scholarly journals 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

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.

scholarly journals Pelvic tilt after total hip arthroplasty in patients with osteoarthritis of the hip

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091831
Author(s):  
Toshiyuki Tateiwa ◽  
Kenji Endo ◽  
Yuji Matsuoka ◽  
Tsunehito Ishida ◽  
Takaaki Shishido ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Hip Osteoarthritis ◽  
Lower Limbs ◽  
Sacral Slope ◽  
Spinal Alignment ◽  
Total Hip ◽  
Postoperative Change ◽  
Sagittal Spinal Alignment

Background: It is important to understand postoperative global sagittal spinal alignment after total hip arthroplasty (THA) to prevent not only the following hip complications but also progressing lumbar degeneration. The purpose of this study was to progress the analysis of the global sagittal spinal alignment between before and after THA in patients without large lower limbs discrepancy. Subjects and methods: The subjects were 87 patients with bilateral hip osteoarthritis (OA) before unilateral primary THA. We measured sagittal vertical axis (SVA), lumbar lordotic angle, sacral slope, pelvic tilt (PT), and pelvic incidence (PI) and compared the postoperative change of those parameters. Excluded criteria were Crowe classification types II, III, and IV and more than 10 mm of leg length difference, spinal scoliosis (Cobb angle > 25°), and lumbar kyphosis. Results: The correlation coefficient between preoperative factors and postoperative sagittal alignments revealed that postoperative SVA has correlation with age ( r = 0.46, p < 0.008) and preoperative PT ( r = 0.42, p = 0.015). Postoperative PT had a correlation with preoperative PI ( r = 0.46, p = 0.007). The change of PT after operation had negative correlation to preoperative PT ( r = −0.47, p < 0.01) and PI ( r = −0.38, p = 0.03). Multiple regression analysis revealed that the change of PT = 4.979 − 0.235 × preoperative PT ( p < 0.05). Therefore, when preoperative PT was less than 20°, the postoperative PT would become larger than the preoperative one. Conclusion: (1) In patient with hip OA without large lower limbs discrepancy, the postoperative PT after THA correlated with PI. (2) The postoperative change of PT was influenced by preoperative PT.

Sagittal spinal alignment after total hip arthroplasty for neglected high hip dysplasia: does changing the distorted mechanics of the hip normalize spinal alignment?

2020 ◽  
Vol 9 (1) ◽  
pp. 221-229
Author(s):  
Omur Caglar ◽  
Samet Isik ◽  
Mehmet Kaymakoglu ◽  
Halil Gokhan Demirkiran ◽  
Bulent Atilla ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Dysplasia ◽  
Spinal Alignment ◽  
Total Hip ◽  
Sagittal Spinal Alignment

scholarly journals Impact of body mass on hospital resource use in total hip arthroplasty

2009 ◽  
Vol 12 (8) ◽  
pp. 1122-1132 ◽  
Author(s):  
John A Batsis ◽  
James M Naessens ◽  
Mark T Keegan ◽  
Amy E Wagie ◽  
Paul M Huddleston ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Resource Utilization ◽  
Hip Arthroplasty ◽  
Tertiary Care ◽  
Obese Group ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Total Hip ◽  
Operative Costs ◽  
The Impact

AbstractObjectiveTo determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).DesignA retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).SettingMayo Clinic Rochester, a tertiary care centre.SubjectsPatients were stratified by pre-operative BMI as normal (18·5–24·9 kg/m2), overweight (25·0–29·9 kg/m2), obese (30·0–34·9 kg/m2) and morbidly obese (≥35·0 kg/m2). Of 5642 patients, 1362 (24·1 %) patients had a normal BMI, 2146 (38·0 %) were overweight, 1342 (23·8 %) were obese and 792 (14·0 %) were morbidly obese.ResultsAdjusted LOS was similar among normal (4·99 d), overweight (5·00 d), obese (5·02 d) and morbidly obese (5·17 d) patients (P= 0·20). Adjusted overall episode costs were no different (P= 0·23) between the groups of normal ($17 211), overweight ($17 462), obese ($17 195) and morbidly obese ($17 655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group ($5688) than in normal ($5553), overweight ($5549) and obese ($5593) patients (P= 0·03). Operating room costs were higher in morbidly obese patients ($3418) than in normal ($3276), overweight ($3291) and obese ($3340) patients (P< 0·001). Post-operative costs were no different (P= 0·30). Blood bank costs differed (P= 0·002) and were lower in the morbidly obese group ($180) compared with the other patient groups (P< 0·05). Other differences in costs were not significant. Morbidly obese patients were more likely to be transferred to a nursing home (24·1 %) than normal (18·4 %), overweight (17·9 %) or obese (16·0 %) patients (P= 0·001 each). There were no differences in the composite endpoint of 30 d mortality, re-admissions, re-operations or intensive care unit utilization.ConclusionsBMI in patients undergoing primary elective THA did not impact LOS or overall institutional acute care costs, despite higher operative costs in morbidly obese patients. Obesity does not increase resource utilization for elective THA.

scholarly journals Hip arthroplasty in obese patients: rising prevalence – standard procedures?

