Kromka Joseph J, Zuke William A, Granger Caroline J, Clohisy John C, Barrack Robert L
Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
J Arthroplasty. 2025 Aug;40(8S1):S25-S29. doi: 10.1016/j.arth.2025.03.055. Epub 2025 Mar 26.
Acetabular cup position is fundamental to total hip arthroplasty (THA) and surface replacement arthroplasty (SRA). Even if initial cup placement is adequate, changes in spinopelvic relationships alter functional acetabular position over time. This can lead to late complications. The purpose of this study was to examine changes in pelvic tilt and acetabular position in patients with at least 10 years of follow-up after THA or SRA.
A retrospective review was conducted of patients from one academic practice who underwent THA or SRA and had at least 10 years of follow-up. Pelvic ratio was measured and converted to pelvic tilt. Changes in pelvic tilt were compared from initial X-rays to final follow-up and between two subgroups based on age. Clinically meaningful changes in pelvic tilt and estimated acetabular position were calculated.
There were 200 patients included: 100 aged 45 to 50 years and 100 aged 55 to 60 years. Their mean age was 52 years, 111 were men, and the mean body mass index was 29.7 (range, 18.8 to 49.3). Pelvic tilt change over the 10-year period was -9.87 degrees (SD 10.22), P < 0.001. This corresponds to an increase in acetabular inclination of 1.97 degrees and anteversion of 7.90 degrees. There was meaningful change in 62.5% of patients' posterior tilt with functional change in version or inclination of > 5 degrees. The subgroup of patients aged 45 to 50 years had a larger change in pelvic tilt (-11.50 degrees, SD 9.04) than patients aged 55 to 60 years (-8.25 degrees, SD 11.01), P = 0.024.
We observed increases in posterior tilt in patients 10 years following THA or SRA, resulting in functionally increased acetabular anteversion and inclination. Larger increases in posterior tilt were seen in the younger group, which has implications for initial cup placement in patients with normal spines.
髋臼杯位置对于全髋关节置换术（THA）和表面置换关节成形术（SRA）至关重要。即使初始杯置入合适，随着时间推移，脊柱骨盆关系的改变也会改变髋臼的功能位置。这可能导致晚期并发症。本研究的目的是检查接受THA或SRA且随访至少10年的患者的骨盆倾斜度和髋臼位置的变化。
对来自一家学术机构的接受THA或SRA且随访至少10年的患者进行回顾性研究。测量骨盆比率并换算为骨盆倾斜度。比较初始X线片至最终随访时骨盆倾斜度的变化，以及基于年龄的两个亚组之间的变化。计算骨盆倾斜度和估计髋臼位置的临床有意义的变化。
共纳入200例患者：100例年龄在45至50岁之间，100例年龄在55至60岁之间。他们的平均年龄为52岁，男性111例，平均体重指数为29.7（范围18.8至49.3）。10年期间骨盆倾斜度变化为-9.87度（标准差10.22），P<0.001。这相当于髋臼倾斜度增加1.97度，前倾角增加7.90度。62.5%的患者后倾有意义变化，同时伴有旋转或倾斜功能变化>5度。45至50岁年龄组患者的骨盆倾斜度变化（-11.50度，标准差9.04）大于55至60岁年龄组患者（-8.25度，标准差11.01），P=0.024。
我们观察到THA或SRA术后10年患者后倾增加，导致髋臼前倾角和倾斜度在功能上增加。年轻组后倾增加更大，这对脊柱正常患者的初始杯置入有影响。
