Pathologic spinopelvic balance in patients with hip osteoarthritis
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Moritz M. Innmann1 · Johannes Weishorn1 · Paul E. Beaule2 · George Grammatopoulos2 · Christian Merle1 1
© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020
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Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany Division of Orthopaedic Surgery, The Ottawa Hospital—General Campus, University of Ottawa, Ottawa, Canada
Pathologic spinopelvic balance in patients with hip osteoarthritis Preoperative screening and therapeutic implications
Background The term hip-spine syndrome (HSS) describes a combination of both hip and spine pathology and was first introduced and classified by Offierski and MacNab in 1983 stating that “failure to recognize concurrent disease at both the hip and spine may lead to misdiagnosis and possibly erroneous treatment” [1]. With an aging population and a rising number of primary total hip arthroplasties (THA), hip arthroplasty surgeons are challenged by an increasing number of patients with both degenerative hip and spine disease or previous spinal surgery [2–8]. In recent years there has been a growing research interest in the topic of spinopelvic balance and associated pathology. It has been shown that the lumbar spine, pelvis and femurs interact as three segments of a kinetic chain in the sagittal plane during activities of daily living [2, 3, 9]. This interaction is directly related to the functional component orientation following THA and is therefore potentially associated with the postoperative functional outcome [2, 3, 10].
The target zone for optimal »acetabular component position and orientation remains controversial In patients with osteoarthritic hips, a high interindividual variability of
spinopelvic parameters has been described from radiographic assessments in supine, standing and sitting positions [11, 12]. The variability, dynamics and associated compensatory mechanisms of spinopelvic parameters are still not fully understood, particularly in patients with both hip and spine pathology. It has been reported that THA appears to improve the overall sagittal balance and that preoperative coexisting lower back pain is alleviated in a substantial proportion of patients undergoing THA [13]; however, patients with hip OA and concomitant degenerative spinal disease or previous spinal fusion often have pathologic spinopelvic alignment and/or mobility, being potentially at increased risk for THA failure as a result of instability or wear-related complications [14]. There is strong evidence that patients with lumbar fusion or stiff degenerative spines have a significantly higher risk for impingement and dislocation following THA [9, 15–21]. Several studies have shown that the risk of impingement and dislocation appears to increase with increasing length of the spinal fusion and in the presence of lumbar spine fusions involving the sacrum [5, 9, 17, 19, 21]. Bedard et al. found that patients with spinopelvic (L5–S1) fusion have dislocation rates of 8–20% compared to control rates of 2.9% [20]. Pathologic spinopelvic mobility has also bee
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