Preoperative spinopelvic hypermobility resolves following total hip arthroplasty

2021 ◽  
Vol 103-B (12) ◽  
pp. 1766-1773
Author(s):  
Peter K. Sculco ◽  
Eric N. Windsor ◽  
Seth A. Jerabek ◽  
David J. Mayman ◽  
Ameer Elbuluk ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Osteoarthritis ◽  
Reoperation Rate ◽  
Preoperative Imaging ◽  
Sacral Slope ◽  
Total Hip ◽  
Clinically Significant ◽  
One Year ◽  
Acetabular Component Position

Aims Spinopelvic mobility plays an important role in functional acetabular component position following total hip arthroplasty (THA). The primary aim of this study was to determine if spinopelvic hypermobility persists or resolves following THA. Our second aim was to identify patient demographic or radiological factors associated with hypermobility and resolution of hypermobility after THA. Methods This study investigated patients with preoperative posterior hypermobility, defined as a change in sacral slope (SS) from standing to sitting (ΔSSstand-sit) ≥ 30°. Radiological spinopelvic parameters, including SS, pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, anterior pelvic plane tilt (APPt), and spinopelvic tilt (SPT), were measured on preoperative imaging, and at six weeks and a minimum of one year postoperatively. The severity of bilateral hip osteoarthritis (OA) was graded using Kellgren-Lawrence criteria. Results A total of 136 patients were identified as having preoperative spinopelvic hypermobility. At one year after THA, 95% (129/136) of patients were no longer categorized as hypermobile on standing and sitting radiographs (ΔSSstand-sit < 30°). Mean ΔSSstand-sit decreased from 36.4° (SD 5.1°) at baseline to 21.4° (SD 6.6°) at one year (p < 0.001). Mean SSseated increased from baseline (11.4° (SD 8.8°)) to one year after THA by 11.5° (SD 7.4°) (p < 0.001), which correlates to an 8.5° (SD 5.5°) mean decrease in seated functional cup anteversion. Contralateral hip OA was the only radiological predictor of hypermobility persisting at one year after surgery. The overall reoperation rate was 1.5%. Conclusion Spinopelvic hypermobility was found to resolve in the majority (95%) of patients one year after THA. The increase in SSseated was clinically significant, suggesting that current target recommendations for the hypermobile patient (decreased anteversion and inclination) should be revisited. Cite this article: Bone Joint J 2021;103-B(12):1766–1773.

What preoperative factors predict postoperative sitting pelvic position one year following total hip arthroplasty?

2018 ◽  
Vol 100-B (10) ◽  
pp. 1289-1296 ◽  
Author(s):  
J. L. Berliner ◽  
C. I. Esposito ◽  
T. T. Miller ◽  
D. E. Padgett ◽  
D. J. Mayman ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lumbar Lordosis ◽  
Sacral Slope ◽  
Rotational Axis ◽  
Total Hip ◽  
Spinopelvic Alignment ◽  
One Year ◽  
Pelvic Position ◽  
Preoperative Factors

