Sacral slope change from sanding to relaxed-seated grossly overpredicts the presence of a stiff spine
Background - Several authors propose that a change in sacral slope of ≤10° between the standing and relaxed-seated positions (ΔSSstanding→relaxed-seated) identifies a patient with a stiff lumbar spine and has suggested the use of dual-mobility bearings for such patients undergoing a total hip arthro...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
April 2023
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| In: |
The journal of arthroplasty
Year: 2023, Volume: 38, Issue: 4, Pages: 713-718.e1 |
| ISSN: | 1532-8406 |
| DOI: | 10.1016/j.arth.2022.05.020 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.arth.2022.05.020 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0883540322005721 
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| Author Notes: | Abhinav K. Sharma, MD, George Grammatopoulos, MBBS, BSc, DPhil, Jim W. Pierrepont, PhD, Chameka S. Madurawe, BEng, Moritz M. Innmann, MD, Jonathan M. Vigdorchik, MD, Andrew J. Shimmin, MBBS |
| Summary: | Background - Several authors propose that a change in sacral slope of ≤10° between the standing and relaxed-seated positions (ΔSSstanding→relaxed-seated) identifies a patient with a stiff lumbar spine and has suggested the use of dual-mobility bearings for such patients undergoing a total hip arthroplasty (THA). The aim of this study was to assess how accurately ΔSSstanding→relaxed-seated can identify patients with a stiff spine. - Methods - A prospective, multicentre, consecutive cohort series of 312 patients had standing, relaxed-seated, and flexed-seated lateral radiographs prior to THA. ΔSSstanding→relaxed-seated was determined by the change in sacral slope between the standing and relaxed-seated positions. Lumbar flexion (LF) was defined as the difference in lumbar lordotic angle between standing and flexed-seated. LF ≤20° was considered a stiff spine. The predictive value of ΔSSstanding→relaxed-seated for characterizing a stiff spine was assessed. - Results - A weak correlation between ΔSSstanding→relaxed-seated and LF was identified (r2 = 0.13). Eighty six patients (28%) had ΔSSstanding→relaxed-seated ≤10° and 19 patients (6%) had a stiff spine. Of the 86 patients with ΔSSstanding→relaxed-seated ≤10°, 13 had a stiff spine. The positive predictive value of ΔSSstanding→relaxed-seated ≤10° for identifying a stiff spine was 15%. - Conclusion - In this cohort, ΔSSstanding→relaxed-seated ≤10° was not correlated with a stiff spine. Using this simplified approach could lead to a 7-fold overprediction of patients with a stiff lumbar spine and abnormal spinopelvic mobility, unnecessary use of dual-mobility bearings, and incorrect component alignment targets. Referring to patients with ΔSSstanding→relaxed-seated ≤10° as being stiff is misleading. The flexed-seated position should be used to effectively assess a patient’s spine mobility prior to THA. |
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| Item Description: | Gesehen am 09.06.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1532-8406 |
| DOI: | 10.1016/j.arth.2022.05.020 |