Measurements of pelvic flexion angle using three-dimensional computed tomography.
The purpose of the current study was to evaluate whether safe acetabular component position depends on differences in pelvic location between the supine, standing, and sitting positions. The subjects of the current study were 101 patients who had total hip arthroplasty. Anteroposterior radiographs of the pelvis with the patients in the supine, standing, and sitting positions were obtained preoperatively and 1 year after total hip arthroplasty. Computed tomography images of the pelvis were obtained preoperatively. Using image matching between the three-dimensional computed tomography model and anteroposterior radiograph, pelvic flexion angles with the patient in the supine, standing, and sitting positions were calculated. The mean preoperative pelvic flexion angle was 5 degrees +/- 9 degrees (range, -37 degrees -30 degrees ) in the supine position, 3 degrees +/- 12 degrees (range, -46 degrees -33 degrees ) in the standing position, and -29 degrees +/- 12 degrees (range, -62 degrees -10 degrees ) in the sitting position. Because there was much intersubject variability in pelvic flexion angle, it is not appropriate to determine orientation of the acetabular component from anatomic landmarks. In 90% of the cases, the difference in pelvic flexion angle between the supine and standing positions preoperatively was 10 degrees or less. In 90% of the cases, there was 20 degrees or greater extension of the pelvis from the supine position to the sitting position preoperatively, and the safe range of flexion of the hip from anterior prosthetic impingement in the sitting position was 20 degrees or greater than that in the supine position. Preoperative pelvic position in each case was almost completely maintained 1 year after total hip arthroplasty. It is reasonable to regard the pelvic position in the supine position as the functional pelvic position and proper pelvic reference frame in determining optimal orientation of the acetabular component in 90% of cases before and 1 year after total hip arthroplasty, although an adjustment of orientation of the acetabular component was needed for the remaining cases.
Nishihara
Shunsaku
S
Department of Orthopaedic Surgery, Osaka University Medical School, Japan. shu-nishihara@umin.ac.jp
Sugano
Nobuhiko
N
Nishii
Takashi
T
Ohzono
Kenji
K
Yoshikawa
Hideki
H
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019644:Arthroplasty, Replacement, Hip; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging* / Q000601:surgery; D011187:Posture / Q000502:physiology*; D014057:Tomography, X-Ray Computed