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 or, D Dept. t. o of Biomed edica cal E Enginee neering ng Univer ersity ty o of Tennes nnessee ee Adjunc unct P t Profes essor or o of Bioeng oengineer neering ng Univer ersity ty o of Denver er Assista tant C nt Clini nical cal P Profes essor or, D Dept. t. o of Orthop hoped edic S c Surger ery Univer ersity ty o of Color orad ado S School ool o of Medici cine ne

DISC ISCLOSU SURE  Cons onsul ultant : : Depuy puy  Roya yaltie ies: De Depuy y / Innom omed  Labora oratory 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 one” • 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 SAME SA 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 op & 3 Mont onth 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 on-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 (-22° → +27°) • 1.2° Fle lexio ion (  Sitting: Pel elvi vis E s Exten ends (-64° → +4 • -36° Ext xten ensi sion ( +4°)  Me Mean F Fle lexio ion-Extens nsion n anding → Sit Arc ( c (Stan 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 onal C Cup Posit itio ion 17.2 ° • Stan tanding 17. 35.4 ° • Sitt tting: 35. 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

SAGITTAL PELVIC ROTATIONS Coronal Plane when standing SITTING STANDING 54° inclination 41° inclination 38° anteversion 10° anteversion Sta Standing g → Si Sitti tting: g: ↑ Cup Inclina nation & on & Antev eversion

DESI DESIRED CUP PO CUP POSI SITION  Ex Exact Ta Targ rget El Elus usive • Pe Pelvic Pos Position on 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 ! !!

Extended Neutral Forward Tilt -29 ° 18° 0 ° 1 ° -18 ° 23 ° Sa Same Cup P up Pos ositi tion on For A or All T Three ?? ?? 1. Data on file – Corin Group UK

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 one 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 orientat 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

CLINICA CAL RELEVANCE NCE  1,000 C 00 Consecu ecutiv tive T e THA  Pre reop S p Standin ding & & Sit itting g Thorac racolum olumbar r → Ankle le I Ima magi ging g (EO (EOS) Per Perfor ormed  Spinop nopelv elvic A ic Alignm nment ent / Mobility lity & & Hip M Motion A on Asses essed ed  Com Compared T Two Coho o Cohorts • Dislocat cators Vs. Vs. N Non-Dis isloc ocator ors Jera rabek, Maym yman an, et et al al, A , AAHKS 20 2017

CLINICA CAL RELEVANCE NCE  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 on Jera rabek, Maym yman an, et et al al, A , AAHKS 20 2017

CLINICA CAL RELEVANCE NCE  16,4 ,453 53 T THAs I s In M Mayo yo Regist stry • 58 Pa Patients Had Pr Preop op Lumb Lumbar Fus Fusion on  Fusio ion Gr Group Ma Matc tched 2 2:1 :1 Wit With T THA Sub Subjects W Withou hout Lumb Lumbar Fus Fusion on  Dislocat cation @ @ 1 Year ear • Fus Fusion on: 6 6% / / Non on-Fu Fusion: on: 1 1.6%  8 8 X In Increased R Risk sk Of Di Disl slocation If If Fus Fusion T on To o Sa Sacrum um !! Pe Perry, Abd Abdel, e et a al, AAHK AAHKS 2017

LUMBO BO-PEL PELVIC C MOBILITY TY  79 79 Yr Yr Fem Female  Primary T THA 11 Y A 11 Yea ears top → L1  7 Year ars P Postop L1-S1 1 Fus Fusion  8 Year ars P Postop top: C Chroni onic c Anter terior or D Disloc ocati ations ons  Treated eated W With th Constr trai ained ned L Liner ner

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 one: 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