Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
J Orthop Res. 2023 Sep;41(9):2026-2031. doi: 10.1002/jor.25555. Epub 2023 Mar 22.
Postoperative spinopelvic changes are associated with increased dislocation risk following total hip arthroplasty (THA). The aim of this study was to identify preoperative patient and radiographic factors associated with high-risk postoperative spinopelvic parameters. A retrospective review of consecutive THA patients who received preoperative and postoperative sitting and standing lateral lumbar spine-hip radiographs with minimum radiographic and clinical follow-up of 10 months was performed. Patient demographics were recorded and preoperative standing and sitting sacral slope (SS), anteinclination, pelvic femoral angle (PFA), and combined sagittal index (CSI) were measured. High-risk patients were defined by decreased spinopelvic motion (∆SS from sitting to standing of >10°), increased hip motion (∆PFA from sitting to standing of >10°), or decreased CSI of >10° at final follow-up compared with preoperative measurements. Univariate and multivariate regression analyses were used to identify preoperative demographic and radiographic factors associated with these high-risk categories. One hundred and fifty-three patients were included with an average age of 62 years, average body mass index of 27.8 kg/m , and average follow-up of 16.2 months. At 1-year follow-up, 43 (28.1%) patients demonstrated a decreased ∆SS > 10° and 67 (43.7%) patients demonstrated an increased ∆PFA > 10° compared with preoperative values. Sitting CSI decreased by >10° in 17 (11.1%) patients. Preoperative increased sitting PFA (adjusted odds ratio [aOR] 1.057, p < 0.001) and decreased preoperative hip motion (∆PFA) were associated with decreased sitting CSI of >10° at 10-month follow-up. Increased spinopelvic motion (∆SS) and decreased hip motion (∆PFA) preoperatively are associated with postoperative radiographic changes that be associated with increased dislocation risk.
术后脊柱骨盆变化与全髋关节置换术后（THA）脱位风险增加有关。本研究旨在确定与术后高危脊柱骨盆参数相关的术前患者和影像学因素。对接受术前和术后坐姿及站立位腰椎侧位-髋部 X 线片的连续 THA 患者进行回顾性分析，影像学和临床随访时间至少为 10 个月。记录患者人口统计学资料，并测量术前站立位和坐姿骶骨倾斜角（SS）、前倾角、骨盆股骨角（PFA）和综合矢状指数（CSI）。高危患者定义为术后脊柱骨盆活动度降低（从坐姿到站立位的 SS 差值>10°）、髋关节活动度增加（从坐姿到站立位的 PFA 差值>10°）或最终随访时 CSI 降低>10°，与术前测量值相比。采用单变量和多变量回归分析来确定与这些高危分类相关的术前人口统计学和影像学因素。共纳入 153 例患者，平均年龄 62 岁，平均体重指数 27.8kg/m2，平均随访时间 16.2 个月。在 1 年随访时，与术前相比，43 例（28.1%）患者的 SS 差值>10°减小，67 例（43.7%）患者的 PFA 差值>10°增加。17 例（11.1%）患者坐姿 CSI 降低>10°。术前坐姿 PFA 增加（校正比值比[aOR]1.057，p<0.001）和术前髋关节活动度降低（∆PFA）与 10 个月随访时坐姿 CSI 降低>10°相关。术前脊柱骨盆活动度增加（∆SS）和髋关节活动度降低（∆PFA）与术后影像学变化相关，这些变化与脱位风险增加有关。