Aims The aims of this study were to measure sagittal standing and sitting lumbar-pelvic-femoral alignment in patients before and following total hip arthroplasty (THA), and to consider what preoperative factors may influence a change in postoperative pelvic position. Patients and Methods A total of 161 patients were considered for inclusion. Patients had a mean age of the remaining 61 years (sd 11) with a mean body mass index (BMI) of 28 kg/m2 (sd 6). Of the 161 patients, 82 were male (51%). We excluded 17 patients (11%) with spinal conditions known to affect lumbar mobility as well as the rotational axis of the spine. Standing and sitting spine-to-lower-limb radiographs were taken of the remaining 144 patients before and one year following THA. Spinopelvic alignment measurements, including sacral slope, lumbar lordosis, and pelvic incidence, were measured. These angles were used to calculate lumbar spine flexion and femoroacetabular hip flexion from a standing to sitting position. A radiographic scoring system was used to identify those patients in the series who had lumbar degenerative disc disease (DDD) and compare spinopelvic parameters between those patients with DDD (n = 38) and those who did not (n = 106). Results Following THA, patients sat with more anterior pelvic tilt (mean increased sacral slope 18° preoperatively versus 23° postoperatively; p = 0.001) and more lumbar lordosis (mean 28° preoperatively versus 35° postoperatively; p = 0.001). Preoperative change in sacral slope from standing to sitting (p = 0.03) and the absence of DDD (p = 0.001) correlated to an increased change in postoperative sitting pelvic alignment. Conclusion Sitting lumbar-pelvic-femoral alignment following THA may be driven by hip arthritis and/or spinal deformity. Patients with DDD and fixed spinopelvic alignment have a predictable pelvic position one year following THA. Patients with normal spines have less predictable postoperative pelvic position, which is likely to be driven by hip stiffness. Cite this article: Bone Joint J 2018;100-B:1289–96.

Pelvic rotation after total hip arthroplasty is dynamic and variable

2020 ◽  
Vol 102-B (7_Supple_B) ◽  
pp. 47-51
Author(s):  
Gregory S. Kazarian ◽  
Derek T. Schloemann ◽  
Toby N. Barrack ◽  
Charles M. Lawrie ◽  
Robert L. Barrack
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Sagittal Alignment ◽  
Component Position ◽  
Total Hip ◽  
One Year ◽  
The One ◽  
Acetabular Component Position

Aims The aims of this study were to determine the change in the sagittal alignment of the pelvis and the associated impact on acetabular component position at one-year follow-up after total hip arthroplasty (THA). Methods This study represents the one-year follow-up of a previous short-term study at our institution. Using the patient population from our prior study, the radiological pelvic ratio was assessed in 91 patients undergoing THA, of whom 50 were available for follow-up of at least one year (median 1.5; interquartile range (IQR) 1.1 to 2.0). Anteroposterior radiographs of the pelvis were obtained in the standing position preoperatively and at one year postoperatively. Pelvic ratio was defined as the ratio between the vertical distance from the inferior sacroiliac (SI) joints to the superior pubic symphysis and the horizontal distance between the inferior SI joints. Apparent acetabular component position changes were determined from the change in pelvic ratio. A change of at least 5° was considered clinically meaningful. Results Pelvic ratio decreased (posterior tilt) in 54.0% (27) of cases, did not change significantly in 34.0% (17) of cases, and increased (anterior tilt) in 12.0% (6) of cases when comparing preoperative to one-year postoperative radiographs. This would correspond with 5° to 10° of abduction error in 22.0% of cases and > 10° of error in 6.0%. Likewise, this would correspond with 5° to 10° of version error in 22.0% of cases and > 10° of error in 44.0%. Conclusion Pelvic sagittal alignment is dynamic and variable after THA, and these changes persist to the one-year postoperative period, altering the orientation of the acetabular component. Surgeons who individualize the acetabular component placement based on preoperative functional radiographs should consider that the rotation of the pelvis (and thus the component version and inclination) changes one year postoperatively. Cite this article: Bone Joint J 2020;102-B(7 Supple B):47–51.

scholarly journals Impact of Jiggling Exercise as Conservative Treatment for Hip Osteoarthritis: A Report of Two Cases

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yohei Teramoto ◽  
Kensuke Fukushima ◽  
Tomohisa Koyama ◽  
Yoshihisa Ohashi ◽  
Katsufumi Uchiyama ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Conservative Treatment ◽  
Hip Arthroplasty ◽  
Hip Osteoarthritis ◽  
Advanced Stage ◽  
Plain Radiographs ◽  
Total Hip ◽  
Joint Preservation ◽  
First Case ◽  
One Year

