"Stuck in the middle": the missing lumbosacral link in total hip arthroplasty.

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-07-01 Epub Date: 2024-03-12 DOI:10.1177/11207000231223706
Christopher M Scanlon, Thomas Christensen, Thomas Bieganowski, Weston Buehring, Morteza Meftah, Matthew S Hepinstall
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Abstract

Introduction: Spinopelvic mobility drives functional acetabular position, influencing dislocation risk after total hip arthroplasty (THA). Patients have been described as "stuck sitting" or "stuck standing" based on pelvic tilt (PT). We hypothesised that some patients are "stuck in the middle," meaning their PT changes minimally from sitting to standing - increasing their risk of dislocation.

Methods: We reviewed 195 patients with standing and sitting whole body radiographs prior to THA. Standing anterior pelvic plane tilt (APPT) and standing and sitting sacral slope (SS) were measured and used to calculate sitting APPT. Normal standing and sitting were defined as APPT >-10° and <-20°, respectively. Spinal stiffness was classified as <10° change in sacral slope between sitting and standing. Patients were categorised as: (A) able to fully sit and stand; (B) "stuck sitting" - able to fully sit; unable to fully stand; (C) "stuck standing" - able to fully stand; unable to fully sit; or (D) "stuck in the middle" - unable to sit or stand fully.

Results: 84 patients could sit and stand normally (A), 22 patients were stuck sitting (B), 76 patients were stuck standing (C), and 13 patients were stuck in the middle (D). While 111 patients (56.9%) were considered stuck, only 58 patients (29.7%) met criteria for spinal stiffness.

Discussion: We identified a subset of patients with stiff spines and abnormal PT in both sitting and standing, including 37.1% of patients who would be classified as "stuck sitting" based only on standing radiographs. Placing acetabular components in less than anatomic anteversion in these patients may increase posterior dislocation risk.

"卡在中间":全髋关节置换术中缺失的腰骶部环节。
简介:脊柱骨盆的活动度会影响髋臼的功能位置,从而影响全髋关节置换术(THA)后的脱位风险。根据骨盆倾斜度(PT),患者被描述为 "坐姿卡住 "或 "站姿卡住"。我们假设一些患者 "卡在中间",即从坐姿到站姿,他们的骨盆倾斜度变化很小,这增加了他们脱位的风险:我们对 195 名患者在接受全髋关节置换术前的站立和坐位全身X光片进行了复查。我们测量了站立时骨盆前平面倾斜(APPT)以及站立和坐位时的骶骨斜度(SS),并将其用于计算坐位时的APPT。正常站姿和坐姿的定义是 APPT >-10° 和 结果:84名患者可以正常坐立(A),22名患者坐姿受限(B),76名患者站姿受限(C),13名患者站姿受限(D)。虽然有 111 名患者(56.9%)被认为脊柱僵硬,但只有 58 名患者(29.7%)符合脊柱僵硬的标准:讨论:我们发现了一部分患者脊柱僵硬,坐姿和站姿的PT均异常,其中37.1%的患者仅根据站姿X光片就被归类为 "坐姿卡住"。将髋臼组件置于这些患者的解剖内翻位可能会增加后脱位风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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