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THA instability in hip-spine syndrome: surgical implications

Published in N°013 - September / October 2021
Article viewed 16 times

THA instability in hip-spine syndrome: surgical implications

By Antonino Giulio BATTAGLIA, Luigi ZAGRA in category
IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan Italy

Total hip arthroplasty (THA) is one of the most commonly performed surgical procedures worldwide. Despite the excellent outcomes associated with primary THA, implant failure and revision continue to burden the healthcare system and the patients. Instability remains a challenging problem in both primary and even more in revision THA.

Introduction

Total hip arthroplasty (THA) is one of the most commonly performed surgical procedures worldwide. Despite the excellent outcomes associated with primary THA, implant failure and revision continue to burden the healthcare system and the patients. Instability remains a challenging problem in both primary and even more in revision THA1. Several risk factors have been described, among them in the last decade spino-pelvic relationships got emerging relevance and the hip-spine evaluation has become part of pre-operative examination.2

It is generally believed that postoperative hip dislocation rate is low, when the acetabular inclination is 45° ± 10° and anteversion angle is placed in the range of 15° ± 10°, according the historical the Lewinneck’s zones. Despite this, hip dislocation may happen after THA even in case of apparently perfectly positioned implants. In recent years, more and more studies have paid attention to the influence of pelvic orientation and hip-spine mobility on the acetabular orientation. The concept of acetabular anteversion changes as the pelvic tilt changes, and is challenging the traditional acetabular prosthesis "safe area"3. Patients with a previous history of lumbar spinal fusion have a significantly higher rate of dislocation.4

Hip-spine...

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