Doug Douglas A. De Dennis, M.D. Adjunc unct P t Profes essor - - PowerPoint PPT Presentation

WATCH T CH THE B BACK: H CK: HIP F FUNCT CTIONS NS BETTER

• ER. D

. DON’T N’T I IGNO NORE P E PELVIC IC T TILT & & SPINE NE --

• - MY SECR

SECRETS

Doug Douglas A. De Dennis, M.D.

Adjunc unct P t Profes essor

• r, D

Dept.

• t. o
• f Biomed

edica cal E Enginee neering ng Univer ersity ty o

• f Tennes

nnessee ee Adjunc unct P t Profes essor

• r o
• f Bioeng
• engineer

neering ng Univer ersity ty o

• f Denver

er Assista tant C nt Clini nical cal P Profes essor

• r, D

Dept.

• t. o
• f Orthop

hoped edic S c Surger ery Univer ersity ty o

• f Color
• rad

ado S School

• ol o
• f Medici

cine ne

DISC ISCLOSU SURE

Cons

• nsul

ultant : : Depuy puy Roya yaltie ies: De Depuy y / Innom

• med

Labora

• ratory

tory R Researc rch S h Support upport

• Depuy

puy

• Port

Porter Adv dventist Hos Hospi pital Owners rship p In Interst st: Joi Joint nt Vue Vue

DESI DESIRED CUP PO CUP POSI SITION

300 THA Dislocation Evaluated Recommended Safe Zone

• 40° + 10° Abduction
• 15° + 10° Anteversion

Dislocation:

• Safe Zone: 1.5%
• Non-Safe Zone: 6%

Lewi winnek, k, e et t al JBJS 1 S 197 978

WHAT AT IS S THE E IDEAL CUP P POSI SITI TION ON ??

Many R

y Reports s Quest stion T The e Pred edici citive ve Valu lue Of Of The Le Lewinn nnek “Sa “Safe Z Zone

• ne”
• Su

Sugan ano et. t.al, CO CORR 2 201 012, Pi Pierchon F, e et. t.al., JBJS B Br, 199 994, P Pad adgett, et t al, J J Arth thro 201 015

Ma

Many D Dis islo locatio tions Oc Occur Wit Within in S Safe Zo Zone

• Abde

del, et al t al CO CORR 2016: 6: Review w Of 9 978 784 T THA

• 58%

8% O Of Di Disloca cations W With thin The “ “Saf afe Z Zone” e”

DESI DESIRED CUP PO CUP POSI SITION

SHO SHOULD ULD THE SA THE SAME A E ACETA ETABUL ULAR COMPO PONENT PO NENT POSI SITI TION B BE E THE THE SA SAME E FO FOR EA EACH H PA PATI TIEN ENT ?? T ?? IS S THER THERE E SO SOMETHI ETHING ELSE ELSE GOI GOING ON G ON ?? ??

PELV LVIC P IC POSIT ITION

Preop

• p & 3 Mont
• nth Pos

h Postop Late teral P l Pelv lvic Xrays ays

• Standin

ing Vs. S . Sit ittin ing

84 THA

THA

Meas

asured ed Pelvi vic c Fl Flexi xion

• n-Exten

ensi sion U Using Ante terio ior P Pelv lvic P Pla lane

Di DiGioia, e et t al CO CORR 2 R 2006 06

PELV LVIC P IC POSIT ITION

Stan

anding: P Pelvis s Upright

• 1.2° Fle

lexio ion ( (-22°→ +27°)

Sitting:

Pel elvi vis E s Exten ends

• -36° Ext

xten ensi sion ( (-64°→+4 +4°)

Me

Mean F Fle lexio ion-Extens nsion n Arc ( c (Stan anding → Sit ittin ing)

• 37.

7.4°

WIDEL

ELY V Y VARI RIABL ABLE E !!

