Preoperative Posterior Tilt Research Articles

Clinical study on the incidence of femoral head posterior tilt angle in non-displaced femoral neck fractures

To investigate the occurrence of posterior femoral head tilt after clinical non-displaced femoral neck fracture, and to provide a reference basis for clinical surgery and improvement of disease prognosis. Total of 165 patients with non-displaced femoral neck fractures of Garden typeⅠandⅡfrom January 2018 to June 2022 were selected as study subjects including 48 males and 117 females, with an average age of (71.5±8.5) years old ranging from 53 to 89, involving 97 cases of typeⅠand 68 of typeⅡ. On the patient's preoperative sagittal or axial CT film of the hip, the angle formed by the radius line of the femoral head and the midline of the femoral neck was used as the posterior tilt angle of the femoral head (α), and the posterior tilt femoral head angle was measured using the method proposed by Palm. The measured data were divided into 6 groups:α<0°, 0°<α< 5°, 5°≤α<10°, 10°≤α<15°, 15°≤α<20°, α≥20°, and the incidence of different ranges of posterior tilt angle was compared. The sex composition ratio of 165 patients were analyzed and compared, and the age of 65 was used as the cut-off point to compare the incidence of fractures between genders. Patients were divided into the posterior tilt <20° group for 135 cases and the posterior tilt ≥20°group for 30 cases according to the preoperative posterior tilt angle, the differences between two groups in terms of gender and age were analyzed. Among 165 patients with non-displaced femoral neck fractures, 143 cases with poaterior tilt of the femoral head occurred with an incidence of 86.7%. Posterior tilt 0°<α<5° accounted for 36 cases with an incidence of 21.8%;5°≤α<10° accounted for 40 cases with an incidence of 24.2%;10°≤α<15° accounted for 27 cases with an incidence of 16.4%;15°≤α<20° accounted for 10 cases with an incidence of 6.1%;posterior tilt angle α≥20° accounted for 30 cases, the incidence was 18.2%, of which the maximum posterior tilt angle was 42.7°. Statistical analysis showed that the percentage of fractures in the 165 patients selected for this study was significantly higher in female than in male, and that the female group was more likely to have fractures before the age of 65 years compared to the male group. However, gender, age and fracture subtypes (GardenⅠ, Ⅱ) were not influential factors for femoral neck fractures with a preoperative posterior femoral head tilt angle >20°(P>0.05). The incidence of femoral head posterior tile in non-displaced femoral neck fractures is relatively high, in which severe posterior tile occurs, and the femoral head posterior tile angle≥20° can reach 18.2%. In patients with closed reduction internal fixation, the fracture end needs to be repositioned as much as possible to reduce the risk of postoperative avascular necrosis of the femoral head. In order to prevent femoral neck fractures, special attention should be paid to anti-osteoporosis treatment for female. Preoperative assessment of posterior tilt is critical for patients of different ages, genders and fracture subtypes (GardenⅠ, Ⅱ).

The association between three-dimensional measurement of posterior tilt angle in impacted femoral neck fractures and osteonecrosis of the femoral head

BackgroundHollow screw internal fixation is commonly used in clinical treatment of impacted femoral neck fractures. Previous studies have demonstrated a correlation between the preoperative posterior tilt angle of the femoral head and failure of internal fixation, but there are fewer studies related to the occurrence of postoperative femoral head necrosis and the posterior tilt angle.MethodsTo examine the relationship between three-dimensional posterior tilt angle measurements in affected femoral neck fractures and postoperative osteonecrosis of the femoral head and related risk variables. We retrospectively examined 130 Yantaishan Hospital patients with affected femoral neck fractures from 2019 to 2022. Three-dimensional reconstruction technology assessed the posterior tilt angle of the femoral head and separated patients into necrosis and non-necrosis groups based on postoperative femoral head necrosis. Univariate analysis compared clinical data between groups, and multivariate logistic regression analyzed risk variables for femoral head necrosis. Postoperative femoral head necrosis was predicted by posterior tilt angle using Receiver operating characteristic (ROC) curve analysis.ResultsOut of 130 patients who were followed up for 16–68 months postoperatively, 20 developed femoral head necrosis. Multivariate logistic regression analysis indicated that the posterior tilt angle and reduction quality level C were risk factors for the occurrence of femoral head necrosis. The ROC curve analysis showed that the three-dimensional measurement of the posterior tilt angle had predictive value for postoperative femoral head necrosis, with a cut-off value of 20.6°.ConclusionsThese results suggest that, for patients with impacted femoral neck fractures, the posterior tilt angle and reduction quality level C are risk factors for femoral head necrosis following closed reduction and internal fixation surgery. Fracture patients with a posterior tilt angle ≥ 20.6°are more likely to experience postoperative femoral head necrosis.

