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Pelvic Tilt Is Minimally Changed by Total Hip Arthroplasty

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

While surgical navigation offers the opportunity to accurately place an acetabular component, questions remain as to the best goal for acetabular component positioning in individual patients. Overall functional orientation of the pelvis after surgery is one of the most important variables for the surgeon to consider when determining the proper goal for acetabular component orientation.

Questions/Purposes

We measured the variation in pelvic tilt in 30 patients before THA and the effect of THA on pelvic tilt in the same patients more than a year after THA.

Methods

Each patient had a CT study for CT-based surgical navigation and standing and supine radiographs before and after surgery. Pelvic tilt was calculated for each of the radiographs using a novel and validated two-dimensional/three-dimensional matching technique.

Results

Mean supine pelvic tilt changed less than 2°, from 4.4° ± 6.4° (range, −7.7° to 20.8°) before THA to 6.3° ± 6.6° (range, −5.7° to 19.6°) after THA. Mean standing pelvic tilt changed less than 1°, from 1.5° ± 7.2° (range, −13.1° to 12.8°) before THA to 2.0° ± 8.3° (range, −12.3° to 16.8°) after THA. Preoperative pelvic tilt correlated with postoperative tilt in both the supine (r2 = 0.75) and standing (r2 = 0.87) positions.

Conclusions

In this population, pelvic tilt had a small and predictable change after surgery. However, intersubject variability of pelvic tilt was high, suggesting preoperative pelvic tilt should be considered when determining desired acetabular component positioning on a patient-specific basis.

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References

  1. Babisch JD, Layher F, Maiot LP. The rationale for tilt-adjusted acetabular cup navigation. J Bone Joint Surg Am. 2008;90:357–365.

    Article  PubMed  Google Scholar 

  2. Bergmann G, Deuretzbacher G, Heller F, Graichen F, Rohlmann A, Strauss J, Duda GN. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34:859–871.

    Article  PubMed  CAS  Google Scholar 

  3. Blendea S, Eckman K, Jaramaz B, Levison TJ, DiGioia AM 3rd. Measurements of acetabular cup position and pelvic spatial orientation after total hip arthroplasty using computed tomography/radiography matching. Comput Aided Surg. 2005;10:37–41.

    PubMed  Google Scholar 

  4. Blondel B, Parratte S, Tropiano P, Pauly V, Aubaniac JM, Argenson JN. Pelvic tilt measurement before and after total hip arthroplasty. Orthop Traumatol Surg Res. 2009;95:568–572.

    Article  PubMed  CAS  Google Scholar 

  5. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.

    Article  PubMed  Google Scholar 

  6. DiGioia AM 3rd, Hafez MA, Jaramaz B, Levison TJ, Moody JE. Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop Relat Res. 2006;453:272–276.

    Article  PubMed  Google Scholar 

  7. Ecker TM, Tannast M, Murphy SB. Computed tomography-based surgical navigation for hip arthroplasty. Clin Orthop Relat Res. 2007;465:100–105.

    PubMed  Google Scholar 

  8. Eckman K, Hafez MA, Ed F, Jaramaz B, Levison TJ, DiGioia AM 3rd. Accuracy of pelvic flexion measurements from lateral radiographs. Clin Orthop Relat Res. 2006;451:154–160.

    Article  PubMed  Google Scholar 

  9. Hube R, Birke A, Hein W, Klima S. CT-based and fluoroscopy-based navigation for cup implantation in total hip arthroplasty (THA). Surg Technol Int. 2003;11:275–280.

    PubMed  Google Scholar 

  10. Huppertz A, Radmer S, Asbach P, Juran R, Schwenke C, Diederichs G, Hamm B, Sparmann M. Computed tomography for preoperative planning in minimal-invasive total hip arthroplasty: radiation exposure and cost analysis. Eur J Radiol. 2011;78:406–413.

    Article  PubMed  Google Scholar 

  11. Jaramaz B, DiGioia AM 3rd, Blackwell M, Nikou C. Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res. 1998;354:70–81.

    Article  PubMed  Google Scholar 

  12. Jolles BM, Genoud P, Hoffmeyer P. Computer-assisted cup placement techniques in total hip arthroplasty improve accuracy of placement. Clin Orthop Relat Res. 2004;426:174–179.

