The Impact of Hip Mobility on Lumbar and Pelvic Mobility before and after Total Hip Arthroplasty

Abstract

Hip arthrosis and total hip arthroplasty (THA) can alter a patient's balance and spinopelvic mobility. In this study, we hypothesized that lumbar, pelvic, and hip mobility and their inter-relations are affected by THA and that their study could give an insight in our understanding of postoperative balance and mobility. A total of 165 patients with hip arthrosis and with an indication for THA were included in this single-center prospective cohort. Sagittal radiographs were acquired in four positions: free-standing, standing extension, relaxed-seating and flexed-seating preoperatively and at 6 and 12 months. Spinopelvic parameters were measured (pelvic tilt and incidence, sacral slope, lumbar lordosis, pelvic-femoral angle). Standing spinopelvic parameters did not significantly change postoperatively. However, the postural changes occurring between positions were significantly altered after THA. In particular, pelvic and lumbar mobility was significantly reduced postoperatively, while hip mobility was increased. Correlations were observed between the changes in lumbar, pelvic and hip mobility before and after THA. This study confirmed that there is a relationship between lumbar, pelvic and hip mobility in osteoarthritis, and that this relationship is modified by the postoperative compensation mechanisms deployed by the patient in dynamic postures. Hence, surgeons should consider these relationships when planning surgery, in order to obtain a physiological pelvic tilt postoperatively and to account for the potential increased risk of impingement and dislocation with hip hypermobility.