scholarly journals Relationship between pelvic morphology and functional parameters in standing position for patient-specific cup planning in THA

10.29007/41f9 ◽  
2018 ◽  
Author(s):  
Maximilian Fischer ◽  
Stephanie Schörner ◽  
Stefan Rohde ◽  
Christian Lüring ◽  
Klaus Radermacher
Keyword(s):  
Pelvic Tilt ◽  
Planning Process ◽  
Pelvic Incidence ◽  
Pubic Symphysis ◽  
Standing Position ◽  
Patient Specific ◽  
Automatic Process ◽  
Sacral Slope ◽  
Functional Parameters ◽  
Eos Imaging

The sagittal orientation of the pelvis commonly called pelvic tilt has an effect on the orientation of the cup in total hip arthroplasty (THA). Pelvic tilt is different between individuals and changes during activities of daily living. In particular, the pelvic tilt in standing position should be considered during the planning of THA to adapt the target angles of the cup patient-specifically to minimize wear and the risk of dislocation. Methods to measure pelvic tilt require an additional step in the planning process, may be time consuming and additional devices or x-ray imaging are necessary.In this study, the relationship between three functional parameters describing the sagittal pelvic orientation in standing position and seven morphological parameters of the pelvis was investigated. Correlations might be used to estimate the pelvic tilt in standing position by the morphology of the pelvis in order to avoid additional measuring techniques of pelvic tilt in the planning process of THA. For 18 subjects a semi-automatic process was established to match a 3D-reconstruction of the pelvis from CT scans to orthogonal EOS imaging in standing position and to calculate the morphological and functional parameters of the pelvis subsequently.The two strongest correlations of the linear correlation analysis were observed between morphological pelvic incidence and functional sacral slope (r = 0.78; p = 0.0001) and between morphological pubic symphysis-posterior superior iliac spines- ratio and functional tilt of anterior pelvic plane (r = -0.59; p = 0.0098). The results of this study suggest that patient-specific adjustments to the orientation of the cup in planning of THA without additional measurement of the sagittal pelvic orientation in standing position should be based on the correlation between morphological pelvic incidence and functional sacral slope.

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

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.

Spinopelvic Characteristics in Acetabular Retroversion: Does Pelvic Tilt Change After Periacetabular Osteotomy?

2019 ◽  
Vol 48 (1) ◽  
pp. 181-187 ◽  
Author(s):  
George Grammatopoulos ◽  
Saif Salih ◽  
Paul E. Beaule ◽  
Johan Witt
Keyword(s):  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Pelvic Ring ◽  
Periacetabular Osteotomy ◽  
Case Series ◽  
Acetabular Retroversion ◽  
Sacral Slope ◽  
Anterior Pelvic Plane ◽  
Level Of Evidence ◽  
Pelvic Position

Background: Acetabular retroversion may lead to impingement and pain, which can be treated with an anteverting periacetabular osteotomy (aPAO). Pelvic tilt influences acetabular orientation; as pelvic tilt angle reduces, acetabular version reduces. Thus, acetabular retroversion may be a deformity secondary to abnormal pelvic tilt (functional retroversion) or an anatomic deformity of the acetabulum and the innominate bone (pelvic ring). Purpose: To (1) measure the spinopelvic morphology in patients with acetabular retroversion and (2) assess whether pelvic tilt changes after successful anteverting PAO (aPAO), thus testing whether preoperative pelvic tilt was compensatory. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of 48 hips (42 patients; 30 ± 7 years [mean ± SD]) with acetabular retroversion that underwent successful aPAO was studied. Spinopelvic morphology (pelvic tilt, pelvic incidence, anterior pelvic plane, and sacral slope) was measured from computed tomography scans including the sacral end plate in 21 patients, with adequate images. In addition, the change in pelvic tilt with aPAO was measured via the sacrofemoral-pubic angle with supine pelvic radiographs at an interval of 2.5 ± 2 years. Results: The spinopelvic characteristics included a pelvic tilt of 4° ± 4°, a sacral slope of 39° ± 9°, an anterior pelvic plane angle of 11° ± 5°, and a pelvic incidence of 42° ± 10°. Preoperative pelvic tilt was 4° ± 4° and did not change postoperatively (4° ± 4°) ( P = .676). Conclusion: Pelvic tilt in acetabular retroversion was within normal parameters, illustrating “normal” sagittal pelvic balance and values similar to those reported in the literature in healthy subjects. In addition, it did not change after aPAO. Thus, acetabular retroversion was not secondary to a maladaptive pelvic tilt (functional retroversion). Further work is required to assess whether retroversion is a reflection of a pelvic morphological abnormality rather than an isolated acetabular abnormality. Treatment of acetabular retroversion should focus on correcting the deformity rather than attempting to change the functional pelvic position.