    Article  PubMed  Google Scholar 

  13. Leenders T, Vandevelde D, Mahieu G, Nuyts R. Reduction in variability of acetabular cup abduction using computer assisted surgery: a prospective and randomized study. Comput Aided Surg. 2002;7:99–106.

    Article  PubMed  CAS  Google Scholar 

  14. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–220.

    PubMed  CAS  Google Scholar 

  15. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.

    PubMed  CAS  Google Scholar 

  16. Murphy SB, Ecker TM, Tannast M. THA performed using conventional and navigated tissue-preserving techniques. Clin Orthop Relat Res. 2006;453:160–167.

    Article  PubMed  Google Scholar 

  17. Nishihara S, Sugano N, Nishii T, Ohzono K, Yoshikawa H. Measurements of pelvic flexion angle using three-dimensional computed tomography. Clin Orthop Relat Res. 2003;411:140–151.

    Article  PubMed  Google Scholar 

  18. Nogler M, Kessler O, Prassi A, Donnelly B, Streicher R, Siedge JB, Krismer M. Reduced variability of acetabular cup positioning with use of an imageless navigation system. Clin Orthop Relat Res. 2004;426:159–163.

    Article  PubMed  Google Scholar 

  19. Parratte S, Pagnano MW, Coleman-Wood K, Kaufman KR, Berry DJ. The 2008 Frank Stinchfield Award. Variation in postoperative pelvic tilt may confound the accuracy of hip navigation systems. Clin Orthop Relat Res. 2009;467:43–49.

    Article  PubMed  Google Scholar 

  20. Patil S, Bergula A, Chen PC, Colwell CW, D’Lima DD. Polyethylene wear and acetabular component orientation. J Bone Joint Surg Am. 2003;85(suppl 4):56–63.

    PubMed  Google Scholar 

  21. Saxler G, Marx A, Vandevelde D, Langlotz U, Tannast M, Wiese M, Michaelis U, Kemper G, Grutzner PA, Steffen R, von Knoch M, Holland-Letz T, Bernsmann K. [Cup placement in hip replacement surgery—a comparison of free-hand and computer assisted cup placement in total hip arthroplasty—a multi-center study] [in German]. Z Orthop Ihre Grenzgeb. 2004;142:286–291.

    Article  PubMed  CAS  Google Scholar 

  22. Steppacher SD, Kowal JH, Murphy SB. Improving cup positioning using a mechanical navigation instrument. Clin Orthop Relat Res. 2011;469:423–428.

    Article  PubMed  Google Scholar 

  23. Steppacher SD, Tannast M, Zheng G, Zhang X, Kowal J, Anderson SE, Siebenrock KA, Murphy SB. Validation of a new method for determination of cup orientation in THA. J Orthop Res. 2009;27:1583–1588.

    Article  PubMed  Google Scholar 

  24. Widmer KH. Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty. Int Orthop. 2007;31(suppl 1):S29–S33.

    Article  PubMed  Google Scholar 

  25. Wolf A, DiGioia AM 3rd, Mor AB, Jaramaz B. Cup alignment error model for total hip arthroplasty. Clin Orthop Relat Res. 2005;437:132–137.

    Article  PubMed  Google Scholar 

  26. Zheng G, Zhang X, Steppacher SD, Murphy SB, Siebenrock KA, Tannast M. HipMatch: an object-oriented cross-platform program for accurate determination of cup orientation using 2D-3D registration of single standard x-ray radiograph and a CT volume. Comput Methods Programs Biomed. 2009;95:236–248.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA

    William S. Murphy, Greg Klingenstein MD & Stephen B. Murphy MD

  2. Department of Orthopaedic Surgery, The Hospital for Special Surgery, New York, NY, USA

    Greg Klingenstein MD

  3. ARTORG Center for Biomedical Engineering Research, ISTB-Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland

    Guoyan Zheng PhD

Authors
  1. William S. Murphy
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  2. Greg Klingenstein MD
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  3. Stephen B. Murphy MD
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  4. Guoyan Zheng PhD
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Corresponding author

Correspondence to Stephen B. Murphy MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

This work was performed at the Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital, Boston, MA, USA.

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Murphy, W.S., Klingenstein, G., Murphy, S.B. et al. Pelvic Tilt Is Minimally Changed by Total Hip Arthroplasty. Clin Orthop Relat Res 471, 417–421 (2013). https://doi.org/10.1007/s11999-012-2581-3

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  • DOI: https://doi.org/10.1007/s11999-012-2581-3

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