How Does Total Hip Impingement Risk During Activities of Daily Living Change With Pelvic Tilt and Spinopelvic Mobility?

Abstract

Dislocation remains one of the leading causes for revision following total hip arthroplasty (THA). With the advent of robotic technology allowing more personalized implant positioning, there is the potential to improve stability. The purpose of this study was to evaluate personalized THA postoperative risk of impingement by simulating 12 dynamic activities of daily living (ADLs) with different spinopelvic parameters. A full-body skeletal computer model was used to estimate hip kinematics for 12 ADLs from marker-based motion capture data: walking, stair climbing, stair descending, pivoting, twisting, chair rising, bending forward, sitting on a low chair, sitting with a crossed leg, seated reaching to the floor, tying shoes, and a golf swing. Preoperative computed tomography scans were retrospectively used to generate three-dimensional personalized pelvis and femur. Spinal stiffness resulted in impingement in 13 of 30 ADL scenarios (43%). With a flexible spine, the case simulation with the most impinging ADLs (n = 3) had posterior pelvic tilt (PT) = 15°. The number of impinging ADLs changed when changing PT in 26 of 40 scenarios (65%). The case with the most impinging ADLs (n = 5) corresponded to a stiff spine with anterior PT = 15°. Observed trends showed that a more posterior PT led to increased impingement in ADLs with high extension and external rotation, whereas a more anterior PT led to impingement in high flexion ADLs when combined with a stiff spine. Spinal stiffness increased the number of impinging ADLs in 43% of scenarios, and the number of impinging ADLs increased in 65% of scenarios when changing the PT. There were three patients who had impingement in their ADLs regardless of the stiffness of the spine or the pelvic tilt. Future studies are needed to examine the utility of three-dimensional dynamic personalized preoperative planning as a potential solution for postoperative impingement and dislocation risk after THA.