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

Jun Ouchida; Hiroaki Nakashima; Tokumi Kanemura; Kotaro Satake; Kei Ando; Kenyu Ito; Mikito Tsushima; Masaaki Machino; Sadayuki Ito; Hidetoshi Yamaguchi; Naoki Segi; Hiroyuki Koshimizu; Hiroyuki Tomita; Shiro Imagama

doi:10.1007/s00586-022-07251-6

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

Eur Spine J. 2022 Sep;31(9):2399-2407. doi: 10.1007/s00586-022-07251-6. Epub 2022 Jul 1.

Affiliations

¹ Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Nagoya-shi, Aichi, 466-8550, Japan.
² Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Nagoya-shi, Aichi, 466-8550, Japan. hirospine@med.nagoya-u.ac.jp.
³ Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.

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

Abstract

Purpose: To clarify the impact of restriction of hip extension on radiographic whole-body sagittal alignment with using postoperative changes of radiographical parameters for hip osteoarthritis.

Methods: We prospectively enrolled 68 patients with hip osteoarthritis scheduled for arthroplasty. Variables included manual examination of hip range of motion (H-ROM) and radiographic whole-body sagittal alignment parameters including sagittal vertical axis (SVA), center of acoustic meatus and femoral head offset (CAM-HA), thoracic kyphosis (TK), lumbar lordosis, sacral slope (SS), and knee flexion angle (KF). We divided patients with preoperative hip extension angle < 0 into the extension restriction (ER) + group and ≥ 0 into the ER- group. Differences in H-ROM, radiographic parameters between groups and postoperative changes were comparatively analyzed.

Results: Fifty-seven patients (The ER + group included 28 patients and the ER- group included 29 patients.) were available for the analysis. Pre-/postoperative H-ROM were 99.7 ± 24.9/118.1 ± 16.0 degrees (p < .01). Greater increases in SVA (5.4 ± 3.4 vs 3.4 ± 2.8 cm, p = .02) and in CAM-HA (3.9 ± 3.9 vs 2.8 ± 3.4 cm, p = 013) were found in the ER + group versus ER- group. Postoperatively, the ER + group showed an increase in TK (pre-/postoperative: 35.2 ± 9.7/37.4 ± 8.8 degrees, p = .04) and decreases in SS (36.5 ± 9.6/33.7 ± 9.9 degrees, p < .01) and KF (9.5 ± 7.0/6.9 ± 6.0 degrees, p = .02). Postoperative changes in radiographic parameters in the ER- group were not significant.

Conclusion: Patients with restriction of hip extension showed global spine imbalance, and significant changes in TK, SS, and KF were observed after arthroplasty. The presence of hip joint disorder and H-ROM restriction must be considered when evaluating spinopelvic alignment and whole-body sagittal alignment.

Keywords: Compensatory mechanism; EOS; Hip spine syndrome; Lordosis; Sagittal alignment; Spinal alignment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Hip*
Hip Joint / surgery
Humans
Kyphosis* / surgery
Lordosis* / surgery
Osteoarthritis, Hip* / diagnostic imaging
Osteoarthritis, Hip* / surgery
Retrospective Studies
Sacrum / surgery