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Comment
. 2016 Aug;474(8):1798-801.
doi: 10.1007/s11999-016-4877-1. Epub 2016 May 10.

CORR Insights(®): Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Lawrence D Dorr  1
Affiliations
Comment

CORR Insights(®): Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Lawrence D Dorr. Clin Orthop Relat Res. 2016 Aug.
No abstract available

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Figures

Fig. 1A–B
Fig. 1A–B
An illustration of the standing position of the spine-pelvis-hip construct with the important angle measurements is shown. (A) The pelvic incidence (the measurement of the width of the pelvis) is 55°, and is the same standing or sitting. With standing, the pelvis is tilted anteriorly. The sacral tilt (also called sacral slope) is a dynamic measure of the spinopelvic motion (normally 40° standing). The pelvic femoral angle is the relationship of the spinopelvic motion and hip motion (normally 180° +/− 10° extension when standing; in the standing image here, it is at 190°). (B) An illustration of the sitting position of the spine-pelvis-hip construct. The pelvis tilts posteriorly with sitting (notice the flattened pelvic brim). The normal sacral tilt is 20° sitting (a ∆ sacral tilt of 20° between standing and sitting). The pelvic femoral angle sitting shows flexion to 125° +/−10°.
Fig. 2A–B
Fig. 2A–B
A radiograph of the standing lateral spinopelvic-hip displays the skeletal and implant measurements of a patient with stiff spinal imbalance from spinal stenosis with loss of disc spaces. (A) The pelvic incidence is at a low normal of 50°. The sacral tilt is 10°, which is below the normal range and indicates excessive posterior tilt of the pelvis (notice the flattened pelvic brim). The pelvic femoral angle is 209°, creating risk for anterior dislocation due to excessive extension. With excessive posterior tilt, hyperextension is necessary for the patient to stand straight, but it risks posterior impingement. Ante-inclination (the combined inclination and anteversion of the cup) is 49° standing in this patient, which is above normal (35° +/− 9°). The sacral acetabular angle (a measure of the relationship of the acetabular opening to spine motion) is 59°. Although static for both standing and sitting, 59° is below the normal range (74° +/− 9°). The below normal sacral acetabular angle is likely due to the excessive posterior tilt of the pelvis, which can indicate an increased risk for bony impingement. (B) A radiograph of the sitting lateral spinopelvic-hip construct in a patient with stiff spinal imbalance. The pelvic incidence is 53° and is different from the standing because of rotation of the radiograph. Sacral tilt is 8° (representing a ∆ sacral tilt of 2° from the standing image in A), indicating a fused spine (biological fusion in this patient). The pelvic femoral angle sitting is 136° because the pelvis is tilted so far posteriorly. A 51° ante-inclination is in the normal range (53° +/− 9°). However, the ∆ ante-inclination between standing and sitting is only 2°, indicating a stiff acetabulum. Because of the stiffness, almost all of the mobility of the spinopelvic-hip construct is at the hip and this increases risk for impingement. The sacral acetabular angle is 59° and is the same standing and sitting.
See this image and copyright information in PMC

Comment on

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