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Pelvic motion acting as a hinge between the spine and hips is essential to maintain proper balance during bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment occurs.
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This pelvic rotation can affect functional acetabular orientation, and consequently functional cup positioning if a total hip arthroplasty (THA) is needed. Pelvic retroversion, frequently associated with degenerative spinal changes, implies an increase of acetabular version.
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Patients with flexible lumbar spines (spine users) protect the hip joint. Patients with stiff, degenerated or fused lumbar spines (hip users) demand higher hip mobility, placing the THA at risk.
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Pelvises in retroversion place the THA at risk for anterior dislocation when standing. In contrast, pelvises in anteversion or with low pelvic incidence (PI) can place THA at risk for posterior dislocation when sitting.
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Try to set the cup in an anatomic position. However, bear in mind that low PI pelvises may need more acetabular ante-inclination, and high PI pelvises more acetabular retroversion.
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If surgery is needed, start first by addressing the hip, except in patients with compensation (high pelvic retroversion), who may need spine surgery first to place the pelvis, and consequently the acetabulum, in a proper position.
Cite this article: EFORT Open Rev 2020;5:522-533. DOI: 10.1302/2058-5241.5.200032
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
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Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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were used in a case control study 82 and in a study on patients at high risk for dislocation, 83 the dislocation rates were lower compared with 36-mm or smaller heads. Head size and bearing wear, taper-trunnion corrosion and groin pain
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use of dual mobility systems has been reported with low dislocation rates, ranging from 0% to 4.6% both in patients at risk for dislocation and in non-selected patients ( Table 1 ). Unlike conventional implants, the cumulative risk for dislocation does
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, malunion or a failed hip arthroplasty and eleven times increased for prosthetic instability. The national Swedish Hip Register 6 has reported an increasing risk for dislocation leading to revision surgery after repeated hip surgery. Dislocation
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Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan
Department of Biomedical Engineering, I-Shou University, Kaohsiung City, Taiwan
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Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
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high risk for dislocation (alcohol abuse and cognitive dysfunction) in Tidermark et al. study ( 51 ). Otherwise, no dislocation was noted in those low risk patients ( 49 , 50 , 51 ). However, heterotopic ossification (brooker I-III) was noted in 4
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than 5° between sitting and standing were identified to be at pathological risk for dislocation even with perfect acetabular component positioning. Stefl et al concluded that this cohort should be considered candidates for DM THA. 42 Cost
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studies have demonstrated a significantly higher risk for dislocation in patients with abnormal spinopelvic characteristics ( 25 , 38 , 39 ). Spinopelvic mobility describes the interaction of the lumbar spine, the pelvis and hip joint, whereas these
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