Total Hip Instability and the Spinopelvic Link

Current Reviews in Musculoskeletal Medicine
Zachary C LumJohn P Meehan

Abstract

Advances in technology, implant design, and surgical technique have lowered the dislocation rate in primary total hip arthroplasty (THA). Despite these advances, there remain a large number of instability episodes without a known etiology. Recent research suggests that the pelvic and lumbar spine interrelationship may be the explanation in prosthetic dislocations without a known cause. In this review, we describe the biomechanics, measurements, diagnoses, classification, management, and outcomes of total hip and revision total hip instability as it relates to spinopelvic alignment. As a person goes from standing to sitting, lumbar lordosis decreases, and the sacrum and entire pelvis tilts posteriorly with sacrum and coccyx rotating posterior-inferiorly, resulting in increased acetabular cup anteversion to accommodate femoral flexion. A fused spine and associated fixed acetabulum can result in abnormal pelvic femoral motion, impingement, and dislocation. Classifying the spinopelvic mechanics by sacral motion based on sitting and standing lateral radiographs provides an understanding of how the acetabulum behaves in space. This information helps appropriate cup positioning, reducing the risk of femoral side impingement and subseq...Continue Reading

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Citations

Jun 1, 2021·The Orthopedic Clinics of North America·Travis R FlickWilliam F Sherman
Sep 17, 2021·The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS·Ahmed K EmaraAtul F Kamath
Dec 2, 2021·The Bone & Joint Journal·Peter K SculcoJonathan M Vigdorchik

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