Differences in Spinopelvic Characteristics Between Hip Osteoarthritis Patients and Controls

Published:March 18, 2021DOI:



      This study of patients with hip primary osteoarthritis and a matched, asymptomatic, volunteers (controls) group aimed to determine spinopelvic differences between the two groups and their consequences for total hip arthroplasty.


      104 patients (52 in each group) had their sagittal spinopelvic parameters (lumbar lordosis angle, sacral slope, pelvic tilt, pelvic incidence, and the pelvic-femoral angle) measured in the standing, relaxed-seated, and deep-flexed seated positions. Spinopelvic movement was calculated as the change between the different positions, and individual spinopelvic mobility was classified in accordance with the change in pelvic tilt as previously described (ΔPT: stiff (<10°), normal (10-30°), and hypermobile (>30°)).


      Transitioning from the standing to relaxed-seated position, patients demonstrated 13˚ less hip flexion (P < .001), 12˚ more posterior pelvic tilt (P = .006), and 6˚ more lumbar flexion (P = .038) compared with controls. Transitioning from the standing to deep-flexed seated position, patients demonstrated 18˚ less hip flexion (P < .001), accompanied by a posterior and not an anterior pelvic tilt as in the controls (7˚ ± 14 vs −6˚ ± 17; P < .001). Patients showed a higher percentage of spinopelvic hypermobility (19% vs 2%; P = .008).


      The reduced ability of flexion in the arthritic hip, leads to posterior pelvic tilt in the relaxed-seated position. This is associated with a likely compensatory increased lumbar flexion to keep an upright position. Therefore, spinopelvic hypermobility has to be defined as pathologic. When moving to the deep-flexed seated position, decreased flexion of the arthritic hip prevents the pelvis from tilting anteriorly while the lumbar spine performs a compensatory flexion by approximately the same amount compared with controls.

      Level of Evidence

      Level II, diagnostic study.


