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      The Prevalence of Abnormal Spinopelvic Relationships in Patients Presenting for Primary Total Hip Arthroplasty

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          Abstract

          Background

          The prevalence of an abnormal spinopelvic relationship in patients presenting for primary total hip arthroplasty (THA) is not well known. The purpose of this study was to identify the prevalence of abnormal spinopelvic relationships in patients presenting for primary THA.

          Methods

          A retrospective chart review of 338 consecutive, nonselected patients undergoing primary THA from the practice of 2 fellowship-trained adult reconstruction surgeons was performed (J.E.O. and T.S.B.). Sitting and standing radiographs were measured for lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS stand), and pelvic tilt; the sacral slope was also measured on sitting radiographs (SS sit). Patients were assessed for the presence of spinopelvic imbalance, defined as PI–LL>10°, and decreased spinopelvic motion, defined as SS stand–SS sit< 10°. Descriptive statistics were reported.

          Results

          A cohort of 338 patients was identified; 110 were excluded. In total, 228 unique patients underwent measurement. One hundred one of 228 patients (44.3%) in the cohort were female. The mean age of the cohort was 60.0 ± 13 years, with the mean body mass index of 31 ± 7 mg/kg 2. Spinopelvic imbalance (PI–LL > 10°) was present in 142 of 228 patients (62.3%). Decreased motion at the spinopelvic junction (SS stand–SS sit < 10°) was present in 78 of 228 patients (34.2%). Fifty (21.9%) patients had both spinopelvic imbalance and decreased spinopelvic motion.

          Conclusions

          In a cohort of 228 patients presenting for primary THA, the prevalence of spinopelvic imbalance was 62.3%, the prevalence of decreased spinopelvic motion was 34.2%, and the prevalence of both spinopelvic imbalance and decreased spinopelvic motion was 22%. Hip surgeons are likely to encounter patients with abnormal spinopelvic relationships.

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          Most cited references20

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          Spinopelvic mobility and acetabular component position for total hip arthroplasty.

          Posterior tilt of the pelvis with sitting provides biological acetabular opening. Our goal was to study the post-operative interaction of skeletal mobility and sagittal acetabular component position.
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            A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position.

            The standing posture of 17 young men and women were studied using Barycentremeter measurements and full spine radiograph with a single referential system. These procedures provide in vivo measurements of the weight and center of weight supported by each vertebra and the coxofemoral joints. The relationship between the vertebra, the sacrum or the coxofemoral rotation axis and the center of weight they support, is displayed. The moment of the corresponding force may also be assessed. Mean values were computed and the relation with spine sagittal curves and pelvic parameters were studied. The position of the center of weight, in front of or behind the vertebra or the coxofemoral joints, requires an opposing muscle force to ensure mechanical stability. The load exerted on the vertebra cannot be precisely evaluated, but we can describe the way in which these loads vary when the spinal curves and the pelvic slope change. This study provides basic data suggesting that there is a tendency to maintain the body in the most economical position in terms of muscle fatigue and vertebral strain. Individual anatomical shapes and pelvic parameters of the pelvis induce corresponding specific sagittal curves of the spine. This concept is very useful for analysing pathological situations and devising appropriate treatment.
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              Outcomes of dual mobility components in total hip arthroplasty

              Instability remains a challenging problem in both primary and revision total hip arthroplasty (THA). Dual mobility components confer increased stability, but there are concerns about the unique complications associated with these designs, as well as the long-term survivorship.
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                Author and article information

                Contributors
                Journal
                Arthroplast Today
                Arthroplast Today
                Arthroplasty Today
                Elsevier
                2352-3441
                16 June 2020
                September 2020
                16 June 2020
                : 6
                : 3
                : 381-385
                Affiliations
                [a ]Department of Orthopedics & Rehabilitation, University of Iowa Hospital & Clinics, Iowa City, IA, USA
                [b ]University of Iowa, Carver College of Medicine, Iowa City, IA, USA
                [c ]OrthoCarolina Hip and Knee Center, Charlotte, NC, USA
                Author notes
                []Corresponding author. Department of Orthopedics and Rehabilitation, 200 Hawkins Dr, 01008 JPP, Iowa City, IA 52242, USA. Tel.: +1 319 353 7550. christopher-carender@ 123456uiowa.edu
                Article
                S2352-3441(20)30094-7
                10.1016/j.artd.2020.05.010
                7303535
                32577482
                71b2aabf-40ec-486c-a5bc-57cc5b2a43a8
                © 2020 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 6 December 2019
                : 8 April 2020
                : 8 May 2020
                Categories
                Original Research

                dual mobility,spinopelvic,relationship,instability,primary total hip arthroplasty

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