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.

The Accuracy of Patient-Specific Instrumentation with Laser Guidance in a Dynamic Total Hip Arthroplasty: A Radiological Evaluation

“…The component positioning and dynamic function are being extensively studied as significant factors in THA stability and survival [ 9 , 19 , 23 , 24 ]. The current literature focuses on understanding individual lumbopelvic sagittal kinematics and the relationship with functional cup alignment during daily life activities [ 13 , 25 , 26 , 27 ].…”

Change of Pelvic Sagittal Tilt after Total Hip Arthroplasty in Patients with Bilateral Crowe Type IV Developmental Dysplasia of the Hip

“… 17 suggested that pelvic posterior tilt occurred a little up to 7 years postoperatively, and Kanto et al . 31 and Blondel et al . 19 reported no significant changes happened in PST in the first year after THA.…”

“…For the patients with simple hip OA, Shareghi et al 17 . suggested that pelvic posterior tilt occurred a little up to 7 years postoperatively, and Kanto et al 31 . and Blondel et al 19 .…”

“…16,18,29 Therefore, the posterior change of PST after THA in our study could happen earlier and more distinctly compared to the results reported by Suzuki et al, because bilateral Crowe type IV DDH may be one of the most severe conditions characterized by severe high dislocation, pelvic deformity and lumbar hyper-lordosis. 6,7,9,24,30 For the patients with simple hip OA, Shareghi et al 17 suggested that pelvic posterior tilt occurred a little up to 7 years postoperatively, and Kanto et al 31 and Blondel et al 19 reported no significant changes happened in PST in the first year after THA. This might be explained by the differences in demography and diagnoses of hip diseases.…”

Risk Factors for Progressive Spinal Sagittal Imbalance in the Short-Term Course after Total Hip Arthroplasty: A 3 Year Follow-Up Study of Female Patients

“…Furthermore, ROC analysis showed that ATMS ≤ 4.3 kPa and SS ≤ 31.9° were associated with spinal sagittal imbalance and may be useful predictors of progressive spinal sagittal imbalance before THA. Although many reports evaluated spinopelvic alignment immediately after THA [ 10 , 11 , 12 , 22 , 23 , 24 , 25 , 26 ], to our knowledge, no studies have reported the risk of spinal sagittal imbalance in the long-term course after THA. Spinal sagittal imbalance after THA may lead to a demand for corrective surgery.…”