Can we identify abnormal pelvic tilt using pre-THA anteroposterior pelvic radiographs?
Arthroplasty
Hip
Pelvic tilt
Spine
Spinopelvic mobility
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
17 Sep 2024
17 Sep 2024
Historique:
received:
15
07
2024
accepted:
09
09
2024
medline:
17
9
2024
pubmed:
17
9
2024
entrez:
17
9
2024
Statut:
aheadofprint
Résumé
Patients with increased pelvic tilt (PT) are at risk for instability following total hip arthroplasty (THA). Identification of increased PT using anteroposterior (AP) pelvic radiographs could avoid additional spinopelvic radiographs. This study aimed to (1) describe which AP pelvic parameters most accurately estimate sagittal PT, and (2) determine thresholds for these parameters that can identify patients with increased PT. This was a retrospective, consecutive, cohort study in a tertiary referral hospital on 225 patients (age: 66 ± 12 years-old; 52% female) listed for THA. Patients underwent pre-operative standing AP pelvic radiographs to measure distance- and angular- based parameters from several anatomical landmarks. Sagittal PT was measured on a standing lateral spinopelvic radiograph and considered high when ≥ 20°. No AP pelvic parameters correlated strongly with sagittal PT. Ratio between horizontal and vertical diameter of the pelvic foramen (C/D ratio) (rho - 0.341; p < 0.001); and vertical distance between trans-SIJ and trans-ASIS line (SITA) (rho 0.307; p < 0.001) correlated moderately with sagittal PT. Sacro-femoral-pubic (SFP) angle < 60° had highest sensitivity (85%), but lowest specificity (52%) to differentiate between patients with and without increased PT. If SITA > 62 mm, C/D ratio < 0.5 and SFP < 60°, specificity increased (88%), but sensitivity was low (49%). In the absence of computerized models, AP pelvic parameters cannot accurately predict sagittal PT. However, an SFP < 60° should alert a hip surgeon that a patient may have an increased PT, and would benefit from additional lateral spinopelvic imaging prior to THA. Level II, diagnostic study.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with increased pelvic tilt (PT) are at risk for instability following total hip arthroplasty (THA). Identification of increased PT using anteroposterior (AP) pelvic radiographs could avoid additional spinopelvic radiographs. This study aimed to (1) describe which AP pelvic parameters most accurately estimate sagittal PT, and (2) determine thresholds for these parameters that can identify patients with increased PT.
METHODS
METHODS
This was a retrospective, consecutive, cohort study in a tertiary referral hospital on 225 patients (age: 66 ± 12 years-old; 52% female) listed for THA. Patients underwent pre-operative standing AP pelvic radiographs to measure distance- and angular- based parameters from several anatomical landmarks. Sagittal PT was measured on a standing lateral spinopelvic radiograph and considered high when ≥ 20°.
RESULTS
RESULTS
No AP pelvic parameters correlated strongly with sagittal PT. Ratio between horizontal and vertical diameter of the pelvic foramen (C/D ratio) (rho - 0.341; p < 0.001); and vertical distance between trans-SIJ and trans-ASIS line (SITA) (rho 0.307; p < 0.001) correlated moderately with sagittal PT. Sacro-femoral-pubic (SFP) angle < 60° had highest sensitivity (85%), but lowest specificity (52%) to differentiate between patients with and without increased PT. If SITA > 62 mm, C/D ratio < 0.5 and SFP < 60°, specificity increased (88%), but sensitivity was low (49%).
CONCLUSION
CONCLUSIONS
In the absence of computerized models, AP pelvic parameters cannot accurately predict sagittal PT. However, an SFP < 60° should alert a hip surgeon that a patient may have an increased PT, and would benefit from additional lateral spinopelvic imaging prior to THA.
LEVEL OF EVIDENCE
METHODS
Level II, diagnostic study.
