Skip to main content

The kinematic relationship between sitting and standing posture and pelvic inclination and its significance to cup positioning in total hip arthroplasty

Abstract

Purpose

The aim of this study is to describe the influence of sitting and standing posture on sagittal pelvic inclination in total hip replacement patients to assist with correct acetabular component positioning.

Methods

Lateral radiographs of the pelvis and lumbar spine in sitting and standing positions were extracted. Pelvic tilt was measured using the vertical inclination of a line from the anterior superior iliac spine (ASIS) to pubic tubercle. Sacral inclination, Cobb angle of the lumbar spine and hip flexion were recorded.

Results

Sixty patients were identified with a mean age of 63. Men were more likely to flex the lumbar spine in sitting (p = 0.004); 80° of hip flexion is required for seated posture. Stiff hips required compensatory pelvic flexion and lumbar flexion in sitting. There is a linear relationship between hip flexion and pelvic tilt, hip flexion and lumbar lordosis.

Conclusions

Pelvic orientation is determined by lumbar and hip stiffness. This impacts on acetabular version.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Fortina M, Carta S, Gambera D, Crainz E, Ferrata P, Maniscalco P (2005) Recovery of physical function and patient’s satisfaction after total hip replacement (THR) surgery supported by a tailored guide-book. Acta Biomed 76(3):152–156

    PubMed  Google Scholar 

  2. AOA (2013) Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide

  3. Walter WL, Insley GM, Walter WK, Tuke MA (2004) Edge loading in third generation alumina ceramic-on-ceramic bearings: stripe wear. J Arthroplasty 19(4):402–413

    Article  PubMed  Google Scholar 

  4. Walter WL, O’Toole GC, Walter WK, Ellis A, Zicat BA (2007) Squeaking in ceramic hips: the importance of acetabular component orientation. J Arthroplasty 22(4):496–503

    Article  PubMed  Google Scholar 

  5. Sexton SA, Yeung E, Jackson MP, Rajaratnam S, Martell JM, Walter WL, Zicat BA, Walter WK (2011) The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements. J Bone Joint Surg Br 93(4):439–442

    Article  CAS  PubMed  Google Scholar 

  6. Lewinnek G, Lewis J, Tarr R, Compere C, Zimmerman J (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217–220

    CAS  PubMed  Google Scholar 

  7. Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg Br 75(2):228–232

    CAS  PubMed  Google Scholar 

  8. DiGioia AM, Mahmoud AH, Jaramaz B, Levison TJ, Moody JE (2006) Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop Relat Res 453:272–276

    Article  PubMed  Google Scholar 

  9. Tang WM, Chiu KY (2000) Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty 15:52–58

    Article  CAS  PubMed  Google Scholar 

  10. Archbold HA, Mockford B, Molloy D, McConway J, Ogonda L, Beverland D (2006) The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br 88(7):883–886

    Article  CAS  PubMed  Google Scholar 

  11. Maruyama M, Feinberg JR, Capello WN, D’Antonio JA (2001) The Frank Stitchfield Award: morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res 393:52–65

    Article  PubMed  Google Scholar 

  12. Sotereanos NG, Miller MC, Smith B, Hube R, Sewecke JJ, Wohlrab D (2006) Using intraoperative pelvic landmarks for acetabular component placement in total hip arthroplasty. J Arthroplasty 21(6):832–840

    Article  PubMed  Google Scholar 

  13. Yoshimine F (2006) The safe-zones for combined cup and neck anteversions that fulfill the essential range of motion and their optimum combination in total hip replacements. J Biomech 39(7):1315–1323

    Article  PubMed  Google Scholar 

  14. Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B (2005) Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br 87:762–769

    Article  CAS  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. McCollum DE, Gray WJ (1990) Dislocation after total hip arthroplasty. Causes and prevention. Clin Orthop Relat Res 261(22):159–170

    PubMed  Google Scholar 

  17. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91(1):128–133

    Article  PubMed  Google Scholar 

  18. Lazennec JY, Rousseau MA, Rangel A, Gorin M, Belicourt C, Brusson A, Catonné Y (2011) Pelvis and total hip arthroplasty acetabular component orientations in sitting and standing positions: measurements reproducibility with EOS imaging system versus conventional radiographies. Orthop Traumatol Surg Res 97:373–380

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  20. Coventry MB, Beckenbaugh RD, Nolan DR, Ilstrup D (1974) 2,012 total hip arthroplasties. A study of postoperative and early complications. J Bone Joint Surg Am 56:273–284

    CAS  PubMed  Google Scholar 

  21. Barrack RL, Lavernia C, Ries M, Thornberry R, Tozakoglou E (2001) Virtual reality computer animation of the effect of component position and design on stability after total hip arthroplasty. Orthop Clin North Am 32:569–577

    Article  CAS  PubMed  Google Scholar 

  22. Wines AP, McNicol D (2006) Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty 21(5):696–701

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  25. Eilander W, Harris SJ, Henkus HE, Cobb JP, Hogervorst T (2013) Functional acetabular component position with supine total hip replacement. Bone Joint J 95-B:1326–1331

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study did not require industry or hospital funding. Support was provided by the Specialist Orthopaedic Group practice in terms of electronic hardware and software.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew Stephens.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Stephens, A., Munir, S., Shah, S. et al. The kinematic relationship between sitting and standing posture and pelvic inclination and its significance to cup positioning in total hip arthroplasty. International Orthopaedics (SICOT) 39, 383–388 (2015). https://doi.org/10.1007/s00264-014-2491-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2491-y

Keywords

  • Pelvic tilt
  • Acetabular anteversion
  • Hip flexion
  • Lumbar flexion