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

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.

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References

  1. Nakashima H, Kawakami N, Ohara T, Saito T, Tauchi R, Imagama S (2021) A new global spinal balance classification based on individual pelvic anatomical measurements in patients with adult spinal deformity. Spine 46:223–231

    Article  Google Scholar 

  2. Schwab F, Lafage V, Patel A, Farcy J-P (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833

    Article  Google Scholar 

  3. Imagama S, Ito Z, Wakao N, Seki T, Hirano K, Muramoto A, Sakai Y, Matsuyama Y, Hamajima N, Ishiguro N (2013) Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males. Eur Spine J 22:1346–1353

    Article  Google Scholar 

  4. Banno T, Togawa D, Arima H, Hasegawa T, Yamato Y, Kobayashi S, Yasuda T, Oe S, Hoshino H, Matsuyama Y (2016) The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers. Eur Spine J 25:3687–3693

    Article  Google Scholar 

  5. Amabile C, Le Huec JC, Skalli W (2018) Invariance of head-pelvis alignment and compensatory mechanisms for asymptomatic adults older than 49 years. Eur Spine J 27:458–466. https://doi.org/10.1007/s00586-016-4830-8

    Article  PubMed  Google Scholar 

  6. Hasegawa K, Okamoto M, Hatsushikano S, Shimoda H, Ono M, Watanabe K (2016) Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects. Eur Spine J 25:3675–3686. https://doi.org/10.1007/s00586-016-4702-2

    Article  PubMed  Google Scholar 

  7. Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. In: Weinstein S (ed) The pediatric spine: principles and practice. Raven Press, New York, pp 479–496

    Google Scholar 

  8. Haddas R, Sambhariya V, Kosztowski T, Block A, Lieberman I (2021) Cone of economy classification: evolution, concept of stability, severity level, and correlation to patient-reported outcome scores. Europ Spine J 30:2271–2282

    Article  Google Scholar 

  9. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy J-P (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606

    Article  Google Scholar 

  10. Ferrero E, Liabaud B, Challier V, Lafage R, Diebo BG, Vira S, Liu S, Vital JM, Ilharreborde B, Protopsaltis TS (2016) Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity. J Neurosurg Spine 24:436–446

    Article  Google Scholar 

  11. Ben-Galim P, Ben-Galim T, Rand N, Haim A, Hipp J, Dekel S, Floman Y (2007) Hip-spine syndrome: the effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip. Spine 32:2099–2102

    Article  Google Scholar 

  12. Weng W, Wu H, Wu M, Zhu Y, Qiu Y, Wang W (2016) The effect of total hip arthroplasty on sagittal spinal–pelvic–leg alignment and low back pain in patients with severe hip osteoarthritis. Eur Spine J 25:3608–3614

    Article  Google Scholar 

  13. Offierski CM, MacNab I (1976) Hip-spine syndrome. Spine 8:316–321

    Article  Google Scholar 

  14. Buckland AJ, Steinmetz L, Zhou P, Vasquez-Montes D, Kingery M, Stekas ND, Ayres EW, Varlotta CG, Lafage V, Lafage R, Errico T, Passias PG, Protopsaltis TS, Vigdorchik J (2019) Spinopelvic compensatory mechanisms for reduced hip motion (rom) in the setting of hip osteoarthritis. Spine Deform 7:923–928. https://doi.org/10.1016/j.jspd.2019.03.007

    Article  PubMed  Google Scholar 

  15. Philippon MJ, Briggs KK, Carlisle JC, Patterson DC (2013) Joint space predicts THA after hip arthroscopy in patients 50 years and older. Clinical Orthop Relat Res 471:2492–2496

    Article  Google Scholar 

  16. Matsumoto T, Kaneuji A, Hiejima Y, Sugiyama H, Akiyama H, Atsumi T, Ishii M, Izumi K, Ichiseki T, Ito H (2012) Japanese orthopaedic association hip disease evaluation questionnaire (JHEQ): A patient-based evaluation tool for hip-joint disease. The subcommittee on hip disease evaluation of the clinical outcome committee of the Japanese Orthopaedic Association. J Orthop Sci 17:25–38

