Pelvic tilt after total hip arthroplasty in patients with osteoarthritis of the hip

Background: It is important to understand postoperative global sagittal spinal alignment after total hip arthroplasty (THA) to prevent not only the following hip complications but also progressing lumbar degeneration. The purpose of this study was to progress the analysis of the global sagittal spinal alignment between before and after THA in patients without large lower limbs discrepancy. Subjects and methods: The subjects were 87 patients with bilateral hip osteoarthritis (OA) before unilateral primary THA. We measured sagittal vertical axis (SVA), lumbar lordotic angle, sacral slope, pelvic tilt (PT), and pelvic incidence (PI) and compared the postoperative change of those parameters. Excluded criteria were Crowe classification types II, III, and IV and more than 10 mm of leg length difference, spinal scoliosis (Cobb angle > 25°), and lumbar kyphosis. Results: The correlation coefficient between preoperative factors and postoperative sagittal alignments revealed that postoperative SVA has correlation with age ( r = 0.46, p < 0.008) and preoperative PT ( r = 0.42, p = 0.015). Postoperative PT had a correlation with preoperative PI ( r = 0.46, p = 0.007). The change of PT after operation had negative correlation to preoperative PT ( r = −0.47, p < 0.01) and PI ( r = −0.38, p = 0.03). Multiple regression analysis revealed that the change of PT = 4.979 − 0.235 × preoperative PT ( p < 0.05). Therefore, when preoperative PT was less than 20°, the postoperative PT would become larger than the preoperative one. Conclusion: (1) In patient with hip OA without large lower limbs discrepancy, the postoperative PT after THA correlated with PI. (2) The postoperative change of PT was influenced by preoperative PT.

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Letter to the Editor Regarding “Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates”

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.12.016 ◽

2020 ◽

Vol 35 (4) ◽

pp. 1165

Author(s):

Takaomi Kobayashi ◽

Tadatsugu Morimoto ◽

Masaaki Mawatari

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spinal Alignment ◽

Total Hip ◽

Letter To The Editor ◽

Sagittal Spinal Alignment

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Response to Letter to the Editor on “Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates”

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.12.017 ◽

2020 ◽

Vol 35 (4) ◽

pp. 1165-1166

Author(s):

Aaron J. Buckland ◽

Jonathan M. Vigdorchik

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spinal Alignment ◽

Total Hip ◽

Letter To The Editor ◽

Sagittal Spinal Alignment

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Sagittal spinal alignment after total hip arthroplasty for neglected high hip dysplasia: does changing the distorted mechanics of the hip normalize spinal alignment?

Spine Deformity ◽

10.1007/s43390-020-00204-3 ◽

2020 ◽

Vol 9 (1) ◽

pp. 221-229

Author(s):

Omur Caglar ◽

Samet Isik ◽

Mehmet Kaymakoglu ◽

Halil Gokhan Demirkiran ◽

Bulent Atilla ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Dysplasia ◽

Spinal Alignment ◽

Total Hip ◽

Sagittal Spinal Alignment

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Chronological Changes in Functional Cup Position at 10 Years after Total Hip Arthroplasty

Hip International ◽

10.5301/hipint.5000487 ◽

2017 ◽

Vol 27 (5) ◽

pp. 477-482 ◽

Cited By ~ 10

Author(s):

Yusuke Okanoue ◽

Masahiko Ikeuchi ◽

Shogo Takaya ◽

Masashi Izumi ◽

Koji Aso ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Osteoarthritis ◽

Standing Position ◽

Anterior Dislocation ◽

Total Hip ◽

Postoperative Change ◽

Significant Difference ◽

Cup Position

Purpose 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. Methods 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. Results 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. Conclusions 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.

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Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.06.036 ◽

2019 ◽

Vol 34 (11) ◽

pp. 2663-2668 ◽

Cited By ~ 7

Author(s):

Aaron J. Buckland ◽

Laviel Fernandez ◽

Andrew J. Shimmin ◽

Jonathan V. Bare ◽

Stephen J. McMahon ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spinal Alignment ◽

Total Hip ◽

Sagittal Spinal Alignment

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Effect of Spinal Alignment Changes on Lower Back Pain in Patients Treated with Total Hip Arthroplasty for Hip Osteoarthritis

Medicina ◽

10.3390/medicina57111219 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1219

Author(s):

Fumiko Saiki ◽

Takeyuki Tanaka ◽

Naohiro Tachibana ◽

Hirofumi Oshima ◽

Taizo Kaneko ◽

...