Di DiGioia, e et t al CO CORR 2 R 2006 06

FUNCTI CTIONA ONAL CUP POSI SITI TION

 AP

AP & Lat Lateral P Pel elvis Xrays ys: S Standi ding V g Vs. Sitti ting ng

 Chang

anges es I In Mean an Functi nctional

• nal C

Cup Posit itio ion

• Stan

tanding 17. 17.2°

• Sitt

tting: 35. 35.4° Laz Lazennac, et et al al

CORR 2011 2011 Sem em Ar Arth throplasty ty, 201 2012

Lazanne nnec CORR RR 2011 11

 Standing: ↑ Sacral Slope (Pelvis Flexion) → ↓ Functional Anteversion  Sitting: ↓ Sacral Slope (Pelvis Extends) → ↑ Functional Anteversion

PELVI PELVIC FLEXI FLEXION (STA (STANDING NG): ↓ FUNC FUNCTI TIONAL A ANTEV NTEVERSI SION

PELVI PELVIC EXTENSI EXTENSION (SI N (SITT TTING): ↑ FUNC FUNCTI TIONAL A ANTEV NTEVERSI SION

54° inclination 38° anteversion 41° inclination 10° anteversion

SITTING STANDING

SAGITTAL PELVIC ROTATIONS

Sta Standing g → Si Sitti tting: g: ↑ Cup Inclina nation &

• n & Antev

eversion

DESI DESIRED CUP PO CUP POSI SITION

Ex

Exact Ta Targ rget El Elus usive

• Pe

Pelvic Pos Position

• n C

Cha hang nges

–Sit

ittin ing  Stand nding ng

–Varie ries Gre reatly ly F Fro rom Pa Pati tient T To Pa Pati tient

–Lumbar

ar D Disea ease se  Cha hange i in n Lor Lordosis

• EXACT

CT POSITION M MAY V VARY B BASED O ON INDIVIDUAL FUNCTIONAL LUMBO- PELV PELVIC FLEXI FLEXIBILITY ! !!

• 18°
• 29°

0° 18° 1° 23°

Extended Neutral Forward Tilt

1. Data on file – Corin Group UK

Sa Same Cup P up Pos

• siti

tion

• n For A
• r All T

Three ?? ??

PA PATI TIEN ENT-SPEC SPECIFIC SA SAFE ZO FE ZONES ? NES ?

350 T

0 THA / / Preoperative ve F Funct ctional al I Imag aging

• Sa

Sagitta ttal Pel elvic R c Radiogr graph aphs / / CT CT Sc Scan an

• Optimize

zed P Posi sitioning S Syst ystem m (OPS)

• De

Dete termine Indi dividu dual alized d Cu Cup Po Positi tion

• Comparis

ison W Wit ith Lewinni nnik Sa Safe Z e Zone

Vigdorchik, AA AAHKS 2017 2017

PA PATI TIEN ENT-SPEC SPECIFIC SA SAFE ZO FE ZONES ? NES ?

On

Only ly 5 56% Of Of I Indiv ividualiz lized C Cup P Positio ition Pla laced Wit Within in The Lewin innik ik Sa Safe Z Zone

• ne

Vigdorchik, Den Dennis, et et al al, A , AAHKS 20 2017

PA PATI TIEN ENT-SPEC SPECIFIC SA SAFE ZO FE ZONES ? NES ?

151

517 T THA

Pr

Preop F p Functional I Imagi ging

• Sa

Sagitta ttal P Pel elvic c Radiogr graph phs

– Sta

Standing / g / Si Sitti tting g

– Flexed S

d Sea eate ted

• CT

CT S Sca can

Pe

Pelvic Tilt (L t (Lumbo bo-Pelv lvic M Mobil ilit ity)

Anal

alyzed E d Effec ect O t Of Pe Pelvic Tilt t On 3-D D Aceta tabu bular Co Compo ponen ent Po Positi tion

Pie ierrepont, t, Shi Shimmi mmin et et al al, , Bone Jt Jt J 2 2017 017

PA PATI TIEN ENT-SPEC SPECIFIC SA SAFE ZO FE ZONES ? NES ?