TWO-HOLE DYNAMIC HIP SCREW (DHS) FIXATION OF GARDEN I AND II NECK OF FEMUR FRACTURES: RADIOLOGICAL OUTCOMES AND PREDICTIVE FACTORS OF AVASCULAR NECROSIS

The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole DHS in Garden I and II neck of femur fractures in patients more than 60 years with a minimum follow up of one year.We retrospectively reviewed 51 consecutive patients aged more than 60 years who underwent DHS fixation for Garden I and II fractures. Demographics, fracture classification, time to surgery, pre-operative AMTS, preoperative posterior tilt angle, quality of reduction, pre and post-operative haemoglobin(hb), creatinine and comorbidities were analysed for correlation with AVN using Chi-Square test, Independent Sample and paired t test.There were 40 (78.4%) females and the mean age of the cohort was 77 years. 28 and 23 were Garden I and II NOF fractures respectively. Union was observed in all our patients except one(kappa =1). 12/51(23.5%) developed AVN of the femoral head. Statistically significant higher incidence of AVN was noted in patients with a pre-op tilt angle &gt; 200 (p = 0.006). The mean drop in Hb was higher in patients who developed AVN (21.5 g/L) versus the non-AVN group (15.9 g/L) (p = 0.001). There was no difference in AVN rates with respect to laterality, mean time to surgery, pre-op AMTS and Charlson comorbidity index. 4/52 (7.6%) had re-operations (one hardware prominence, two conversions to arthroplasty, one fixation failure during the immediate post-op period). The 30-day and one year mortality rates were 1.9 % and 11.7 % respectively.2-hole DHS fixation in undisplaced NOF fractures has excellent union rates. A pre-operative posterior tilt angle of &gt;200 and a greater difference in pre and post operative haemoglobin were found to correlate positively with the progression to AVN . No correlation was observed between AVN and time to surgery, laterality, quality of reduction and comorbidities.

Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years.

Background:The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation.Methods:A retrospective multicenter study was performed on a consecutive series of patients ≥60 years of age who had undergone primary internal fixation for the treatment of Garden Type-I and II femoral neck fractures. The study included 1,505 patients with a minimum follow-up of 2 years. Radiographic assessments encompassed preoperative and postoperative tilt, implant inclination, and treatment failure. Data on reoperation and mortality were collected. The risk of treatment failure was assessed with use of Cox proportional hazard regression analysis.Results:The study comprised 1,505 patients (71% female) with a median age of 81 years (range, 60 to 108 years). Overall, 234 patients (16%) were classified as having a treatment failure and 251 patients (17%) underwent reoperation. A preoperative anterior tilt of >10° and a posterior tilt of >20° were predictors of treatment failure and reoperation, respectively. Treatment failure occurred in 74 (25%) of 301 patients with a posterior tilt of >20° and in 17 (43%) of 40 patients with an anterior tilt of >10°.Conclusions:This multicenter cohort study identified a subgroup of patients with Garden Type-I and II femoral neck fractures with an anterior tilt of >10° as having high treatment failure rates and major reoperation rates comparable with those associated with displaced femoral neck fractures. A preoperative posterior tilt of >20° increases the risk of treatment failure, and the potential benefit of arthroplasty in this subgroup of patients remains to be further investigated.Level of Evidence:Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.

