Hip replacement improves lumbar flexibility and intervertebral disc height — a prospective observational investigation with standing and sitting assessment of ... View Full Text


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Article Info

DATE

2022-07-11

AUTHORS

Maximilian Muellner, Zhen Wang, Zhouyang Hu, Sebastian Hardt, Matthias Pumberger, Luis Becker, Henryk Haffer

ABSTRACT

PurposeThe pathogenic mechanism of the hip–spine syndrome is still poorly elucidated. Some studies have reported a reduction in low back pain after total hip arthroplasty (THA). However, the biomechanical mechanisms of THA acting on the lumbar spine are not well understood. The aim of the study is to evaluate the influence of THA on (1) the lumbar lordosis and the lumbar flexibility and (2) the lumbar intervertebral disc height.MethodsA total of 197 primary THA patients were prospectively enrolled. Pre- and post-operative biplanar stereoradiography was performed in standing and sitting positions. Spinopelvic parameters (lumbar lordosis (LL), pelvic tilt, sacral slope, pelvic incidence), sagittal spinal alignment (sagittal vertical axis, PI-LL mismatch (PI-LL)) and lumbar disc height index (DHI) for each segment (L1/2 to L5/S1) were evaluated. The difference between standing and sitting LL (∆LL = LLstanding − LLsitting) was determined as lumbar flexibility. Osteochondrosis intervertebralis was graded according to Kellgren and Lawrence (0–4), and patients were assigned to subgroups (mild: 0–2; severe: 3–4).ResultsLumbar flexibility increased significantly after THA (pre: 22.04 ± 12.26°; post: 25.87 ± 12.26°; p < 0.001), due to significant alterations in LL in standing (pre: 51.3 ± 14.3°; post: 52.4 ± 13.8°; p < 0.001) and sitting (pre: 29.4 ± 15.4°; post: 26.7 ± 15.4°; p = 0.01). ∆LL increased significantly in both subgroups stratified by osteochondrosis (pre/post: ΔLLmild: 25.4 (± 11.8)/29.4 ± 12.0°; p < 0.001; ΔLLsevere: 17.5 (± 11.4)/21.0 ± 10.9°; p = 0.003). The DHI increased significantly from pre-operatively to post-operatively in each lumbar segment. PI-LL mismatch decreased significantly after THA (pre: 3.5°; post: 1.4°; p < 0.001).ConclusionThe impact of THA on the spinopelvic complex was demonstrated by significantly improved lumbar flexibility and a gain in post-operative disc height. These results illustrate the close interaction between the pelvis and the vertebral column. The investigation provides new insights into the biomechanical patterns influencing the hip–spine syndrome. More... »

PAGES

2195-2203

References to SciGraph publications

  • 2019-11. Spinopelvic Compensatory Mechanisms for Reduced Hip Motion (ROM) in the Setting of Hip Osteoarthritis in SPINE DEFORMITY
  • 2021-10-11. Acetabular cup position differs in spinopelvic mobility types: a prospective observational study of primary total hip arthroplasty patients in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2017-03-16. Spinopelvic parameter changes and low back pain improvement due to femoral neck anteversion in patients with severe unilateral primary hip osteoarthritis undergoing total hip replacement in EUROPEAN SPINE JOURNAL
  • 2010-02-03. Back Pain and Total Hip Arthroplasty: A Prospective Natural History Study in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2011-08-26. Sagittal spino-pelvic alignment in chronic low back pain in EUROPEAN SPINE JOURNAL
  • 2011-08-02. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology in EUROPEAN SPINE JOURNAL
  • 2015-11-09. Risk factors for lumbar intervertebral disc height narrowing: a population-based longitudinal study in the elderly in BMC MUSCULOSKELETAL DISORDERS
  • 2008-07-04. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis in EUROPEAN SPINE JOURNAL
  • 2016-02-16. The effect of total hip arthroplasty on sagittal spinal–pelvic–leg alignment and low back pain in patients with severe hip osteoarthritis in EUROPEAN SPINE JOURNAL
  • 2013-09-20. Compensatory mechanisms contributing to keep the sagittal balance of the spine in EUROPEAN SPINE JOURNAL
  • 2012-11-28. Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults in EUROPEAN SPINE JOURNAL
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00264-022-05497-9

    DOI

    http://dx.doi.org/10.1007/s00264-022-05497-9

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    28 schema:description Abstract PurposeThe pathogenic mechanism of the hip–spine syndrome is still poorly elucidated. Some studies have reported a reduction in low back pain after total hip arthroplasty (THA). However, the biomechanical mechanisms of THA acting on the lumbar spine are not well understood. The aim of the study is to evaluate the influence of THA on (1) the lumbar lordosis and the lumbar flexibility and (2) the lumbar intervertebral disc height.MethodsA total of 197 primary THA patients were prospectively enrolled. Pre- and post-operative biplanar stereoradiography was performed in standing and sitting positions. Spinopelvic parameters (lumbar lordosis (LL), pelvic tilt, sacral slope, pelvic incidence), sagittal spinal alignment (sagittal vertical axis, PI-LL mismatch (PI-LL)) and lumbar disc height index (DHI) for each segment (L1/2 to L5/S1) were evaluated. The difference between standing and sitting LL (∆LL = LLstanding − LLsitting) was determined as lumbar flexibility. Osteochondrosis intervertebralis was graded according to Kellgren and Lawrence (0–4), and patients were assigned to subgroups (mild: 0–2; severe: 3–4).ResultsLumbar flexibility increased significantly after THA (pre: 22.04 ± 12.26°; post: 25.87 ± 12.26°; p < 0.001), due to significant alterations in LL in standing (pre: 51.3 ± 14.3°; post: 52.4 ± 13.8°; p < 0.001) and sitting (pre: 29.4 ± 15.4°; post: 26.7 ± 15.4°; p = 0.01). ∆LL increased significantly in both subgroups stratified by osteochondrosis (pre/post: ΔLLmild: 25.4 (± 11.8)/29.4 ± 12.0°; p < 0.001; ΔLLsevere: 17.5 (± 11.4)/21.0 ± 10.9°; p = 0.003). The DHI increased significantly from pre-operatively to post-operatively in each lumbar segment. PI-LL mismatch decreased significantly after THA (pre: 3.5°; post: 1.4°; p < 0.001).ConclusionThe impact of THA on the spinopelvic complex was demonstrated by significantly improved lumbar flexibility and a gain in post-operative disc height. These results illustrate the close interaction between the pelvis and the vertebral column. The investigation provides new insights into the biomechanical patterns influencing the hip–spine syndrome.
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    91 reduction
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