High Prevalence of Spinopelvic Risk Factors in Patients With Post-Operative Hip Dislocations

被引:21
作者
Vigdorchik, Jonathan M. [1 ,5 ]
Madurawe, Chameka S. [2 ]
Dennis, Douglas A. [3 ]
Pierrepont, Jim W. [2 ]
Jones, Tristan [2 ]
Huddleston, James I. [4 ]
机构
[1] Hosp Special Surg, Dept Orthoped Surg Adult Reconstruct & Joint Repla, New York, NY USA
[2] Corin Grp, Cirencester, Glos, England
[3] Centura Hlth Phys Grp, Colorado Joint Replacement, Denver, CO USA
[4] Stanford Univ, Med Ctr, Dept Orthopaed Surg, Palo Alto, CA USA
[5] Hosp Special Surg, 535 E 70th St, New York, NY 10021 USA
关键词
dislocation; pelvic tilt; total hip arthroplasty; instability; spinopelvic; ACETABULAR COMPONENT; ARTHROPLASTY PATIENTS; SPINAL DEFORMITY; FUSION; ORIENTATION; MOBILITY; CLASSIFICATION; ANTEVERSION; MAJORITY;
D O I
10.1016/j.arth.2022.05.016
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Excessive standing posterior pelvic tilt (PT), lumbar spine stiffness, low pelvic incidence (PI), and severe sagittal spinal deformity (SSD) have been linked to increased dislocation rates. We aimed to determine the prevalence of these 4 parameters in a cohort of unstable total hip arthroplasty (THA) patients and compare these to a large representative control population of primary THA patients.Methods: Forty-eight patients with instability following primary THA were compared to a control cohort of 9414 THA patients. Lateral X-rays in standing and flexed-seated positions were used to assess PT and lumbar lordosis (LL). Computed tomography scans were used to measure PI and acetabular cup orien-tation. Thresholds for "at risk" spinopelvic parameters were standing posterior PT <-15 degrees, lumbar flexion (LLstand-LLseated) < 20 degrees, PI < 41 degrees, PI >= 70 degrees, and SSD (PI-LLstand mismatch >= 20 degrees).Results: There were significant differences in mean spinopelvic parameters between the dislocating and control cohorts (P < .001). There were no differences in mean PI (58 degrees versus 56 degrees, respectively, P =.29) or prevalence of high and low PI between groups. 67% of the dislocating patients had one or more signif-icant risk factors, compared to only 11% of the control. A total of 71% of the dislocating patients had cup orientations within the traditional safe zone. Conclusion: Excessive standing posterior PT, low lumbar flexion, and a severe SSD are more prevalent in unstable THAs. Pre-op screening for these parameters combined with appropriate planning and implant selection may help identify at risk patients and reduce the prevalence of dislocation.(c) 2022 Elsevier Inc. All rights reserved.
引用
收藏
页码:706 / 712
页数:7
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