Application of modified acetabular anteversion and inclination angles test system in patients undergoing total hip arthroplasty after lumbar fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIONG Changjun ^1,2 , ZUO Yunzhou ^1,2 , YAN Xiaokang ^1,2 , WANG Guan ^1,2 , FU Hao ^1,2 ,  JIANG Xueming ^1,2

1. Department of Joint Surgery, Wuhan Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Hubei, 430079, P. R. China;
2. Department of Joint Surgery, Wuhan Sports University Affiliated Hospital, Wuhan Hubei, 430079, P. R. China;

Corresponding author：

JIANG Xueming, Email: 44456349@qq.com

Keywords：

Total hip arthroplasty; acetabular prosthesis; anteversion angle; inclination angle; lumbar fusion

DOI：

10.7507/1002-1892.202401001

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Objective To investigate the accuracy and effectiveness of acetabular cup placement in total hip arthroplasty (THA) after lumbar fusion applying of modified acetabular anteversion and inclination angles test system. Methods A clinical data of 45 patients undergoing THA for osteoarthritis between January 2018 and June 2023 was retrospectively analyzed. All patients had previously received lumbar fusion. The modified acetabular anteversion and inclination angle test system was used in 26 cases (observation group) and not used in 19 cases (control group) during THA. There was no significant difference in baseline data such as gender, age, body mass index, operative side, number of lumbar fusion segments, and preoperative Harris score between the two groups (P>0.05). The position of acetabular prosthesis, hip function (Harris score), and incidence of complications were compared between the two groups.Results In the observation group, all acetabular cups were in the safe zone (anteversion angle, 25°-30°) during operation, and 1 acetabular cup (3.85%) was not in the safe zone after operation. In the control group, 9 acetabular cups (47.37%) were not in the safe zone. The postoperative difference between the two groups was significant (P<0.05). There was no significant difference between intra- and post-operative acetabular inclination angles in the observation group (P>0.05), and the postoperative acetabular inclination angle was significantly smaller in the observation group than in the control group (P<0.05). All incisions healed by first intention and no infection occurred. All patients were followed up 6 months. There was no significant difference in Harris score between the two groups at different time point (P>0.05), and there were significant differences between different time points in the two groups (P<0.05). No joint dislocation occurred in the observation group during follow-up, while dislocation occurred in 2 cases and femoral impingement syndrome occurred in 1 case of the control group. There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion For THA patients with lumbar fusion, the ideal placement angle of the acetabular cup can be obtained by using the modified acetabular anteversion and inclination angles test system during operation.

Citation： XIONG Changjun, ZUO Yunzhou, YAN Xiaokang, WANG Guan, FU Hao, JIANG Xueming. Application of modified acetabular anteversion and inclination angles test system in patients undergoing total hip arthroplasty after lumbar fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(5): 576-582. doi: 10.7507/1002-1892.202401001 Copy