Nomogram for predicting reoperation following internal fixation of nondisplaced femoral neck fractures in elderly patients

ObjectiveWe aimed to evaluate risk factors and develop a nomogram for reoperation after internal fixation of nondisplaced femoral neck fractures (FNFs) in elderly patients.MethodsWe conducted a retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced FNFs between January 2016 and January 2019. We collected data on demographics, preoperative radiological parameters, surgery, serum biochemical markers, and postoperative rehabilitation. In addition, we performed univariate and multivariate logistic regression analyses to determine independent risk factors for reoperation, and then developed a nomogram to assess the risks of reoperation. Besides, discriminative ability, calibration, and clinical usefulness of the nomogram were evaluated using the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA), respectively. We employed bootstrap method to validate the performance of the developed nomogram.ResultsOur analysis showed that among the 255 patients, 28 (11.0%) underwent reoperation due to osteonecrosis of the femoral head (14 cases), mechanical failure (8 cases) or nonunion (6 cases). All of the 28 patients underwent conversion surgery to arthroplasty. The multivariate logistic regression analysis demonstrated that preoperative posterior tilt angle ≥ 20°, Pauwel’s III type, younger patients, preoperative elevated levels of alkaline phosphatase (ALP), preoperative hypoalbuminemia, and early postoperative weight-bearing were independent risk factors for reoperation. In addition, the C-index and the bootstrap value of the developed nomogram was 0.850 (95% CI = 0.803–0.913) and 0.811, respectively. Besides, the calibration curve showed good consistency between the actual diagnosed reoperation and the predicted probability, while the DCA indicated that the nomogram was clinically valuable.ConclusionsOur analysis showed we successfully developed and validated a nomogram for personalized prediction of reoperation after internal fixation of nondisplaced FNFs in elderly patients. This model would help in individualized evaluation of the need for reoperation and inform strategies aimed at eliminating the need for the reoperation.

Addressing posterior tilt displacement during surgery to lower failure risk of sub-capital Garden types 1 and 2 femoral fractures.

Sub-capital femoral fractures (SCFF) are impacted or non-displaced in Garden types 1 and 2, respectively. Non-surgical treatment is protected weight-bearing combined with physiotherapy and radiographic follow-up in selected patients. Traditionally, in situ pinning is the surgical treatment of choice. The aim of this study was to estimate whether the valgus deformity in Garden types 1 and 2 (AO classification 31B1.1 and 31B1.2) SCFF is a virtual perception of a posterior tilt deformity and if addressing this deformity improves patients' outcomes. The records of 96 patients with Garden Types 1 and 2 SCFF treated in tertiary medical center between 1/2014 and 9/2017 were retrospectively reviewed. They all had preoperative hip joint anteroposterior and lateral radiographic views. 75 patients had additional computed tomography (CT) scans. Femoral head displacement was measured on an anteroposterior and axial radiograph projections and were performed before and after surgery. Preoperative 3D reconstructions were performed for a better fracture characterization, and assessment of the imaging was performed by the first author. The average age of the study cohort was 73years (range 28-96, 68% females). There were 58 right-sided and 38 left-sided fractures. Ninety patients had Type 1 and six patients had Type 2 fractures. The average preoperative posterior tilt was 15 degrees and the average valgus displacement was 10 degrees on plain radiographs compared to 28 degrees and 11 degrees, respectively, on CT scans. Posterior tilt was found with a virtual perception as valgus-impacted fractures. The postoperative posterior tilt was corrected to an average of 3 degrees and the valgus displacement to 5 degrees. CT provides an accurate modality for measuring femoral head displacement and fracture extent. The posterior tilt displacement should be addressed during surgery to lower failure risk and the need for additional procedures. TLV-0292-15. IV.

