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      Evaluation of the Radiographic Parameters of Sagittal and Spinopelvic Alignment in Patients with Osteoarthritis submitted to Total Hip Arthroplasty *

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          Abstract

          Objective  To evaluate radiographic parameters of sagittal and spinopelvic alignment in patients with hip osteoarthritis (OA) undergoing primary total hip arthroplasty (THA) to define the primary surgical approach in individuals with concomitant spinal and hip joint disease.

          Methods  Longitudinal, prospective, comparative study with 27 patients undergoing THA and 43 subjects without OA.

          Results  An association between hip and spine degenerative disease in patients with OA was noted. After THA, radiographic parameters of pelvic tilt angle, sagittal vertical axis (EVS) and seventh cervical vertebra/sacrofemoral distance (C7/DSF) ratio were similar to values from volunteers without joint disease. Global coronal alignment (ACG), sagittal alignment, spinopelvic T1 and T9 tilts (IT1EP and IT9EP), sacral tilt (IS), pelvic version (VP), pelvic type and lumbopelvic complex (CLP) did not change after THA.

          Conclusion  Among the sagittal and spinopelvic alignment parameters evaluated, the pelvic tilt angle, the EVS, and the C7/DSF ratio were corrected after THA and can guide the surgeon in the decision-making process for patients with concomitant spinal and hip joint disease. Spinal deformity may compensate for hip changes.

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          Most cited references17

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          Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

          Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbar-pelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized. Therefore, we measured standing and sitting lumbar-pelvic-femoral alignment in patients with radiographic signs of DDD and in patients with no radiographic signs of spine arthrosis.
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            Hip–spine relations and sagittal balance clinical consequences

            Introduction The role of the pelvic area in sagittal balance is evident for spinal surgeons, but the influence of the coxofemoral joint is underestimated and inadequately explained by conventional imagery. Comprehensive analysis of the pelvic and subpelvic sectors as part of the sagittal, frontal and cross-sectional balance of the trunk sheds new light on some spinal diseases and their relation to the pelvis. Methods This analysis, based on innovative radiologic methods as the EOS® technology but also on a new look at conventional imaging makes it possible to better analyze standing lateral images and seated images. Results Disturbances can come from atypical morphotypes or from unusual postures as in aging spine. The measurement of available extension and the concept of available flexion provide new information regarding individual’s adaptation to the imbalance induced by disorders of the spine or lower limbs. Conclusion A comprehensive assessment of each patient and in particular of the complex comprising the spine and the pelvis, is essential for understanding each individual’s adaptation to the imbalance induced by disorders of the spine or lower limbs.
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              The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty.

              The interaction between the lumbosacral spine and the pelvis is dynamically related to positional change, and may be complicated by co-existing pathology. This review summarises the current literature examining the effect of sagittal spinal deformity on pelvic and acetabular orientation during total hip arthroplasty (THA) and provides recommendations to aid in placement of the acetabular component for patients with co-existing spinal pathology or long spinal fusions. Pre-operatively, patients can be divided into four categories based on the flexibility and sagittal balance of the spine. Using this information as a guide, placement of the acetabular component can be optimal based on the type and significance of co-existing spinal deformity.

                Author and article information

                Journal
                Rev Bras Ortop (Sao Paulo)
                Rev Bras Ortop (Sao Paulo)
                10.1055/s-00042410
                Revista Brasileira de Ortopedia
                Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda (Rio de Janeiro, Brazil )
                0102-3616
                1982-4378
                October 2020
                16 March 2020
                : 55
                : 5
                : 591-596
                Affiliations
                [1 ]Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
                [2 ]Laboratório de Pesquisa de Ciências Farmacêuticas, Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste (UEZO), Rio de Janeiro, Brasil
                Author notes
                Endereço para correspondência Vanessa da Costa Sousa, MS Instituto Nacional de Traumatologia e Ortopedia Av. Brasil, 500, Caju, Rio de Janeiro, RJ, 20940-070Brasil vanessamedrj@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-8308-2264
                http://orcid.org/0000-0002-7683-0698
                http://orcid.org/0000-0001-5186-1239
                http://orcid.org/0000-0002-5647-2248
                http://orcid.org/0000-0003-2248-2410
                http://orcid.org/0000-0003-1157-6243
                Article
                1900048pt
                10.1055/s-0040-1701286
                7575383
                33093724
                9f9eec84-8dc1-4bf8-8735-32c453bb521e
                The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                : 18 March 2019
                : 30 October 2019
                Categories
                Artigo Original
                Quadril

                sagittal alignment,arthroplasty, replacement, hip,osteoarthritis,spinopelvic parameters,alinhamento sagital,artroplastia de quadril,osteoartrite,parâmetros espinopélvicos

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