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The Impact of Total Hip Arthroplasty on Pelvic Motion and Functional Component Position is Highly Variable
Denis Nam1, Venessa Riegler2, John C Clohisy2
1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
Background:
This study's purpose was to determine the impact of THA implantation on pelvic motion, and to assess motion in patients with a history of lumbar fusion or prosthetic dislocation.
Methods:
This was an IRB-approved, prospective investigation of 3 cohorts: (1) patients without a history of lumbar surgery undergoing THA (group A), (2) patients with a lumbar fusion (group B), and (3) patients with a THA prosthetic dislocation (group C). All patients received both standing and sitting lateral pelvis images to measure sacral slope and pelvic tilt in the sagittal plane.
Results:
Fifty-eight patients were enrolled (24 group A, 27 group B, and 7 group C), with no differences in age, gender, or body mass index (P = .1-.7). In group A, the mean change in sacral slope from standing to sitting was 22.1° ± 15.2° preoperatively and 19.5° ± 14.8° postoperatively. However, in 13 patients, the difference in pelvic motion from the standing to seated position, from preoperatively to postoperatively, was >5° and in 10 patients, this difference was >10°. The change in standing to sitting sacral slope was significantly less in patients with a lumbar fusion (9.8° ± 8.2°) and history of prosthetic dislocation (12.5° ± 4.7°) vs group A (P < .001 and P = .008).
Conclusion:
Implantation of a THA can increase or decrease sagittal plane pelvic motion from the standing to seated position with a high degree of variability. Thus, the ability to predict ideal component positioning from preoperative images may be challenging.
