Hip Pelvis.  2019 Mar;31(1):4-10. 10.5371/hp.2019.31.1.4.

Effect of Spine-Pelvis Relationship in Total Hip Arthroplasty

• Lee SH
• Lim CW
• Choi KY
• Jo S

• KMID: 2448035
• DOI: http://doi.org/10.5371/hp.2019.31.1.4

Abstract

When spine-pelvic motion is normally coordinated, the pelvis may tilt posteriorly and acetabular anteversion may increase as the patient's position changes from standing to sitting; this scenario allows for improved clearance of the femoral head and neck during hip flexion. However, changes in the mobility of the spine and pelvis may result in impingement after total hip arthroplasty (THA), with the most obvious complication being dislocation. Understanding the spinal-pelvic relationship in the sagittal plane is essential for planning THA in patients with spinal fusion or a known spine disease. Careful attention should be payed to the cup position when performing THA on patients with an increased risk of dynamic impingement.

Keyword

Acetabular anteversion; Dislocation; Instability; Spinopelvic alignment; Hip replacement arthroplasty

MeSH Terms

Acetabulum
Arthroplasty, Replacement, Hip*
Dislocations
Head
Hip
Humans
Neck
Pelvis
Spinal Fusion
Spine

Figure

• 

  Fig. 1 Method of measurement of spino-pelvic relationship. (A) Pelvic parameter (a: pelvic tlit-angle, b: pelvic incidenceangle, c: sacral slope-angle). (B) Spinal parameters.

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  Fig. 2 Example of compensatory pelvic tilt as a result of flat back. Note the hip extension and adaptive knee flexion.

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  Fig. 3 Change of spine-pelvic motion in sagittal plane from standing to sitting. Pelvis tilts posteriorly in a sitting position and this result in decrease of sacral slope and increase of acetabular anteversion. SS: sacral slope, PT: pelvic tilt, AA: acetabular anteversion.

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  Fig. 4 Rigid and balanced type. There is no compensatory change in acetabular anteversion (AA) when going to a seated position, so possible anterior impingement when sitting.

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  Fig. 5 Flexible and unbalanced type. In the standing position, with increased lumbar kyphosis, there is a compensatory increase in acetabular anteversion (AA). So there is possible posterior impingement when standing.

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