1.	董佩龙, 唐晓波, 王健, 等. 两种入路全髋关节置换术治疗老年股骨颈骨折的疗效比较. 临床骨科杂志, 2022, 25(4): 477-481.
2.	梁庆晨, 孙凤龙, 王宏庆, 等. 磁导航脊柱内镜下腰椎融合术治疗单节段腰椎退行性疾病的疗效观察. 中国脊柱脊髓杂志, 2023, 33(8): 707-714, 723.
3.	Miyagi M, Fukushima K, Inoue G, et al. Hip-spine syndrome: cross-sectional-study of spinal alignment in patients with coxalgia. Hip Int, 2019, 29(1): 21-25.
4.	Haffer H, Wang Z, Hu Z, et al. Effect of coronal and sagittal spinal malalignment on spinopelvic mobility in patients undergoing total hip replacement: a prospective observational study. Clin Spine Surg, 2022, 35(6): E510-E519.
5.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
6.	Grammatopoulos G, Falsetto A, Sanders E, et al. Integrating the combined sagittal index reduces the risk of dislocation following total hip replacement. J Bone Joint Surg (Am), 2022, 104(5): 397-411.
7.	Tezuka T, Heckmann ND, Bodner RJ, et al. Functional safe zone is superior to the lewinnek safe zone for total hip arthroplasty: why the lewinnek safe zone is not always predictive of stability. J Arthroplasty, 2019, 34(1): 3-8.
8.	Seagrave KG, Troelsen A, Malchau H, et al. Acetabular cup position and risk of dislocation in primary total hip arthroplasty. Acta Orthop, 2017, 88(1): 10-17.
9.	Kanawade V, Dorr LD, Wan Z. Predictability of acetabular component angular change with postural shift from standing to sitting position. J Bone Joint Surg (Am), 2014, 96(12): 978-986.
10.	Maratt JD, Esposito CI, McLawhorn AS, et al. Pelvic tilt in patients undergoing total hip arthroplasty: when does it matter? J Arthroplasty, 2015, 30(3): 387-391.
11.	Tanabe H, Homma Y, Yanagisawa N, et al. Validation of a preoperative formula to estimate postoperative pelvic sagittal alignment and mobility before performing total hip arthroplasty for patients with hip osteoarthritis. Arthroplasty, 2023, 5(1): 13. doi: 10.1186/s42836-023-00171-w.
12.	伍海昭, 王守立, 陈忠义, 等. 伴腰椎退变性后凸畸形的人工全髋关节置换安放髋臼假体前倾角的策略. 中国骨伤, 2020, 33(11): 1006-1011.
13.	Rutherford M, Connor JD, Gill HS, et al. Operative and radio graphic acetabular component orientation in total hip replace ment: Influence of pelvic orientation and surgical positioning technique. Med Eng Phys, 2019, 64: 7-14.
14.	左云周, 熊昌军, 甘学文, 等. 改良髋臼前倾角及外展角校验系统在不同入路全髋关节置换术中的应用. 实用骨科杂志, 2023, 29(4): 310-314.
15.	于德家, 李树锋, 闫新峰, 等. 髋臼横韧带可作为臼杯前倾角安放的参考. 中华关节外科杂志(电子版), 2020, 14(6): 703-708.
16.	曹林虎, 谭伦, 林旭, 等. 非骨水泥人工全髋关节置换术中髋臼骨缺损重建方式选择及对臼杯位置影响的研究. 中国修复重建外科杂志, 2015, 29(6): 693-699.
17.	张文辉, 许杰, 李登, 等. 穿桌侧位片及骨盆正位片测量髋臼杯前倾角的对比. 中华关节外科杂志(电子版), 2021, 15(2): 151-156.
18.	李腾飞, 王业华, 王绍龙. 腰椎僵直对全髋关节置换术患者姿势性骨盆活动度的影响. 实用骨科杂志, 2022, 28(2): 109-113.
19.	Haffer H, Wang Z, Hu Z, et al. Does obesity affect acetabular cup position, spinopelvic function and sagittal spinal alignment? A prospective investigation with standing and sitting assessment of primary hip arthroplasty patients. J Orthop Surg Res, 2021, 16(1): 640. doi: 10.1186/s13018-021-02716-8.
20.	郭卓涛, 张凯, 查国春, 等. 腰椎融合对全髋关节置换后中期疗效影响的匹配对照试验. 中国组织工程研究, 2023, 27(36): 5801-5805.
21.	Sing DC, Barry JJ, Aguilar TU, et al. Prior lumbar spinal arthrodesis increases risk of prosthetic-related complication in total hip arthroplasty. J Arthroplasty, 2016, 31(9 Suppl): 227-232.
22.	Buckland AJ, Puvanesarajah V, Vigdorchik J, et al. Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion. Bone Joint J, 2017, 99-B(5): 585-591.
23.	Gausden EB, Parhar HS, Popper JE, et al. Risk factors for early dislocation following primary elective total hip arthroplasty. J Arthroplasty, 2018, 33(5): 1567-1571.
24.	Innmann MM, Weishorn J, Beaule PE, et al. Pathologic spinopelvic balance in patients with hip osteoarthritis: Preoperative screening and therapeutic implications. Orthopade, 2020, 49(10): 860-869.
25.	王亚超, 黄健. 腰椎融合后全髋关节置换患者假体脱位与腰椎骨盆矢状面参数的关系. 中国组织工程研究, 2021, 25(30): 4870-4876.
26.	Wan Z, Malik A, Jaramaz B, et al. Imaging and navigation measurement of acetabular component position in THA. Clin Orthop Relat Res, 2009, 467(1): 32-42.
27.	Heckmann N, McKnight B, Stefl M, et al. Late dislocation following total hip arthroplasty: spinopelvic imbalance as a causative factor. J Bone Joint Surg (Am), 2018, 100(21): 1845-1853.
28.	Luthringer TA, Vigdorchik JM. A preoperative workup of a “hip-spine” total hip arthroplasty patient: a simplified approach to a complex problem. J Arthroplasty, 2019, 34(7S): S57-S70.
29.	Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.

