Vigdorchik Jonathan M, Sharma Abhinav K, Buckland Aaron J, Elbuluk Ameer M, Eftekhary Nima, Mayman David J, Carroll Kaitlin M, Jerabek Seth A
Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, New York, USA.
NYU Langone Health, Department of Orthopaedic Surgery, New York, New York, USA.
Bone Joint J. 2021 Jul;103-B(7 Supple B):17-24. doi: 10.1302/0301-620X.103B7.BJJ-2020-2448.R2.
Patients with spinal pathology who undergo total hip arthroplasty (THA) have an increased risk of dislocation and revision. The aim of this study was to determine if the use of the Hip-Spine Classification system in these patients would result in a decreased rate of postoperative dislocation in patients with spinal pathology.
This prospective, multicentre study evaluated 3,777 consecutive patients undergoing THA by three surgeons, between January 2014 and December 2019. They were categorized using The Hip-Spine Classification system: group 1 with normal spinal alignment; group 2 with a flatback deformity, group 2A with normal spinal mobility, and group 2B with a stiff spine. Flatback deformity was defined by a pelvic incidence minus lumbar lordosis of > 10°, and spinal stiffness was defined by < 10° change in sacral slope from standing to seated. Each category determined a patient-specific component positioning. Survivorship free of dislocation was recorded and spinopelvic measurements were compared for reliability using intraclass correlation coefficient.
A total of 2,081 patients met the inclusion criteria. There were 987 group 1A, 232 group 1B, 715 group 2A, and 147 group 2B patients. A total of 70 patients had a lumbar fusion, most had L4-5 (16; 23%) or L4-S1 (12; 17%) fusions; 51 patients (73%) had one or two levels fused, and 19 (27%) had > three levels fused. Dual mobility (DM) components were used in 166 patients (8%), including all of those in group 2B and with > three level fusions. Survivorship free of dislocation at five years was 99.2% with a 0.8% dislocation rate. The correlation coefficient was 0.83 (95% confidence interval 0.89 to 0.91).
This is the largest series in the literature evaluating the relationship between hip-spine pathology and dislocation after THA, and guiding appropriate treatment. The Hip-Spine Classification system allows surgeons to make appropriate evaluations preoperatively, and it guides the use of DM components in patients with spinopelvic pathology in order to reduce the risk of dislocation in these high-risk patients. Cite this article: 2021;103-B(7 Supple B):17-24.
接受全髋关节置换术（THA）的脊柱病变患者发生脱位和翻修的风险增加。本研究的目的是确定在这些患者中使用髋-脊柱分类系统是否会降低脊柱病变患者术后脱位的发生率。
这项前瞻性、多中心研究评估了2014年1月至2019年12月期间由三位外科医生连续进行THA的3777例患者。他们使用髋-脊柱分类系统进行分类：1组脊柱排列正常；2组为平背畸形，2A组脊柱活动度正常，2B组脊柱僵硬。平背畸形定义为骨盆入射角减去腰椎前凸大于10°，脊柱僵硬定义为从站立到坐下时骶骨倾斜度变化小于10°。每个类别确定特定患者的假体组件定位。记录无脱位的生存率，并使用组内相关系数比较脊柱骨盆测量的可靠性。
共有2081例患者符合纳入标准。其中1A组987例，1B组232例，2A组715例，2B组147例。共有70例患者进行了腰椎融合术，大多数为L4-5（16例；23%）或L4-S1（12例；17%）融合；51例患者（73%）融合了1或2个节段，19例（27%）融合节段超过3个。166例患者（8%）使用了双动（DM）组件，包括所有2B组患者和融合节段超过3个的患者。五年时无脱位生存率为99.2%，脱位率为0.8%。相关系数为0.83（95%置信区间0.89至0.91）。
这是文献中评估髋-脊柱病变与THA术后脱位之间关系并指导适当治疗的最大系列研究。髋-脊柱分类系统使外科医生能够在术前进行适当评估，并指导在脊柱骨盆病变患者中使用DM组件，以降低这些高危患者的脱位风险。引用本文：2021；103-B(7 Supple B):17-24。
