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Influence of the sagittal balance of the spine on the anterior pelvic plane and on the acetabular orientation

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Abstract

The Anterior Pelvic Plane (APP), defined by the anterior superior iliac spines and the pubic tubercle, was commonly used as reference for positioning and postoperative evaluation of the orientation of the acetabular cup in total hip arthroplasty. APP was assumed to be vertical, but was not observed always so, mostly because of associated spinal diseases inducing perturbations in the harmony of the sagittal balance of the pelvi-spinal unit. Consequently a sagittal rotation of the pelvis occurs, and so a tilt of the APP which alters directly the orientation of the cup in upright position. An analysis of the APP tilt related to the sagittal balance of the spine was provided and its implication on the cup orientation. It appeared essential for an individual adjustment of the cup positioning to avoid a functional mal-position which can lead to an increased risk of dislocation and impingement.

Résumé

Le plan antérieur pelvien (APP) définit par les crêtes iliaques et le pubis est communément appelé plan de référence pour le positionnement et l'orientation de la cupule acétabulaire dans les prothèses totales de hanche. Ce plan peut être modifié par la position verticale et du fait de pathologies associées au niveau de la colonne vertébrale entraînant une perturbation des courbures et de la balance pelvienne. En conséquence, une rotation sagittale du pelvis peut survenir avec conséquences sur le plan pelvien antérieur APP. Ceci peut avoir des conséquences directes sur l'orientation de la cupule en position debout. Une analyse de ce plan pelvien antérieur APP et des modifications entraînées par la balance pelvienne sont indispensables. Il apparaît essentiel d'ajuster le positionnement de la cupule de façon à éviter une mal position qui peut être responsable d'un risque accru de luxations ou de conflits.

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Authors and Affiliations

  1. Department of Orthopaedics, University Hospital of Mont-Godinne, 5530, Yvoir, Belgium

    Jean Legaye

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  1. Jean Legaye
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Correspondence to Jean Legaye.

Appendix

Appendix

  1. 1.

    Anteversion of a circle measured from the elliptical appearance of a circular marker wire is: arc sin of the ratio between the lengths of the minor and major axes [1].

  2. 2.

    The impact of a sagittal pelvic rotation (γ) on the acetabular orientation is three-dimensional and acts as a sagittal rotation of a local axis system into a global reference system. This influence on the acetabular anteversion is so connected to the amount of lateral inclination (β), as described in 1986 by Ackland et al. [1]: it is total for a “β” angle strictly horizontal; nil if it is vertical.

The consequence of a pelvic rotation “γ” on the anteversion (α) of a cup with an inclination “β” is

$$\alpha = \gamma * \cos \left( {\beta + \left( {\gamma * \sin \left( \beta \right) * \cos \left( \beta \right)} \right)} \right)$$

All angles expressed in degrees.

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Legaye, J. Influence of the sagittal balance of the spine on the anterior pelvic plane and on the acetabular orientation. International Orthopaedics (SICOT) 33, 1695–1700 (2009). https://doi.org/10.1007/s00264-008-0702-0

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  • DOI: https://doi.org/10.1007/s00264-008-0702-0

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