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The 2008 Frank Stinchfield award: variation in postoperative pelvic tilt may confound the accuracy of hip navigation systems.

ABSTRACT: Most computer navigation systems used in total hip arthroplasty integrate preoperative pelvic tilt to calculate the anterior pelvic plane assuming tilt is constant; however, the consistency of pelvic tilt after THA has never been proven. Therefore, using a modern comprehensive gait analysis before and after arthroplasty we sought to compare (1) dynamic pelvic tilt changes and (2) pelvic flexion/extension range-of-motion changes. Twenty-one patients who underwent unilateral THA were prospectively studied. Quantitative pelvic tilt changes (in the sagittal plane) and pelvic range of flexion/extension motion relative to a laboratory coordinate system were compared using a computerized video motion system. Mean gait pelvic tilt was 13.9 masculine +/- 4.8 masculine (range, 1.73 masculine-23.1 masculine) preoperatively, 12.5 masculine +/- 4.5 masculine (range, 1.4 masculine-18.7 masculine) 2 months postoperatively, and 10.5 degrees +/- 5.5 masculine (range, -2.36 masculine-19.2 masculine) 12 months postoperatively. A significant proportion (31%) of patients had more than a 5 degrees difference between preoperative and 12-month postoperative measurements and the variability was spread over 20 degrees . Significant dynamic changes in pelvic tilt occurred after THA. While navigation clearly improves the anatomical position of the component during THA, the functional position of the component will not always be improved because of the significant change between preoperative and postoperative pelvic tilt.

SUBMITTER: Parratte S

PROVIDER: S-EPMC2600967 | biostudies-other | 2009 Jan

REPOSITORIES: biostudies-other

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Pelvic Tilt Reduces the Accuracy of Acetabular Component Placement When Using a Portable Navigation System: An In Vitro Study.

Project description:BackgroundA portable navigation system (PNS) was recently introduced. The PNS enables surgeons to place the acetabular component accurately. While the margin of the error for the cup abduction and anteversion was larger than the values obtained from a computed tomography-based navigation system. We hypothesized that the accuracy of the PNS might be affected by pelvic tilt.Material and methodsA bone substitute model of the pelvis was used in this in vitro study. We set the acetabular component using PNS. We set the acetabular component angle after changing the sagittal, coronal, and axial pelvic tilt. We calculated the difference between the angle displayed on the PNS display and the actual angle of the acetabular component. The difference in inclination angle was defined as ΔRI, and the difference in the anteversion angle was defined as ΔRA. We evaluated the trends in this ΔRI and ΔRA due to the pelvic tilt.ResultsIn this in vitro study, the placement of the acetabular component was accurate in the neutral position; ΔRI was 0.5 ± 0.7° and ΔRA was 1.0 ± 0.7°. Sagittal pelvic tilt and axial pelvic tilt increased both the ΔRA and ΔRI (P = .017). Coronal tilt increased ΔRI but did not change ΔRA.ConclusionsWhile the PNS may enable surgeons to place accurate component placement in the neutral position, its accuracy decreased by pelvic tilt. The surgeons should use a solid pelvic lateral positioner for reducing discrepancies in pelvic tilt when using the PNS in the lateral decubitus position.

| S-EPMC7856392 | biostudies-literature

Influence of Contralateral Hip Status on Pelvic Tilt After Total Hip Arthroplasty.

Project description:BackgroundEvery degree of change in pelvic tilt (PT) leads to a 0.7° change in anteversion and a 0.3° change in inclination. This study aimed to determine the significance of contralateral hip arthritis on changes in PT using preoperative and postoperative anteroposterior radiographs.MethodsThere were 193 primary total hip arthroplasties done by 2 surgeons at a single academic tertiary referral center reviewed between September 2021 and January 2023. PT was calculated as Tilt = -(ln[(B/A) × (1/0.483)]) / 0.051. Value A is the distance from the base of the SI joint to the superior margin of the obturator foramen; value B is the height of the obturator foramen. After exclusions, contralateral hips were identified as being normal (n = 75), arthritic (n = 39) (Tönnis grade 3/4), replaced (n = 34), or having undergone simultaneous bilateral total hip arthroplasty (n = 5) on postoperative films. Difference in PT was measured between preoperative and postoperative films taken 1-3 months after surgery. Analyses for statistical significance were calculated using t-tests and one-way analysis of variance.ResultsAverage change in PT in patients with normal contralateral hips was -5.2° with an absolute mean difference of 7.6°, -1.5° for arthritic contralateral hips with an absolute mean difference of 5.0°, -1.6° for replaced contralateral hips with a mean absolute difference of 4.3°, and 2.2° for bilateral hips with a mean absolute difference of 2.6° (P < .01).ConclusionsDifferences in postoperative PT changes between healthy, arthritic, and replaced contralateral hip study groups were significant. Changes in preoperative to postoperative tilt may have implications for optimal cup placement.

