Abstract
Spinopelvic mobility represents the complex interaction of hip, pelvis, and spine. Understanding this interaction is relevant for both arthroplasty and spine surgeons, as a predicted increasing number of patients will suffer from hip and spinal pathologies simultaneously. We conducted a comprehensive literature review, defined the nomenclature, summarized the various classifications of spinopelvic mobility, and outlined the corresponding treatment algorithms. In addition, we developed a step-by-step workup for spinopelvic mobility and total hip arthroplasty (THA). Normal spinopelvic mobility changes from standing to sitting; the hip flexes, and the posterior pelvic tilt increases with a concomitant increase in acetabular anteversion and decreasing lumbar lordosis. Most classifications are based on a division of spinopelvic mobility based on ΔSS (sacral slope) into stiff, normal, and hypermobile, and a categorization of the sagittal spinal balance regarding pelvic incidence (PI) and lumbar lordosis (LL) mismatch (PI–LL = ± 10° balanced versus PI–LL > 10° unbalanced) and corresponding adjustment of the acetabular component implantation. When performing THA, patients with suspected pathologic spinopelvic mobility should be identified by medical history and examination, and a radiological evaluation (a.p. pelvis standing and lateral femur to L1 or C7 (if EOS (EOS imaging, Paris, France) is available), respectively, for standing and sitting radiographs) of spinopelvic parameters should be conducted in order to classify the patient and determine the appropriate treatment strategy. Spine surgeons, before planned spinal fusion in the presence of osteoarthritis of the hip, should consider a hip flexion contracture and inform the patient of an increased risk of complications with existing or planned THA.
Highlights
Spinopelvic MobilityThe spine, pelvis, and hips take part in dynamic and complex interaction with one another
Spinopelvic mobility represents the complex interaction of hip, pelvis, and spine
The hip bends about 55–70◦, the pelvis tilts back (posterior Anterior Plane Pelvic Tilt (APPt)) approximately 20◦, and the lumbar spine lordosis decreases by about 20◦ [1] (Figure 1)
Summary
The spine, pelvis, and hips take part in dynamic and complex interaction with one another. The hip bends about 55–70◦, the pelvis tilts back (posterior APPt (anterior plane pelvic tilt)) approximately 20◦, and the lumbar spine lordosis decreases by about 20◦ [1] (Figure 1). For each degree (1.0◦) of posterior pelvic movement, there is an increase of 0.7◦ to 0.8◦ in acetabular anteversion [3,4]. When changing position from standing to supine, the pelvis moves anteriorly and leads to a reduction in acetabular anteversion [6]. Spinopelvic mobility can be affected by degenerative diseases of the spine and hip and by spinal fusioSnpisnuorpgeelrvyi.cImn aonbialigtyincgasnobceieatyf,fethcteedprbeyvadleegnecneeorfadtievgeedniesreaatsivese omfuthsceuslpoisnkeelaentadlhdiipseaansdesbiyncsrpeiansaels. Med. 2020, 9, 2569 investigate the necessary imaging, analyze different classifications of spinopelvic mobility, and identify the consequences to be drawn and possible surgical strategies with a particular focus on hip and spine surgeons
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