Sevick Johnathan, Plaskos Christopher, Speirs Andrew, Pierrepont Jim, Grammatopoulos George
The Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
CORIN Ltd., Raynham, Massachusetts.
JB JS Open Access. 2025 Apr 25;10(2). doi: 10.2106/JBJS.OA.24.00169. eCollection 2025 Apr-Jun.
The aim of this study was to assess whether replication of native acetabular anatomy would satisfy cup orientation targets using 3 commonly described hip-spine algorithms. Whether spinopelvic characteristics influence ability to achieve cup orientation targets when replicating native anatomy and the agreement between algorithm recommendations was tested.
A prospective database was queried to identify patients with adverse (n = 70) spinopelvic characteristics. These were matched for age and sex with patients without adverse characteristics (n = 70). Spinopelvic characteristics were obtained from radiographs and computed tomography (CT) scans. CT scans were segmented to determine native acetabular anatomy, particularly anteversion. Three hip-spine planning algorithms were evaluated for each patient (Optimized Positioning System [OPS], Combined-Sagittal Index [CSI], Hip-Spine Classification). Differences between target orientations and native anatomy were determined. Agreement between algorithms was tested.
OPS plan had significantly reduced inclination compared with native (39° vs. 52°, p < 0.001). No significant difference between OPS and native anteversions was seen (18° vs. 18°, p = 0.1) for the adverse group. OPS-planned anteversion was greater than native (23° vs. 16°, p < 0.001) in the nonadverse group. Most native orientations met published CSI targets (90% nonadverse, 59% adverse). Most native acetabular orientations (61% adverse and 58% nonadverse) failed to meet Hip-Spine Classification targets. Overall, in 88% of cases, replication of native acetabular version and 40° of inclination satisfied at least one suggested target. Agreement of all 3 algorithms was 31%; greater agreement was seen between Hip-Spine Classification and OPS (64%).
Native acetabular anteversion and radiographic inclination of 40° are reliable targets, satisfying at least one hip-spine algorithm and thus justifying such practice, when advanced hip-spine analysis is not performed. The discrepancy between suggested orientations by the various published techniques, despite their validated low dislocation rates, emphasizes that although achieving a target cup orientation is important, the nature of hip stability is multifactorial and merits a holistic approach.
本研究的目的是评估使用3种常用的髋-脊柱算法复制髋臼原生解剖结构是否能满足髋臼杯方向目标。测试了脊柱骨盆特征在复制原生解剖结构时对实现髋臼杯方向目标能力的影响以及算法建议之间的一致性。
查询前瞻性数据库以识别具有不良（n = 70）脊柱骨盆特征的患者。将这些患者与无不良特征的患者（n = 70）按年龄和性别进行匹配。从X线片和计算机断层扫描（CT）中获取脊柱骨盆特征。对CT扫描进行分割以确定髋臼原生解剖结构，特别是前倾角。对每位患者评估三种髋-脊柱规划算法（优化定位系统[OPS]、联合矢状指数[CSI]、髋-脊柱分类）。确定目标方向与原生解剖结构之间的差异。测试算法之间的一致性。
与原生结构相比，OPS计划的倾斜度显著降低（39°对52°，p < 0.001）。不良组中OPS与原生前倾角之间未见显著差异（18°对18°，p = 0.1）。非不良组中OPS计划的前倾角大于原生前倾角（23°对16°，p < 0.001）。大多数原生方向符合已发表的CSI目标（非不良组90%，不良组59%）。大多数髋臼原生方向（不良组61%，非不良组58%）未达到髋-脊柱分类目标。总体而言，在88%的病例中，复制髋臼原生版本和40°倾斜度至少满足一个建议目标。所有三种算法的一致性为31%；髋-脊柱分类与OPS之间的一致性更高（64%）。
髋臼原生前倾角和40°的X线倾斜度是可靠的目标，在未进行高级髋-脊柱分析时，能满足至少一种髋-脊柱算法，因此证明了这种做法的合理性。尽管各种已发表技术建议的方向之间存在差异，但其脱位率已得到验证，但这强调了虽然实现目标髋臼杯方向很重要，但髋关节稳定性的本质是多因素的，需要采取整体方法。