    Article  Google Scholar 

  17. Hsieh P-H, Chang Y, Chen DW, Lee MS, Shih H-N, Ueng SW (2012) Pain distribution and response to total hip arthroplasty: A prospective observational study in 113 patients with end-stage hip disease. J Orthop Sci 17:213–218

    Article  Google Scholar 

  18. Radcliff KE, Orozco F, Molby N, Delasotta L, Chen E, Post Z, Ong A (2013) Change in spinal alignment after total hip arthroplasty. Orthop Surg 5:261–265. https://doi.org/10.1111/os.12076

    Article  PubMed  PubMed Central  Google Scholar 

  19. Morita D, Yukawa Y, Nakashima H, Ito K, Yoshida G, Machino M, Kanbara S, Iwase T, Kato F (2014) Range of motion of thoracic spine in sagittal plane. Eur Spine J 23:673–678

    Article  Google Scholar 

  20. Tsukagoshi R, Tateuchi H, Fukumoto Y, Akiyama H, So K, Kuroda Y, Okumura H, Ichihashi N (2015) Factors associated with restricted hip extension during gait in women after total hip arthroplasty. Hip Int 25:543–548

    Article  Google Scholar 

  21. Rasch A, Dalén N, Berg HE (2010) Muscle strength, gait, and balance in 20 patients with hip osteoarthritis followed for 2 years after THA. Acta Orthop 81:183–188

    Article  Google Scholar 

  22. Lugade V, Klausmeier V, Jewett B, Collis D, Chou L-S (2008) Short-term recovery of balance control after total hip arthroplasty. Clin Orthop Relat Res 466:3051–3058

    Article  Google Scholar 

  23. Buckland AJ, Vigdorchik J, Schwab FJ, Errico TJ, Lafage R, Ames C, Bess S, Smith J, Mundis GM, Lafage V (2015) Acetabular anteversion changes due to spinal deformity correction: Bridging the gap between hip and spine surgeons. J Bone Jt Surg 97:1913–1920

    Article  Google Scholar 

  24. Sultan AA, Khlopas A, Piuzzi NS, Chughtai M, Sodhi N, Mont MA (2018) The impact of spino-pelvic alignment on total hip arthroplasty outcomes: a critical analysis of current evidence. J Arthroplast 33:1606–1616. https://doi.org/10.1016/j.arth.2017.11.021

    Article  Google Scholar 

  25. Kummer FJ, Shah S, Iyer S, DiCesare PE (1999) The effect of acetabular cup orientations on limiting hip rotation. J Arthroplast 14:509–513

    CAS  Article  Google Scholar 

  26. Furuhashi H, Togawa D, Koyama H, Hoshino H, Yasuda T, Matsuyama Y (2017) Repeated posterior dislocation of total hip arthroplasty after spinal corrective long fusion with pelvic fixation. Eur Spine J 26:100–106

    Article  Google Scholar 

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Acknowledgements

The authors acknowledge Grant of Japan Orthopaedics and Traumatology Research Foundation No. 424. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Correspondence to Hiroaki Nakashima.

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The authors declare that they have no conflict of interest.

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The study was approved by the Institutional Review Board of Konan Kosei Hospital.

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Ouchida, J., Nakashima, H., Kanemura, T. et al. Impact of the hip joint mobility on whole-body sagittal alignment: prospective analysis in case with hip arthroplasty. Eur Spine J (2022). https://doi.org/10.1007/s00586-022-07251-6

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  • DOI: https://doi.org/10.1007/s00586-022-07251-6

Keywords

  • EOS
  • Lordosis
  • Compensatory mechanism
  • Spinal alignment
  • Sagittal alignment
  • Hip spine syndrome