Palit Arnab, Williams Mark A, Seemala Vineet, Donnelly Mike, Renkawitz Tobias, Weber Markus
WMG, The University of Warwick, Coventry, UK.
Department of Orthopaedic Surgery, Regensburg University, Regensburg, Bad Abbach, Germany.
J Orthop Res. 2025 Jul;43(7):1303-1314. doi: 10.1002/jor.26085. Epub 2025 Apr 12.
Impingement is a significant complication following total hip arthroplasty (THA), resulting in restricted range of motion (ROM). Pelvic tilt (PT) and its variation could alter both post-THA ROM and impingement types, which remains relatively unexplored in the literature. Therefore, this study aims to investigate the impact of PT changes on post-THA ROM and impingement types. Subject-specific ROM was simulated using 3D-CT and clinical data for 56 THA patients. Subsequently, the effect of no-PT, standing preoperative (StPT) and postoperative PT at 6 (StPT) and 12 months (StPT) on maximum ROM (flexion, extension, abduction, adduction, external rotation (ER) and internal rotation at 90° Flexion (IR@90°Flex)) and impingement types (implant-to-implant impingement (ITII), implant-to-bone impingement (ITBI), and bone-to-bone impingement (BTBI)) were investigated. Stong correlations existed between PT and flexion (R ≥ 0.686), extension (R ≥ 0.527), and IR@90°Flex (R ≥ 0.547). Anterior PT exceeding 8.1° and 11.8° were linked to decreased flexion below 110° and IR@90°Flex below 30°, respectively. Each 10° increase in anterior PT resulted in a 10° reduction in flexion and a 10.7° reduction in IR@90°Flex. Impingement types due to PT remained unchanged for flexion/extension, with increased ITII for abduction (8.9%), adduction (23.2%), and IR@90°Flex (16.1%), and increased BTBI (16.1%) for ER. In total, 12.5% and 19.6% of patients experienced clinically relevant ROM change for flexion and IR@90°Flex, respectively for StPT-StPT. However, it affected below 5.4% cases when comparing StPT and StPT. Minor changes in impingement type (< 6% of cases) were observed due to changes in PT before and after THA, as well as temporal changes in PT post-THA. However, PT had a substantial impact on impingement types when comparing ROM without considering PT to ROM with PT included. Specifically, anterior PT was associated with reduced flexion and IR@90°Flex, indicating a higher risk of impingement. PT changes over time may lead to clinically relevant alterations in ROM but not impingement types. Trial Registration: German Clinical Trials Register; Main ID: DRKS00000739.
撞击是全髋关节置换术（THA）后一种严重的并发症，会导致活动范围（ROM）受限。骨盆倾斜（PT）及其变化可能会改变THA后的ROM和撞击类型，而这在文献中相对未被充分探索。因此，本研究旨在调查PT变化对THA后ROM和撞击类型的影响。使用56例THA患者的3D-CT和临床数据模拟了个体特异性ROM。随后，研究了无PT、术前站立位（StPT）以及术后6个月（StPT）和12个月（StPT）时的PT对最大ROM（屈曲、伸展、外展、内收、外旋（ER）和90°屈曲时的内旋（IR@90°Flex））和撞击类型（植入物对植入物撞击（ITII）、植入物对骨撞击（ITBI）和骨对骨撞击（BTBI））的影响。PT与屈曲（R≥0.686）、伸展（R≥0.527）和IR@90°Flex（R≥0.547）之间存在强相关性。前PT超过8.1°和11.8°分别与屈曲低于110°和IR@90°Flex低于30°的减少有关。前PT每增加10°，屈曲减少10°，IR@90°Flex减少10.7°。由于PT导致的撞击类型在屈曲/伸展时保持不变，外展（8.9%）、内收（23.2%）和IR@90°Flex（16.1%）时ITII增加，ER时BTBI增加（16.1%）。总体而言，分别有12.5%和19.6%的患者在StPT-StPT时屈曲和IR@90°Flex出现了临床相关的ROM变化。然而，在比较StPT和StPT时，受影响的病例低于5.4%。由于THA前后PT的变化以及THA后PT的时间变化，观察到撞击类型有轻微变化（<6%的病例）。然而，在比较不考虑PT的ROM和包含PT的ROM时，PT对撞击类型有重大影响。具体而言，前PT与屈曲和IR@90°Flex的减少相关，表明撞击风险更高。PT随时间的变化可能导致ROM出现临床相关改变，但不会导致撞击类型改变。试验注册：德国临床试验注册中心；主要编号：DRKS00
