scholarly journals Paradoxical spinopelvic motion: does global balance influence spinopelvic motion in total hip arthroplasty?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yu-Hsien Lin ◽  
Yu-Tsung Lin ◽  
Kun-Hui Chen ◽  
Chien-Chou Pan ◽  
Cheng-Min Shih ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Sacral Slope ◽  
Global Alignment ◽  
Lumbosacral Spine ◽  
Position Change ◽  
Total Hip ◽  
Paradoxical Motion ◽  
Hip Motion

Abstract Background Recent research has proposed a classification of spinopelvic stiffness according to pelvic spatial orientation for risk stratification in patients who undergo total hip arthroplasty (THA). However, the influence of global alignment was not investigated, and this study evaluated the effect of global balance (sagittal vertical axis [SVA]) on spinopelvic motion. Methods We conducted a retrospective review of consecutive primary THA patients. We measured SVA, spinopelvic parameters (pelvic tilt [PT], pelvic incidence, and sacral slope), thoracic kyphosis (TK), lumbar lordosis (LL), proximal femur angle (PFA), and cup version using functional radiographs of patients in the standing and upright sitting positions. Linear regression was performed to identify parameters related to global trunk alignment change (∆SVA). Spinopelvic stiffness was defined as PT position change < 10°, and a subset of patients with PT change < 0° was categorized into a paradoxical spinopelvic motion group. Results One hundred twenty-four patients were analyzed (mean age: 65 years, 61% female). In univariate regression analysis, ∆TK, ∆LL, and ∆PFA were correlated to ∆SVA. In multivariate regression analysis, ΔLL (p < 0.001) and ΔPFA (p < 0.001) were found to be correlated to ΔSVA (ΔSVA = − 11.97 + 0.05ΔTK – 0.23ΔLL – 0.17ΔPFA; adjusted R2 = 0.558). Spinopelvic stiffness was observed in 40 patients (32%), including five (4%) with paradoxical motion (∆PT = − 3° ± 1°, p < 0.001) with characteristics of balanced standing global trunk alignment (standing SVA = − 1.0 ± 5.1 cm), similar stiffness of the lumbosacral spine (∆LL = − 7° ± 5°), higher hip motion (∆PFA = − 78° ± 6°, p = 0.017), and higher anterior trunk shift (∆SVA = 6.2 ± 2.0 cm, p = 0.003) from standing to sitting as compared to the stiffness group. Two of these five patients experienced dislocation events after THA. Conclusions The lumbosacral and hip motions were the major contributors to global alignment postural change. Paradoxical motion is a rare but dangerous clinical condition in THA that might be related to a disproportionally large trunk shift in the stiff lumbosacral spine causing excessive hip motion. In paradoxical motion, diminishing functional acetabular clearance during position change might pose the prosthesis at higher risk of impingement and instability than spinopelvic stiffness.

Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty?

2019 ◽  
Vol 101-B (8) ◽  
pp. 902-909 ◽  
Author(s):  
M. M. Innmann ◽  
C. Merle ◽  
T. Gotterbarm ◽  
V. Ewerbeck ◽  
P. E. Beaulé ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Screening Tools ◽  
Sacral Slope ◽  
Sitting Position ◽  
Total Hip ◽  
Patient Reported ◽  
Hip Flexion

Aims This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. Patients and Methods A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. Results Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. Conclusion The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902–909.

scholarly journals Patient- and Surgery-Related Factors that Affect Patient-Reported Outcomes after Total Hip Arthroplasty

2018 ◽  
Vol 7 (10) ◽  
pp. 358 ◽  
Author(s):  
Toshiyuki Kawai ◽  
Masanao Kataoka ◽  
Koji Goto ◽  
Yutaka Kuroda ◽  
Kazutaka So ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Activity Score ◽  
Harris Hip Score ◽  
Related Factors ◽  
Ucla Activity Score ◽  
Factors Associated ◽  
Total Hip ◽  
Patient Reported