Preoperative Posterior Tilt Increases the Risk of Later Conversion to Arthroplasty After Osteosynthesis for Femoral Neck Fracture

BackgroundFemoral neck fractures (FNFs) are one of the most common injuries in the elderly. Treatment is either internal fixation or primary arthroplasty. The main aim of this study is to assess the risk factors associated with fixation failure leading to further arthroplasty in FNFs treated with cannulated screws. MethodsData on internal fixations of FNFs performed at Turku University Hospital between January 1, 2012 and December 31, 2017 were collected retrospectively from the patient database. Radiographical measurements were performed for preoperative displacement and posterior tilt, postoperative displacement, reduction quality, and implant shaft angle. ResultsAltogether 301 cases were included in the study. The overall reoperation rate was 25% and conversion to arthroplasty was performed in 16% of cases. In the multiple variant analysis, adjusted for age and gender, nondisplaced fractures with a 0°-20° preoperative posterior tilt had a significantly lower risk of later conversion to arthroplasty than did nondisplaced fractures with a ≤0° or ≥20° posterior tilt (odds ratio [OR] 4.0, 95% confidence interval [Cl] 1.8-8.6, P = .0005) and displaced fractures (OR 7.2, 95% CI 3.0-17.4, P < .0001). No statistically significant association was found between preoperatively nondisplaced fractures with a <0° or ≥20° posterior tilt and displaced fractures (OR 0.6, 95% Cl 0.2-1.3, P = .2). ConclusionDisplaced fractures and fractures with a preoperative posterior tilt of <0° or ≥20° have a considerably increased risk of reoperation and conversion to arthroplasty. Primary arthroplasty should be considered as treatment for displaced FNFs and fractures with >20° or <0° posterior tilt, especially in fragile patients, to avoid further operations.

More than 20\xb0 posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

PurposeIn this study, we aimed to determine the correlation between the preoperative posterior tilt of the femoral head and treatment failure in patients with a Garden type I and II femoral neck fracture (FNF) treated with the dynamic locking blade plate (DLBP).MethodsPreoperative posterior tilt was measured in a prospective documented cohort of 193 patients with a Garden type I and II FNF treated with the DLBP. The correlation between preoperative posterior tilt and failure, defined as revision surgery because of avascular necrosis, non-union, or cut-out, was analyzed.ResultsPatients with failed fracture treatment (5.5%) had a higher degree of posterior tilt on the initial radiograph than the patients with uneventful healed fractures: 21.4° and 13.8°, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20° and 12.5% if the preoperative posterior tilt was ≥ 20°. A posterior tilt of ≥ 20° was associated with an odds ratio of 4.24 (95% CI 1.09–16.83; p = 0.04).ConclusionGarden type I and II FNFs with a significant preoperative posterior tilt (≥ 20°) seem to behave like unstable fractures and have a four times higher risk of failure. Preoperative posterior tilt ≥ 20° of the femoral head should be considered as a significant predictor for failure of treatment in Garden type I and II FNFs treated with the DLBP.

Role of preoperative posterior tilt on the outcomes of internal fixation of non-displaced femoral neck fractures: A systematic review and meta-analysis.

There has been an increased interest in the role of preoperative posterior tilt, as measured on lateral radiographs, on the outcomes of internal fixation of non-displaced femoral neck fractures (FNF). The goal was to assess the available evidence for this in the literature. PRISMA guidelines were followed. PubMed, Embase and Cochrane were searched on June 10th, 2020 for studies assessing the role of posterior tilt on outcomes of internal fixation of non-displaced FNF. Primary outcomes were non-union and fixation failure, avascular necrosis (AVN), treatment failure, and reoperation (excluding symptomatic hardware removal). Outcomes were reported in Odds Ratio (OR) with 95% confidence intervals [CI]. Fourteen studies and 3729 patients were included (mean age 76 years, 72% female, mean follow-up 25 months). Moderate evidence was noted for the following: patients with greater preoperative posterior tilt had an increased risk of non-union and fixation failure (OR 2.4 [1.3 - 4.3]; p=0.006), no increased risk of AVN (p=0.550), an increased risk of treatment failure (OR 6.0 [2.2 - 15.9]; p<0.001) and reoperation (OR 2.5 [1.4 - 4.4]; p=0.002). Furthermore, a greater preoperative tilt of 9.0° [4.1° - 13.9°] for treatment failure and 6.1° [3.7° - 8.5°] (p<0.001) for reoperation were noted in the unsuccessfully treated groups when compared to the successfully treated groups. Four studies found a threshold for posterior tilt ranging from 7° to 20° CONCLUSION: There is moderate evidence that patients with non-displaced FNF and greater tilt have an increased risk of unsuccessful outcomes following internal fixation. Older patients with a preoperative tilt of ≥20° might benefit from arthroplasty surgery, although studies assessing the optimal threshold are needed.

Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture

Background and purpose — Preoperative posterior tilt of the femoral head as seen on lateral radiographs has been reported to affect the risk of fixation failure in cases of minimally displaced femoral neck fractures (Garden I–II). We investigated radiological risk factors of treatment failure.Patients and methods — We included 417 patients (68% women, median age: 78 years (50–108) with a minimally displaced femoral neck fracture (Garden I–II) treated with internal fixation in a retrospective cohort study. The patients were followed for 3.4 years (2–14). Data on age, sex, housing, cognitive impairment, implant angulation, pre- and postoperative tilt, hip complications, and reoperations were recorded. The risk of fixation failure was assessed using Cox proportional hazards regression analysis.Results — The overall reoperation rate was 17%, and the rate of treatment failure (fixation failure, nonunion, avascular necrosis, or posttraumatic osteoarthritis) was 13%. Cox proportional hazard analysis revealed an increased risk of treatment failure with a preoperative posterior tilt of at least 20° and a preoperative anterior tilt greater than 10°. A failure occurred in 13 of the 65 patients with a posterior tilt of at least 20° and in 5 of the 9 patients with an anterior tilt greater than 10°.Interpretation — A preoperative posterior tilt of 20° and an anterior tilt greater than 10° in cases of Garden I and II femoral neck fractures increase the risk of fixation failure necessitating additional surgery. In this group of patients, there is a need for future interventional studies regarding the feasibility of primary hip arthroplasty.

Undisplaced femoral neck fractures need a closed reduction before internal fixation.

Undisplaced femoral neck fractures (UFNF) are generally treated with in situ internal fixation, and few studies have addressed the impact of closed reduction. The aim of this study was to investigate the clinical outcome of UFNF treated with internal fixation using the Hansson pinloc system after closed reduction. This was a retrospective study of 40 patients who underwent internal fixation using the Hansson pinloc system after closed reduction between September 2014 and May 2016. In the present study, posterior tilt, presence of complete fracture, interval from injury to surgery, and changes in activities of daily living were statistically analyzed to investigate the association between nonunion and late segmental collapse (LSC). Five cases each of nonunion and LSC were identified. The frequency of LSC was significantly higher in patients with preoperative posterior tilt ≥ 20° (p < 0.05). The risks of nonunion and LSC were lower in patients with incomplete fracture (p < 0.05) and fixation within 48h (p < 0.05). Of the 40 patients, 34 were categorized in the sufficient reduction group fixed with posterior tilt ≤ 5°. Secondary operation rate was lower in the sufficient reduction group (5/34 cases) than in the insufficient reduction group (3/6 cases). The fixation timing < 48h decrease the risk of fracture healing complications and sufficient reduction may reduce the risk of secondary operation. Preoperative posterior tilt ≥ 20° and complete fractures on CT scans were related to poor prognosis.

Eight orthopedic surgeons achieved moderate to excellent reliability measuring the preoperative posterior tilt angle in 50 Garden-I and Garden-II femoral neck fractures

BackgroundStudies of elderly patients with Garden-I and Garden-II femoral neck fractures (FNFs) suggest that a preoperative posterior tilt of the femoral head of at least 20° increases the risk of fixation failure. A recently published treatment algorithm recommended hemiarthroplasty over internal fixation for elderly patients with Garden-I and Garden-II FNFs and a preoperative posterior tilt of at least 20°. However, the reliability of the method used to measure the posterior tilt has not been assessed according to recommended standards for reliability trials.MethodsFour orthopedic registrars and four consultants measured the posterior tilt angle in 50 preoperative lateral radiographs at two occasions six weeks apart. We estimated inter- and intrarater reliability by intraclass correlation coefficient (ICC). We also assessed repeatability by the repeatability coefficient (RC) and agreement by the minimal detectable change (MDC). Based on the suggested cutoff value of 20°, we reported the overall percentage and specific agreement for the choice of implant.ResultsInter- and intrarater reliability for all raters was excellent with an ICC (95% CI) of 0.77 (0.69–0.85) and 0.77 (0.67–0.86), respectively. The RC was 13.9 and the MDC 14.1. Specific agreement for choosing arthroplasty was 61.3 and 54.6% for the first and second test occasion, respectively.ConclusionsEight orthopedic surgeons measured the posterior tilt in 50 Garden-I and Garden-II FNFs and achieved excellent inter- and intrarater reliability. However, variations in repeated measurements and variations in measurements made by different raters, as assessed by the RC and the MDC respectively, ranged from 13.9° to 14.1°. The variations in posterior tilt measurements should be taken into account when choosing the type of implant for elderly patients with Garden-I and Garden-II femoral neck fractures.

Chronological changes in functional cup position at 10 years after total hip arthroplasty.

This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period. We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery. Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion. Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.

Preoperative posterior tilt of at least 20° increased the risk of fixation failure in Garden-I and -II femoral neck fractures

Background and purpose — It has been suggested that preoperative posterior tilt of the femoral head may increase the risk of fixation failure in Garden-I and -II femoral neck fractures. To investigate this association, we studied a cohort of 322 such patients.Patients and methods — Patients treated with internal fixation between 2005 and 2012 were retrospectively identified using hospital records and the digital image bank. 2 raters measured the preoperative posterior tilt angle and categorized it into 3 groups: < 10°, 10–20°, and ≥ 20°. The inter-rater reliability (IRR) was determined. Patients were observed until September 2013 (with a minimum follow-up of 18 months) or until failure of fixation necessitating salvage arthroplasty. The risk of fixation failure was assessed using competing-risk regression analysis, adjusting for time to surgery.Results — Patients with a posterior tilt of ≥ 20° had a higher risk of fixation failure: 19% (8/43) as compared to 11% (14/127) in the 10–20° category and 6% (9/152) in the < 10° category (p = 0.03). Posterior tilt of ≥ 20° increased the risk of fixation failure, with an adjusted hazard ratio of 3.4 (95% CI: 1.3–8.9; p = 0.01). The interclass correlation coefficient for angular measurements of posterior tilt was 0.90 (95% CI: 0.87–0.92), and the IRR for the categorization of posterior tilt into 3 groups was 0.76 (95% CI: 0.69–0.81).Interpretation — Preoperative posterior tilt of ≥ 20° in Garden-I and -II femoral neck fractures increased the risk of fixation failure necessitating salvage arthroplasty. The reliability of the methods that we used to measure posterior tilt ranged from good to excellent.

Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position

Objectives: Total hip arthroplasty (THA) is often performed in the lateral decubitus (lateral) position. In this position, the pelvis may have various degrees of tilt leading to implant malposition. We sought to quantify the pelvic tilt in lateral position and further pelvic movement during surgery.Methods: In 95 cases with primary THA, three-dimensional pelvic tilts were quantified by superimposing images reconstructed from CT data onto antero-posterior radiographs taken in lateral position at set-up and after cup placement. Pelvises were fixed with a device compressing anterior superior iliac spines and sacrum.Results: Various degrees of pelvic tilt occurred compared to the supine position; sagittal: −3.1° (−25.5° to 10.2°), axial: 3.9° (−8.4° to 17°), coronal: 0.9° (−11.9° to 13.2°). Absolute changes more than 5° were observed 43%, 47%, and 12% in the sagittal, axial, and coronal planes, respectively. The more preoperative posterior pelvic tilt resulted in the more change in the sagittal plane. Further pelvic movement of about 3° in three planes were observed ranging from −11° to 20° after cup placement.Conclusion: This study showed various pelvic tilt and movement during THA. As pelvic tilt directly alters the cup orientation, its changes should be well understood. Improved tools for positioning and holding the pelvis are required.

Internal Fixation of Garden I and II Femoral Neck Fractures

To analyze factors influencing the reoperation rate due to fracture healing complications after internal fixation of Garden I and II femoral neck fractures with special reference to a new validated method assessing the preoperative posterior tilt on lateral radiographs. Prospective cohort study. Level II trauma center. A consecutive cohort of 382 hips in 379 patients who underwent internal fixation for a Garden I or II femoral neck fracture. The posterior tilt in preoperative radiographs was analyzed with a new validated method. A Cox regression analysis was used to evaluate factors associated with reoperation due to fracture healing complications. Age, gender, cognitive function, ASA classification, time to surgery, and the posterior tilt were tested as independent factors in the model. Reoperation rate due to fracture healing complications with a minimal follow-up of 5 years. Reoperation data were validated against the National Board of Health and Welfare's national registry using unique Swedish personal identification numbers. The overall reoperation rate was 19% (72 of 382 hips) and the reoperation rate due to fracture healing complications was 12% (45 of 382 hips). The posterior tilt had no influence on the risk for reoperation due to fracture healing complication, nor had the age, gender, cognitive function, ASA classification, or the time to surgery. Preoperative posterior tilt measurement on lateral radiographs cannot be used as a discriminator for fracture healing complications in Garden I and II femoral neck fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Changes in pelvic tilt following total hip arthroplasty

BackgroundIt is important to understand chronological changes in pelvic tilt after total hip arthroplasty (THA). In this study, we first investigated changes in pelvic tilt after THA. Second, we determined the correlation between preoperative pelvic tilt and the extent of postoperative changes in the pelvic tilt. Third, we evaluated the effects of changes in pelvic tilt on postoperative function and disability. MethodsWe examined 149 patients who received primary THA over a follow-up period of 1 year. We compared postoperative changes with the preoperative pelvic tilt on the basis of the anterior pelvic plane (APP) defined by DiGioia and patient demographics. ResultsA significant correlation was observed between preoperative APP and the amount of postoperative change in APP, suggesting that patients with severe preoperative pelvic tilt generally experience greater postoperative changes in pelvic tilt. Our data showed that patients with preoperative anterior pelvic tilt generally exhibit posterior changes in pelvic tilt after operation, while patients with preoperative posterior pelvic tilts did not experience significant postoperative changes in pelvic tilt. The 1-year postoperative function scores in patients with preoperative anterior pelvic tilt were lower than those in patients with preoperative posterior pelvic tilt. ConclusionsPelvic tilt changed by varying degrees following THA. Special attention must be paid when positioning the acetabular component, particularly in patients with severe pelvic tilt prior to surgery. A greater understanding of the postoperative changes in pelvic tilt may improve the outcome of THA.

A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures

Background and purpose Preoperative posterior tilt in undisplaced (Garden I–II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral radiographs and investigated its association with later reoperation.Patients and methods A consecutive series of 113 patients, ≥ 60 years of age with undisplaced (Garden I–II) femoral neck fractures treated with two parallel implants, was assessed regarding patient characteristics, radiographs, and rate of reoperation within the first year. In a subgroup of 50 randomly selected patients, reliability tests for measurement of posterior tilt were performed.Results Intra-and interclass coefficients for the new measurement were ≥ 0.94. 23% (26/113) of patients were reoperated and increased posterior tilt was an accurate predictor of failure (p = 0.002). 14/25 of posteriorly tilted fractures ≥ 20° were reoperated, as compared to 12/88 of fractures with less tilt (p < 0.001). In multiple logistic regression analysis including sex, age, ASA score, cognitive function, new mobility score, time from admission to operation, surgeon's expertise, postoperative reduction, and implant positioning, a preoperative posterior tilt of ≥ 20° was the only significant predictor of reoperation (p < 0.001).Interpretation The new measurement for posterior tilt appears to be reliable and able to predict reoperation in patients with undisplaced (Garden I–II) femoral neck fractures.