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

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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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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Utility of CT-based navigation in revision total hip arthroplasty for a patient with severe posterior pelvic tilt-case report-

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03263-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shintaro Watanabe ◽

Hyonmin Choe ◽

Naomi Kobayashi ◽

Hiroyuki Ike ◽

Daigo Kobayashi ◽

...

Keyword(s):

Case Report ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Pelvic Tilt ◽

Revision Total Hip Arthroplasty ◽

Total Hip

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Late Anterior Dislocation Due to Posterior Pelvic Tilt in Total Hip Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001610010206 ◽

2016 ◽

Vol 10 (1) ◽

pp. 206-212 ◽

Cited By ~ 11

Author(s):

Hiroki Kobayashi ◽

Yasuharu Nakashima ◽

Takuaki Yamamoto ◽

Goro Motomura ◽

Masayuki Kanazawa ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Conservative Treatment ◽

Hip Arthroplasty ◽

Pelvic Tilt ◽

Compression Fracture ◽

Anterior Dislocation ◽

Minor Trauma ◽

Thoracolumbar Kyphosis ◽

Acetabular Cup ◽

Total Hip

Background: Excessive pelvic tilt may be one of the factors leading to instability in total hip arthroplasty (THA), even when the acetabular cup is placed properly. To our knowledge, only a few studies have described late anterior dislocation due to posterior pelvic tilt. We present 3 cases with late anterior dislocations possibly due to posterior pelvic tilt. Cases Presentations: Case-1: An 84-years-old woman fell and presented with an anterior dislocation 12-years after THA. Her pelvis had tilted to approximately 30° posteriorly in a supine position. After conservative treatment, she presented with 10 recurrent anterior dislocations. She had thoracolumbar kyphosis due to multiple compression fractures. Revision with anterior placement of an elevated liner and a 32-mm head corrected the dislocation, and no further dislocations occurred. Case-2: A 78-years-old woman fell and presented with an anterior dislocation 4-years after THA. Her posterior pelvic tilt had increased 23° due to a lumbar compression fracture. Revision by decreasing the cup anteversion was performed, but recurrent posterior dislocations occurred. Owing to her worsened general condition, further treatment was abandoned. Case-3: A 79-years-old woman twisted her body and presented an anterior dislocation 3-years after THA. After manual reduction and conservative treatment, the dislocation recurred. Her posterior pelvic tilt had increased 16°. Conclusion: Although minor trauma triggered the anterior instability in these patients, the underlying pathomechanism existed in the progressive pelvic posterior tilt due to thoracolumbar kyphosis. As longer life expectancy as well as implant survivorship is predicted, attention must be paid to the change of pelvic tilt in elderly patients.

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