Total Hip Instability and the Spinopelvic Link
| Autor: | John P. Meehan, Zachary C. Lum, Mauro Giordani |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Sports medicine Radiography Coccyx Ante-inclination Bioengineering Sitting Clinical Research medicine Orthopedics and Sports Medicine Orthodontics Spinopelvic motion business.industry Rehabilitation Hot Topics Biomechanics Spinopelvic mobility musculoskeletal system Sacrum Acetabulum Sacro-acetabular angle medicine.anatomical_structure Musculoskeletal Orthopedic surgery total hip arthroplasty instability business |
| Zdroj: | Curr Rev Musculoskelet Med Current reviews in musculoskeletal medicine, vol 13, iss 4 |
| ISSN: | 1935-9748 |
| DOI: | 10.1007/s12178-020-09648-6 |
| Popis: | PURPOSE OF REVIEW: Advances in technology, implant design, and surgical technique have lowered the dislocation rate in primary total hip arthroplasty (THA). Despite these advances, there remain a large number of instability episodes without a known etiology. Recent research suggests that the pelvic and lumbar spine interrelationship may be the explanation in prosthetic dislocations without a known cause. In this review, we describe the biomechanics, measurements, diagnoses, classification, management, and outcomes of total hip and revision total hip instability as it relates to spinopelvic alignment. RECENT FINDINGS: As a person goes from standing to sitting, lumbar lordosis decreases, and the sacrum and entire pelvis tilts posteriorly with sacrum and coccyx rotating posterior-inferiorly, resulting in increased acetabular cup anteversion to accommodate femoral flexion. A fused spine and associated fixed acetabulum can result in abnormal pelvic femoral motion, impingement, and dislocation. Classifying the spinopelvic mechanics by sacral motion based on sitting and standing lateral radiographs provides an understanding of how the acetabulum behaves in space. This information helps appropriate cup positioning, reducing the risk of femoral side impingement and subsequent dislocation. SUMMARY: Surgical techniques to consider in the spinopelvic at-risk patient are positioning considerations in acetabular cup inclination and anteversion, high offset femoral stems, high offset acetabular liners, dual mobility articulations, and removal of impinging structures. Future research is needed to define the safest order of operation in concomitant hip and spine pathology, the effects on pelvic femoral biomechanics in spine surgery, and whether preoperative and intraoperative management strategies have a long-term beneficial effect on the dislocation rate. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink