Are Measurements of Sacral Slopes Reliable?

Norio Imai^1, , Dai Miyasaka¹, Yoji Horigome¹, Hayato Suzuki¹, Ryota Takubo¹ and Naoto Endo¹

¹Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan

Cite this paper

Norio Imai, Dai Miyasaka, Yoji Horigome, Hayato Suzuki, Ryota Takubo and Naoto Endo. Are Measurements of Sacral Slopes Reliable?. American Journal of Clinical Medicine Research. 2014; 2(3):57-60. doi: 10.12691/AJCMR-2-3-2

Abstract

Background: Malpositioning during total hip arthroplasty may cause dislocation, pain, and other complications. To evaluate the potential of sacral slope (SS) as a reliable parameter of pelvic flexion. Methods: We developed a model of pelvic flexion to determine the intraobserver and interobserver variability and reliability of SS measurements by lateral radiography by three independent observers. Results: Measurement error was 1.2 and the intraobserver reliability was moderate to substantial (Interclass correlation coefficient: 0.31 to 0.66). Based on the Spearman-Brown formula, the measurement is reliable if it is done at least seven times by two observers, and four times by three observers. Conclusions: The data suggest that measurement of SS of pelvic flexion is a clinically useful parameter for the optimization of THA conditions.

Keywords

anterior pelvic plane, lateral radiograph, total hip arthroplasty, sacral slope, pelvic flexion angle, accuracy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Kummer, F,J., Shah, S., Iyer, S. and DiCesare, P,E,. “The effect of acetabular cup orientations on limiting hip rotation,” J Arthroplasty. 14(4). 509-13. 1999.
[2]	Zhu, J., Wan, Z. and Dorr, L, D,. “Quantification of pelvic tilt in total hip arthroplasty,” Clin Orthop Relat Res. 468(2). 571-5. 2010.
[3]	Malik, A., Maheshwari, A. and Dorr, L, D, “Impingement with total hip replacement,” J Bone Joint Surg Am. 89(8). 1832-42.2007.
[4]	Dorr, L,D., Malik, A., Dastane, M. and Wan, Z., “Combined anteversion technique for total hip arthroplasty,” Clin Orthop Relat Res. 467(1). 119-27. 2009.
[5]	Widmer, K,H. and Zurfluh, B., “Compliant positioning of total hip components for optimal range of motion,” J Orthop Res. 22(4). 815-21. 2004.
[6]	Yoshimine, F,. “The safe-zones for combined cup and neck anteversions that fulfill the essential range of motion and their optimum combination in total hip replacements,” J Biomech. 39(7). 1315-23. 2006.
[7]	DiGioia, A,M,. Jaramaz, B. and Blackwel,l M., “The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment, “Clin Orthop Relat Res”. (355). 8-22. 1998.
[8]	Lewinneck, G,E., Lewis, J,L. Tarr, R., Compere, C,L. and Zimmerman, J,R., “Dislocation after total hip-replacement arthroplasties”. J Bone Joint Surg Am. 60(2). 217-20. 1978.
[9]	DiGioia, A,M,. Hafez, M,A,. Jaramaz, B., Levison, T,J. and Moody, J,E., ”Functional pelvic orientation measured from lateral standing and sitting radiographs”. Clin Orthop Relat Res. 453. 272-6. 2006.
[10]	Kalteis, T,A., Handel, M., Herbst, B., Grifka, J. and Renkawitz, T., ”In vitro investigation of the influence of pelvic tilt on acetabular cup alignment”. J Arthroplasty. 24(1). 152-7. 2009.
[11]	Lembeck, B., Mueller, O., Reize, P. and Wuelker, N., “Pelvic tilt makes acetabular cup navigation inaccurate”. Acta Orthop. 76(4). 517-23. 2005.
[12]	Parratte, S. and Argenson, J,N., “Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study”. J Bone Joint Surg Am. 89(3). 494-9. 2007.
[13]	Blondel, B,. Parratte, S., Tropiano, P,. Pauly, V., Aubaniac, J,M. and Argenson, J,N., “Pelvic tilt measurement before and after total hip arthroplasty”. Orthop Traumatol Surg Res. 95(8). 568-72.2009.
[14]	Eckman, K., Hafez, M,A., Jaramaz, B., Levison, T,J. and Digioia, A,M, 3rd., “Accuracy of pelvic flexion measurements from lateral radiographs”. Clin Orthop Relat Res. 451. 154-60. 2006.
[15]	Legaye, J., “The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum”. Eur Spine J. 16(2). 219-25. 2007.
[16]	Babisch, J,W., Layher, F. and Amiot, L,P., “The rationale for tilt-adjusted acetabular cup navigation”. J Bone Joint Surg Am. 90(2). 357-65. 2008.
[17]	Nishihara, S., Sugano, N., Nishii, T., Ohzono, K. and Yoshikawa, H., “Measurements of pelvic flexion angle using three-dimensional computed tomography”. Clin Orthop Relat Res. 411. 140-51. 2003.
[18]	Kobayashi, K., Sakamoto, M. and Tanabe, Y., “Automated image registration for assessing three-dimensional alignment of entire lower extremity and implant position using bi-plane radiography”. J Biomech. 42(16). 2818-22. 2009.
[19]	Tannast, M., Zheng, G. and Anderegg, C., “Tilt and rotation correction of acetabular version on pelvic radiographs”. Clin Orthop Relat Res. 438. 182-90. 2005.
[20]	Ben-Galim, P., Ben-Galim, T. and Rand, N., “Hip-spine syndrome: the effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip”. Spine. 32(19). 2099-102. 2007.
[21]	Jackson, R,P., Kanemura, T., Kawakami, N. and Hales C., “Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain”. Spine. 25(5), 575-86. 2000.
[22]	Offierski, C,M. and MacNab, I., “Hip-spine syndrome”. Spine. 8(3). 316-21. 1983.
[23]	Yoshimoto, H., Sato, S. and Masuda, T., “Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain”. Spine. 30(14). 1650-7. 2005.
[24]	Imai, N., Ito, T., Suda, K., Miyasaka, D. and Endo, N., “Pelvic flexion measurement from lateral projection radiographs is clinically reliable”. Clin Orthop Relat Res. 471(4). 1271-6. 2013.
[25]	Ariumi, A., Sato, T. and Kobayashi, K., “Three-dimensional lower extremity alignment in the weight-bearing standing position in healthy elderly subjects”. J Orthop Sci. 15(1). 64-70. 2010.
[26]	Sato, T., Koga, Y. and Omori, G., “Three-dimensional lower extremity alignment assessment system: application to evaluation of component position after total knee arthroplasty”. J Arthroplasty. 19(5). 620-8. 2004.
[27]	Allinson, P,D., “A simple proof of the Spearman-Brown formula for continuous test lengths”. Psychometriaka. 40. 135. 1975.