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Spinopelvic Compensatory Mechanisms for Reduced Hip Motion (ROM) in the Setting of Hip Osteoarthritis

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Abstract

Study Design

Retrospective review from a single institution.

Objective

To investigate the effect of hip osteoarthritis (OA) on spinopelvic compensatory mechanisms as a result of reduced hip range of motion (ROM) between sitting and standing.

Summary of Background Data

Hip OA results in reduced hip ROM and contracture, causing pain during postural changes. Hip flexion contracture is known to reduce the ability to compensate for spinal deformity while standing; however, the effects of postural spinal alignment change between sitting and standing is not well understood.

Methods

Sit-stand radiographs of patients without prior spinal fusion or hip prosthesis were evaluated. Hip OA was graded by Kellgren-Lawrence grades and divided into low-grade (LOA; grade 0–2) and severe (SOA; grade 3 or 4) groups. Radiographic parameters evaluated were pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), SVA, T1-pelvic angle (TPA), T10–L2, proximal femoral shaft angle (PFSA), and hip flexion (PT change–PFSA change). Changes in sit-stand parameters were compared between LOA and SOA groups.

Results

548 patients were included (LOA = 311; SOA = 237). After propensity score matching for age, body mass index, and PI, 183 LOA and 183 SOA patients were analyzed. Standing analysis demonstrated that SOA had higher SVA (31.1 vs. 21.7), lower TK (−36.2 vs. −41.1), and larger PFSA (9.1 vs. 7.4) (all p < .05). Sitting analysis demonstrated that SOA had higher PT (29.7 vs. 23.3), higher PI-LL (21.6 vs. 12.4), less LL (31.7 vs. 41.6), less TK (−33.2 vs. −38.6), and greater TPA (27.9 vs. 22.5) (all p < .05). SOA had less hip ROM from standing to sitting versus LOA (71.5 vs. 81.6) (p < .05). Therefore, SOA had more change in PT (15.2 vs. 7.3), PI-LL (20.6 vs. 13.7), LL (−21.4 vs. −13.1), and T10–L2 (−4.9 vs. −1.1) (all p < .001), allowing the femurs to change position despite reduced hip ROM. SOA had greater TPA reduction (15.1 vs. 9.6) and less PFSA change (86.7 vs. 88.8) compared with LOA (both p < .001).

Conclusions

Spinopelvic compensatory mechanisms are adapted for reduced hip joint motion associated with hip OA in standing and sitting.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Medical Center–NYU Langone Orthopedic Hospital, 301 East 17th St, New York, NY, 10003, USA

    Aaron J. Buckland MBBS, FRACS, Leah Steinmetz BA, Peter Zhou BA, Dennis Vasquez-Montes MS, Matthew Kingery BA, Nicholas D. Stekas BS, Ethan W. Ayres MPH, Christopher G. Varlotta BS, Thomas Errico MD, Peter G. Passias MD, Themistocles S. Protopsaltis MD & Jonathan Vigdorchik MD

  2. Department of Orthopaedics, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA

    Virginie Lafage PhD & Renaud Lafage MS

Authors
  1. Aaron J. Buckland MBBS, FRACS
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  2. Leah Steinmetz BA
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  5. Matthew Kingery BA
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  11. Thomas Errico MD
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  13. Themistocles S. Protopsaltis MD
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  14. Jonathan Vigdorchik MD
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Corresponding author

Correspondence to Aaron J. Buckland MBBS, FRACS.

Additional information

Author disclosures: AJB (Personal fees from NuVasive, K2M, EOS Imaging), LS (none), PZ (none), DVM (none), MK (none), NDS (none), EWA (none), CGV (none), VL (none), RL (personal fees and other from Nemaris; personal fees from DePuy Synthes, NuVasive, United States, K2M, and Medtronic, United States, outside the submitted work), Thomas Errico (personal fees from Fastenetix and K2M; grants and personal fees from Pfizer; grants from Medtronic, United States, International Spine Study Group Foundation [ISSGF], and Paradigm Spine; other from OMEGA, outside the submitted work), PGP (personal fees from Medicrea, Spinewave, and Zimmer Biomet; grants from Grants, outside the submitted work), TSP, Thailand (grants from Cervical Spine Research Society, United States and Zimmer Biomet; personal fees from Globus, Innovasis, K2M, Medicrea, and NuVasive; other from Torus Medical, outside the submitted work), JV (none).

Ethical review committee statement: Each institution obtained approval from their local Institutional Review Board to enroll patients in the prospective database, and informed consent was obtained from each patient.

Source of funding: The investigators report no funding for this project.

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Buckland, A.J., Steinmetz, L., Zhou, P. et al. Spinopelvic Compensatory Mechanisms for Reduced Hip Motion (ROM) in the Setting of Hip Osteoarthritis. Spine Deform 7, 923–928 (2019). https://doi.org/10.1016/j.jspd.2019.03.007

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  • DOI: https://doi.org/10.1016/j.jspd.2019.03.007

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