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        • Stefl M.
        • Lundergan W.
        • Heckmann N.
        • McKnight B.
        • Ike H.
        • Murgai R.
        • et al.
        Spinopelvic mobility and acetabular component position for total hip arthroplasty.
        Bone Joint J. 2017; 99-B: 37
        • Esposito C.I.
        • Miller T.T.
        • Kim H.J.
        • Barlow B.T.
        • Wright T.M.
        • Padgett D.E.
        • et al.
        Does degenerative lumbar spine disease influence femoroacetabular flexion in patients undergoing total hip arthroplasty?.
        Clin Orthop Relat Res. 2016; 474: 1788
        • Phan D.
        • Bederman S.S.
        • Schwarzkopf R.
        The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty.
        Bone Joint J. 2015; 97-B: 1017
        • Esposito C.I.
        • Carroll K.M.
        • Sculco P.K.
        • Padgett D.E.
        • Jerabek S.A.
        • Mayman D.J.
        Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation.
        J Arthroplasty. 2018; 33: 1449
        • Malkani A.L.
        • Garber A.T.
        • Ong K.L.
        • Dimar J.R.
        • Baykal D.
        • Glassman S.D.
        • et al.
        Total hip arthroplasty in patients with previous lumbar fusion surgery: are there more dislocations and revisions?.
        J Arthroplasty. 2018; 33: 1189
        • Salib C.G.
        • Reina N.
        • Perry K.I.
        • Taunton M.J.
        • Berry D.J.
        • Abdel M.P.
        Lumbar fusion involving the sacrum increases dislocation risk in primary total hip arthroplasty.
        Bone Joint J. 2019; 101-B: 198
        • Buckland A.J.
        • Puvanesarajah V.
        • Vigdorchik J.
        • Schwarzkopf R.
        • Jain A.
        • Klineberg E.O.
        • et al.
        Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion.
        Bone Joint J. 2017; 99-B: 585
        • Grammatopoulos G.
        • Gofton W.
        • Jibri Z.
        • Coyle M.
        • Dobransky J.
        • Kreviazuk C.
        • et al.
        2018 frank stinchfield award: spinopelvic hypermobility is associated with an inferior outcome after THA: examining the effect of spinal arthrodesis.
        Clin Orthop Relat Res. 2019; 477: 310
        • Heckmann N.
        • McKnight B.
        • Stefl M.
        • Trasolini N.A.
        • Ike H.
        • Dorr L.D.
        Late dislocation following total hip arthroplasty: spinopelvic imbalance as a causative factor.
        J Bone Joint Surg Am. 2018; 100: 1845
        • Berliner J.L.
        • Esposito C.I.
        • Miller T.T.
        • Padgett D.E.
        • Mayman D.J.
        • Jerabek S.A.
        What preoperative factors predict postoperative sitting pelvic position one year following total hip arthroplasty?.
        Bone Joint J. 2018; 100-B: 1289
        • Tezuka T.
        • Heckmann N.D.
        • Bodner R.J.
        • Dorr L.D.
        Functional safe zone is superior to the Lewinnek safe zone for total hip arthroplasty: why the Lewinnek safe zone is not always predictive of stability.
        J Arthroplasty. 2019; 34: 3
        • Pierrepont J.
        • Hawdon G.
        • Miles B.P.
        • Connor B.O.
        • Bare J.
        • Walter L.R.
        • et al.
        Variation in functional pelvic tilt in patients undergoing total hip arthroplasty.
        Bone Joint J. 2017; 99-B: 184
        • Luthringer T.A.
        • Vigdorchik J.M.
        A preoperative workup of a "Hip-Spine" total hip arthroplasty patient: a simplified approach to a complex problem.
        J Arthroplasty. 2019; 34: S57
        • Riviere C.
        • Harman C.
        • Parsons T.
        • Villet L.
        • Cobb J.
        • Maillot C.
        Kinematic alignment versus conventional techniques for total hip arthroplasty: a retrospective case control study.
        Orthop Traumatol Surg Res. 2019; 105: 895
        • Kim Y.
        • Vergari C.
        • Girinon F.
        • Lazennec J.Y.
        • Skalli W.
        Stand-to-Sit kinematics of the pelvis is not always as expected: hip and spine pathologies can have an impact.
        J Arthroplasty. 2019; 34: 2118
        • Hey H.W.
        • Lau E.T.
        • Lim J.L.
        • Choong D.A.
        • Tan C.S.
        • Liu G.K.
        • et al.
        Slump sitting X-ray of the lumbar spine is superior to the conventional flexion view in assessing lumbar spine instability.
        Spine J. 2017; 17: 360
        • Innmann M.M.
        • Merle C.
        • Gotterbarm T.
        • Ewerbeck V.
        • Beaule P.E.
        • Grammatopoulos G.
        Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty? A prospective, diagnostic study of patients with end-stage hip osteoarthritis.
        Bone Joint J. 2019; 101-B: 902
        • Hallgren K.A.
        Computing inter-rater reliability for observational data: an overview and tutorial.
        Tutor Quant Methods Psychol. 2012; 8: 23
        • McKnight B.M.
        • Trasolini N.A.
        • Dorr L.D.
        Spinopelvic motion and impingement in total hip arthroplasty.
        J Arthroplasty. 2019; 34: S53
        • Schwab F.J.
        • Blondel B.
        • Bess S.
        • Hostin R.
        • Shaffrey C.I.
        • Smith J.S.
        • et al.
        International Spine Study G. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis.
        Spine (Phila Pa 1976). 2013; 38: E803
        • Bess S.
        • Schwab F.
        • Lafage V.
        • Shaffrey C.I.
        • Ames C.P.
        Classifications for adult spinal deformity and use of the scoliosis research society-schwab adult spinal deformity classification.
        Neurosurg Clin N Am. 2013; 24: 185
        • Nam D.
        • Riegler V.
        • Clohisy J.C.
        • Nunley R.M.
        • Barrack R.L.
        The impact of total hip arthroplasty on pelvic motion and functional component position is highly variable.
        J Arthroplasty. 2017; 32: 1200
        • Kanawade V.
        • Dorr L.D.
        • Wan Z.
        Predictability of acetabular component angular change with postural shift from standing to sitting position.
        J Bone Joint Surg Am. 2014; 96: 978
        • DiGioia A.M.
        • Hafez M.A.
        • Jaramaz B.
        • Levison T.J.
        • Moody J.E.
        Functional pelvic orientation measured from lateral standing and sitting radiographs.
        Clin Orthop Relat Res. 2006; 453: 272
        • Innmann M.M.
        • Reichel F.
        • Schaper B.
        • Beaule P.E.
        • Merle C.
        • Grammatopoulos G.
        How does spinopelvic mobility and sagittal functional cup orientation affect patient reported outcome 1 year after THA? - a prospective diagnostic cohort study.
        J Arthroplasty. 2021;
        • Hey H.W.D.
        • Lau E.T.
        • Tan K.A.
        • Lim J.L.
        • Choong D.
        • Lau L.L.
        • et al.
        Lumbar spine alignment in six common postures: an ROM analysis with implications for deformity correction.
        Spine (Phila Pa 1976). 2017; 42: 1447
        • Roussouly P.
        • Gollogly S.
        • Berthonnaud E.
        • Dimnet J.
        Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position.
        Spine (Phila Pa 1976). 2005; 30: 346
        • Devin C.J.
        • McCullough K.A.
        • Morris B.J.
        • Yates A.J.
        • Kang J.D.
        Hip-spine syndrome.
        J Am Acad Orthop Surg. 2012; 20: 434
        • Parvizi J.
        • Pour A.E.
        • Hillibrand A.
        • Goldberg G.
        • Sharkey P.F.
        • Rothman R.H.
        Back pain and total hip arthroplasty: a prospective natural history study.
        Clin Orthop Relat Res. 2010; 468: 1325
        • Sharma A.K.
        • Vigdorchik J.M.
        The hip-spine relationship in total hip arthroplasty: how to execute the plan.
        J Arthroplasty. 2021;
        • Wiznia D.H.
        • Buchalter D.B.
        • Kirby D.J.
        • Buckland A.J.
        • Long W.J.
        • Schwarzkopf R.
        Applying the hip-spine relationship in total hip arthroplasty.
        Hip Int. 2020; (1120700020949837)
        • Innmann M.M.
        • Merle C.
        • Phan P.
        • Beaule P.E.
        • Grammatopoulos G.
        How can patients with mobile hips and stiff lumbar spines Be identified prior to total hip arthroplasty? A prospective, diagnostic cohort study.
        J Arthroplasty. 2020; 35: S255