Identifiants
pubmed: 39287789
doi: 10.1007/s00402-024-05575-0
pii: 10.1007/s00402-024-05575-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Heckmann N, McKnight B, Stefl M, Trasolini NA, Ike H, Dorr LD (2018) Late dislocation following total hip arthroplasty: Spinopelvic Imbalance as a causative factor. J Bone Joint Surg Am 100(21):1845–1853
pubmed: 30399079
Grammatopoulos G, Gofton W, Jibri Z, Coyle M, Dobransky J, Kreviazuk C et al (2019) 2018 Frank Stinchfield Award: Spinopelvic Hypermobility is Associated with an Inferior Outcome after THA: examining the effect of spinal arthrodesis. Clin Orthop Relat Res 477(2):310–321
pubmed: 30300162
Innmann MM, Reichel F, Schaper B, Merle C, Beaulé PE, Grammatopoulos G (2021) How does Spinopelvic mobility and Sagittal Functional Cup Orientation affect patient-reported outcome 1 year after THA?-A prospective diagnostic cohort study. J Arthroplasty 36(7):2335–2342
pubmed: 33637383
Esposito CI, Carroll KM, Sculco PK, Padgett DE, Jerabek SA, Mayman DJ (2018) Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation. J Arthroplasty 33(5):1449–1454
pubmed: 29310920
Esposito CI, Miller TT, Kim HJ, Barlow BT, Wright TM, Padgett DE et al (2016) Does degenerative lumbar spine Disease Influence Femoroacetabular Flexion in patients undergoing total hip arthroplasty? Clin Orthop Relat Res 474(8):1788–1797
pubmed: 27020429
pmcid: 4925410
Vigdorchik JM, Sharma AK, Buckland AJ, Elbuluk AM, Eftekhary N, Mayman DJ et al (2021) 2021 Otto Aufranc Award: a simple hip-spine classification for total hip arthroplasty: validation and a large multicentre series. Bone Joint J. 103-b(7 Supple B):17–24
Grammatopoulos G, Falsetto A, Sanders E, Weishorn J, Gill HS, Beaulé PE et al (2022) Integrating the combined Sagittal Index reduces the risk of dislocation following total hip replacement. J Bone Joint Surg Am 104(5):397–411
pubmed: 34767540
Innmann MM, Merle C, Phan P, Beaulé PE, Grammatopoulos G (2020) How can patients with Mobile hips and stiff lumbar spines be identified prior to total hip arthroplasty? A prospective, diagnostic cohort study. J Arthroplasty 35(6s):S255–s61
pubmed: 32205003
Langston J, Pierrepont J, Gu Y, Shimmin A (2018) Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty. Bone Joint J. 100–b(7):845–52
Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7(2):99–103
pubmed: 9629932
pmcid: 3611230
Innmann MM, McGoldrick NP, Ratra A, Merle C, Grammatopoulos G (2022) The accuracy in determining pelvic tilt from anteroposterior pelvic radiographs in patients awaiting hip arthroplasty. J Orthop Res 40(4):854–861
pubmed: 34081347
Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA (2006) Estimation of pelvic tilt on anteroposterior X-rays–a comparison of six parameters. Skeletal Radiol 35(3):149–155
pubmed: 16365745
Uemura K, Atkins PR, Okamoto M, Tokunaga K, Anderson AE (2020) Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination? J Orthop Res 38(7):1477–1485
pubmed: 32320097
pmcid: 7335595
Chai Y, Boudali AM, Khadra S, Dasgupta A, Maes V, Walter WL (2023) Evaluating pelvic tilt using the pelvic antero-posterior projection images: a systematic review. J Arthroplasty
Heimann AF, Schwab JM, Popa V, Zheng G, Tannast M (2023) Measurement of pelvic tilt and rotation on AP radiographs using HipRecon: validation and comparison to other parameters. J Orthop Res 41(8):1746–1753
pubmed: 36691861
Atilla HA, Raju S, Akdogan M, Ozturk A, Bilgetekin YG, Kose O (2021) Rear drop: a new radiographic landmark for estimation of pelvic tilt on pelvis AP radiographs. J Hip Preserv Surg 8(1):58–66
pubmed: 34567601
pmcid: 8460171
Kanazawa M, Nakashima Y, Arai T, Ushijima T, Hirata M, Hara D et al (2016) Quantification of pelvic tilt and rotation by width/height ratio of obturator foramina on anteroposterior radiographs. Hip Int 26(5):462–467
pubmed: 27174062
Labott JR, Smith JH, Mara KC, Wyles CC, Taunton MJ, Abdel MP (2023) Pubic symphysis to Sacrococcygeal Joint: a poor correlate to other spinopelvic measurements. J Arthroplasty 38(8):1535–1538
pubmed: 36754336
Chai Y, Boudali AM, Khadra S, Walter WL (2023) The Sacro-femoral-pubic Angle is unreliable to Estimate Pelvic Tilt: a Meta-analysis. Clin Orthop Relat Res 481(10):1928–1936
pubmed: 37071455
Innmann MM, Verhaegen JCF, Reichel F, Schaper B, Merle C, Grammatopoulos G (2022) Spinopelvic characteristics normalize 1 year after total hip arthroplasty: a prospective, longitudinal, case-controlled study. J Bone Joint Surg Am 104(8):675–683
pubmed: 35196302
Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ et al (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 90 Suppl 4(Suppl 4):47–66
Grammatopoulos G, Innmann M, Phan P, Bodner R, Meermans G (2023) Spinopelvic challenges in primary total hip arthroplasty. EFORT Open Rev 8(5):298–312
pubmed: 37158334
pmcid: 10233804
Siebenrock KA, Kalbermatten DF, Ganz R (2003) Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. (407):241–248
