Association of global sagittal spinal deformity with functional disability two years after total hip arthroplasty

Yoshinori Okamoto,Tomohiro Okayoshi,Tomohiro Okayoshi,Masashi Neo,Masashi Neo,Shuhei Otsuki,Shuhei Otsuki,Hitoshi Wakama,Hitoshi Wakama

doi:10.1186/s12891-021-04415-1

Abstract

BackgroundThe relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. Therefore, our aim was to assess the effect of global sagittal spinal deformity on post-operative disability.MethodsThis analysis was based on 208 cases of THA, with functional disability measured at a follow-up of 2 years. The Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR), ranging from a scale of 0 (complete joint disability) to 100 (perfect joint health), was used to divide eligible patients into two groups, namely with and without disability, using a score of 70 as the cut-off. The following factors were compared between the two groups using multivariate analysis: age, sex, body height, body mass index, spinopelvic parameters, and surgeon experience. To identify the cut-off value of the parameters for predicting disability (HOOS-JR < 70/100), we used the receiver-operating characteristic curve.ResultsThe disability (30 hips) and control (178 hips) groups showed a significant difference in pre-operative body height (p = 0.020), T1 pelvic angle divided by pelvic incidence (T1PA/PI; p = 0.018), PI minus lumbar lordosis (p = 0.027), post-operative HOOS-JR (p = 0.010), patient satisfaction (p = 0.033), and the modified Harris Hip Score (p = 0.038). On multivariate analysis, the following factors were associated with persistent disability: T1PA/PI > 0.2 (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.19–4.14; p < 0.001) and height < 148 cm equivalent to legal standards as short stature (OR, 1.26; 95% CI, 1.09–1.48; p = 0.011). The cut-off value of pre-operative T1PA/PI was > 0.19, with a sensitivity of 95% and specificity of 85%. Post-operative satisfaction (p < 0.001), HOOS-JR (p = 0.023), and EuroQol 5-Dimension (p = 0.041) differed between the two groups when the pre-operative cut-off value was chosen as 0.2.ConclusionsA T1PA/PI > 0.2 was associated with greater disability after THA. Clinicians should be aware that patient-related factors, including global spinal deformities, particularly in patients with a short stature, can influence THA outcomes at 2 years postoperatively.

Highlights

The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures
Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR) of 70 as a clinically significant cut-off value and divided patients into the following two groups for comparison: the disability group, who had a postoperative HOOS-JR < 70, indicating hip disability, and Results The disability (30 hips, 14.4%) and control (178 hips, 85.6%) groups showed a significant difference in body height (p = 0.020), pre-operative T1 pelvic angle (T1PA)/pelvic incidence (PI) (p = 0.018), PI minus lumbar lordosis (LL) (p = 0.027), post-operative Trendelenburg sign (p < 0.001), osseous complications (p = 0.006), HOOS-JR (p = 0.010), satisfaction (p = 0.033), and modified Harris Hip Score (HHS) (p = 0.038)
In patients classified as Kellgren-Lawrence grade III, no differences between the groups were seen with respect to PI or pelvic tilt (PT) postoperatively; PT in grade IV differed significantly (p = 0.034) (Fig. 3)

Summary

Introduction

The relationship between spinopelvic alignment and functional disability after total hip arthroplasty (THA) has not been fully elucidated despite the growing recognition of its importance on patient-reported outcome measures. Patient satisfaction plays an important role in assessing therapeutic effects, the impact of the pre-operative spinopelvic alignment on disability after THA has not been reported, even if only over a short term. The key to successful THA necessitates a further comprehensive analysis of the influence of sagittal spinopelvic interactions on functional outcomes. This argument is important to evaluate considering the importance of patient-reported outcome measures (PROMs) in today’s healthcare system

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