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Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA.

ABSTRACT: Background:Sagittal spinopelvic translation (SSPT) is the horizontal distance from the hip center to the C7 plumb line (C7PL). SSPT is an important variable showing the overall patient balance in different functional positions which could affect the rate of hip instability. This study investigates the SSPT modification in patients who underwent total hip arthroplasty (THA). Methods:A total of 120 patients were assessed preoperatively and postoperatively on standing and sitting acquisitions (primary unilateral THA without complication). SSPT is zero when the C7PL goes through the center of the femoral heads and positive when the C7PL is posterior to the hips' center (negative if anterior). Three subgroups were defined based on the pelvic incidence (PI): low PI <45°, 45°< normal PI <65°, or high PI >65°. Results:The overall mean preoperative SSPT change from standing to sitting was 2.2 cm ([-7.2 to 17.4]) (P < .05). The overall mean postoperative SSPT change from standing to sitting was 1.2 cm ([-14.2 to 22.4]) (P < .05). In low- and normal-PI groups, standing to sitting SSPT and preoperative to postoperative changes in standing SSPT were increased significantly after surgery with the C7PL behind the hips' center (P < .05). In the high-PI group, standing to sitting SSPT was increased postoperatively (P = .034) (no significant changes from preoperative to postoperative status in standing and sitting). Conclusions:Adaptation from standing to sitting positions combines pelvic tilt and anteroposterior pelvic translation. THA implantation induces significant changes in SSPT mainly for low- and standard-PI patients. This is an important variable to consider when investigating the causes of THA subluxation or dislocation.

SUBMITTER: Lazennec JY

PROVIDER: S-EPMC7451919 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA.

Lazennec Jean Yves JY Kim Youngwoo Y Folinais Dominique D Pour Aidin Eslam AE

Arthroplasty today 20200823 4

<h4>Background</h4>Sagittal spinopelvic translation (SSPT) is the horizontal distance from the hip center to the C7 plumb line (C7PL). SSPT is an important variable showing the overall patient balance in different functional positions which could affect the rate of hip instability. This study investigates the SSPT modification in patients who underwent total hip arthroplasty (THA).<h4>Methods</h4>A total of 120 patients were assessed preoperatively and postoperatively on standing and sitting acq ...[more]

PMID: 32875018

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Project description:BackgroundTotal 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.MethodsOne 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.ResultsStanding 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%).ConclusionsThe 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.

Project description:ObjectiveSpinal cord stimulation (SCS) has become a popular nonopioid pain intervention. However, the treatment failure rate for SCS remains significantly high and many of these patients have poor sagittal spinopelvic balance, which has been found to correlate with increased pain and decreased quality of life. The purpose of this study was to determine if poor sagittal alignment is correlated with SCS treatment failure.Materials and methodsComparative retrospective analysis was performed between two cohorts of patients who had undergone SCS placement, those who had either subsequent removal of their SCS system (representing a treatment failure cohort) and those that underwent generator replacement (representing a successful treatment cohort). The electronic medical record was used to collect demographic and surgical characteristics, which included radiographic measurements of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Also included were data on pain medication usage including opioid and nonopioid therapies.ResultsEighty-one patients met inclusion criteria, 31 had complete removal, and 50 had generator replacements. Measurement of sagittal balance parameters demonstrated that many patients had poor alignment, with 34 outside normal range for LL (10 vs 24 in removal and replacement cohorts, respectively), 30 for PI (12 [38.7%] vs 18 [36.0%]), 46 for PT (18 [58.1%] vs 28 [56.0%]), 38 for SS (18 [58.1%] vs 20 [40.0%]), and 39 for PI-LL mismatch (14 [45.2%] vs 25 [50.0%]). There were no significant differences in sagittal alignment parameters between the two cohorts.ConclusionsThis retrospective cohort analysis of SCS patients did not demonstrate any relationship between poor sagittal alignment and failure of SCS therapy. Further studies of larger databases should be performed to determine how many patients ultimately go on to have additional structural spinal surgery after failure of SCS and whether or not those patients go on to have positive outcomes.

Project description:BackgroundOutdoor fitness training has become popular as a tool for improving the health, especially middle-aged and older adults. For this purpose, outdoor fitness equipment (OFE) have been installed in public areas. However, their safety and effectiveness are still unknown. The aim of the present research was to analyze the sagittal disposition of the spine and pelvic tilt during the use of OFE, and to determine the influence of anthropometric variables on these factors in middle-aged and older adults.MethodsSeventy healthy volunteers, 56 women and 14 men (age: 63.14 ± 8.19 years) participated in the study. Sagittal spine disposition and pelvic tilt were measured using a Spinal Mouse®, in the relaxed standing position, and during the use of the OFE. In addition, kinanthropometry variables were also measured according to the guidelines of the International Society for the Advancement of Kinanthropometry.ResultsRegarding thoracic kyphosis, a significant decrease was found in thoracic kyphosis in the initial position (IP) in single bonny rider (SBR) (p = 0.006) and row (p = 0.046), and a significant increase in the final position (FP) in the row (p = 0.011), surfboard (p < 0.001) and air walker (p = 0.027) machines. In relation to the lumbar curvature and pelvic tilt, a significant decrease in lumbar lordosis and a decrease in pelvic anteversion were observed in the IP and FP in SBR and row; and in the bike (p < 0.001) machine. In the surfboard machine, a significant decrease in lumbar lordosis was found (p = 0.002), with no changes in pelvic tilt. According to the multiple linear regression analysis, the subjects with a higher cormic index and height were more at risk of increasing their thoracic kyphosis, decreasing lumbar lordosis and/or decreasing pelvic anteversion towards pelvic retroversion.ConclusionsMiddle-aged and older adults show spinal misalignments when using the OFE with respect to the standing position, showing a decrease in the thoracic kyphosis in IP of SBR and ROW, and a significant increase in the surfboard and air walker, and in the FP of Row, in the lumbar lordosis in all the OFE in sitting and some in standing, and in the pelvic anteversion in all the OFE in sitting. The variables height and the cormic index explained most of the changes in sagittal spine disposition.

Project description: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.

Dataset Information

Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA.

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Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA.

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