| S-EPMC11347829 | biostudies-literature

Pelvic tilt in patients undergoing total hip arthroplasty: when does it matter?

Project description:Pelvic tilt (PT) affects the functional anteversion and inclination of acetabular components in total hip arthroplasty (THA). One-hundred and thirty-eight consecutive patients who underwent unilateral primary THA were reviewed. Most cases had some degree of pre-operative PT, with 17% having greater than 10° of PT on standing pre-operative radiographs. There was no significant change in PT following THA. A computer model of a hemispheric acetabular component implanted in a range of anatomic positions in a pelvis with varying PT was created to determine the effects of PT on functional anteversion and inclination. Based on the study results, tilt-adjustment of the acetabular component position based on standing pre-operative imaging will likely improve functional component position in most patients undergoing THA.

| S-EPMC4359644 | biostudies-literature

Assessing Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty Using Sensor Technology.

Project description:BackgroundThe purpose of our study was to assess the accuracy of a commercially available wearable sensor in replicating pelvic tilt movement in both the sitting and standing position in patients before total hip arthroplasty.MethodsThis prospective study evaluated patients undergoing a primary unilateral total hip arthroplasty by a single surgeon. Patients were excluded if they had a body mass index (BMI) greater than 40 kg/m2. Two sensors were adhered directly to patients' skin at S2 and T12. The S2 angle was recorded on the sensor at maximum flexion and extension angles and compared with pelvic tilt measurements on both sitting and standing radiographs. The primary outcomes recorded were patients' pelvic tilts measured using radiographs (PT-RAD) and sensors (PT-SEN), with Pearson correlation coefficients and intraclass correlation coefficients (ICCs) calculated.ResultsSixty-one patients (35 males and 26 females) with an average age of 61.5 ± 8.5 years and BMI of 26.9 ± 4.1 kg/m2 were analyzed. The mean prestanding PT-RAD and PT-SEN were 1.5 ± 8.3 and 1.0 ± 8.1, respectively, with an ICC of 0.98 (95% confidence interval, 0.96-0.99). The mean presitting PT-RAD and PT-SEN were -21.9 ± 12.5 and -20.9 ± 11.7, respectively, with an ICC of 0.97 (95% confidence interval, 0.95-0.98). The multiple R2 was 0.95 for the prestanding and presitting comparisons. The R2 for all comparisons between PT-RAD and PT-SEN was >0.85, regardless of BMI or sex.ConclusionsAlthough the use of wearable technology may have limitations, based on our results, a wearable sensor is accurate in replicating pelvic tilt movement.

| S-EPMC8784288 | biostudies-literature

Variations in lower limb alignments indicate pelvic tilt after total hip arthroplasty.