Total hip arthroplasty has been recognized as a feasible treatment for hip osteoarthritis, especially in advanced and terminal stages, but whether it is the best treatment for patients who are younger, have comorbidities, and/or are likely to have low compliance to medical treatment is unknown. Jiggling exercise, which involves the continuous shaking of the foot and leg in small steps, has been reported to be the easiest and a less invasive exercise for patients with hip osteoarthritis. We herein report two patients who performed jiggling exercise as conservative treatment and had successful outcomes. The first case was a 28-year-old woman with advanced-stage hip osteoarthritis that could not be treated with hip preservation surgery; furthermore, the patient refused to undergo total hip arthroplasty because of her young age. The second case was a 74-year-old woman with terminal-stage hip osteoarthritis in whom total hip arthroplasty was deemed not feasible because of possible low compliance due to mental disorder. One year after the initiation of the jiggling exercise, both patients had remarkable clinical improvement. Three years later, remarkable joint remodelling was also revealed in plain radiographs. Jiggling exercise might be a feasible conservative treatment option for joint preservation.

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.

Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty?

2019 ◽  
Vol 101-B (8) ◽  
pp. 902-909 ◽  
Author(s):  
M. M. Innmann ◽  
C. Merle ◽  
T. Gotterbarm ◽  
V. Ewerbeck ◽  
P. E. Beaulé ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Screening Tools ◽  
Sacral Slope ◽  
Sitting Position ◽  
Total Hip ◽  
Patient Reported ◽  
Hip Flexion

Aims This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. Patients and Methods A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. Results Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. Conclusion The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902–909.

scholarly journals Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery

2012 ◽  
Vol 64 (3) ◽  
pp. 415-423 ◽  
Author(s):  
Kristi Elisabeth Heiberg ◽  
Vigdis Bruun-Olsen ◽  
Arne Ekeland ◽  
Anne Marit Mengshoel
Keyword(s):  
Total Hip Arthroplasty ◽  
Training Program ◽  
Hip Arthroplasty ◽  
Skill Training ◽  
Total Hip ◽  
Skill Training Program ◽  
One Year

scholarly journals Cementless one-stage bilateral total hip arthroplasty in osteoarthritis patients: functional outcomes and complications

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
Afshin Taheriazam ◽  
Amin Saeidinia
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Hip Osteoarthritis ◽  
Harris Hip Score ◽  
Superficial Infection ◽  
Total Hip ◽  
One Stage ◽  
The Mean ◽  
Hardinge Approach

Total hip arthroplasty (THA) is one of the successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA) has a large number of advantages, although there are concerns about the higher complications in this procedure. Aim of our study was to evaluate the complications and outcomes of cementless one-stage BTHA in osteoarthritis patients. A total of 147 patients from 2009 till 2012, underwent one-stage BTHA in Milad and Erfan hospitals, Tehran, Iran. A prospective analysis of the functional outcomes and complications of one-stage BTHA through Hardinge approach in patients with osteoarthritis was performed. We evaluated all patients clinically and radiologically with serial followups. A clinical hip score based upon the modified Harris Hip Score (MHHS) was performed preoperatively and again postoperatively. During the period of study 89 men (60.5%) and 58 women (39.4%) with a mean age of 54.67±7.08 years at the time of presentation were recruited. The mean surgical time was 2.8±0.25 hrs. The mean hospital stay was 3.83±0.65 days. Hemoglobin level decreased significantly after operation (P=0.038). There was two deep venous thromboses, one superficial infection and one temporal proneal palsy but no pulmonary embolism, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 41.64±5.42 in patients. MHHS score improved to 89.26±4.68 in the last followup (P=0.0001). Our results recommended the use of cementless one-stage BTHA through Hardinge approach in patients with bilateral hip osteoarthritis.

scholarly journals 5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

2022 ◽  
Vol 11 (2) ◽  
pp. 346
Author(s):  
Ali Darwich ◽  
Kim Pankert ◽  
Andreas Ottersbach ◽  
Marcel Betsch ◽  
Sascha Gravius ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Hip Osteoarthritis ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Total Hip ◽  
The Mean

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

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