1. 董佩龙, 唐晓波, 王健, 等. 两种入路全髋关节置换术治疗老年股骨颈骨折的疗效比较. 临床骨科杂志, 2022, 25(4): 477-481.
2. 梁庆晨, 孙凤龙, 王宏庆, 等. 磁导航脊柱内镜下腰椎融合术治疗单节段腰椎退行性疾病的疗效观察. 中国脊柱脊髓杂志, 2023, 33(8): 707-714, 723.
3. Miyagi M, Fukushima K, Inoue G, et al. Hip-spine syndrome: cross-sectional-study of spinal alignment in patients with coxalgia. Hip Int, 2019, 29(1): 21-25.
4. Haffer H, Wang Z, Hu Z, et al. Effect of coronal and sagittal spinal malalignment on spinopelvic mobility in patients undergoing total hip replacement: a prospective observational study. Clin Spine Surg, 2022, 35(6): E510-E519.
5. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
6. Grammatopoulos G, Falsetto A, Sanders E, et al. Integrating the combined sagittal index reduces the risk of dislocation following total hip replacement. J Bone Joint Surg (Am), 2022, 104(5): 397-411.
7. Tezuka T, Heckmann ND, Bodner RJ, et al. Functional safe zone is superior to the lewinnek safe zone for total hip arthroplasty: why the lewinnek safe zone is not always predictive of stability. J Arthroplasty, 2019, 34(1): 3-8.
8. Seagrave KG, Troelsen A, Malchau H, et al. Acetabular cup position and risk of dislocation in primary total hip arthroplasty. Acta Orthop, 2017, 88(1): 10-17.
9. Kanawade V, Dorr LD, Wan Z. Predictability of acetabular component angular change with postural shift from standing to sitting position. J Bone Joint Surg (Am), 2014, 96(12): 978-986.
10. Maratt JD, Esposito CI, McLawhorn AS, et al. Pelvic tilt in patients undergoing total hip arthroplasty: when does it matter? J Arthroplasty, 2015, 30(3): 387-391.
11. Tanabe H, Homma Y, Yanagisawa N, et al. Validation of a preoperative formula to estimate postoperative pelvic sagittal alignment and mobility before performing total hip arthroplasty for patients with hip osteoarthritis. Arthroplasty, 2023, 5(1): 13. doi: 10.1186/s42836-023-00171-w.
12. 伍海昭, 王守立, 陈忠义, 等. 伴腰椎退变性后凸畸形的人工全髋关节置换安放髋臼假体前倾角的策略. 中国骨伤, 2020, 33(11): 1006-1011.
13. Rutherford M, Connor JD, Gill HS, et al. Operative and radio graphic acetabular component orientation in total hip replace ment: Influence of pelvic orientation and surgical positioning technique. Med Eng Phys, 2019, 64: 7-14.
14. 左云周, 熊昌军, 甘学文, 等. 改良髋臼前倾角及外展角校验系统在不同入路全髋关节置换术中的应用. 实用骨科杂志, 2023, 29(4): 310-314.
15. 于德家, 李树锋, 闫新峰, 等. 髋臼横韧带可作为臼杯前倾角安放的参考. 中华关节外科杂志(电子版), 2020, 14(6): 703-708.
16. 曹林虎, 谭伦, 林旭, 等. 非骨水泥人工全髋关节置换术中髋臼骨缺损重建方式选择及对臼杯位置影响的研究. 中国修复重建外科杂志, 2015, 29(6): 693-699.
17. 张文辉, 许杰, 李登, 等. 穿桌侧位片及骨盆正位片测量髋臼杯前倾角的对比. 中华关节外科杂志(电子版), 2021, 15(2): 151-156.
18. 李腾飞, 王业华, 王绍龙. 腰椎僵直对全髋关节置换术患者姿势性骨盆活动度的影响. 实用骨科杂志, 2022, 28(2): 109-113.
19. Haffer H, Wang Z, Hu Z, et al. Does obesity affect acetabular cup position, spinopelvic function and sagittal spinal alignment? A prospective investigation with standing and sitting assessment of primary hip arthroplasty patients. J Orthop Surg Res, 2021, 16(1): 640. doi: 10.1186/s13018-021-02716-8.
20. 郭卓涛, 张凯, 查国春, 等. 腰椎融合对全髋关节置换后中期疗效影响的匹配对照试验. 中国组织工程研究, 2023, 27(36): 5801-5805.
21. Sing DC, Barry JJ, Aguilar TU, et al. Prior lumbar spinal arthrodesis increases risk of prosthetic-related complication in total hip arthroplasty. J Arthroplasty, 2016, 31(9 Suppl): 227-232.
22. Buckland AJ, Puvanesarajah V, Vigdorchik J, et al. Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion. Bone Joint J, 2017, 99-B(5): 585-591.
23. Gausden EB, Parhar HS, Popper JE, et al. Risk factors for early dislocation following primary elective total hip arthroplasty. J Arthroplasty, 2018, 33(5): 1567-1571.
24. Innmann MM, Weishorn J, Beaule PE, et al. Pathologic spinopelvic balance in patients with hip osteoarthritis: Preoperative screening and therapeutic implications. Orthopade, 2020, 49(10): 860-869.
25. 王亚超, 黄健. 腰椎融合后全髋关节置换患者假体脱位与腰椎骨盆矢状面参数的关系. 中国组织工程研究, 2021, 25(30): 4870-4876.
26. Wan Z, Malik A, Jaramaz B, et al. Imaging and navigation measurement of acetabular component position in THA. Clin Orthop Relat Res, 2009, 467(1): 32-42.
27. Heckmann N, McKnight B, Stefl M, et al. Late dislocation following total hip arthroplasty: spinopelvic imbalance as a causative factor. J Bone Joint Surg (Am), 2018, 100(21): 1845-1853.
28. Luthringer TA, Vigdorchik JM. A preoperative workup of a “hip-spine” total hip arthroplasty patient: a simplified approach to a complex problem. J Arthroplasty, 2019, 34(7S): S57-S70.
29. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.

Chinese Journal of Reparative and Reconstructive Surgery

Application of modified acetabular anteversion and inclination angles test system in patients undergoing total hip arthroplasty after lumbar fusion

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