Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2021 Jul;36(7S):S111-S120. doi: 10.1016/j.arth.2021.01.008. Epub 2021 Jan 11.
Patients with spinopelvic pathology, including lumbar spine stiffness and sagittal spinal deformity, are at increased risk for postoperative complications, including instability, dislocation, and revision after total hip arthroplasty (THA). Recent evidence has suggested that the Lewinnek safe zone should no longer be considered an appropriate target for all patients, especially those with spinopelvic pathology, as the safe zone is a dynamic rather than static target. There are 2 distinct issues for arthroplasty surgeons to consider: lumbar spinal stiffness and sagittal spinal deformity, each of which has its own management.
In order to manage patients with spinopelvic pathology undergoing THA, a basic understanding of spinopelvic parameters, including sagittal balance, sacral slope, and anterior pelvic plane, is essential. Techniques outlined in this manuscript describe a systematic preoperative work-up and intraoperative management of acetabular component positioning according to patient-specific spinopelvic parameters, ensuring optimal component placement and a reduced risk for impingement, instability, and poor postoperative outcomes.
Evaluation of each patient's spinopelvic parameters informs patient classification according to the Hip-Spine Classification for THA. Patient classification is determined by the presence of spinal stiffness and spinal deformity, with corresponding scoring and classification into one of the 4 categories used to determine risk for postoperative dislocation, define patient-specific cup positioning, and create their functional safe zone.
A simple 2-step preoperative assessment with measurements of the anterior pelvic plane and the sacral slope on standing and seated lateral X-rays will identify patients at high risk for postoperative dislocation due to spinal deformity and/or stiffness. Accounting for spinopelvic pathology and adhering to the Hip-Spine Classification guidelines for acetabular component positioning can help reduce the burden of instability and revisions in this complex patient population.
患有脊柱骨盆病变的患者，包括腰椎僵硬和矢状位脊柱畸形，术后并发症的风险增加，包括不稳定、脱位和全髋关节置换术（THA）后翻修。最近的证据表明，Lewinnek 安全区不再被认为是所有患者的合适目标，尤其是脊柱骨盆病变患者，因为安全区是一个动态而不是静态的目标。关节置换外科医生需要考虑两个截然不同的问题：腰椎僵硬和矢状位脊柱畸形，每个问题都有其自身的处理方法。
为了管理接受 THA 的脊柱骨盆病变患者，了解脊柱骨盆参数，包括矢状位平衡、骶骨倾斜度和前骨盆平面，是必不可少的。本文描述的技术概述了根据患者特定的脊柱骨盆参数进行髋臼组件定位的系统术前检查和术中管理，确保了最佳组件放置，并降低了撞击、不稳定和术后不良结果的风险。
评估每个患者的脊柱骨盆参数，根据髋关节脊柱分类对患者进行分类。患者分类取决于脊柱僵硬和脊柱畸形的存在，根据评分和分类为 4 个类别之一，用于确定术后脱位的风险、定义患者特定的杯状位置，并创建其功能安全区。
通过站立和坐位侧位 X 线片测量前骨盆平面和骶骨倾斜度的简单两步术前评估，可以识别出由于脊柱畸形和/或僵硬而术后脱位风险高的患者。考虑到脊柱骨盆病变，并遵循髋关节脊柱分类指南进行髋臼组件定位，可以帮助减少这一复杂患者群体中不稳定和翻修的负担。
