Factors Associated with the Progression of Sagittal Spinal Deformity After Total Hip Arthroplasty: a Propensity Score-matched Cohort Study

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2024 Apr 8

PMID 38589707

Authors

Junya Matsuyama

Yoshinori Okamoto

Hitoshi Wakama

Kaito Nakamura

Takafumi Saika

Shuhei Otsuki

Masashi Neo

Affiliations

Soon will be listed here.

Abstract

Purpose: The functional interaction between the hip and spine in patients undergoing total hip arthroplasty (THA) is clinically significant, as it impacts post-operative outcomes. Therefore, this study aimed to identify factors associated with the progression of sagittal spinal deformity and assess the association with patient-reported outcomes.

Methods: This retrospective case-control study included 200 patients who underwent primary THA and completed a mean follow-up duration of 42.2 months (range, 24.0-78.0). We employed a multivariate logistic regression to identify variables predictive of a post-THA sagittal vertical axis (SVA) ≥ 50 mm, which was indicative of a spinal sagittal imbalance. Propensity score-matched cohorts for age, sex, body mass index, follow-up duration, hip flexion contracture, developmental dysplasia, pelvic incidence (PI), and SVA were created, and the outcomes were compared between the two groups.

Results: PI (odds ratio 1.39; 95% confidence interval 1.04-1.86, p = 0.033) was associated with an SVA ≥ 50 mm. After successfully matching patients with (n = 50) and without (n = 50) an SVA ≥ 50 mm, the minimum clinically important difference showed significant differences between the 50 matched pairs (p = 0.016 for EuroQol-5D, p = 0.003 for Hip Disability and Osteoarthritis Outcome Score Joint Replacement, and p < 0.001 for low back pain).

Conclusion: PI is associated with the development of a positive sagittal spinal malalignment post-THA. This finding can assist surgeons in managing patient expectations and in optimising outcomes. Feasible strategies are warranted to minimise the risk of spinal deformity progression post-THA.

References

Sharma A, Vigdorchik J . The Hip-Spine Relationship in Total Hip Arthroplasty: How to Execute the Plan. J Arthroplasty. 2021; 36(7S):S111-S120. DOI: 10.1016/j.arth.2021.01.008. View

Haffer H, Wang Z, Hu Z, Palmowski Y, Hardt S, Schmidt H . Does Total Hip Arthroplasty Affect Spinopelvic and Spinal Alignment?: A Prospective Observational Investigation. Clin Spine Surg. 2022; 35(8):E627-E635. DOI: 10.1097/BSD.0000000000001320. View

Zagra L, Benazzo F, Dallari D, Falez F, Solarino G, DApolito R . Current concepts in hip-spine relationships: making them practical for total hip arthroplasty. EFORT Open Rev. 2022; 7(1):59-69. PMC: 8788146. DOI: 10.1530/EOR-21-0082. View

Vergari C, Kim Y, Takemoto M, Shimizu Y, Tanaka C, Fukae S . Sagittal alignment in patients with flexion contracture of the hip before and after total hip arthroplasty. Arch Orthop Trauma Surg. 2022; 143(6):3587-3596. DOI: 10.1007/s00402-022-04606-y. View

Glassman S, Bridwell K, Dimar J, Horton W, Berven S, Schwab F . The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005; 30(18):2024-9. DOI: 10.1097/01.brs.0000179086.30449.96. 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

Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Saika T, Otsuki S . Clinical significance of relative pelvic version measurement as a predictor of low back pain after total hip arthroplasty. Eur Spine J. 2023; 32(12):4452-4463. DOI: 10.1007/s00586-023-07956-2. View

Tang H, Guo S, Ma Z, Wang S, Zhou Y . A patient-specific algorithm for predicting the standing sagittal pelvic tilt one year after total hip arthroplasty. Bone Joint J. 2023; 106-B(1):19-27. DOI: 10.1302/0301-620X.106B1.BJJ-2023-0640.R1. View

Anakwe R, Jenkins P, Moran M . Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients. J Arthroplasty. 2010; 26(2):209-13. DOI: 10.1016/j.arth.2010.03.013. View

10.

Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Otsuki S, Neo M . Association of the Psoas Muscle Index and Sagittal Spinal Alignment With Patient-Reported Outcomes After Total Hip Arthroplasty: A Minimum 5-Year Follow-Up. J Arthroplasty. 2022; 37(6):1111-1117. DOI: 10.1016/j.arth.2022.02.012. View

11.

Florissi I, Galea V, Shin D, Sauder N, Colon Iban Y, Ingelsrud L . External Validation of Achieving the Patient Acceptable Symptom State for the EuroQol-5 Dimension 1 Year After Total Hip Arthroplasty. J Bone Joint Surg Am. 2020; 103(2):e5. DOI: 10.2106/JBJS.20.00184. View

12.

Kunze K, Fontana M, Maclean C, Lyman S, McLawhorn A . Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty. J Bone Joint Surg Am. 2021; 104(4):345-352. DOI: 10.2106/JBJS.21.00550. View

13.

Deckey D, Verhey J, Christopher Z, Gerhart C, Clarke H, Spangehl M . Discordance Abounds in Minimum Clinically Important Differences in THA: A Systematic Review. Clin Orthop Relat Res. 2022; 481(4):702-714. PMC: 10013655. DOI: 10.1097/CORR.0000000000002434. View

14.

Perronne L, Haehnel O, Chevret S, Wybier M, Hannouche D, Nizard R . How is quality of life after total hip replacement related to the reconstructed anatomy? A study with low-dose stereoradiography. Diagn Interv Imaging. 2020; 102(2):101-107. DOI: 10.1016/j.diii.2020.05.004. View

15.

Okamoto Y, Wakama H, Okayoshi T, Otsuki S, Neo M . Association of global sagittal spinal deformity with functional disability two years after total hip arthroplasty. BMC Musculoskelet Disord. 2021; 22(1):523. PMC: 8185940. DOI: 10.1186/s12891-021-04415-1. View

16.

Iwasa M, Ando W, Uemura K, Hamada H, Takao M, Sugano N . Pelvic incidence is not associated with the development of hip osteoarthritis. Bone Joint J. 2021; 103-B(11):1656-1661. DOI: 10.1302/0301-620X.103B11.BJJ-2021-0472.R1. View

17.

Wakama H, Okamoto Y, Okayoshi T, Ikeda K, Matsuyama J, Otsuki S . Unfavorable cortical hypertrophy potentially predisposes to periprosthetic "axe splitter" fracture in a collarless polished curved triple-tapered cemented stem: The time-dependent radiographic change in five SC-stem cases. J Orthop Sci. 2022; 29(1):439-444. DOI: 10.1016/j.jos.2022.09.004. View

18.

Danoff J, Goel R, Sutton R, Maltenfort M, Austin M . How Much Pain Is Significant? Defining the Minimal Clinically Important Difference for the Visual Analog Scale for Pain After Total Joint Arthroplasty. J Arthroplasty. 2018; 33(7S):S71-S75.e2. DOI: 10.1016/j.arth.2018.02.029. View

19.

Goodman S, Mehta B, Kahlenberg C, Krell E, Nguyen J, Finik J . Assessment of a Satisfaction Measure for Use After Primary Total Joint Arthroplasty. J Arthroplasty. 2020; 35(7):1792-1799.e4. DOI: 10.1016/j.arth.2020.02.039. View

20.

Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F . Standardized way for imaging of the sagittal spinal balance. Eur Spine J. 2011; 20 Suppl 5:602-8. PMC: 3175923. DOI: 10.1007/s00586-011-1927-y. View