The Impact of Lumbar Spine Disease on Hip-Spine Relationship in Total Hip Arthroplasty: A Mini-Review

Abstract

Background: Patients with severe lumbar spine diseases run a high risk of dislocation after total hip arthroplasty. Therefore, it is essential to determine the pathological effect of common lumbar diseases on pelvic motions before the surgery. Aim: This study reviewed the literature on the hip-spine relationship during total hip arthroplasty and explored the degenerative presentations and management of four common lumbar disorders. The review showed that patients with the spinal deformity in ankylosing spondylitis (AS) were characterized by thoracolumbar kyphosis with corresponding hip extension and pelvic retroversion, prone to anterior hip dislocation; patients with lumbar spinal fusion (LSF) were more susceptible to prosthetic impingement and ultimate dislocation, especially in the limited posterior tilt of the pelvis while sitting; those with degenerative disc disease (DDD) had a greater compensatory pelvic posterior angle while standing and greater hip joint flexion while sitting to compensate for the reduced lumbar flexion; those with degenerative lumbar spondylolisthesis (DSPL) demonstrated a pelvic flexibility with a much wider range and relative acetabular anteversion, especially when standing. Recommendation: According to the literature, spinal osteotomy and total hip arthroplasty are the most common surgical interventions in AS cases. DSPL is classified into the Flexible & Unbalanced type and should be placed more posteriorly, but the literature suggests that patients with lumbar instability should first be placed in a more predictable position. In contrast, LSF and DDD are categorized as the Rigid & Balanced type. For these two types of disorders, the literature suggests that acetabular prostheses require more anterior tilt at the time of implantation. Conclusion: These findings indicate that for degenerative lumbar disorders, a balance between stable component implantation and minimal wear should be based on the different changes in spinopelvic mobility.