The impact of the leg-lengthening total hip arthroplasty on the coronal alignment of the spine

Abstract

BackgroundCoronal imbalance of the pelvis is recognized to lead to the development of degenerative lumbar scoliosis. We hypothesized that an abrupt change of pelvic obliquity may show a reproducible trend of coronal compensation in the lumbosacral spine. The aim of the study was to classify the change of coronal alignment of spine after THA.MethodsThis is a retrospective study based on the radiological analysis of 195 patients who underwent THA between 2009 and 2010. The mean age at surgery was 61.5 years old, and minimum follow up period was 24 months. Pelvic obliquity (POb) and Cobb’s angle of lumbar scoliosis (LS) in coronal plane were measured. Over 3.5 degrees of change in POb was regarded as ΔPOb(+) and over 10 degrees of lumbar scoliosis was regarded as LS(+). The change of LS were classified into 3 subtypes; ΔLS(+), over 5 degrees of progress in LS, ΔLS(-), over 5 degrees of improvement in LS, and ΔLS(n), changes in LS within 5 degrees.ResultsOver 3.5 degrees of change in POb was significantly correlated with the change in LS. Among195 patients, 120 patients improved their pelvic obliquity (ΔPOb(+)), and 75 patients did not have an improved pelvic obliquity (ΔPOb(-)). 99 patients out of 120 ΔPOb(+) patients did not show changes (54, ΔLS(n)) or improvement in scoliosis (45, ΔLS(-)).The remaining 21 patients showed progress or development of de novo scoliosis. Patients who failed to compensate for the POb change at lumbosacral area developed de novo lumbar scoliosis (7 cases), showed progression in lumbar scoliosis (7 cases) or developed coronal trunk shift over 20mm (7 cases)ConclusionsThe patterns of compensation in lumbar or lumbosacral spine in coronal plane after leg lengthening THA were classified with regards to pelvic obliquity and Cobb’s angle. 89.2% of 195 patients showed acceptable compensation in lumbar spine, 21 patients developed coronal imbalance. THA therefore is considered to be safe, as regards to spinal balance in coronal plane. However we have to keep in mind that preoperative rigid scoliosis could have a risk in progress for spinal imbalance.

Hip-Spine Syndrome: The Coronal Alignment of the Lumbar Spine and Pelvis in Patients with Ankylosed Hips

“…In contrast, some patients with structural scoliosis may develop problems with balance after THA for ankylosed hips. Abe et al 14) reported that coronal balance in flexible scoliosis in patients with degenerative hip osteoarthritis, even in some ridged scoliosis cases, tended to improve after Several limitations associated with the present study must be noted. First, this cross-sectional study was limited with respect to distinguishing de novo scoliosis from preexisting deformities and, therefore, did not allow for analyses of the temporal sequence of events.…”

Avaliação dos parâmetros radiográficos do alinhamento sagital e espinopélvico em pacientes com osteoartrite submetidos à artroplastia total do quadril

“…Assim, as deformidades da coluna que são estruturadas podem piorar após a ATQ. 14 Recentemente, Esposito et al 15 observaram que 40% dos pacientes submetidos a ATQ primária apresentavam espondilodiscopatia degenerativa em diferentes níveis. Nossos resultados confirmam esta associação, uma vez que os parâmetros diagnósticos de doença degenerativa da coluna (osteófitos, redução do espaço intervertebral e artrose das articulações interapofisárias) foram prevalentes nos pacientes submetidos à ATQ.…”

“…14 Foi observada a redução do ângulo da báscula da bacia depois da ATQ para valores semelhantes aos valores dos voluntários sem doença articular, de acordo com o estudo de Abe et al, já que 61,5% de um total de 195 pacientes submetidos à ATQ primária apresentaram correção do ângulo da báscula da bacia. 14 O EVS e a razão de C7/DSF foram corrigidos depois da ATQ. A correção desses parâmetros após a cirurgia de ATQ sugere uma melhora significativa do equilíbrio da coluna vertebral no plano sagital.…”

“…Patients with rigid scoliosis are at an increased risk for spinal imbalance after THA due to the abrupt change in pelvic obliquity. 14 A scoliotic curve can be maintained after THA by the concomitance of degenerative changes, impairing the spinopelvic alignment and the compensation of pelvic anteversion parameters. Thus, structured spinal deformities may worsen after THA.…”

“…Radiographic parameters of sagittal and spinopelvic alignment arise as an important tool to increase diagnostic accuracy and guide the correct treatment. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 However, there is not enough data in the literature about the real contribution to the differential diagnosis of spinal and hip lesions. As such, the present study aimed to describe and evaluate radiographic parameters of sagittal and spinopelvic alignment in hip OA patients before and after primary THA, to define whether the procedure should be the primary approach in individuals with concomitant spine and hip joint disease.…”