Acetabular Anteversion Changes Due to Spinal Deformity Correction: Bridging the Gap Between Hip and Spine Surgeons

Hip osteoarthritis often coexists with adult spinal deformity, an abnormality in which sagittal spinopelvic malalignment is present. Debate exists whether to perform spinal realignment correction or total hip arthroplasty first. Hip extension and pelvic tilt are important compensatory mechanisms in...

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Veröffentlicht in:Journal of bone and joint surgery. American volume Jg. 97; H. 23; S. 1913
Hauptverfasser: Buckland, Aaron J, Vigdorchik, Jonathan, Schwab, Frank J, Errico, Thomas J, Lafage, Renaud, Ames, Christopher, Bess, Shay, Smith, Justin, Mundis, Gregory M, Lafage, Virginie
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 02.12.2015
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ISSN:1535-1386, 1535-1386
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Abstract Hip osteoarthritis often coexists with adult spinal deformity, an abnormality in which sagittal spinopelvic malalignment is present. Debate exists whether to perform spinal realignment correction or total hip arthroplasty first. Hip extension and pelvic tilt are important compensatory mechanisms in the setting of sagittal spinopelvic malalignment and change after spinal realignment. We performed this study to evaluate the effect that the spinal realignment surgical procedure has on acetabular anteversion. This study is a retrospective review of a multicenter, prospective, consecutive database of patients with adult spinal deformity who underwent surgical spinal realignment. Only patients who already had undergone a total hip arthroplasty prior to the spinal realignment procedure were retained for analysis. Patients were excluded if they had insufficient imaging or large-head, metal-on-metal bearings or they had undergone revision total hip arthroplasty in the study period. Acetabular anteversion was calculated via the ellipse method on a standing, posterior-anterior, 90-cm radiograph with a well-centered pelvis. Anteversion was measured preoperatively and at six weeks or three months after the spinal realignment procedure. Spinopelvic parameters measured included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, T1 pelvic angle, sagittal vertical axis, T1-spinopelvic inclination, and thoracic kyphosis. Forty-one hips (thirty-three patients) were identified. Acetabular anteversion significantly reduced (p < 0.001) after spinal correction by mean change of -4.96° (range, -22.32° to +2.36°). The change in anteversion correlated with the changes in sagittal pelvic orientation (0.828 for the pelvic tilt, -0.757 for the sacral slope, and -0.691 for the lumbar lordosis) and global spinopelvic alignment (0.579 for the sagittal vertical axis and 0.585 for the T1 pelvic angle). Regression analysis revealed that anteversion decreased by 1° for each of the following spinopelvic parameter changes (p < 0.001): 1.105° for spinopelvic tilt, 1.032° for sacral slope, and 3.163° for lumbar lordosis. Patients with spinopelvic malalignment had a high prevalence of excessively anteverted acetabular components. Sagittal spinal correction following total hip arthroplasty resulted in reduced acetabular anteversion, which may have implications for stability. Changes in anteversion are most closely related to changes in pelvic tilt in an almost one-to-one ratio.
AbstractList Hip osteoarthritis often coexists with adult spinal deformity, an abnormality in which sagittal spinopelvic malalignment is present. Debate exists whether to perform spinal realignment correction or total hip arthroplasty first. Hip extension and pelvic tilt are important compensatory mechanisms in the setting of sagittal spinopelvic malalignment and change after spinal realignment. We performed this study to evaluate the effect that the spinal realignment surgical procedure has on acetabular anteversion.BACKGROUNDHip osteoarthritis often coexists with adult spinal deformity, an abnormality in which sagittal spinopelvic malalignment is present. Debate exists whether to perform spinal realignment correction or total hip arthroplasty first. Hip extension and pelvic tilt are important compensatory mechanisms in the setting of sagittal spinopelvic malalignment and change after spinal realignment. We performed this study to evaluate the effect that the spinal realignment surgical procedure has on acetabular anteversion.This study is a retrospective review of a multicenter, prospective, consecutive database of patients with adult spinal deformity who underwent surgical spinal realignment. Only patients who already had undergone a total hip arthroplasty prior to the spinal realignment procedure were retained for analysis. Patients were excluded if they had insufficient imaging or large-head, metal-on-metal bearings or they had undergone revision total hip arthroplasty in the study period. Acetabular anteversion was calculated via the ellipse method on a standing, posterior-anterior, 90-cm radiograph with a well-centered pelvis. Anteversion was measured preoperatively and at six weeks or three months after the spinal realignment procedure. Spinopelvic parameters measured included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, T1 pelvic angle, sagittal vertical axis, T1-spinopelvic inclination, and thoracic kyphosis.METHODSThis study is a retrospective review of a