Current Concepts in Diagnosis and Management of Patients Undergoing Total Hip Replacement with Concurrent Disorders of Spinopelvic Anatomy: A Narrative Review
Abstract
:1. Introduction
2. Nomenclature
3. Management Algorithms
4. Conclusions
5. Case Example
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Term | Definition | Relevance | Normal Values |
---|---|---|---|
Pelvic incidence (PI) | Angle between the perpendicular to the midpoint of sacral plate (S1) and the line connecting it to the center of the bicoxofemoral axis | Represents the relative anatomic position of the hip joint to the sacrum. | 40°–65° |
Lumbar lordosis angle (LL) | Angle between the superior plate of L1 to the sacral end plate (S1) | Compensatory to pelvic morphology and position. | Within 10° of PI |
Sacral slope (SS) | Angle of the sacral end plate (S1) and the horizontal line | Preferred parameter to assess spinopelvic motion, related to PI and PT | SSstanding > 30° OR 0.75 × PI SSsitting 5°–30° |
Anterior pelvic plane tilt (APPt) | Functional pelvic plane as a triangle formed by ASIS and pubic symphysis relative to the vertical line | Used for pelvic tilt in arthroplasty literature, describes the rotation of pelvis in the sagittal plane | 0 or slightly anteverted in standing retroverted in sitting |
Pelvic tilt (PT) | Angle formed by the line from bicoxofemoral axis to the midpoint of S1 and a vertical line | It describes the position of the femoral heads to the base of the spine, related to SS and PI | PTstanding < 22° ΔPT ≈ 20° PI = SS + PT |
Pelvic femoral angle (PFA) | Angle between the line connecting midpoint of S1 endplate with the center of the measured femoral head and femoral mechanical axis | Assesses flexion deformity and femoral motion. Does not change post-THR (≈3°) | ΔPFA 55°–75° PFAstanding 180–190 PFAsitting 120–130 Proportionality with PI |
Acetabular anteinclination (AI) | Angle between the long axis of the cup and the horizontal on lateral radiographs | Sagittal plane orientation of the acetabular cup, represents anteversion | AIstanding 25°–45° AIsitting 45°–65° Surgeon dependent |
PI-LL mismatch | Difference between PI and LL angle | Compensatory ability of lumbosacral spine to changes in pelvic tilt; sagittal balance | <10 in standing lateral radiographs |
Combined sagittal index (CSI) | CSI = PFA + AI | Validated predictor for acute and late dislocations in postoperative assessment. Possible to plan AI based on PFA | CSIstanding 205°–245° If low PI, sagittal imbalance, stiffness: range 215°–235° |
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Ambrus, R.; Douša, P.; Almási, J.; Šteňo, B. Current Concepts in Diagnosis and Management of Patients Undergoing Total Hip Replacement with Concurrent Disorders of Spinopelvic Anatomy: A Narrative Review. Medicina 2023, 59, 1591. https://doi.org/10.3390/medicina59091591
Ambrus R, Douša P, Almási J, Šteňo B. Current Concepts in Diagnosis and Management of Patients Undergoing Total Hip Replacement with Concurrent Disorders of Spinopelvic Anatomy: A Narrative Review. Medicina. 2023; 59(9):1591. https://doi.org/10.3390/medicina59091591
Chicago/Turabian StyleAmbrus, Richard, Pavel Douša, Jozef Almási, and Boris Šteňo. 2023. "Current Concepts in Diagnosis and Management of Patients Undergoing Total Hip Replacement with Concurrent Disorders of Spinopelvic Anatomy: A Narrative Review" Medicina 59, no. 9: 1591. https://doi.org/10.3390/medicina59091591