Patient-reported outcome measures (PROMs) are used to assess satisfaction after total hip arthroplasty (THA); however, the factors that determine these PROMs remain unclear. This study aimed to identify the patient- and surgery-related factors that affect patient satisfaction after THA as indicated by the Oxford Hip Score (OHS). One-hundred-and-twenty patients who underwent primary THA were included. Various patient-related factors, including clinical scores, and surgery-related factors were examined for potential correlations with the OHS at 3, 6, and 12 months post-THA. Univariate regression analysis showed that higher preoperative University of California Los Angeles (UCLA) activity score (p = 0.027) and better preoperative OHS (p = 0.0037) were correlated with better OHS at 3 months post-THA. At 6 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.039), better preoperative OHS (p = 0.0006), and use of a cemented stem (p = 0.0071). At 12 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.0075) and better preoperative OHS (p < 0.0001). Multivariate regression analysis showed that the factors significantly correlated with better OHS were female sex (p = 0.011 at 3 months post-THA), osteoarthritis (p = 0.043 at 6 months), higher preoperative OHS (p < 0.001 at 3 and 12 months, p = 0.018 at 6 months), higher preoperative Harris Hip Score (p = 0.001 at 3 months), higher preoperative UCLA activity score (p = 0.0075 at 3 months), and the use of a cemented femoral component (p = 0.012 at 6 months). Patient- and surgery-related factors affecting post-THA PROMs were identified, although the effect of these factors decreased over time.

scholarly journals Long-term survival of cemented versus uncemented total hip arthroplasty in the treatment of acute femoral neck fracture: A retrospective observational study with a mean 10-year follow-up

2020 ◽  
Author(s):  
Xiulan Han ◽  
Weiguang Yu ◽  
Jinluan Lin ◽  
Mingdong Zhao ◽  
Guowei Han ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Total Hip ◽  
Kaplan Meier ◽  
Uncemented Total Hip Arthroplasty

Abstract Background Despite the increased use of uncemented total hip arthroplasty (UTHA), there is little evidence of its superiority over cemented total hip arthroplasty (CTHA). The purpose of this retrospective study was to compare the long-term survivorship and Harris Hip Scores (HHSs) of CTHA versus UTHA in the treatment of acute femoral neck fractures (FNFs). Methods Data involving 224 hips (CTHA, n= 112; UTHA, n=112) that underwent primary surgery in our medical institutions during 2005-2017 were analysed retrospectively. The primary endpoint was the risk of all-cause revision. The difference in the risk of all-cause revision between groups was assessed by Kaplan-Meier survival analysis with a log-rank test and Cox regression analysis. Results The mean follow-up from surgery was 10 years (range, 3 - 13 years). Kaplan-Meier estimated that the 10-year implant survival was 98.1% (CI: 96.1–98.5) in the CTHA group and 96.2% (CI: 95.2–97.3) in the UTHA group (p = 0.030). The adjusted Cox regression analysis demonstrated a lower risk of revision in CTHA than in UTHA (hazard ratio [HR] = 1.4, 95% confidence interval [CI] = 1.1-2.6, p = 0.000). At the final follow-up, significant differences were detected in HHS (85.10[±12.21] for CTHA vs. 79.11[±13.19] for UTHA). Conclusion This retrospective analysis demonstrates that CTHA has superior survival to UTHA, with a significantly reduced revision risk and higher functional outcome scores. Further follow-up is necessary to verify whether the CTHA advantage persists over time.

Correlation of measured range of hip motion following total hip arthroplasty and responses to a questionnaire

1996 ◽  
Vol 11 (5) ◽  
pp. 565-571 ◽  
Author(s):  
Brian J. McGrory ◽  
Andrew A. Freiberg ◽  
Andrew A. Shinar ◽  
William H. Harris
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Measured Range ◽  
Total Hip ◽  
Hip Motion

Does gender influence how patients rate their patient experience after total hip arthroplasty?

2017 ◽  
Vol 28 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Ronald E. Delanois ◽  
Chukwuweike U. Gwam ◽  
Jaydev B. Mistry ◽  
Morad Chughtai ◽  
Anton Khlopas ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Men And Women ◽  
Total Hip ◽  
Gender Influence ◽  
Patient Gender ◽  
Gender Biases ◽  
Weighted Means

