School of Aerospace, Mechanical and Mechatronic Engineering, Faculty of Engineering, The University of Sydney, Camperdown, New South Wales, Australia; Corin Group, Pymble, New South Wales, Australia.
Melbourne Orthopaedic Group, Windsor, Victoria, Australia.
J Arthroplasty. 2021 Jul;36(7):2523-2529. doi: 10.1016/j.arth.2021.02.035. Epub 2021 Feb 16.
Despite the placement of acetabular components in the traditional "safe-zone", dislocations and all parts of the instability spectrum, including impingement, continue to be an issue. Recent research has established the importance of a degenerative spine and adverse pelvic mobility on functional acetabular orientation. The purpose of this study is to quantify the clinical consequences of a degenerative spine and adverse pelvic mobility on prosthetic impingement in patients undergoing total hip arthroplasty.
Between January 2018 and December 2019, a series of 1592 patients undergoing total hip arthroplasty had functional lateral radiographs and a computed tomography scan taken. Two spinal parameters and 2 pelvic mobility parameters were investigated for their association with impingement. Each patient was evaluated for anterior and posterior impingement, at all orientations within a traditional supine safe zone and a patient-specific functional safe zone.
Patients with limited lumbar flexion (stiff spine), higher pelvic incidence-lumbar lordosis mismatch (sagittal imbalance), and more anterior pelvic mobility from stand to flexed-seated, exhibit increased anterior impingement. Patients with larger posterior pelvic mobility from supine-to-stand exhibited increased posterior impingement. Impingement was reduced 3-fold when the target cup orientation was tailored to a patient's functional safe zone rather than a generic target. Six percent of patients showed unavoidable impingement even with an optimized functional cup orientation.
Our results support growing evidence that patients with a degenerative spine and adverse pelvic mobility are likely to have unfavorable functional cup orientations, resulting in prosthetic impingement. Preoperative functional radiographic screening is recommended to assess the likelihood of a patient experiencing impingement due to their unique spinopelvic mobility.
尽管髋臼部件被放置在传统的“安全区”，但脱位和所有不稳定范围的部分，包括撞击，仍然是一个问题。最近的研究已经确定了退行性脊柱和不良骨盆活动度对功能性髋臼方向的重要性。本研究的目的是量化退行性脊柱和不良骨盆活动度对全髋关节置换术后假体撞击的临床影响。
在 2018 年 1 月至 2019 年 12 月期间，对 1592 例接受全髋关节置换术的患者进行了功能侧位 X 线和 CT 扫描。研究了两个脊柱参数和两个骨盆活动度参数与撞击的关系。根据传统仰卧安全区和患者特定功能安全区的所有方向，评估每个患者的前向和后向撞击。
腰椎活动度受限（僵硬脊柱）、骨盆入射角-腰椎前凸差值较大（矢状面失平衡）、站立到弯曲坐位时骨盆前向活动度较大的患者，前向撞击增加。从仰卧位到站立位时骨盆后向活动度较大的患者，后向撞击增加。当目标杯的方向根据患者的功能安全区而不是通用目标进行调整时，撞击减少了 3 倍。即使采用优化的功能性杯位，仍有 6%的患者存在不可避免的撞击。
我们的研究结果支持越来越多的证据表明，退行性脊柱和不良骨盆活动度的患者可能会有不利的功能性杯位，导致假体撞击。建议进行术前功能性放射学筛查，以评估患者因独特的脊柱骨盆活动度而发生撞击的可能性。
