Investigating Sagittal Spinal Alignment, Low Back Pain, and Clinical Outcomes After Total Hip Arthroplasty for Lumbar Hyperlordosis: a Retrospective Study

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2021 Nov 26

PMID 34825248

Citations 3

Authors

Yaichiro Okuzu

Takuma Miyahara

Koji Goto

Yutaka Kuroda

Toshiyuki Kawai

Shuichi Matsuda

Affiliations

Soon will be listed here.

Abstract

Introduction: Hip-spine syndrome, wherein flexion deformity of the hip might exaggerate normal lumbar lordosis (LL), was first described in 1983. It could result in subluxation of the posterior facets and cause low back pain (LBP). However, the clinical outcomes of total hip arthroplasty (THA) and spinal alignment changes in patients with lumbar hyperlordosis (hyper LL) remain unknown. We aimed to clarify the proportion of patients with hyper LL before THA and compare pre- and post-operative sagittal spinal alignment, LBP, and clinical outcomes between patients with hyper LL and those with normal LL.

Materials And Methods: We investigated 278 patients who underwent primary THA between December 2015 and December 2019. Spine radiographs in the standing position were examined preoperatively and 1 year postoperatively. Patients with hyper LL were defined as having a pelvic incidence (PI) minus LL of < - 9° preoperatively. The control group included age- and sex-matched patients with normal LL, defined by a PI minus LL of - 9° to 9°. Clinical outcomes were evaluated using the visual analogue scale (VAS) for LBP, Harris hip score (HHS), Oxford hip score (OHS), and University of California, Los Angeles (UCLA) activity score.

Results: Thirty-eight patients (13.7%) had hyper LL, and they exhibited a lower pelvic tilt, lower sagittal vertical axis, and greater sigmoid curvature than did the controls. Evaluation of changes in the spinal alignment after surgery showed that the pelvis tilted more posteriorly, and LL decreased more in the hyper LL group than in the control group. Pre- and post-operative VAS for LBP, HHS, OHS, and UCLA activity scores were not significantly different between the two groups.

Conclusion: Hyper LL in patients with hip osteoarthritis had no adverse effects on LBP and the clinical outcomes of THA. Hyper LL may partially result from a flexible and adaptable lumbo-pelvic structure.

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References

Ellenrieder M, Bader R, Bergschmidt P, Frohlich S, Mittelmeier W . Coexistent lumbar spine disorders have a crucial impact on the clinical outcome after total hip replacement. J Orthop Sci. 2015; 20(6):1046-52. DOI: 10.1007/s00776-015-0764-y. View

Prather H, van Dillen L, Kymes S, Armbrecht M, Stwalley D, Clohisy J . Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty. Spine J. 2012; 12(5):363-9. PMC: 3340523. DOI: 10.1016/j.spinee.2011.11.002. View

Ochi H, Homma Y, Baba T, Nojiri H, Matsumoto M, Kaneko K . Sagittal spinopelvic alignment predicts hip function after total hip arthroplasty. Gait Posture. 2016; 52:293-300. DOI: 10.1016/j.gaitpost.2016.12.010. View

Di Martino A, Bordini B, Ancarani C, Viceconti M, Faldini C . Does total hip arthroplasty have a higher risk of failure in patients who undergo lumbar spinal fusion?. Bone Joint J. 2021; 103-B(3):486-491. DOI: 10.1302/0301-620X.103B3.BJJ-2020-1209.R1. View

Jentzsch T, Geiger J, Konig M, Werner C . Hyperlordosis is Associated With Facet Joint Pathology at the Lower Lumbar Spine. Clin Spine Surg. 2017; 30(3):129-135. DOI: 10.1097/BSD.0b013e3182aab266. View

Chun S, Lim C, Kim K, Hwang J, Chung S . The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J. 2017; 17(8):1180-1191. DOI: 10.1016/j.spinee.2017.04.034. View

Kim Y, Eslam Pour A, Lazennec J . How do global sagittal alignment and posture change after total hip arthroplasty?. Int Orthop. 2019; 44(2):267-273. DOI: 10.1007/s00264-019-04363-5. View

Radcliff K, Orozco F, Molby N, Delasotta L, Chen E, Post Z . Change in spinal alignment after total hip arthroplasty. Orthop Surg. 2013; 5(4):261-5. PMC: 6583183. DOI: 10.1111/os.12076. View

Taki N, Mitsugi N, Mochida Y, Akamatsu Y, Saito T . Change in pelvic tilt angle 2 to 4 years after total hip arthroplasty. J Arthroplasty. 2011; 27(6):940-4. DOI: 10.1016/j.arth.2011.10.003. View

10.

Suzuki H, Inaba Y, Kobayashi N, Ishida T, Ike H, Saito T . Postural and Chronological Change in Pelvic Tilt Five Years After Total Hip Arthroplasty in Patients With Developmental Dysplasia of the Hip: A Three-Dimensional Analysis. J Arthroplasty. 2015; 31(1):317-22. DOI: 10.1016/j.arth.2015.07.026. View

11.

Lembeck B, Mueller O, Reize P, Wuelker N . Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop. 2005; 76(4):517-23. DOI: 10.1080/17453670510041501. View

12.

Moskal J, Capps S . Acetabular component positioning in total hip arthroplasty: an evidence-based analysis. J Arthroplasty. 2011; 26(8):1432-7. DOI: 10.1016/j.arth.2010.11.011. View

13.

DiGioia 3rd A, Jaramaz B, Plakseychuk A, Moody Jr J, Nikou C, Labarca R . Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty. 2002; 17(3):359-64. DOI: 10.1054/arth.2002.30411. View

14.

Lewinnek G, Lewis J, Tarr R, COMPERE C, Zimmerman J . Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978; 60(2):217-20. View

15.

Le Huec J, Thompson W, Mohsinaly Y, Barrey C, Faundez A . Sagittal balance of the spine. Eur Spine J. 2019; 28(9):1889-1905. DOI: 10.1007/s00586-019-06083-1. View

16.

Riviere C, Lazennec J, Van Der Straeten C, Auvinet E, Cobb J, Muirhead-Allwood S . The influence of spine-hip relations on total hip replacement: A systematic review. Orthop Traumatol Surg Res. 2017; 103(4):559-568. DOI: 10.1016/j.otsr.2017.02.014. View