Background: Patient satisfaction, as measured by Press Ganey (PG) surveys, partially determines reimbursement rates. Knowing what influences these scores can lead to higher reimbursement for total hip arthroplasty (THA) surgeons. Currently, it is unknown whether gender biases exist in satisfaction surveys post-THA. Therefore, we asked: (i) which PG survey factors most influence hospital ratings among men and women after THA; and (ii) is there a difference in survey element responses and overall hospital ratings between men and women post-THA? Methods: We queried the PG database for patients who underwent THA from November 2009 to January 2015, which yielded 692 patients (277 men, 415 women). Weighted means were analysed for the scores of PG domains between men and women. A multiple regression analysis was performed for each gender, with overall hospital satisfaction as the dependent variable, in order to assess the influence (β-weight) of each PG domain. Results: For men, pain management (β = 0.317, p = 0.021) most influenced overall hospital rating. For women, staff responsiveness (β = 0.451, p<0.001) most influenced overall hospital rating. This was followed by communication with nurses (β = 0.373, p<0.001), and doctors (β = 0.236, p = 0.002). There were no significant differences in mean overall hospital rating between groups. Conclusions: It is advantageous for orthopaedic surgeons to focus on the PG domains most pertinent to each patient gender post-THA. Focusing efforts based on gender may allow for better patient satisfaction, optimised reimbursements, and improved hospital ratings.

scholarly journals Preoperative Factors Predicting the Severity of BMD Loss Around the Implant after Total Hip Arthroplasty

2021 ◽  
Author(s):  
Akira Morita ◽  
Kobayashi Naomi ◽  
Hyonmin Choe ◽  
Taro Tezuka ◽  
Shota Higashihira ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Multivariate Regression ◽  
Harris Hip Score ◽  
Lateral Side ◽  
Mineral Density ◽  
Factors Associated ◽  
Total Hip ◽  
Preoperative Factors

Abstract BackgroundStress shielding after total hip arthroplasty (THA) leads to the loss of bone mineral density (BMD) around the femoral implants, particularly in the proximal area. BMD loss around the implant is likely to occur within 1 year after THA, but its severity depends on patient characteristics. This study evaluated preoperative factors associated with the severity of zone 7 BMD loss after THA.MethodsThis retrospective cohort study included 48 patients who underwent primary THA at our hospital from October 2011 to December 2015. All patients underwent implantation of a Zweymüller-type femoral component without any postoperative osteoporosis medications. The objective variable was change in zone 7 BMD after 1 year. Factors evaluated included age, body mass index (BMI), Japanese Orthopaedic Association (JOA) score, Harris Hip Score (HHS), Canal Flare Index (CFI), and lumbar BMD on the frontal and lateral sides. Factors associated with loss of zone 7 BMD were identified by univariate and multivariate regression analyses.ResultsUnivariate regression analysis showed that CFI (P=0.003) and preoperative lumbar BMD on the frontal (P=0.003) and lateral (P<0.001) sides were significantly correlated with loss of zone 7 BMD. Multivariate regression analysis showed that CFI (P=0.014) and lumbar BMD on the lateral side (P<0.001) were independently correlated with loss of zone 7 BMD.ConclusionLower preoperative lumbar BMD on the lateral side and lower CFI were significantly associated with zone 7 BMD loss after THA. Patients with these characteristics should be carefully monitored for severe BMD loss after THA.

What preoperative factors predict postoperative sitting pelvic position one year following total hip arthroplasty?

2018 ◽  
Vol 100-B (10) ◽  
pp. 1289-1296 ◽  
Author(s):  
J. L. Berliner ◽  
C. I. Esposito ◽  
T. T. Miller ◽  
D. E. Padgett ◽  
D. J. Mayman ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lumbar Lordosis ◽  
Sacral Slope ◽  
Rotational Axis ◽  
Total Hip ◽  
Spinopelvic Alignment ◽  
One Year ◽  
Pelvic Position ◽  
Preoperative Factors