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Michael Skutek ◽  
Nils Wirries ◽  
Gabriela Von Lewinski
Keyword(s):  
Hip Arthroplasty ◽  
Lateral Approach ◽  
Harris Hip Score ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Control Series ◽  
Standard Procedures ◽  
Direct Lateral Approach ◽  
Cup Position ◽  
Room Time

We examined our experience and, in particular, complications associated with total hip arthroplasty in obese and morbidly obese patients. We prospectively gathered 50 patients in a matched control series including 25 obese and morbidly obese patients. All patients were operated using the direct lateral approach and standard postoperative protocols. Operating room time, complications, dislocations, blood loss, cup position and clinical parameters using the Harris Hip Score and the Western Ontario and McMaster Universities Arthritis Index results were compared. Although there were some significant differences in clinical outcomes, standard procedures yielded good overall results and an acceptable rate of complications. Details approaching this patient entity are being discussed.

scholarly journals Sitting Posture, Sagittal Spinal Curvatures and Back Pain in 8 to 12-Year-Old Children from the Region of Murcia (Spain): ISQUIOS Programme

2020 ◽  
Vol 17 (7) ◽  
pp. 2578 ◽  
Author(s):  
Pilar Sainz de Baranda ◽  
Antonio Cejudo ◽  
María Teresa Martínez-Romero ◽  
Alba Aparicio-Sarmiento ◽  
Olga Rodríguez-Ferrán ◽  
...  
Keyword(s):  
Back Pain ◽  
Pelvic Tilt ◽  
Sitting Position ◽  
Spinal Alignment ◽  
Cross Sectional ◽  
Spinal Curvatures ◽  
Mean Values ◽  
Sitting Posture ◽  
Sagittal Spinal Alignment ◽  
Lumbar Kyphosis

To explore sagittal spinal alignment and pelvic disposition of schoolchildren in a slump sitting position is needed in order to establish preventive educational postural programs. The purposes of this study were to describe sagittal spinal alignment and pelvic tilt (LSA) in a slump sitting position and to explore the association of sagittal spine and pelvic tilt with back pain (BP) among 8–12-year-old children. It was a cross-sectional study. Sagittal spinal curvatures, BP and pelvic tilt were assessed in 582 students from 14 elementary schools. It was found that 53.44% of children had slight thoracic hyperkyphosis and that 48.80% presented moderate lumbar hyperkyphosis and 38.66% presented slight lumbar hyperkyphosis. Those who did not suffer from BP in any part of the back had a higher lumbar kyphosis (24.64 ± 7.84) or a greater LSA (107.27 ± 5.38) than children who had some type of BP in the previous year or week (lumbar kyphosis: 23.08 ± 8.06; LSA: 105.52 ± 6.00), although with no clinically relevant differences. In fact, neither sufferers nor those who did not have BP presented normal mean values for lumbar kyphosis or LSA according to normality references. This study demonstrates the need to assess sagittal morphotype in childhood since schoolchildren remain incorrectly seated for many hours and it greatly affects their spinal curvatures.

scholarly journals Acetabular cup position and risk of dislocation in primary total hip arthroplasty

2016 ◽  
Vol 88 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Kurt G Seagrave ◽  
Anders Troelsen ◽  
Henrik Malchau ◽  
Henrik Husted ◽  
Kirill Gromov
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Cup Position ◽  
Acetabular Cup Position ◽  
Primary Total Hip Arthroplasty

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

2016 ◽  
Vol 10 (1) ◽  
pp. 206-212 ◽  
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.

A Multiplanar Radiography Method for Assessing Cup Orientation in Total Hip Arthroplasty

2012 ◽  
Vol 134 (10) ◽  
Author(s):  
Shahram Amiri ◽  
Bassam A. Masri ◽  
Donald Garbuz ◽  
Carolyn Anglin ◽  
David R. Wilson
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Patient Specific ◽  
Systematic Bias ◽  
Acetabular Cup ◽  
Cadaveric Specimen ◽  
Total Hip ◽  
Correct Orientation ◽  
Bony Landmarks

Correct orientation of the acetabular cup considering patient-specific functional pelvic angles is an important factor for improving outcomes and avoiding complications after total hip arthroplasty. This study introduces a new, noninvasive radiographic tool for accurately determining a patient’s specific pelvic tilt angle preoperatively, as well as accurately assessing acetabular cup orientation with respect to bony landmarks intraoperatively and postoperatively. The method was validated by imaging a bone replica model of the pelvis with implanted hip components, in comparison to digitized references, and verified with a cadaveric specimen. Pelvic tilt was measured with an accuracy of 0.1 deg and SD of 0.4 deg. Operative cup inclination and anteversion showed accuracies of 0.6 deg and 2.5 deg, with SD of 0.4 deg and 0.6 deg, respectively; these could be improved further by subtracting systematic bias. The method shows accuracy advantages over existing radiographic and fluoroscopic methods and exposes the subjects to a lower radiation dose compared to the similar computed tomography methods. These results suggest that the proposed method is feasible for assessing cup placement with reference to the functional and anatomical references. Furthermore, the ability to reference the same bony landmarks preoperatively, intraoperatively, and postoperatively has important research and clinical advantages.

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