Mobility of the lumbo-pelvic-hip complex (spinopelvic mobility) and sagittal spinal alignment - implications for surgeons performing hip arthroplasty

• Published in: Archives of orthopaedic and trauma surgery 2024-05, Vol.144 (5), p.1945-1953
• Main Authors: Łaziński, Mariusz, Niemyjski, Włodzimierz, Niemyjski, Michał, Olewnik, Łukasz, Drobniewski, Marek, Synder, Marek, Borowski, Andrzej
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - methods; Female; Hip Dislocation - diagnostic imaging; Hip Dislocation - physiopathology; Hip Dislocation - prevention & control; Hip Dislocation - surgery; Hip Joint - diagnostic imaging; Hip Joint - physiopathology; Hip Joint - surgery; Hip Prosthesis; Humans; Joint surgery; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - physiopathology; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopaedic Surgery; Orthopedics; Pelvic Bones - diagnostic imaging; Pelvis; Pelvis - diagnostic imaging; Spine - diagnostic imaging; Spine - surgery; Surgeons
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-024-05241-5

Introduction The optimal positioning of the hip prosthesis components is influenced by the mobility and balance of the spine. The present study classifies patients with pathology of the spino-pelvic-hip complex, showing possible methods of preventing hip dislocations after arthroplasty. Hypothesis Hip-Spine Classification helps arthroplasty surgeons to implant components in more patient-specific position. Materials and methods The group of 100 patients treated with total hip arthroplasty. Antero-posterior (AP) X-rays of the pelvis in a standing position, lateral spine (standing and sitting) and AP of the pelvis (supine after the procedure) were analyzed. We analyzed a change in sacral tilt value when changing from standing to sitting (∆SS), Pelvic Incidence (PI), Lumbar Lordosis (LL) Mismatch, sagittal lumbar pelvic balance (standing position). Patients were classified according to the Hip-Spine Classification. Postoperatively, the inclination and anteversion of the implanted acetabular component were measured. Results In our study 1 A was diagnosed in 61% of all cases, 1B in 18%, 2 A in 16%, 2B in 5%. 50 out of 61 (82%) in group 1 A were placed within the Levinnek “safe zone”. In 1B, 2 A, 2B, the position of the acetabular component was influenced by both the spinopelvic mobility and sagittal spinal balance. The mean inclination was 43.35° and the anteversion was 17.4°. Conclusions Categorizing patients according to Hip-Spine Classification one can identify possible consequences the patients at risk. Pathology of the spino-pelvic-hipcomplex can lead to destabilization or dislocation of hip after surgery even though implanted according to Lewinnek’s indications. Our findings suggest that Lewinnek safe zone should be abandoned in favor of the concept of functional safe zones.