Total Hip Replacement Influences Spinopelvic Mobility: A Prospective Observational Study

  • Henryk Haffer
    Correspondence
    Address correspondence to: Henryk Haffer, MD, Charité - Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Campus Mitte, Luisenstr.64, 10117 Berlin, Germany.
    Affiliations
    Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Zhen Wang
    Affiliations
    Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Zhouyang Hu
    Affiliations
    Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Christian Hipfl
    Affiliations
    Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Carsten Perka
    Affiliations
    Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Matthias Pumberger
    Affiliations
    Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Published:November 03, 2021DOI:https://doi.org/10.1016/j.arth.2021.10.029

      Abstract

      Background

      Abnormal spinopelvic mobility is identified as a contributing element of total hip arthroplasty (THA) instability. Preoperative identification of THA patients at risk is still a remaining challenge. We therefore conducted this study to (1) evaluate if preoperative and postoperative spinopelvic mobility differs, (2) determine the interactions between the elements of the spinopelvic complex, and (3) identify preoperative parameters for predicting spinopelvic mobility.

      Methods

      A prospective observational study assessing 197 THA patients was conducted with biplanar stereoradiography in standing and relaxed sitting positions preoperatively and postoperatively. Two independent investigators determined spinopelvic mobility based on 2 different classifications (Δ sacral slope [SS] and Δ pelvic tilt [PT]; Δ from standing to sitting; Δ < 10° stiff, Δ ≥ 10°-30° normal, Δ > 30° hypermobile). Multiple regression analysis and receiver operating characteristic analysis were used to identify predictors for postoperative spinopelvic mobility.

      Results

      Spinopelvic mobility significantly increased after THA based on ΔPT (Pre/Post: 18.5°/22.8°; P < .000) and ΔSS (Pre/Post 17.9°/22.4°; P < .000). A distinct shift in the ratio from stiff (Pre/Post: 24%/9.7%) to hypermobile (Pre/Post: 10.2%/22.1%) mobility postoperatively was observed. Receiver operating characteristic analysis predicted postoperative stiffness using preoperative PTStanding ≥ 13.0° with a sensitivity of 90% and a specificity of 51% and hypermobility with preoperative SSStanding ≥ 35.2° with a sensitivity of 81% and a specificity of 34%. Age at surgery, preoperative PTStanding, and pelvic incidence were independent predictors of spinopelvic mobility (R2 = 0.24).

      Conclusion

      Definition of preoperative stiffness should be interpreted with caution by arthroplasty surgeons as mobility itself is influenced by THA. For the first time thresholds for standing preoperative parameters for predicting postoperative spinopelvic mobility could be provided. For preoperative standing only lateral assessment could serve as a screening tool for spinopelvic mobility.

      Keywords

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