Influence of total hip arthroplasty on sagittal lumbar-pelvic balance: Evaluation of radiographic parameters

Miranda, Saulo Fouani de; Corotti, Vitor Gustavo de Paiva; Menegaz, Phelipe; Ueda, Welington; Vialle, Emiliano Neves; Vialle, Luiz Roberto

doi:10.1016/j.rbo.2018.04.005

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Revista Brasileira de Ortopedia

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Sumário

Artigo Original • Rev. bras. ortop. 54 (6) • Nov-Dec 2019 • https://doi.org/10.1016/j.rbo.2018.04.005 copy

Influence of total hip arthroplasty on sagittal lumbar-pelvic balance: Evaluation of radiographic parameters^* * Work performed at the Orthopedics and Traumatology Service of the Hospital Universitário Cajuru (PUC-PR), Curitiba, PR, Brazil. Originally Published by Elsevier Editora Ltda.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To prospectively analyze the radiographic variables of lumbosacral sagittal balance in the pre- and postoperative period of patients submitted to total hip arthroplasty (THA).

Methods

A prospective, observational, comparative study that evaluated pre- and postoperative radiographic parameters of 71 patients, submitted to 72 total hip arthroplasties in a 3-year period (2014-2017) for primary coxarthrosis, of whom 28 performed late postoperative control (6 months) through the Surgimap Spine software (Surgimap, New York, NY, USA). Statistical analysis was performed using the Student t-test, the analysis of covariance (ANCOVA) model, and the Kolmogorov-Smirnov test. The data were analyzed using the IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). A p-value < 0.05 indicated statistical significance.

Results

A total of 72 cases, presenting a mean age of 57.9 years old, predominantly females (60.6%) and patients > 50 years old (71.8%). There was an overall decrease in lumbar lordosis values in the immediate postoperative period, without major global changes in late evolution. It was found that patients with a pelvic incidence ≥ 60° tended to have their other sagittal balance parameters elevated.

Conclusion

There was no significant difference between the radiographic variables of sagittal lumbopelvic balance in the evaluated periods. Lumbar lordosis and pelvic incidence were the main modifying factors. Improvement of low back pain after THA, without changes in parameters, suggests different pathology mechanisms still to be clarified.

Keywords
hip arthroplasty; spine; low back pain

SS Variable	Line 1	Line 2	Normal value
Lumbar lordosis (LL)	Superior L1 plate	Terminal S1 plate	41 ± 11º/46 ± 11º
Pelvic tilt (PT)	Line vertical to the ground	Midpoint from the sacral plate to the femoral head axis	10º-25º
Pelvic incidence (PI)	Perpendicular to the sacral plate	Midpoint from the sacral plate to the femoral head axis	45º-65º
Sacral slope (SS)	Superior S1 plateau	Line horizontal to the ground	30º-50º

LL	Preoperative period		Postoperative period		Late postoperative period
	n	%	n	%	n	%
Hyperlordosis^a a Women > 57º; Men > 52º.	47	65.3	40	55.6	18	64.3
Normolordosis^b b Women 35º to 57º; Men 30º to 52º.	23	31.9	30	41.7	10	35.7
Hypolordosis^c c Women < 35º; Men < 30º.	2	2.8	2	2.8	0	0
Total	72	100	72	100	28	100

	n	Mean	Median	Minimum	Maximum	Standard deviation	p-value ^a a Student's t-test for paired samples (p < 0.05).
Pelvic tilt
Preoperative	72	13,3	14,5	-1,3	36	10.1
Postoperative	72	11,9	11	-11	39	10.30
Difference (postoperative-preoperative)	72	-1,4	-1	-33	29	9.9	0.219
Pelvic incidence
Preoperative	72	55,9	53	25	100	13.0
Postoperative	72	54,8	52	20	100	13.5
Difference (postoperative-preoperative)	72	-1,1	0	-21	15	6.3	0.158
Sacral slope
Preoperative	72	42,4	42	-2	74	11.0
Postoperative	72	42,9	41	23	85	11.5
Difference (postoperative-preoperative)	72	0,4	0	-25	29	8.5	0.658
Lumbar lordosis
Preoperative	72	-57,3	-58	-96	-2	13.6
Postoperative	72	-56,8	-56	-116	-27	14.3
Difference (postoperative-preoperative)	72	0,5	0	-53	33	12.1	0.750