multicenter, prospective, consecutive database of patients with adult spinal deformity who underwent surgical spinal realignment. Only patients who already had undergone a total hip arthroplasty prior to the spinal realignment procedure were retained for analysis. Patients were excluded if they had insufficient imaging or large-head, metal-on-metal bearings or they had undergone revision total hip arthroplasty in the study period. Acetabular anteversion was calculated via the ellipse method on a standing, posterior-anterior, 90-cm radiograph with a well-centered pelvis. Anteversion was measured preoperatively and at six weeks or three months after the spinal realignment procedure. Spinopelvic parameters measured included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, T1 pelvic angle, sagittal vertical axis, T1-spinopelvic inclination, and thoracic kyphosis.Forty-one hips (thirty-three patients) were identified. Acetabular anteversion significantly reduced (p < 0.001) after spinal correction by mean change of -4.96° (range, -22.32° to +2.36°). The change in anteversion correlated with the changes in sagittal pelvic orientation (0.828 for the pelvic tilt, -0.757 for the sacral slope, and -0.691 for the lumbar lordosis) and global spinopelvic alignment (0.579 for the sagittal vertical axis and 0.585 for the T1 pelvic angle). Regression analysis revealed that anteversion decreased by 1° for each of the following spinopelvic parameter changes (p < 0.001): 1.105° for spinopelvic tilt, 1.032° for sacral slope, and 3.163° for lumbar lordosis.RESULTSForty-one hips (thirty-three patients) were identified. Acetabular anteversion significantly reduced (p < 0.001) after spinal correction by mean change of -4.96° (range, -22.32° to +2.36°). The change in anteversion correlated with the changes in sagittal pelvic orientation (0.828 for the pelvic tilt, -0.757 for the sacral slope, and -0.691 for the lumbar lordosis) and global spinopelvic alignment (0.579 for the sagittal vertical axis and 0.585 for the T1 pelvic angle). Regression analysis revealed that anteversion decreased by 1° for each of the following spinopelvic parameter changes (p < 0.001): 1.105° for spinopelvic tilt, 1.032° for sacral slope, and 3.163° for lumbar lordosis.Patients with spinopelvic malalignment had a high prevalence of excessively anteverted acetabular components. Sagittal spinal correction following total hip arthroplasty resulted in reduced acetabular anteversion, which may have implications for stability. Changes in anteversion are most closely related to changes in pelvic tilt in an almost one-to-one ratio.CONCLUSIONSPatients with spinopelvic malalignment had a high prevalence of excessively anteverted acetabular components. Sagittal spinal correction following total hip arthroplasty resulted in reduced acetabular anteversion, which may have implications for stability. Changes in anteversion are most closely related to changes in pelvic tilt in an almost one-to-one ratio.
Hip osteoarthritis often coexists with adult spinal deformity, an abnormality in which sagittal spinopelvic malalignment is present. Debate exists whether to perform spinal realignment correction or total hip arthroplasty first. Hip extension and pelvic tilt are important compensatory mechanisms in the setting of sagittal spinopelvic malalignment and change after spinal realignment. We performed this study to evaluate the effect that the spinal realignment surgical procedure has on acetabular anteversion. This study is a retrospective review of a multicenter, prospective, consecutive database of patients with adult spinal deformity who underwent surgical spinal realignment. Only patients who already had undergone a total hip arthroplasty prior to the spinal realignment procedure were retained for analysis. Patients were excluded if they had insufficient imaging or large-head, metal-on-metal bearings or they had undergone revision total hip arthroplasty in the study period. Acetabular anteversion was calculated via the ellipse method on a standing, posterior-anterior, 90-cm radiograph with a well-centered pelvis. Anteversion was measured preoperatively and at six weeks or three months after the spinal realignment procedure. Spinopelvic parameters measured included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, T1 pelvic angle, sagittal vertical axis, T1-spinopelvic inclination, and thoracic kyphosis. Forty-one hips (thirty-three patients) were identified. Acetabular anteversion significantly reduced (p < 0.001) after spinal correction by mean change of -4.96° (range, -22.32° to +2.36°). The change in anteversion correlated with the changes in sagittal pelvic orientation (0.828 for the pelvic tilt, -0.757 for the sacral slope, and -0.691 for the lumbar lordosis) and global spinopelvic alignment (0.579 for the sagittal vertical axis and 0.585 for the T1 pelvic angle). Regression analysis revealed that anteversion decreased by 1° for each of the following spinopelvic parameter changes (p < 0.001): 1.105° for spinopelvic tilt, 1.032° for sacral slope, and 3.163° for lumbar lordosis. Patients with spinopelvic malalignment had a high prevalence of excessively anteverted acetabular components. Sagittal spinal correction following total hip arthroplasty resulted in reduced acetabular anteversion, which may have implications for stability. Changes in anteversion are most closely related to changes in pelvic tilt in an almost one-to-one ratio.
