Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey Suite 3B, Boston 02114, Massachusetts.
J Orthop Res. 2019 Mar;37(3):674-680. doi: 10.1002/jor.24234. Epub 2019 Feb 21.
Anterior instability after total hip arthroplasty (THA) has been described in patients with thoracolumbar kyphotic deformity. Although compensatory posterior pelvic tilt with subsequent increased functional anteversion has been described as the mechanism, there is a paucity of in vivo data. The purpose of our study was to compare pelvic tilt, anteversion, inclination, and position of head-cup contact points in patients with lumbar degenerative disc disease (DDD) and a matched patient cohort without DDD. A total of 50 THA, 18 hips with lumbar DDD and 32 hips without DDD, underwent CT imaging for 3D hip reconstruction. Component orientations and in vivo hip gait kinematics was quantified using a validated dual fluoroscopic imaging system. Hip kinematics and head-cup contact points were compared. Patients with lumbar DDD demonstrated decreased maximum (5.9° ± 4.2° vs. 9.3° ± 5.4°, p = 0.02) and minimum (2.4° ± 4.1° vs. 6.2° ± 5.6°, p = 0.01) anterior pelvic tilt, and increased maximum cup anteversion (29.3° ± 8.7° vs. 25.1° ± 8.1°, p = 0.05). The peak head-cup contact points were shifted closer to the anterior edge of the polyethylene (7.8 ± 1.7 mm vs. 9.6 ± 2.2 mm, p = 0.02). Patients with lumbar degenerative disc disease demonstrated increased posterior pelvic tilt, functional acetabular anteversion, inclination as well as shifting of the peak head-cup contact pattern significantly closer to an anterior edge, suggesting sagittal spinopelvic deformity may predispose to anterior instability in THA patients during upright activities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
全髋关节置换术后（THA）的前不稳定已在伴有胸腰椎后凸畸形的患者中描述过。尽管已经描述了代偿性的骨盆后倾，随之而来的功能性前外展增加是其机制，但目前体内数据很少。我们研究的目的是比较腰椎退行性椎间盘疾病（DDD）患者和匹配的无 DDD 患者的骨盆倾斜度、前倾角、倾斜度和头杯接触点位置。共 50 例 THA、18 例腰椎 DDD 髋关节和 32 例无 DDD 髋关节进行 CT 成像三维髋关节重建。使用经过验证的双荧光透视成像系统定量评估了组件方向和体内髋关节运动学。比较了髋关节运动学和头杯接触点。腰椎 DDD 患者的最大（5.9°±4.2° vs. 9.3°±5.4°，p=0.02）和最小（2.4°±4.1° vs. 6.2°±5.6°，p=0.01）骨盆前倾以及最大杯前倾角增加（29.3°±8.7° vs. 25.1°±8.1°，p=0.05）。峰值头杯接触点更靠近聚乙烯前缘（7.8±1.7mm vs. 9.6±2.2mm，p=0.02）。腰椎退行性椎间盘疾病患者表现出明显增加的骨盆后倾、功能性髋臼前倾角、倾斜度以及峰值头杯接触模式向聚乙烯前缘显著靠近，这表明矢状脊柱骨盆畸形可能使 THA 患者在直立活动中容易发生前不稳定。
