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



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.


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.


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.


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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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 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).

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