	n	Mean	Median	Minimum	Maximum	Standard deviation	p-value ^a a Student's t-test for paired samples (p < 0.05).
Pelvic tilt
Preoperative	28	16.0	16	0	34	7.8
Postoperative	28	13.5	13	-4	33	7.5
Difference (postoperative-preoperative)	28	-2.5	-2	-24	17	7.9	0.105
Pelvic incidence
Preoperative	28	57.1	57	32	100	12.8
Postoperative	28	54.5	52	31	87	14.9
Difference (postoperative-preoperative)	28	-2.6	-3.5	-17	14	7.6	0.085
Sacral slope
Preoperative	28	40.3	41	18	74	10.7
Postoperative	28	41.1	39	28	69	10.5
Difference (postoperative-preoperative)	28	0.7	-2	-13	26	8.2	0.632

Variable	Evaluation	Preoperative PI	n	Mean	Minimum	Maximum	Standard deviation	p value^a a Student's t-test for independent samples (preoperative evaluation); adjusted analysis of covariance (ANCOVA) for preoperative evaluation (for remaining assessments); p < 0.05.
Pelvic tilt	Preoperative	< 60	49	9,8	-13	34	9.0
		≥ 60	23	20,7	9	36	8.3	< 0.001
	Postoperative	< 60	49	9,1	-11	32	9.4
		≥ 60	23	17,8	-1	39	10.0	0.157
	Late postoperative	< 60	18	10,5	-4	23	6.4
		≥ 60	10	18,9	11	33	6.3	0.017
	Difference	< 60	49	-0,7	-33	29	9.8
	(postoperative-preoperative)	≥ 60	23	-3,0	-33	13	10.2	0.157
	Difference (late postoperative-	< 60	18	-3,3	-24	7	8.0
	preoperative)	≥ 60	10	-1,0	-10	17	7.8	0.017
	Difference (postoperative-	< 60	18	-0,1	-18	10	6.4
	late postoperative)	≥ 60	10	-0,6	-19	17	9.1	0.672
Sacral slope	Preoperative	< 60	49	39,3	-2	57	10.1
		≥ 60	23	49,2	31	74	9.9	< 0.001
	Postoperative	< 60	49	39,4	23	61	9.1
		≥ 60	23	50,4	31	85	12.6	0.050
	Late postoperative	< 60	18	35,7	28	48	6.1
		≥ 60	10	50,7	33	69	10.0	0.007
	Difference	< 60	49	1	-25	29	8.9
	(postoperative-preoperative)	≥ 60	23	1,2	-14	21	7.7	0.050
	Difference (late postoperative-	< 60	18	-0,1	-13	26	8.8
	preoperative)	≥ 60	10	2,3	-9	13	7.1	0.007
	Difference (late postoperative-	< 60	18	-1,1	-10	11	6.2
	postoperative	≥ 60	10	0,7	-16	16	8.6	0.112
Lordosis	Preoperative	< 60	49	-53,9	-77	-2	12.6
		≥ 60	23	-64,5	-96	-34	13.1	0.002
	Postoperative	< 60	49	-53,9	-71	-31	10.6
		≥ 60	23	-64,7	-116	-27	17.8	0.077
	Late postoperative	< 60	18	-55,2	-75	-39	9.5
		≥ 60	10	-65,3	-82	-40	11.9	0.402
	Difference	< 60	49	0,8	-32	33	10.9
	(postoperative-preoperative)	≥ 60	23	-0,2	-53	28	14.6	0.077
	Difference (late postoperative-	< 60	18	-4,2	-32	11	11.5
	preoperative)	≥ 60	10	-0,8	-14	14	8.6	0.402
	Difference (late postoperative-	< 60	18	-3,8	-20	11	7.7
	postoperative)	≥ 60	10	3,2	-9	39	14.9	0.263

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[1] Address for correspondence, Saulo Fouani de Miranda, MD, Orthopedics Service, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil. (e-mail: s_fm@hotmail.com).

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Influence of total hip arthroplasty on sagittal lumbar-pelvic balance: Evaluation of radiographic parameters* * Work performed at the Orthopedics and Traumatology Service of the Hospital Universitário Cajuru (PUC-PR), Curitiba, PR, Brazil. Originally Published by Elsevier Editora Ltda.

Abstract

Objective

Methods

Results

Conclusion

Influence of total hip arthroplasty on sagittal lumbar-pelvic balance: Evaluation of radiographic parameters^* * Work performed at the Orthopedics and Traumatology Service of the Hospital Universitário Cajuru (PUC-PR), Curitiba, PR, Brazil. Originally Published by Elsevier Editora Ltda.