Douglas E. Padgett
DALLAS — Gaining an understanding of the spine complex in a patient prior to total hip replacement is critical to a successful outcome and the patient’s postoperative function, according to a presenter at the American Association of Hip and Knee Surgeons Annual Meeting.
“This is not as easy as we think,” Douglas E. Padgett, MD, said during a symposium about the hip-spine relationship.
However, probably the most important step “is admit that the patient with spinopelvic disease presents a real barrier to successful total hip replacement,” he said.
Padgett recommended a thorough work-up of the patient prior to THR and to determine the extent of the patient’s sacral slope and lumbar lordosis and to recognize the impact of those factors on functional position. This, he said, will reveal information that is critical to the surgical THR plan, particularly in patients with an altered hip-spine relationship.
In terms of intraoperative adjustments that are called for, 2-D or 3-D imaging done intraoperatively is invaluable in these cases, according to Padgett, He typically uses a system from EOS Imaging to capture whole body images and to calculate patient position.
“It shows pelvic tilt changes in sitting, for example,” he said.
“Step three, and perhaps the most important, is how you execute your plan,” he said. “Do you need a robot or navigation? I think it is your call.”
Furthermore, THR components must be optimized in terms of design, size and fixation, Padgett said.
“So, in summary, in the hip-spine relationship, recognition, I think, is the key upon the impact of functional position. Preoperative assessment is certainly crucial, and it is all about execution,” he said. – by Susan M. Rapp
Padgett DE. What do I need to do differently intraoperatively? Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 1-4, 2018; Dallas.
Disclosure: Padgett reports he did initial validation work with colleagues on robotic technology related to Mako and the first clinical series with that system.