Keyword(s):

Back Pain ◽

Total Hip Arthroplasty ◽

Lower Back Pain ◽

Hip Arthroplasty ◽

Hip Osteoarthritis ◽

X Rays ◽

Spinal Alignment ◽

Total Hip ◽

Lower Back ◽

Patient Reported

Background and objectives: The influence of changes in spinal alignment after total hip arthroplasty (THA) on improvement in lower back pain (LBP) remains controversial. To evaluate how changes in spinal malalignment correlate with improvement in preoperative LBP in patients who underwent THA for hip osteoarthritis. Materials and Methods: From November 2015 to January 2017, 104 consecutive patients who underwent unilateral THA were prospectively registered. Whole spine X-rays and patient-reported outcomes (PROs) were obtained preoperatively and 12 months postoperatively. The PROs used were the Numerical Rating Scale (NRS) for back pain, EuroQol 5 Dimension, and Short Form-12. Results: Seventy-four (71%) patients with complete data were eligible for the analysis. The sagittal parameters changed slightly but significantly. Coronal alignment significantly improved. Twenty-six (37%) patients had LBP preoperatively. These patients had smaller lumbar lordosis (LL), larger PT, and larger PI minus LL than the patients without LBP. Fourteen (54%) of the 26 patients with preoperative LBP showed pain improvement, but there were no significant differences in the radiographic parameters. Conclusions: Although preoperative LBP was likely to be resolved after THA, there were no significant correlations between alignment changes and LBP improvement. The cause of LBP in patients with hip osteoarthritis (OA) patients might be multifactorial.

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Preoperative spinopelvic hypermobility resolves following total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b12.bjj-2020-2451.r2 ◽

2021 ◽

Vol 103-B (12) ◽

pp. 1766-1773

Author(s):

Peter K. Sculco ◽

Eric N. Windsor ◽

Seth A. Jerabek ◽

David J. Mayman ◽

Ameer Elbuluk ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Osteoarthritis ◽

Reoperation Rate ◽

Preoperative Imaging ◽

Sacral Slope ◽

Total Hip ◽

Clinically Significant ◽

One Year ◽

Acetabular Component Position

Aims Spinopelvic mobility plays an important role in functional acetabular component position following total hip arthroplasty (THA). The primary aim of this study was to determine if spinopelvic hypermobility persists or resolves following THA. Our second aim was to identify patient demographic or radiological factors associated with hypermobility and resolution of hypermobility after THA. Methods This study investigated patients with preoperative posterior hypermobility, defined as a change in sacral slope (SS) from standing to sitting (ΔSSstand-sit) ≥ 30°. Radiological spinopelvic parameters, including SS, pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, anterior pelvic plane tilt (APPt), and spinopelvic tilt (SPT), were measured on preoperative imaging, and at six weeks and a minimum of one year postoperatively. The severity of bilateral hip osteoarthritis (OA) was graded using Kellgren-Lawrence criteria. Results A total of 136 patients were identified as having preoperative spinopelvic hypermobility. At one year after THA, 95% (129/136) of patients were no longer categorized as hypermobile on standing and sitting radiographs (ΔSSstand-sit < 30°). Mean ΔSSstand-sit decreased from 36.4° (SD 5.1°) at baseline to 21.4° (SD 6.6°) at one year (p < 0.001). Mean SSseated increased from baseline (11.4° (SD 8.8°)) to one year after THA by 11.5° (SD 7.4°) (p < 0.001), which correlates to an 8.5° (SD 5.5°) mean decrease in seated functional cup anteversion. Contralateral hip OA was the only radiological predictor of hypermobility persisting at one year after surgery. The overall reoperation rate was 1.5%. Conclusion Spinopelvic hypermobility was found to resolve in the majority (95%) of patients one year after THA. The increase in SSseated was clinically significant, suggesting that current target recommendations for the hypermobile patient (decreased anteversion and inclination) should be revisited. Cite this article: Bone Joint J 2021;103-B(12):1766–1773.

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Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty?

The Bone & Joint Journal ◽

10.1302/0301-620x.101b8.bjj-2019-0106.r1 ◽

2019 ◽

Vol 101-B (8) ◽

pp. 902-909 ◽

Cited By ~ 8

Author(s):

M. M. Innmann ◽

C. Merle ◽

T. Gotterbarm ◽

V. Ewerbeck ◽

P. E. Beaulé ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Reported Outcome Measures ◽

Screening Tools ◽

Sacral Slope ◽

Sitting Position ◽

Total Hip ◽

Patient Reported ◽

Hip Flexion

Aims This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. Patients and Methods A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. Results Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. Conclusion The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902–909.

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