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. 2009 Dec;33(6):1695-700.
doi: 10.1007/s00264-008-0702-0. Epub 2009 Jan 16.

Influence of the sagittal balance of the spine on the anterior pelvic plane and on the acetabular orientation

Jean Legaye  1
Affiliations

Influence of the sagittal balance of the spine on the anterior pelvic plane and on the acetabular orientation

Jean Legaye. Int Orthop. 2009 Dec.

Abstract
in English, French

The Anterior Pelvic Plane (APP), defined by the anterior superior iliac spines and the pubic tubercle, was commonly used as reference for positioning and postoperative evaluation of the orientation of the acetabular cup in total hip arthroplasty. APP was assumed to be vertical, but was not observed always so, mostly because of associated spinal diseases inducing perturbations in the harmony of the sagittal balance of the pelvi-spinal unit. Consequently a sagittal rotation of the pelvis occurs, and so a tilt of the APP which alters directly the orientation of the cup in upright position. An analysis of the APP tilt related to the sagittal balance of the spine was provided and its implication on the cup orientation. It appeared essential for an individual adjustment of the cup positioning to avoid a functional mal-position which can lead to an increased risk of dislocation and impingement.

Le plan antérieur pelvien (APP) définit par les crêtes iliaques et le pubis est communément appelé plan de référence pour le positionnement et l'orientation de la cupule acétabulaire dans les prothèses totales de hanche. Ce plan peut être modifié par la position verticale et du fait de pathologies associées au niveau de la colonne vertébrale entraînant une perturbation des courbures et de la balance pelvienne. En conséquence, une rotation sagittale du pelvis peut survenir avec conséquences sur le plan pelvien antérieur APP. Ceci peut avoir des conséquences directes sur l'orientation de la cupule en position debout. Une analyse de ce plan pelvien antérieur APP et des modifications entraînées par la balance pelvienne sont indispensables. Il apparaît essentiel d'ajuster le positionnement de la cupule de façon à éviter une mal position qui peut être responsable d'un risque accru de luxations ou de conflits.

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Figures

Fig. 1
Fig. 1
The angular sagittal pelvic parameters: the sagittal anterior pelvic plane angle (SAPPA), the pelvic incidence (PI), the sacral slope (SS), the lordosis angle (LA), the lever arm of the gravity in the third lumbar vertebra (LAG), the femoral axis (FA)
Fig. 2
Fig. 2
Relationship of the forward and backward variability of the angle of the sagittal anterior pelvic plane angle (SAPPA) (black columns for the normal subjects, white columns for the low back pain cases)
Fig. 3
Fig. 3
Relationship between the sagittal anterior pelvic plane angle (SAPPA) and the difference between the observed and theoretical values of sacral slope (DSS) (black points were for the normal subjects, white points were for the low back pain cases)
Fig. 4
Fig. 4
Relation between the pelvic sagittal tilting and the angle of inclination and anteversion of the acetabular cup for an aimed 45° inclination
See this image and copyright information in PMC

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