Kojima A, Nakagawa T, Tohkura A (1998) Simulation of acetabular coverage of femoral head using anteroposterior pelvic radiographs. Arch Orthop Trauma Surg 117(6–7):330–336
pubmed: 9709845
Thorén B, Sahlstedt B (1990) Influence of pelvic position on radiographic measurements of the prosthetic acetabular component. An experimental study on a pelvic model. Acta Radiol 31(2):133–136
pubmed: 2372455
Nishihara S, Sugano N, Nishii T, Ohzono K, Yoshikawa H (2003) Measurements of pelvic flexion angle using three-dimensional computed tomography. Clin Orthop Relat Res. (411):140–151
Katada S, Ando K A rontgenographic evaluation of the indices for hip dysplasia in children influenced by pelvic tilt. Amsterdam: Excerpta Medica, 184
Muir JM, Vincent J, Schipper J, Gobin VD, Govindarajan M, Fiaes K et al (2019) A Novel Method for correcting pelvic tilt on Anteroposterior pelvic radiographs. Cureus 11(12):e6274
pubmed: 31911867
pmcid: 6939981
Blondel B, Schwab F, Patel A, Demakakos J, Moal B, Farcy JP et al (2012) Sacro-femoral-pubic angle: a coronal parameter to estimate pelvic tilt. Eur Spine J 21(4):719–724
pubmed: 22113529
Esposito C, Miller T, Kim H, Barlow B, Wright T, Padgett D et al (2016) Does degenerative lumbar spine Disease Influence Femoroacetabular Flexion in patients undergoing total hip arthroplasty? Clin Orthop Relat Res 474(8):1788–1797
pubmed: 27020429
pmcid: 4925410
Innmann M, Merle C, Gotterbarm T, Ewerbeck V, Beaulé P, Grammatopoulos G (2019) Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty? A prospective, diagnostic study of patients with end-stage hip osteoarthritis. Bone Joint J 101–B(8):902–909
pubmed: 31362559
Stefl M, Lundergan W, Heckmann N, McKnight B, Ike H, Murgai R et al (2017) Spinopelvic mobility and acetabular component position for total hip arthroplasty. Bone Joint J 99–B(1 Suppl A):37–45
Heckmann N, McKnight B, Stefl M, Trasolini N, Ike H, Dorr L (2018) Late dislocation following total hip arthroplasty: Spinopelvic Imbalance as a causative factor. J Bone Joint Surg Am 100(21):1845–1853
pubmed: 30399079
Grammatopoulos G, Salih S, Beaulé P, Witt J (2020) Spinopelvic characteristics in Acetabular Retroversion: does pelvic tilt change after Periacetabular Osteotomy? Am J Sports Med 48(1):181–187
pubmed: 31877100
Hosmer D, Lemeshow S (2000) Area under the ROC curve. Applied Logistic Regression. Wiley, New York, pp 160–164
Bodner R, Tezuka T, Heckmann N, Chung B, Jadidi S (2022) The Dorr classification for spinopelvic functional safe component positioning in total hip replacement: a primer for all. J Orthopaedic Experience & Innovation
Bodner RJ (2022) The functional mechanics of the Acetabular component in total hip arthroplasty. J Arthroplasty 37(11):2199 – 207.e1
Cabitza F, Locoro A, Banfi G (2018) Machine learning in Orthopedics: A literature review. Front Bioeng Biotechnol 6:75
pubmed: 29998104
pmcid: 6030383
Arsuaga JL, Carretero JM (1994) Multivariate analysis of the sexual dimorphism of the hip bone in a modern human population and in early hominids. Am J Phys Anthropol 93(2):241–257
pubmed: 8147439
Leong A (2006) Sexual dimorphism of the pelvic architecture: a struggling response to destructive and parsimonious forces by natural & mate selection. Mcgill J Med 9(1):61–66
pubmed: 19529812
pmcid: 2687900
Bedard NA, Martin CT, Slaven SE, Pugely AJ, Mendoza-Lattes SA, Callaghan JJ (2016) Abnormally high dislocation rates of total hip arthroplasty after spinal deformity surgery. J Arthroplasty 31(12):2884–2885
pubmed: 27612605
Salib CG, Reina N, Perry KI, Taunton MJ, Berry DJ, Abdel MP (2019) Lumbar fusion involving the sacrum increases dislocation risk in primary total hip arthroplasty. Bone Joint J. 101–b(2):198–206
Buckland AJ, Puvanesarajah V, Vigdorchik J, Schwarzkopf R, Jain A, Klineberg EO et al (2017) Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion. Bone Joint J. 99–b(5):585–91
Vigdorchik JM, Sharma AK, Madurawe CS, Pierrepont JW, Dennis DA, Shimmin AJ (2021) Prevalence of risk factors for adverse spinopelvic mobility among patients undergoing total hip arthroplasty. J Arthroplasty 36(7):2371–2378
pubmed: 33446383
Pierrepont J, Hawdon G, Miles BP, Connor BO, Baré J, Walter LR et al (2017) Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. Bone Joint J. 99–b(2):184–91
Buckland AJ, Ayres EW, Shimmin AJ, Bare JV, McMahon SJ, Vigdorchik JM (2020) Prevalence of Sagittal spinal deformity among patients undergoing total hip arthroplasty. J Arthroplasty 35(1):160–165
pubmed: 31493962
Gu YM, Kim W, Pierrepont JW, Li Q, Shimmin AJ (2021) The Effect of a degenerative spine and adverse pelvic mobility on prosthetic impingement in patients undergoing total hip arthroplasty. J Arthroplasty 36(7):2523–2529
pubmed: 33692000
Innmann MM, Verhaegen J, Renkawitz T, Merle C, Grammatopoulos G (2023) How to screen for lumbar spine stiffness in patients awaiting total hip arthroplasty. J Arthroplasty