scholarly journals ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

2015 ◽  
Vol 14 (3) ◽  
pp. 205-209
Author(s):  
Jefferson Coelho de Léo ◽  
Álvaro Coelho de Léo ◽  
Igor Machado Cardoso ◽  
Charbel Jacob Júnior ◽  
José Lucas Batista Júnior
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Lumbar Disc ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Lateral Recess ◽  
Central Disc

Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the lumbar spine, the sacrum and the proximal femur. The affected segment was identified as the level and location of lumbar disc herniation in the axial plane with MRI scans.Results:Of 61 patients, 29 (47.5%) had low lumbar lordosis; in this group 24 (82.8%) had central disc herniation, 4 (13.8%) had lateral recess disc herniation and 1 (3.4%) had extraforaminal disc herniation (p<0.05). Of the 61 patients, 18 (29.5%) had low sacral slope; of this group 15 (83.3%) had central disc herniation and 3 (16.7%) had disc herniation in lateral recess (p<0.05).Conclusions:There is a trend towards greater load distribution in the anterior region of the spine when the spine has hypolordotic curve. This study found an association between low lordosis and central disc herniation, as well as low sacral slope and central disc herniation.

The effect of direct vertebral rotation on the spine parameters (coronal and sagittal) in adolescent idiopathic scoliosis

2021 ◽  
pp. 1-8
Author(s):  
Carlos Eduardo Gonçales Barsotti ◽  
Carlos Augusto Belchior B. Junior ◽  
Rodrigo Mantelatto Andrade ◽  
Alexandre Penna Torini ◽  
Ana Paula Ribeiro
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Vertebral Rotation ◽  
Sacral Slope ◽  
Post Surgery ◽  
Radiographic Parameters

BACKGROUND: Idiopathic scoliosis is accompanied by postural alterations, instability of gait, and functional disabilities. The objective was to verify radiographic parameters (coronal and sagittal) of adolescents with idiopathic scoliosis (AIS) pre- and post-surgery with direct vertebral rotation (DVR), associated with type 1 osteotomies in all segments (except the most proximal) and type 2 in the periapical vertebrae of the curves. METHODS: A prospective study design was employed in which 41 AIS were evaluated and compared pre- and post-surgery. Scoliosis was confirmed by a spine X-ray exam (Cobb angle). Eight radiographic parameters were measured: Cobb angles (thoracic proximal and distal), segmental kyphosis, total kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. RESULTS: The Cobb angle averaged 51.3∘± 14.9∘. Post-surgery, there were significant reductions for the following spine measurement parameters: Cobb angle thoracic proximal (p= 0.003); Cobb angle thoracic distal (p= 0.001); Cobb angle lumbar (p= 0.001); kyphosis (T5-T12, p= 0.012); and kyphosis (T1-T12, p= 0.002). These reductions showed the effectiveness of surgical correction to reduce Cobb angles and improve thoracic kyphosis. The values obtained for lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt were not significantly different pre- and post-surgery. CONCLUSION: The surgical technique of DVR in AIS proved to be effective in the coronal and sagittal parameters directed at Cobb angles and thoracic kyphosis in order to favor the rehabilitation process.

scholarly journals Synchronous imaging of pelvic geometry and muscle morphometry: a pilot study of pelvic retroversion using upright MRI

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Noor Shaikh ◽  
Honglin Zhang ◽  
Stephen H. M. Brown ◽  
Hamza Lari ◽  
Oliver Lasry ◽  
...  
Keyword(s):  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Sacral Slope ◽  
Resonance Imaging ◽  
Cross Sectional ◽  
Future Studies ◽  
Upright Mri ◽  
Asymptomatic Volunteers ◽  
Good Repeatability ◽  
Magnetic Resonance Imaging Mri