Project description:ObjectiveWe sought to correlate various spinopelvic and lower limb alignments, and to examine the current spinopelvic theories on a Chinese cohort.MethodsWe retrospectively reviewed 166 patients undergoing THA. Among them, 138 patients with unilateral THA met the inclusion criteria. Sagittal alignments and cup orientations were measured on standing and sitting lateral EOS images. Patients were categorized into two groups with a scoring system for lumbar spine degeneration. Patients' demographics including age, sex, lumbar spine degeneration and radiographic measurements were studied.ResultsPT, SS, LL and TK differed significantly between standing and sitting within each group except for TK in degenerative group (32.8 ± 13.9 vs. 32.9 ± 14.2, p = 0.905). Compared with degenerative spine group, non-degenerative spine patients have great pelvic mobility (ΔPT, -24.4 ± 12.5° vs. -17.6 ± 10.7, p = 0.0008), greater lumbar mobility (ΔLL, -34.8 ± 15.2 vs. -21.7 ± 12.2, p = < 0.0001) and compensatory cup orientation changes (ΔRA, -15.5 ± 11.1 vs. -12.0 ± 8.4, p = 0.00920; ΔRI, -10.8 ± 11.5 vs. -5.6 ± 7.5, p = 0.0055). Standing PT and ankle dorsiflexion angle correlated positively (R2 = 0.236, p = 0.005).ConclusionTHA patients in this cohort showed a spinopelvic motion paradigm similar to that from previous studies on Caucasians. Ankle dorsiflexion indicate greater posterior pelvic tilt on standing. Surgeons should beware of risks of instability in patients with lower limb compensations.Advances in knowledgeThis study provides new insights into the clinical relevance of lower limb alignments to spinopelvic motion after THA in a relatively young Chinese population.

| S-EPMC9773480 | biostudies-literature

Is the Rate of Change in Posterior Pelvic Tilt After Total Hip Arthroplasty Constant?

Project description:BackgroundThe purpose of this study was to evaluate the age-related change in pelvic sagittal inclination in the standing position after total hip arthroplasty (THA). This study hypothesized that the rate of progression of posterior tilt is not constant.Material and methodsWe measured sacral slope and pelvic tilt in 36 patients who were followed up for more than 10 years after unilateral primary THA.ResultsThe posterior pelvic tilt in the standing position progressed significantly in the first year after THA and then progressed slowly. However, there was a tendency to accelerate again for those older than 75 years. Posterior pelvic tilt tended to progress rapidly after surgery in patients with femoral neck fractures and subchondral fractures of the femoral head.ConclusionsIn patients older than 75 years and those with fragility fractures, postoperative pelvic tilt in the standing position tends to be greater, suggesting that the use of a large head or dual mobility system should be considered.

| S-EPMC9108515 | biostudies-literature

Handheld Navigation Improves Accuracy in Direct Anterior Total Hip Replacement.

Project description:BackgroundThis study sought to determine the accuracy in placing the acetabular component, estimation of leg length, offset, radiation time and dose, and operative time using a handheld navigation device compared to conventional anterior total hip arthroplasty (THA). It also examined the learning curve of the handheld navigation device.MethodsData were prospectively collected for a consecutive series of 159 THAs; 99 THAs with handheld navigation and 60 conventional THAs. Thresholds of <5°, ≥5° to <10°, and ≥10° for acetabular inclination and version and thresholds of <5 mm, ≥5 mm to <10 mm, and ≥10 mm for leg-length and combined offset discrepancy were used to assess accuracy. Fluoroscopy time and exposure, operative time, and complications were compared. Learning curve was determined using operative time. Statistical analysis was performed for the different accuracy thresholds with P values set a <0.05 for significance.ResultsThe handheld navigation device demonstrated a mean accuracy of 3.2° and 1.8° for version and inclination, respectively. The handheld navigation group had significantly fewer outliers in version (P < .001), inclination (P < .001), leg-length discrepancy (P < .001), and offset discrepancy (P < .001). Fluoroscopic dose and time (P < .001) were lower in the handheld navigation cohort. The learning curve for handheld navigation was 31-35 cases. The mean operative time after the learning curve was similar to that in the conventional fluoroscopy group (P = .113).ConclusionsHandheld navigation technology provided more accurate results while mitigating radiation exposure to the surgeon and patient. There were fewer outliers in the handheld navigation group. After the learning curve, all metrics improved in accuracy, and operative time was similar to that of the conventional technique.

| S-EPMC9399378 | biostudies-literature

How much does lumbar fusion change sagittal pelvic tilt in individuals receiving total hip arthroplasty?

