Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty

Abstract

Objective: To evaluate the impact of spinopelvic parameters and hip contracture on change in the pelvic tilt (PT) after Total hip arthroplasty (THA).

Methods: One hundred patients (15 male and 85 female) who underwent THA were included in this prospective study. Radiographic data were obtained preoperatively and 1 year after THA. Radiographic parameters included sagittal anterior pelvic plane (APP), sagittal vertical axis (SVA), sacral slope (SS), pelvic inclination (PI), and lumbar lordosis angle (LL). The APP was defined as the angle between the anterior pelvic plane and the vertical plane. A positive value indicates pelvic retroversion. Postoperative changes in PT were divided into three groups: the PA group (pelvic anteversion, ΔAPP < -5°), the PR group (pelvic retroversion, ΔAPP > 5°), and the PT group (minimal change, ΔAPP ≤ ± 5°). The Kruskal-Wallis test and the Steel-Dwass test were used to compare the preoperative and postoperative spinopelvic parameters among the three groups. The Spearman's rank correlation coefficient was used to evaluate the correlation between ΔAPP and spinopelvic parameters.

Results: Minimal change in pelvic tilt was observed in 59% of patients, while pelvic anteversion was observed in 16% of patients and pelvic retroversion was observed in 25% of patients. There were no significant changes in the spinopelvic parameters, including TK, LL, SVA, LL, SS, and APP after THA. The Femoral angle (FA) was significantly decreased after THA (P < 0.001). Preoperative APP was significantly more retroverted in the PA group than the PR group, and the PT group (6.8 ± 12.2, 0.2 ± 9.9, -8.3 ± 8.3, P < 0.001). Preoperative SS, PI-LL, and PI were significantly smaller in the PA group than the PT group and the PR group. A significant negative correlation was identified between preoperative APP and ΔAPP (r = -0.418, P < 0.001).

Conclusion: Approximately 60% of the patients did not have any marked change in PT after THA. Preoperative APP was the only predictive factor associated with marked anterior or posterior change in PT.

Keywords: Anterior pelvic plane; Change in pelvic tilt; Hip-spine syndrome; Total hip arthroplasty.