linear LASSO regression. On average, the SOP changed significantly (p < 0.001) between the preoperative and postoperative standing position three months after THA by 3° ± 4° in the posterior direction. The age, standing lumbar lordosis angle (LLA) and preoperative supine and standing SOP significantly (p < 0.001) improve the prediction of the postoperative standing SOP. The linear regression model for the prediction of the postoperative standing SOP is significantly (p < 0.001) improved by adding the parameters preoperative standing SOP and LLA, in addition to the preoperative supine SOP, reducing the root mean square error derived from a leave-one-out cross-validation by more than 1°. The mean standing SOP in Japanese patients changes already three months after THA in comparison to the preoperative value. The preoperative factors age, LLA, supine and standing SOP can significantly improve the prediction of the postoperative standing SOP and should be considered within the preoperative planning process of a patient-specific functional cup orientation.

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The Delta of Correction: a novel, more reliable variable than limb-length discrepancy at predicting outcome after total hip arthroplasty

Hip International ◽

10.1177/1120700019843121 ◽

2019 ◽

Vol 30 (5) ◽

pp. 536-543

Author(s):

Nicolas Reina ◽

Jonathan Hourtal ◽

Christopher G Salib ◽

Gauthier Gracia ◽

Etienne Cavaignac ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Limb Length Discrepancy ◽

Leg Length ◽

Total Hip ◽

Length Discrepancy ◽

Eos Imaging ◽

Functional Scores

Background: Leg-length discrepancy (LLD) is a frequent and recurring issue after total hip arthroplasty (THA). It can lead to discomfort and litigation due to the patient’s perception of this inequality. Purpose: The aim of this study was to evaluate the functional impact of postoperative LLD and length correction in patients after primary THA. We hypothesised that clinical outcomes are inversely correlated to length correction and residual discrepancy. Methods: In a prospective cohort, we included 121 patients undergoing unilateral primary THA. Patients were categorised into 3 groups based on their residual LLD using routine EOS imaging; Shorter (<-5 mm); Equal (-5 mm to +5 mm); and Longer (>+5 mm). Delta of Correction (DC) was defined as the difference between pre- and postoperative discrepancy measured on EOS imaging. Functional scores (HHS, Postel Merle d’Aubigné, and WOMAC) were measured preoperatively and at last follow-up. The average follow-up was 24 months. We evaluated the clinical and radiographic outcomes regarding the residual LLD and DC. Results: All patients had improvement in their functional scores at last follow-up. There was no difference in clinical outcomes, regardless of preoperative or residual LLD. The highest scores were found in the population with the smallest variations (DC -5 to +5 mm, HHS 96). Conversely, poorer results were found in shortened patients (DC <-5 mm), HHS 86, and lengthened patients, corrected by > 15 mm, with HHS of 83, p < 0.005. Patient perception of postoperative LLD correlated with the DC ( p = 0.004). Conclusion: The DC measurement is a more effective assessment than arthroplasty.

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