How much change in pelvic sagittal tilt can result in hip dislocation due to prosthetic impingement? A computer simulation study.
How much change in pelvic sagittal tilt can result in hip dislocation due to prosthetic impingement? A computer simulation study.
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DOI：
10.1002/jor.25022
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Dorr LD
中科院分区：
文献类型：
--
作者：
Pour AE;Schwarzkopf R;Patel KPK;Anjaria MP;Lazennec JY;Dorr LD
全髋关节置换术（THA）后发生的脊柱病变和脊柱融合可导致骨盆后倾增加（例如，平背畸形）或骨盆前倾增加（由椎管狭窄、脊柱融合或其他病变引起）。矢状骨盆倾斜（SPT）的这种变化可导致假体撞击和脱位。我们的目的是确定可能导致假体撞击的SPT变化幅度。我们假设可能导致THA脱位的SPT变化幅度小于10°，并且因不同的髋关节运动而异。在Matlab软件中模拟站立、坐姿、坐立、前屈、下蹲和旋转时的髋关节运动。以1°增量修改植入物方向和SPT角度。由骨盆后倾增加引起的假体在旋转中撞击的风险（接受者工作特征[ROC]阈值低至1-3°）高于骨盆前倾增加引起的假体撞击的风险（ROC阈值低至16-18°）。较大的股骨头可降低假体撞击的风险（比值比{OR}：0.08 [932 mm股骨头]; OR：0.01 [36 mm股骨头]; OR：0.002 [40 mm股骨头]）。由于需要髋关节屈曲运动的SPT变化，具有较高颈干角的股骨柄可减少假体撞击（OR：1.16 [132°股骨柄]; OR：4.94 [135°股骨柄]）。我们的研究结果表明，总的来说，由于SPT变化引起的假体撞击风险较低。特别是，当使用更大直径的股骨头并重建股骨偏心距和长度以防止骨对骨撞击时，这种风险非常低。
Developing spinal pathologies and spinal fusion after total hip arthroplasty (THA) can result in increased pelvic retroversion (e.g., flat back deformity) or increased anterior pelvic tilt (caused by spinal stenosis, spinal fusion or other pathologies) while bending forward. This change in sagittal pelvic tilt (SPT) can result in prosthetic impingement and dislocation. Our aim was to determine the magnitude of SPT change that could lead to prosthetic impingement. We hypothesized that the magnitude of SPT change that could lead to THA dislocation is less than 10° and it varies for different hip motions. Hip motion was simulated in standing, sitting, sit‐to‐stand, bending forward, squatting and pivoting in Matlab software. The implant orientations and SPT angle were modified by 1° increments. The risk of prosthetic impingement in pivoting caused by increased pelvic retroversion (reciever operating characteristic [ROC] threshold as low as 1–3°) is higher than the risk of prosthetic impingement with increased pelvic anteversion (ROC threshold as low as 16–18°). Larger femoral heads decrease the risk of prosthetic impingement (odds ratio {OR}: 0.08 [932 mm head]; OR: 0.01 [36 mm head]; OR: 0.002 [40 mm head]). Femoral stems with a higher neck‐shaft angle decrease the prosthetic impingement due to SPT change in motions requiring hip flexion (OR: 1.16 [132° stem]; OR: 4.94 [135° stem]). Our results show that overall, the risk of prosthetic impingement due to SPT change is low. In particular, this risk is very low when a larger diameter head is used and femoral offset and length are recreated to prevent bone on bone impingement.
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