Change in Spinal Alignment After Total Hip Arthroplasty

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2013 Nov 21

PMID 24254449

Citations 21

Authors

Kristen E Radcliff

Fabio Orozco

Nicholas Molby

Lawrence Delasotta

Eric Chen

Zachary Post

Alvin Ong

Affiliations

Soon will be listed here.

Abstract

Objective: The study hypotheses were that: (i) there would be a difference in sagittal plane alignment between patients with symptomatic osteoarthritis of the hip and those with lumbar degenerative disk disease; and (ii) that sagittal plane lumbar alignment would change following total hip arthroplasty (THA).

Methods: In this prospective study, a series of patients without back pain or lumbar complaints who were scheduled to undergo THA underwent lateral lumbar radiography prior to and nine months after elective THA. Radiographic measurements of lumbar alignment included sacral slope, lumbar lordosis, and L1 axis S1 distance (L1 ASD). All measurements were performed on upright, standing, lateral radiographs. A control group of patients underwent serial radiography over the same period for evaluation of lumbar degenerative disease. The independent sample t-test was used to compare the mean sacral slope, lumbar lordosis, and L1 ASD in the THA and control groups.

Results: There were 12 patients in the THA group and 34 in the control group. Mean follow-up was 9 months. Average age in the control group was 63 years and in the THA group 64.2 years. The sacral slope was greater in the THA group (mean, 23°) than in the lumbar patients (control group) and this difference was statistically significant (mean, 11°, P = 0.001). There were no statistically significant differences between THA and control patients in lumbar lordosis or L1 ASD. Change before and after THA was measured. There were no statistically significant differences in assessed radiographic variables preoperatively versus postoperatively.

Conclusion: There is no significant change in spinal alignment after unilateral THA. At baseline, patients with symptomatic spine complaints have less sacral slope than their hip arthroplasty counterparts.

Citing Articles

Validation of a preoperative formula to estimate postoperative pelvic sagittal alignment and mobility before performing total hip arthroplasty for patients with hip osteoarthritis.

Tanabe H, Homma Y, Yanagisawa N, Watari T, Ishii S, Shirogane Y Arthroplasty. 2023; 5(1):13.

PMID: 37020254 PMC: 10077599. DOI: 10.1186/s42836-023-00171-w.

Hip replacement improves lumbar flexibility and intervertebral disc height - a prospective observational investigation with standing and sitting assessment of patients undergoing total hip arthroplasty.

Muellner M, Wang Z, Hu Z, Hardt S, Pumberger M, Becker L Int Orthop. 2022; 46(10):2195-2203.

PMID: 35821119 PMC: 9492615. DOI: 10.1007/s00264-022-05497-9.

Impact of the hip joint mobility on whole-body sagittal alignment: prospective analysis in case with hip arthroplasty.

Ouchida J, Nakashima H, Kanemura T, Satake K, Ando K, Ito K Eur Spine J. 2022; 31(9):2399-2407.

PMID: 35776178 DOI: 10.1007/s00586-022-07251-6.

Spinopelvic alignment and low back pain after total hip arthroplasty: a scoping review.

Pourahmadi M, Sahebalam M, Dommerholt J, Delavari S, Mohseni-Bandpei M, Keshtkar A BMC Musculoskelet Disord. 2022; 23(1):250.

PMID: 35291992 PMC: 8925238. DOI: 10.1186/s12891-022-05154-7.

[A study of low back pain and changes in spinal sagittal parameters after total hip arthroplasty in patients with unilateral Crowe type developmental dysplasia of the hip].

Ma M, Liu Y, Yang M, Kong X, Chai W Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021; 35(12):1543-1548.

PMID: 34913310 PMC: 8669188. DOI: 10.7507/1002-1892.202107120.

