The significant relationship among the factors of pelvic incidence, standing lumbar lordosis, and lumbar flexibility in Japanese patients with hip osteoarthritis: A descriptive radiographic study

Abstract

IntroductionSpine stiffness is known to increase the risk of total hip replacement (THR) instability. The sagittal posture and lumbo-pelvic kinematics have therefore become parameters of interest when planning THR. We conducted this study to investigate (1) the distribution and characteristics of the spino-pelvic standing alignment, (2) the relationship between pelvic incidence (PI) and standing lumbar lordosis (LL) and lumbar flexibility, in Japanese hip osteoarthritis patients. Hypothesis(1) Japanese hip osteoarthritis patients with different sagittal spino-pelvic alignments do not differ markedly in their demographics, PI, or lumbar flexibility; and (2) there is no significant relationship between PI, standing LL, and lumbar flexibility in a population of Japanese hip osteoarthritis patients. Material and MethodsA retrospective study of radiographs from 945 Japanese patients who consecutively received THR for the treatment of hip osteoarthritis. All patients pre-operatively underwent lateral standing and deep-seated lumbo-pelvic radiography on which the spino-pelvic parameters were measured. The difference between the standing and deep-seated LL angles defined the lumbar flexibility and was calculated as the delta (Δ) LL. Individual spino-pelvic standing alignment was stratified based on the difference between the PI and standing LL (‘PI-LL mismatch’). ‘PI-LL mismatch’ of<−10°, between −10° and 10°, and>10° was defined as hyperlordosis, normolordosis, and flatback, respectively. ResultsIn the present study, the spinal alignment of 115/945 (12.2%), 559/945 (59.2%), and 271/945 (28.6%) patients were classified as hyperlordosis, normolordosis, and flatback, respectively. Hyperlordotic patients had significantly lower PI (47.6°±7.8° vs. 52.7°±10.5°, p<0.001) and higher ΔLL (60.6°±12.6° vs. 51.6°±12.8°, p<0.001) than normolordotic patients. Patients with flatback were significantly older (age, 69.1±9.1 years vs. 62.7±9.8 years, p<0.001) with higher PI (56.9°±11.7° vs. 52.7°±10.5°, p<0.001) and lower ΔLL (35.2°±17.4° vs. 51.6°±12.8°, p<0.001) than normolordotic patients. A significant relationship between PI and the standing LL was found in the whole cohort (r=0.409, p=0.009), hyperlordotic (r=0.785, p<0.001), normolordotic (r=0.857, p<0.001), and flatback (r=0.664, p<0.001) patients. Significant relationships between the PI and ΔLL were also found in normolordotic (r=0.442, p=0.004) and flatback (r=0.449, p=0.003) patients but not hyperlordotic patients (r=0.154, p=0.367). DiscussionA large proportion of Japanese hip osteoarthritis patients have abnormal PI-LL mismatch (12% and 29% have hyperlordosis and flatback, respectively). The PI was a determinant of the standing LL and the lumbar flexibility, especially in the normolordotic and flatback individuals. Level of EvidenceIII; retrospective diagnostic radiographic study.