• Eur Spine J · Sep 2022

    Impact of the hip joint mobility on whole-body sagittal alignment: prospective analysis in case with hip arthroplasty.

    • Jun Ouchida, Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Kei Ando, Kenyu Ito, Mikito Tsushima, Masaaki Machino, Sadayuki Ito, Hidetoshi Yamaguchi, Naoki Segi, Hiroyuki Koshimizu, Hiroyuki Tomita, and Shiro Imagama.
    • Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Nagoya-shi, Aichi, 466-8550, Japan.
    • Eur Spine J. 2022 Sep 1; 31 (9): 2399-2407.

    PurposeTo clarify the impact of restriction of hip extension on radiographic whole-body sagittal alignment with using postoperative changes of radiographical parameters for hip osteoarthritis.MethodsWe prospectively enrolled 68 patients with hip osteoarthritis scheduled for arthroplasty. Variables included manual examination of hip range of motion (H-ROM) and radiographic whole-body sagittal alignment parameters including sagittal vertical axis (SVA), center of acoustic meatus and femoral head offset (CAM-HA), thoracic kyphosis (TK), lumbar lordosis, sacral slope (SS), and knee flexion angle (KF). We divided patients with preoperative hip extension angle < 0 into the extension restriction (ER) + group and ≥ 0 into the ER- group. Differences in H-ROM, radiographic parameters between groups and postoperative changes were comparatively analyzed.ResultsFifty-seven patients (The ER + group included 28 patients and the ER- group included 29 patients.) were available for the analysis. Pre-/postoperative H-ROM were 99.7 ± 24.9/118.1 ± 16.0 degrees (p < .01). Greater increases in SVA (5.4 ± 3.4 vs 3.4 ± 2.8 cm, p = .02) and in CAM-HA (3.9 ± 3.9 vs 2.8 ± 3.4 cm, p =  013) were found in the ER + group versus ER- group. Postoperatively, the ER + group showed an increase in TK (pre-/postoperative: 35.2 ± 9.7/37.4 ± 8.8 degrees, p = .04) and decreases in SS (36.5 ± 9.6/33.7 ± 9.9 degrees, p < .01) and KF (9.5 ± 7.0/6.9 ± 6.0 degrees, p = .02). Postoperative changes in radiographic parameters in the ER- group were not significant.ConclusionPatients with restriction of hip extension showed global spine imbalance, and significant changes in TK, SS, and KF were observed after arthroplasty. The presence of hip joint disorder and H-ROM restriction must be considered when evaluating spinopelvic alignment and whole-body sagittal alignment.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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