Masanori Okamoto1, Masashi Kawasaki2, Toshiaki Okura2, Taisuke Seki3, Shiro Imagama3. 1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. masaokamotoo@yahoo.co.jp. 2. Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan. 3. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Abstract
BACKGROUND: Intraoperative pelvic tilt changes that occurs during total hip arthroplasty (THA) in the supine position affects cup placement and sometimes causes malalignment. The relationship between body mass index (BMI) and pelvic movement has been reported for some procedures, but not the direct anterior approach (DAA). The purpose of this study was to investigate intraoperative pelvic tilt changes that occurs during DAA. METHODS: In this single-center, retrospective study, we reviewed 200 hips that underwent primary THA via DAA in the supine position using an accelerometer-based navigation system. Intraoperative changes in pelvic tilt and axial rotation from the start of surgery to cup placement were assessed using the navigation system. Preoperative clinical factors that increased pelvic tilt and axial rotation toward the surgical side by > 10° were analyzed via univariate and multiple logistic regression analyses. RESULTS: The mean pelvic tilt value increased by 7.6° ± 3.8° (95% confidence interval [CI], 7.1-8.2; range, - 5.0-19.0) intraoperatively, and the axial rotation increased by 3.2° ± 2.7° (95% CI, 2.7-3.7; range, - 13.0-12.0). Univariate analysis revealed that the group with increased pelvic tilt showed significantly greater range of abduction and internal rotation, and significantly lower BMI than the group with no increased tilt. Pre-incisional pelvic tilt was significantly greater in the group with increased axial rotation than in the group with no increased rotation. On logistic regression analysis, BMI (odds ratio [OR], 0.889; 95% CI, 0.809-0.977; p = 0.014) and the range of internal rotation (OR, 1.310; 95% CI, 1.002-1.061; p = 0.038) were predictors of large increases in pelvic tilt. No predictors of large increases in axial rotation were identified. CONCLUSION: Significant forward pelvic tilt was observed in patients with a low BMI values and high ranges of internal rotation via THA using the DAA. Findings indicated that surgeons should pay attention to intraoperative pelvic movements, which may help identify patients with significant pelvic tilt changes.
BACKGROUND: Intraoperative pelvic tilt changes that occurs during total hip arthroplasty (THA) in the supine position affects cup placement and sometimes causes malalignment. The relationship between body mass index (BMI) and pelvic movement has been reported for some procedures, but not the direct anterior approach (DAA). The purpose of this study was to investigate intraoperative pelvic tilt changes that occurs during DAA. METHODS: In this single-center, retrospective study, we reviewed 200 hips that underwent primary THA via DAA in the supine position using an accelerometer-based navigation system. Intraoperative changes in pelvic tilt and axial rotation from the start of surgery to cup placement were assessed using the navigation system. Preoperative clinical factors that increased pelvic tilt and axial rotation toward the surgical side by > 10° were analyzed via univariate and multiple logistic regression analyses. RESULTS: The mean pelvic tilt value increased by 7.6° ± 3.8° (95% confidence interval [CI], 7.1-8.2; range, - 5.0-19.0) intraoperatively, and the axial rotation increased by 3.2° ± 2.7° (95% CI, 2.7-3.7; range, - 13.0-12.0). Univariate analysis revealed that the group with increased pelvic tilt showed significantly greater range of abduction and internal rotation, and significantly lower BMI than the group with no increased tilt. Pre-incisional pelvic tilt was significantly greater in the group with increased axial rotation than in the group with no increased rotation. On logistic regression analysis, BMI (odds ratio [OR], 0.889; 95% CI, 0.809-0.977; p = 0.014) and the range of internal rotation (OR, 1.310; 95% CI, 1.002-1.061; p = 0.038) were predictors of large increases in pelvic tilt. No predictors of large increases in axial rotation were identified. CONCLUSION: Significant forward pelvic tilt was observed in patients with a low BMI values and high ranges of internal rotation via THA using the DAA. Findings indicated that surgeons should pay attention to intraoperative pelvic movements, which may help identify patients with significant pelvic tilt changes.
Entities:
Keywords:
Accelerometer-based navigation system; Direct anterior approach; Pelvic tilt; Total hip Arthroplasty
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