Sacral Slope Change From Standing to Relaxed-Seated Grossly Overpredicts the Presence of a Stiff Spine.

Autor: Sharma AK; Department of Orthopaedic Surgery, University of California, Irvine, School of Medicine, Orange, California., Grammatopoulos G; Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada., Pierrepont JW; Corin Group, The Corinium Centre, Cirencester, Gloucestershire., Madurawe CS; Corin Group, The Corinium Centre, Cirencester, Gloucestershire., Innmann MM; Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany., Vigdorchik JM; Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York., Shimmin AJ; Melbourne Orthopaedic Group, Melbourne, Australia.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2023 Apr; Vol. 38 (4), pp. 713-718.e1. Date of Electronic Publication: 2022 May 16.
DOI: 10.1016/j.arth.2022.05.020
Abstrakt: Background: Several authors propose that a change in sacral slope of ≤10° between the standing and relaxed-seated positions (ΔSS standing→relaxed-seated ) identifies a patient with a stiff lumbar spine and has suggested the use of dual-mobility bearings for such patients undergoing a total hip arthroplasty (THA). The aim of this study was to assess how accurately ΔSS standing→relaxed-seated can identify patients with a stiff spine.
Methods: A prospective, multicentre, consecutive cohort series of 312 patients had standing, relaxed-seated, and flexed-seated lateral radiographs prior to THA. ΔSS standing→relaxed-seated was determined by the change in sacral slope between the standing and relaxed-seated positions. Lumbar flexion (LF) was defined as the difference in lumbar lordotic angle between standing and flexed-seated. LF ≤20° was considered a stiff spine. The predictive value of ΔSS standing→relaxed-seated for characterizing a stiff spine was assessed.
Results: A weak correlation between ΔSS standing→relaxed-seated and LF was identified (r 2  = 0.13). Eighty six patients (28%) had ΔSS standing→relaxed-seated ≤10° and 19 patients (6%) had a stiff spine. Of the 86 patients with ΔSS standing→relaxed-seated ≤10°, 13 had a stiff spine. The positive predictive value of ΔSS standing→relaxed-seated ≤10° for identifying a stiff spine was 15%.
Conclusion: In this cohort, ΔSS standing→relaxed-seated ≤10° was not correlated with a stiff spine. Using this simplified approach could lead to a 7-fold overprediction of patients with a stiff lumbar spine and abnormal spinopelvic mobility, unnecessary use of dual-mobility bearings, and incorrect component alignment targets. Referring to patients with ΔSS standing→relaxed-seated ≤10° as being stiff is misleading. The flexed-seated position should be used to effectively assess a patient's spine mobility prior to THA.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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