Aims The aims of this study were to measure sagittal standing and sitting lumbar-pelvic-femoral alignment in patients before and following total hip arthroplasty (THA), and to consider what preoperative factors may influence a change in postoperative pelvic position. Patients and Methods A total of 161 patients were considered for inclusion. Patients had a mean age of the remaining 61 years (sd 11) with a mean body mass index (BMI) of 28 kg/m2 (sd 6). Of the 161 patients, 82 were male (51%). We excluded 17 patients (11%) with spinal conditions known to affect lumbar mobility as well as the rotational axis of the spine. Standing and sitting spine-to-lower-limb radiographs were taken of the remaining 144 patients before and one year following THA. Spinopelvic alignment measurements, including sacral slope, lumbar lordosis, and pelvic incidence, were measured. These angles were used to calculate lumbar spine flexion and femoroacetabular hip flexion from a standing to sitting position. A radiographic scoring system was used to identify those patients in the series who had lumbar degenerative disc disease (DDD) and compare spinopelvic parameters between those patients with DDD (n = 38) and those who did not (n = 106). Results Following THA, patients sat with more anterior pelvic tilt (mean increased sacral slope 18° preoperatively versus 23° postoperatively; p = 0.001) and more lumbar lordosis (mean 28° preoperatively versus 35° postoperatively; p = 0.001). Preoperative change in sacral slope from standing to sitting (p = 0.03) and the absence of DDD (p = 0.001) correlated to an increased change in postoperative sitting pelvic alignment. Conclusion Sitting lumbar-pelvic-femoral alignment following THA may be driven by hip arthritis and/or spinal deformity. Patients with DDD and fixed spinopelvic alignment have a predictable pelvic position one year following THA. Patients with normal spines have less predictable postoperative pelvic position, which is likely to be driven by hip stiffness. Cite this article: Bone Joint J 2018;100-B:1289–96.

scholarly journals Influence of Pelvic Tilt on Polyethylene Wear after Total Hip Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Taro Tezuka ◽  
Yutaka Inaba ◽  
Naomi Kobayashi ◽  
Hiroyuki Ike ◽  
So Kubota ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Supine Position ◽  
Significant Relationship ◽  
Pelvic Tilt ◽  
Polyethylene Wear ◽  
Standing Position ◽  
Total Hip ◽  
Close Observation

We aimed to evaluate the effects of pelvic tilt on polyethylene wear after total hip arthroplasty (THA). A total of 105 joints treated with primary THA were included; conventional polyethylene (CPE) liners were used in 43 hips and highly cross-linked polyethylene (HXLPE) liners were used in the remaining 62 hips. The pelvis was tilted 6° posteriorly in the standing position as compared to the supine position, which resulted in significant increases of 1.7° and 2.8° in cup inclination in the CPE and HXLPE groups, respectively. Moreover, the change in pelvic tilt resulted in significant increases of 3.6° and 4.9° in cup anteversion in the CPE and HXLPE groups, respectively. For the CPE group, multiple regression analysis showed a significant association between the angle of pelvic tilt (PTA) and cup inclination and the polyethylene wear ratio. The adjustedR2of the regression model was larger for measures obtained in the standing position as compared to the supine position. For the HXLPE group, there was no significant relationship between radiographic parameters and polyethylene wear. Close observation of polyethylene wear is recommended for patients with severe posterior pelvic tilt who have undergone THA with conventional polyethylene.

scholarly journals Preoperative factors predicting the severity of BMD loss around the implant after Total hip Arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Akira Morita ◽  
Naomi Kobayashi ◽  
Hyonmin Choe ◽  
Taro Tezuka ◽  
Shota Higashihira ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Multivariate Regression ◽  
Japanese Orthopaedic Association ◽  
Harris Hip Score ◽  
Lateral Side ◽  
Mineral Density ◽  
Total Hip ◽  
Preoperative Factors

Abstract Background Stress shielding after total hip arthroplasty (THA) leads to loss of bone mineral density (BMD) around the femoral implants, particularly in the proximal area. Loss of BMD around the implant is likely to occur within 1 year after THA; however, its severity depends on patient characteristics. This study evaluated preoperative factors correlated with the severity of zone 7 BMD loss after THA. Methods This retrospective cohort study included 48 patients who underwent primary THA from October 2011 to December 2015. All patients underwent implantation of a Zweymüller-type femoral component without any postoperative osteoporosis medications. The objective variable was a change in zone 7 BMD after 1 year. Factors evaluated included age, body mass index, Japanese Orthopaedic Association score, Harris Hip Score, Canal Flare Index (CFI), and lumbar BMD on the frontal and lateral sides. Univariate and multivariate regression analyses identified factors correlated with loss of zone 7 BMD. Results Univariate regression analysis identified CFI (P = 0.003) and preoperative lumbar BMD on the anterior-posterior (P = 0.003) and lateral (P < 0.001) sides as being correlated with loss of zone 7 BMD. Multivariate regression analysis identified CFI (P = 0.014) and lumbar BMD on the lateral side (P < 0.001) as being correlated independently with loss of zone 7 BMD. Conclusion Lower preoperative lumbar BMD on the lateral side and lower CFI were correlated with zone 7 BMD loss after THA. Patients with these characteristics should be monitored carefully for severe BMD loss after THA.

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