Author Smith, Justin
Errico, Thomas J
Schwab, Frank J
Lafage, Renaud
Mundis, Gregory M
Lafage, Virginie
Bess, Shay
Ames, Christopher
Vigdorchik, Jonathan
Buckland, Aaron J
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  surname: Buckland
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  organization: Spine Research Center, NYU Langone Medical Center, 306 East 15th Street, New York, NY, 10003. E-mail address for A. Buckland: aaronbuckland@me.com
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  givenname: Jonathan
  surname: Vigdorchik
  fullname: Vigdorchik, Jonathan
  email: aaronbuckland@me.com
  organization: Spine Research Center, NYU Langone Medical Center, 306 East 15th Street, New York, NY, 10003. E-mail address for A. Buckland: aaronbuckland@me.com
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  givenname: Frank J
  surname: Schwab
  fullname: Schwab, Frank J
  email: aaronbuckland@me.com
  organization: Spine Research Center, NYU Langone Medical Center, 306 East 15th Street, New York, NY, 10003. E-mail address for A. Buckland: aaronbuckland@me.com
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  surname: Errico
  fullname: Errico, Thomas J
  email: aaronbuckland@me.com
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  givenname: Christopher
  surname: Ames
  fullname: Ames, Christopher
  email: aaronbuckland@me.com
  organization: Spine Research Center, NYU Langone Medical Center, 306 East 15th Street, New York, NY, 10003. E-mail address for A. Buckland: aaronbuckland@me.com
– sequence: 7
  givenname: Shay
  surname: Bess
  fullname: Bess, Shay
  email: aaronbuckland@me.com
  organization: Spine Research Center, NYU Langone Medical Center, 306 East 15th Street, New York, NY, 10003. E-mail address for A. Buckland: aaronbuckland@me.com
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  givenname: Justin
  surname: Smith
  fullname: Smith, Justin
  email: aaronbuckland@me.com
  organization: Spine Research Center, NYU Langone Medical Center, 306 East 15th Street, New York, NY, 10003. E-mail address for A. Buckland: aaronbuckland@me.com
– sequence: 9
  givenname: Gregory M
  surname: Mundis
  fullname: Mundis, Gregory M
  email: aaronbuckland@me.com
  organization: Spine Research Center, NYU Langone Medical Center, 306 East 15th Street, New York, NY, 10003. E-mail address for A. Buckland: aaronbuckland@me.com
– sequence: 10
  givenname: Virginie
  surname: Lafage
  fullname: Lafage, Virginie
  email: aaronbuckland@me.com
  organization: Spine Research Center, NYU Langone Medical Center, 306 East 15th Street, New York, NY, 10003. E-mail address for A. Buckland: aaronbuckland@me.com
BackLink https://www.ncbi.nlm.nih.gov/pubmed/26631991$$D View this record in MEDLINE/PubMed
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PublicationTitle Journal of bone and joint surgery. American volume
PublicationTitleAlternate J Bone Joint Surg Am
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Snippet Hip osteoarthritis often coexists with adult spinal deformity, an abnormality in which sagittal spinopelvic malalignment is present. Debate exists whether to...
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SubjectTerms Acetabulum - diagnostic imaging
Adult
Arthroplasty, Replacement, Hip
Bone Anteversion - diagnostic imaging
Bone Anteversion - etiology
Humans
Osteoarthritis, Hip - complications
Osteoarthritis, Hip - surgery
Postoperative Complications - diagnostic imaging
Radiography
Retrospective Studies
Spinal Curvatures - complications
Spinal Curvatures - surgery
Treatment Outcome
Title Acetabular Anteversion Changes Due to Spinal Deformity Correction: Bridging the Gap Between Hip and Spine Surgeons
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