Project description:BackgroundThis study primarily aims to examine the effect of lumbar fusion on changes in sagittal pelvic tilt (SPT) in total hip arthroplasty (THA) patients.MethodsWe reviewed 19 hip osteoarthritic patients undergoing THA with or without lumbar fusion. The gender, age, primary disease, Deyo comorbidity score, and year of surgery were sorted and matched. All patients were followed up for at least 12 months. They were compared in terms of the SPT angle, Harris hip score (HHS) and complications.ResultsOn average, the patients receiving lumbar fusion had a - 3.9 (95% CI - 7.7 to - 1.5) degrees of SPT before THA and - 2.7 (95% CI - 6.5 to 1.1) degrees postoperatively, and the THA patients without lumbar fusion averaged 2.5 (95% CI - 0.1 to 5.0) degrees and 4.2 (95% CI 2.0 to 6.4) degrees, respectively. In the lumbar fusion patients, the mean SPT was - 3.9 (95% CI - 9.9 to 2.0) degrees with L5S1 fusion and - 4.0(95% CI - 10.0 to 2.1) degrees without L5S1 fusion on the standing radiograph before THA (t = 0.01, P = 0.99). The mean SPT was - 1.2 (95% CI - 4.9 to 2.6) degrees with one- and two-segment fusion and - 10.0 (95% CI - 18.5 to 1.5) degrees with three- and four-segment fusion before THA (t = 2.60, P = 0.02). There was no statistically significant difference in cup inclination and cup anteversion after THA between the lumbar fusion and control groups. These patients in the two groups achieved a similar HHS 12 months after THA despite the fact that they had different SPT and HHS before THA.ConclusionLumbar fusion appears to increase the posterior SPT by approximately 6 degrees in the patients undergoing THA. Lumbar fusion of more than two segments is a predictor of more posterior SPT changes, but fusion of L5S1 is not.

| S-EPMC8796607 | biostudies-literature

The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled.

Project description:The modified Thomas test was developed to assess the presence of hip flexion contracture and to measure hip extensibility. Despite its widespread use, to the authors' knowledge, its criterion reference validity has not yet been investigated. The purpose of this study was to assess the criterion reference validity of the modified Thomas test for measuring peak hip extension angle and hip extension deficits, as defined by the hip not being able to extend to 0º, or neutral. Twenty-nine healthy college students (age = 22.00 ± 3.80 years; height = 1.71 ± 0.09 m; body mass = 70.00 ± 15.60 kg) were recruited for this study. Bland-Altman plots revealed poor validity for the modified Thomas test's ability to measure hip extension, which could not be explained by differences in hip flexion ability alone. The modified Thomas test displayed a sensitivity of 31.82% (95% CI [13.86-54.87]) and a specificity of 57.14% (95% CI [18.41-90.10]) for testing hip extension deficits. It appears, however, that by controlling pelvic tilt, much of this variance can be accounted for (r = 0.98). When pelvic tilt is not controlled, the modified Thomas test displays poor criterion reference validity and, as per previous studies, poor reliability. However, when pelvic tilt is controlled, the modified Thomas test appears to be a valid test for evaluating peak hip extension angle.

| S-EPMC4991856 | biostudies-literature

Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty.

Project description:Total hip arthroplasty is an increasingly common procedure used to address degenerative changes in the hip joint due to osteoarthritis. Although generally associated with good results, among the challenges associated with hip arthroplasty are accurate measurement of biomechanical parameters such as leg length, offset, and cup position, discrepancies of which can lead to significant long-term consequences such as pain, instability, neurological deficits, dislocation, and revision surgery, as well as patient dissatisfaction and, increasingly, litigation. Current methods of managing these parameters are limited, with manual methods such as outriggers or calipers being used to monitor leg length; however, these are susceptible to small intraoperative changes in patient position and are therefore inaccurate. Computer-assisted navigation, while offering improved accuracy, is expensive and cumbersome, in addition to adding significantly to procedural time. To address the technological gap in hip arthroplasty, a new intraoperative navigation tool (Intellijoint HIP®) has been developed. This innovative, 3D mini-optical navigation tool provides real-time, intraoperative data on leg length, offset, and cup position and allows for improved accuracy and precision in component selection and alignment. Benchtop and simulated clinical use testing have demonstrated excellent accuracy, with the navigation tool able to measure leg length and offset to within <1 mm and cup position to within <1° in both anteversion and inclination. This study describes the indications, procedural technique, and early accuracy results of the Intellijoint HIP surgical tool, which offers an accurate and easy-to-use option for hip surgeons to manage leg length, offset, and cup position intraoperatively.

| S-EPMC5125765 | biostudies-literature

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