Hospital del Trabajador, Santiago, Chile
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Hospital del Trabajador, Santiago, Chile
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Hospital Roberto del Río, Santiago, Chile
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balance (SB), where the forces exerted are evenly distributed. Sagittal alteration or imbalance (SI) of these curves conditions the requirement of additional forces to counteract this imbalance in order to maintain an upright posture. This can be
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neoplastic disease with pathological fracture, spondylitis or from iatrogenic causes ( Fig. 4 ). The ideal candidates for PSO are patients with type 2 sagittal deformity and a substantial sagittal imbalance more than 12 cm (SVA > 12 cm) with a sharp
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vigorously act and counteract in response. If this imbalance continues over time, the muscles of the spine and pelvis will eventually require more energy, leading to fatigue, discomfort and pain. 4 Then, spinal surgery may be necessary to restore a more
South West London Elective Orthopaedic Centre, UK
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(‘compensated stage’ with normal C7pl). However, with progressive ageing of the spine, this compensatory mechanism becomes ineffective and the patient starts to become sagittally imbalanced as shown by the excessively anterior C7pl (‘decompensated stage’). 8
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structures. When considering these, it is important to recognise that the knee is stabilised in the frontal (coronal) and sagittal plane by primary and secondary mechanisms. Following ACL rupture, chronic imbalance in these planes is considered a significant
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head size), the acetabular cup orientation (using the TAL 19 , 46 ) and the need for spinal surgery to correct a severe sagittal imbalance ( Table 1 ). The more stiff a lumbopelvic complex is, the more it seems sensible firstly to use a large
Personalized Arthroplasty Society, Atlanta, Georgia, USA
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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Department of Knee Surgery, Casa di Cura Solatrix, Rovereto, TN, Italy
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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deformity, the sagittal extra-articular deformity could be so severe and/or multiplanar that the intra-articular correction (hybrid technique) would create important imbalances, requiring a constrained prosthesis. Then, the ideal option might be restoring
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balanced Low standing SS, sagittally imbalanced Fused spine Explanation Physiologic mobility Stiffness Spine-ageing modifications Spine-ageing modifications Spine surgery Risk assessment Very low–low Moderate–high Moderate
Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
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Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
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/DJK ( Fig. 6 ) risk factors include short fusion, greater pre-operative sagittal imbalance, correction of sagittal deformity, more posterior LIV plumb line, low bone mineral density and a smaller postoperative kyphosis ( 65 , 66 ). Hypercorrection is one of
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others ( 8 , 9 , 10 , 11 , 12 ). Furthermore, a large number or patients with cup orientations outside these boundaries do not exhibit hip instability ( 8 , 9 , 10 ). The interaction between the hip and spine and the assessment of the sagittal plane