AbstractThis study investigated feasibility of imaging lumbopelvic musculature and geometry in tandem using upright magnetic resonance imaging (MRI) in asymptomatic adults, and explored the effect of pelvic retroversion on lumbopelvic musculature and geometry. Six asymptomatic volunteers were imaged (0.5 T upright MRI) in 4 postures: standing, standing pelvic retroversion, standing 30° flexion, and supine. Measures included muscle morphometry [cross-sectional area (CSA), circularity, radius, and angle] of the gluteus and iliopsoas, and pelvic geometry [pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), L3–S1 lumbar lordosis (LL)] L3-coccyx. With four volunteers repeating postures, and three raters assessing repeatability, there was generally good repeatability [ICC(3,1) 0.80–0.97]. Retroversion had level dependent effects on muscle measures, for example gluteus CSA and circularity increased (up to 22%). Retroversion increased PT, decreased SS, and decreased L3–S1 LL, but did not affect PI. Gluteus CSA and circularity also had level-specific correlations with PT, SS, and L3–S1 LL. Overall, upright MRI of the lumbopelvic musculature is feasible with good reproducibility, and the morphometry of the involved muscles significantly changes with posture. This finding has the potential to be used for clinical consideration in designing and performing future studies with greater number of healthy subjects and patients.

scholarly journals In-vivo precision of a non-invasive ultrasound-based device to measure pelvic tilt for THA

10.29007/ql68 ◽  
2019 ◽  
Author(s):  
Guillaume Dardenne ◽  
Jean-Philippe Pluchon ◽  
Hoel Letissier ◽  
Aziliz Guezou-Philippe ◽  
Romain Gérard ◽  
...  
Keyword(s):  
Pelvic Tilt ◽  
Intraclass Correlation ◽  
High Body Mass Index ◽  
Standing Position ◽  
Patient Specific ◽  
Non Invasive ◽  
User Expertise ◽  
Hip Kinematics ◽  
Expertise Level

The cup orientation plays a major role in the long-term implant stability following Total Hip Arthroplasty (THA). Because of the patient specific spine-hip kinematics, the safe zone introduced by Lewinnek is more and more controversial. Several solutions have been recently developed to take into account such parameter for THA but are all either invasive, difficult to use or expensive. A non-invasive ultrasound (US) based device has been recently proposed which allows the acquisition of the pelvic tilt in different daily positions. The goal of this study is to analyze the in-vivo intra and inter-observer precision of this device. Measurements were realized by three physicians on three healthy subjects having a low, medium and high Body Mass Index (BMI). Among the three physicians, there were an expert, an intermediate, and a novice user. For each subject, the pelvic tilt was measured ten times by the three physicians in the supine, standing and sitting positions. The inter and intra-observer precisions have been analyzed using the intraclass correlation coefficient (ICC) and according to the BMI, the positions and the user expertise level. The inter-observer precision was therefore excellent whatever the BMI. It was also excellent regarding the supine and the sitting positions and good concerning the standing position. The in-vivo intra-observer precision was excellent for all measurements and whatever the user’s expertise, the BMI and the positions. This study shows therefore that the precision of our system meets the clinical requirement. Introduction

Postlaminectomy lumbopelvic sagittal changes in patients with developmental lumbar spinal stenosis grouped into Roussouly lumbopelvic sagittal profiles: 2- to 10-year prospective follow-up

2021 ◽  
pp. 1-9
Author(s):  
Sameer A. Kitab ◽  
Andrew E. Wakefield ◽  
Edward C. Benzel
Keyword(s):  
Spinal Stenosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Sacral Slope ◽  
Compensatory Mechanisms ◽  
Lumbar Segment ◽  
Lumbar Spinal

