High Prevalence of Spinopelvic Risk Factors in Patients With Post-Operative Hip Dislocations |
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| Institution: | 1. Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, New York;2. Corin Group, Cirencester, Gloucestershire, United Kingdom;3. Colorado Joint Replacement, Centura Health Physician Group, Denver, CO;4. Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA;1. Keck School of Medicine of USC, Los Angeles, California;2. American Academy of Orthopaedic Surgeons, Rosemont, Illinois;3. University of Arkansas for Medical Sciences, Little Rock, Arkansas;1. Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona;2. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota;3. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota;1. Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil;2. University of São Paulo, Ribeirão Preto Medicine School, Brazil |
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| Abstract: | BackgroundExcessive 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.MethodsForty-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 orientation. Thresholds for “at risk” spinopelvic parameters were standing posterior PT ≤ −15°, lumbar flexion (LLstand–LLseated) ≤ 20°, PI ≤ 41°, PI ≥ 70°, and SSD (PI–LLstand mismatch ≥ 20°).ResultsThere were significant differences in mean spinopelvic parameters between the dislocating and control cohorts (P < .001). There were no differences in mean PI (58° versus 56°, respectively, P = .29) or prevalence of high and low PI between groups. 67% of the dislocating patients had one or more significant 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.ConclusionExcessive 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. |
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| Keywords: | dislocation pelvic tilt total hip arthroplasty instability spinopelvic |
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