References

Offierski C, Macnab I . Hip-spine syndrome. Spine (Phila Pa 1976). 1983; 8(3):316-21. DOI: 10.1097/00007632-198304000-00014. View

Espinosa N, Beck M, Rothenfluh D, Ganz R, Leunig M . Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007; 89 Suppl 2 Pt.1:36-53. DOI: 10.2106/JBJS.F.01123. View

Lazennec J, Charlot N, Gorin M, Roger B, Arafati N, Bissery A . Hip-spine relationship: a radio-anatomical study for optimization in acetabular cup positioning. Surg Radiol Anat. 2003; 26(2):136-44. DOI: 10.1007/s00276-003-0195-x. View

Kim W, Hutchinson C, Andrew J, Allen P . The relationship between acetabular retroversion and osteoarthritis of the hip. J Bone Joint Surg Br. 2006; 88(6):727-9. DOI: 10.1302/0301-620X.88B6.17430. View

Lafage V, Schwab F, Patel A, Hawkinson N, Farcy J . Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009; 34(17):E599-606. DOI: 10.1097/BRS.0b013e3181aad219. View

Fogel G, Esses S . Hip spine syndrome: management of coexisting radiculopathy and arthritis of the lower extremity. Spine J. 2003; 3(3):238-41. DOI: 10.1016/s1529-9430(02)00453-9. View

Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R . Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005; 438:182-90. DOI: 10.1097/01.blo.0000167669.26068.c5. View

Kawakami M, Tamaki T, Ando M, Yamada H, Hashizume H, Yoshida M . Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976). 2002; 27(1):59-64. DOI: 10.1097/00007632-200201010-00014. View

Legaye J, Duval-Beaupere G, Hecquet J, Marty C . Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998; 7(2):99-103. PMC: 3611230. DOI: 10.1007/s005860050038. View

10.

Farcy J, Schwab F . Management of flatback and related kyphotic decompensation syndromes. Spine (Phila Pa 1976). 1997; 22(20):2452-7. DOI: 10.1097/00007632-199710150-00025. View

11.

Siebenrock K, Kalbermatten D, Ganz R . Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003; (407):241-8. DOI: 10.1097/00003086-200302000-00033. View

12.

Vaz G, Roussouly P, Berthonnaud E, Dimnet J . Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 2002; 11(1):80-7. PMC: 3610486. DOI: 10.1007/s005860000224. View

13.

Lazennec J, Brusson A, Rousseau M . Hip-spine relations and sagittal balance clinical consequences. Eur Spine J. 2011; 20 Suppl 5:686-98. PMC: 3175930. DOI: 10.1007/s00586-011-1937-9. View

14.

Lafage V, Schwab F, Skalli W, Hawkinson N, Gagey P, Ondra S . Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976). 2008; 33(14):1572-8. DOI: 10.1097/BRS.0b013e31817886a2. View

15.

Legaye J . Influence of the sagittal balance of the spine on the anterior pelvic plane and on the acetabular orientation. Int Orthop. 2009; 33(6):1695-700. PMC: 2899171. DOI: 10.1007/s00264-008-0702-0. View

16.

Chaleat-Valayer E, Mac-Thiong J, Paquet J, Berthonnaud E, Siani F, Roussouly P . Sagittal spino-pelvic alignment in chronic low back pain. Eur Spine J. 2011; 20 Suppl 5:634-40. PMC: 3175927. DOI: 10.1007/s00586-011-1931-2. View

17.

Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P . Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am. 2005; 87(2):260-7. DOI: 10.2106/JBJS.D.02043. View

18.

Lazennec J, Ramare S, Arafati N, Laudet C, Gorin M, Roger B . Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J. 2000; 9(1):47-55. PMC: 3611353. DOI: 10.1007/s005860050008. View

19.

Yoshimoto H, Sato S, Masuda T, Kanno T, Shundo M, Hyakumachi T . Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine (Phila Pa 1976). 2005; 30(14):1650-7. DOI: 10.1097/01.brs.0000169446.69758.fa. View

20.

Parvizi J, Pour A, Hillibrand A, Goldberg G, Sharkey P, Rothman R . Back pain and total hip arthroplasty: a prospective natural history study. Clin Orthop Relat Res. 2010; 468(5):1325-30. PMC: 2853644. DOI: 10.1007/s11999-010-1236-5. View