OBJECTIVE Roussouly lumbopelvic sagittal profiles are associated with distinct pathologies or distinct natural histories and prognoses. The associations between developmental lumbar spinal stenosis (DLSS) and native lumbopelvic sagittal profiles are unknown. Moreover, the relative effects of multilevel decompression on lumbar sagittal alignment, geometrical parameters of the pelvis, and compensatory mechanisms for each of the Roussouly subtypes are unknown. This study aimed to explore the association between DLSS and native lumbar lordosis (LL) subtypes. It also attempts to understand the natural history of postlaminectomy lumbopelvic sagittal changes and compensatory mechanisms for each of the Roussouly subtypes and to define the critical lumbar segment or specific lordosis arc that is recruited after relief of the stenosis effect. METHODS A total of 418 patients with multilevel DLSS were grouped into various Roussouly subtypes, and lumbopelvic sagittal parameters were prospectively compared at follow-up intervals of preoperative to < 2 years, 2 to < 5 years, and 5 to ≥ 10 years after laminectomy. The variables analyzed included LL, upper lordosis arc from L1 to L4, lower lordosis arc from L4 to S1, and segmental lordosis from L1 to S1. Pelvic parameters included pelvic incidence, sacral slope, pelvic tilt, and pelvic incidence minus LL values. RESULTS Of the 329 patients who were followed up throughout this study, 33.7% had Roussouly type 1 native lordosis, whereas the incidence rates of types 2, 3, and 4 were 33.4%, 21.9%, and 10.9%, respectively. LL was not reduced in any of the Roussouly subtypes after multilevel decompressions. Instead, LL increased by 4.5° (SD 11.9°—from 27.3° [SD 11.5°] to 31.8° [SD 9.8°]) in Roussouly type 1 and by 3.1° (SD 11.6°—from 41.3° [SD 9.5°] to 44.4° [SD = 9.7°]) in Roussouly type 2. The other Roussouly types showed no significant changes. Pelvic tilt decreased significantly—by 2.8°, whereas sacral slope increased significantly—by 2.9° in Roussouly type 1 and by 1.7° in Roussouly type 2. The critical lumbar segment that recruits LL differs between Roussouly subtypes. Increments and changes were sustained until the final follow-up. CONCLUSIONS The study findings are important in predicting patient prognosis, LL evolution, and the need for prophylactic or corrective deformity surgery. Multilevel involvement in DLSS and the high prevalence of Roussouly types 1 and 2 suggest that spinal canal dimensions are closely linked to the developmental evolution of LL.

Changes in Pelvic Incidence, Pelvic Tilt, and Sacral Slope in Situations of Pelvic Rotation

2017 ◽  
Vol 30 (7) ◽  
pp. E923-E930 ◽  
Author(s):  
Hai-Ming Jin ◽  
Dao-Liang Xu ◽  
Jun Xuan ◽  
Jiao-Xiang Chen ◽  
Kai Chen ◽  
...  
Keyword(s):  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Sacral Slope ◽  
Pelvic Rotation

scholarly journals Relationship Between Spinal-Pelvic Sagittal Balance and Pelvic-Femoral Injuries in Professional Soccer Players

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989496
Author(s):  
Antoine Ferenczi ◽  
Antoine Moraux ◽  
Franck Le Gall ◽  
André Thevenon ◽  
Valérie Wieczorek
Keyword(s):  
Sagittal Balance ◽  
Pelvic Tilt ◽  
Imaging System ◽  
Pubic Symphysis ◽  
Soccer Players ◽  
Injury Incidence ◽  
Radiographic Imaging ◽  
Level Of Evidence ◽  
Professional Soccer ◽  
Eos Imaging

Background: Pelvic-femoral injuries are a common problem in football (soccer) players. However, the risk factors for these injuries are unclear. Our knowledge of spinal-pelvic sagittal balance has increased considerably over the past few years, notably as a result of new radiographic techniques such the EOS radiographic imaging system. Purpose: To investigate the link between spinal-pelvic sagittal balance on EOS imaging and the incidence of pelvic-femoral injuries. Study Design: Cohort study; Level of evidence, 2. Methods: Players in a League 1 professional soccer team were observed for 5 consecutive seasons. All players included in the study underwent EOS radiographic imaging. All acute and microtraumatic injuries to the pelvic-femoral complex were recorded prospectively: hamstrings, psoas, quadriceps, adductors, obturators, and pubic symphysis. We analyzed the relationship between injury incidence and key radiographic parameters involved in pelvic balance. Results: A total of 61 players were included (mean age, 24.5 years; n = 149 injuries; mean pelvic tilt, 9.08° ± 5.6°). A significant link was observed between the incidence of pelvic-femoral injuries and pelvic tilt ( P = .02). A significant link was also observed between the incidence of acute pelvic-femoral injuries and pelvic tilt ( P = .05). In both cases, a high pelvic tilt was associated with a low incidence of injuries. Conclusion: In professional soccer players, a low pelvic tilt was associated with a high incidence of all pelvic-femoral injuries as well as acute pelvic-femoral injuries. These results could lead to new preventive methods for these musculotendinous injuries through physical therapy.

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