Abstract
Abnormal spinopelvic movements are associated with inferior outcomes following total hip arthroplasty (THA). This study aims to (1) characterize the agreement between dynamic motion and radiographic sagittal assessments of the spine, pelvis, and hip; (2) determine the effect of hip osteoarthritis (OA) on kinematics by comparing healthy individuals with pre-THA patients suffering from uni- or bilateral hip OA. Twenty-four OA patients pre-THA and eight healthy controls underwent lateral spinopelvic radiographs in standing and seated bend-and-reach (SBR) positions. Lumbar-lordosis (LL), sacral-slope (SS), and pelvic–femoral (PFA) angles were measured in both positions, and the differences (Δ) between SBR and standing were computed to assess spine flexion (SF), pelvic tilt (PT), and hip flexion (HF), respectively. Dynamic SBR and seated maximal trunk rotation (STR) tasks were performed at the biomechanics laboratory. Peak sagittal and axial kinematics for spine, pelvis, and hip, and range of motion (ROM), were calculated for SBR and STR. Radiograph readings correlated with sagittal kinematics during SBR for ΔLL and SFmax (r = 0.66, p < 0.001), ΔPT and PTmax (r = 0.44, p = 0.014), and ΔPFA and HFmax (r = 0.70, p < 0.001), with a satisfactory agreement in Bland–Altman analyses. Sagittal SBR spinal (r = 0.33, p = 0.022) and pelvic (r =0.35, p = 0.018) flexions correlated with the axial STR rotations. All axial spinopelvic parameters were different between the OA patients and controls, with the latter exhibiting significantly greater mobility and less variability. Bilaterally affected patients exhibited lower peak and ROM compared to controls. The biomechanics laboratory performed reliable assessments of spinopelvic and hip characteristics, in which the axial plane can be included. The sagittal and axial pelvic kinematics correlate, illustrating that pelvic rotation abnormalities are likely also contributing to the inferior outcomes seen in patients with abnormal spinopelvic flexion characteristics. Axial rotations of the pelvis and spine were least in patients with bilateral hip disease, further emphasizing the importance of the hip–pelvic–spine interaction.
Highlights
Introduction iationsThe dynamic interaction between the femur, pelvis, and lumbar spine has been an emerging issue amongst hip and spine surgeons
Were seenlaboratory between the patients flexion (SFmax)differences during SBRinmotion analysis capture tasks were testedand for the corhealthy volunteers (Table relation using Spearman’s r with the respective radiographic measurements (ΔPT, ΔPFA, ΔLL)
Our findings show that assessments of spinopelvic characteristics in the motion analysis laboratory can produce reliable results, albeit with certain inherent limitations pertinent to the assessment of the pelvic, sagittal kinematics
Summary
The dynamic interaction between the femur, pelvis, and lumbar spine has been an emerging issue amongst hip and spine surgeons. The importance of this interaction was first highlighted by observational studies that reported inferior outcomes following hip arthroplasty in patients with spinal arthrodesis. Patients with spinal arthrodesis exhibit abnormal spinopelvic movement and have been shown to be at increased risk of dislocation following total hip replacement (THA) [1,2]. These observations [4,5] emphasize the relevance of considering the spinopelvic characteristics in all arthroplasty patients, as they determine the position of the pelvis in space, which, in turn, determines the functional acetabular orientation.
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