In 259 P

Patie ients ( (17%), P Pelv lvic M Motio ion Patte Pattern Coul Could → Cup M Malori

• rientat

entation ion

• Add

Add 5 5° Sur Surgical I Ins nsertion Er n Error

– 51%

1% R Ris isk Of Of Cup Ma Malo lorienta tati tion

Pi Pierrepo pont, , Shim immin et a t al, B Bone Jt Jt J 2 2017 17

1,000 C

00 Consecu ecutiv tive T e THA

Pre

reop S p Standin ding & & Sit itting g Thorac racolum

• lumbar

r → Ankle le I Ima magi ging g (EO (EOS) Per Perfor

• rmed

Spinop

nopelv elvic A ic Alignm nment ent / Mobility lity & & Hip M Motion A

• n Asses

essed ed

Com

Compared T Two Coho

• Cohorts
• Dislocat

cators Vs.

• Vs. N

Non-Dis isloc

• cator
• rs

CLINICA CAL RELEVANCE NCE

Jera rabek, Maym yman an, et et al al, A , AAHKS 20 2017

Spi

Spine D ne Disease Subj Subjects Ha Had d ↓ Spin inopelv lvic ic Mo Mobilit ility & ↑ Hi Hip p Fle lexio ion

Dislocators

tors Demons nstra trate ted S Similar r ↓ In In Spin inopelv lvic ic Mo Mobilit ility Wit With ↑ Magni gnitudes O Of f Hi Hip Fl p Flexion

• n

CLINICA CAL RELEVANCE NCE

Jera rabek, Maym yman an, et et al al, A , AAHKS 20 2017

16,4

,453 53 T THAs I s In M Mayo yo Regist stry

• 58 Pa

Patients Had Pr Preop

• p Lumb

Lumbar Fus Fusion

• n

Fusio

ion Gr Group Ma Matc tched 2 2:1 :1 Wit With T THA Sub Subjects W Withou hout Lumb Lumbar Fus Fusion

• n

Dislocat

cation @ @ 1 Year ear

• Fus

Fusion

• n: 6

6% / / Non

• n-Fu

Fusion:

• n: 1

1.6%

8

8 X In Increased R Risk sk Of Di Disl slocation If If Fus Fusion T

• n To
• Sa

Sacrum um !!

CLINICA CAL RELEVANCE NCE

Pe Perry, Abd Abdel, e et a al, AAHK AAHKS 2017

 79

79 Yr Yr Fem Female

 Primary T

THA 11 Y A 11 Yea ears

 7 Year

ars P Postop top → L1 L1-S1 1 Fus Fusion

 8 Year

ars P Postop top: C Chroni

• nic

c Anter terior

• r D

Disloc

• cati

ations

• ns

 Treated

eated W With th Constr trai ained ned L Liner ner

LUMBO BO-PEL PELVIC C MOBILITY TY

CONTI TINUED UED T TO DISLOCATE ATE ANTERI TERIORL RLY

CUP P REV REVISION

• Sol

Solved O Onl nly W With Cup th Cup Revis isio ion W n Which h Reduc uced ed A Acetab tabul ular ar Component nent Antev evers ersio ion

FU FUTURE

Pr

Preop Pel elvi vic Mobility A y Anal alysi ysis

Indi

dividu dual alization O Of Ideal Cu Cup Po Positi tion

Improved T

d Technology gy T To A Acc ccurately Hit t Targe get

85 85 YR R RA: RA:SEVERE LUMBA BAR R SPONDYLOSIS

SUMMARY ARY

Cup Positio

ition C Crit itical

• Dis

islo locatio ion / / We Wear / / Ion T Toxic icity ity

Exact

act T Target et E Elusive ve

• Dif

ifferences I In F Functio tional P l Pelv lvic P Positio ition

Le

Lewinn nnek Sa Safe Z Zone

• ne: Ou

Outd tdate ted

Preo

eop A Asses sessm smen ent O Of L Lumbo-Pelvi vic c Mo Mobility ility I Is V Valu luable T To Dete termin ine Patient t Spec ecific “ c “Saf afe Z Zones” s” For A Acet etabular ar Componen ent P Place acemen ent

THA THANK NK YOU OU