Spinopelvic alignment and low back pain after total hip arthroplasty: a scoping review

Abstract

Objective Spinopelvic alignment is increasingly considered as an essential factor for maintaining an energy-efficient posture in individuals with normal or pathological status. Although several previous studies have shown that changes in the sagittal spinopelvic alignment may occur in patients undergoing total hip arthroplasty (THA), no review of this area has been completed so far. Thus, the objective of this scoping review was to summarize the evidence investigating changes in spinopelvic alignment and low back pain (LBP) following THA. Data sources We adhered to the established methodology for scoping reviews. Four electronic databases were systematically searched from inception-December 31, 2021. Study selection We selected prospective or retrospective observational or intervention studies that included patients with THA. Data extraction Data extraction and levels of evidence were independently performed using standardized checklists. Data synthesis A total of 45 papers were included in this scoping review, involving 5185 participants with THA. Pelvic tilt was the most common parameter measured in the eligible studies (n = 26). The results were not consistent across all studies; however, it was demonstrated that the distribution of pelvic tilt following THA had a range of 25° posterior to 20° anterior. Moreover, decreased sacral slope and lower pelvic incidence were associated with increased risk of dislocation in patients with THA. Lumbar spine scoliosis did not change significantly after THA in patients with bilateral hip osteoarthritis (5.50°(1.16°) vs. 3.73°(1.16°); P-value = 0.29). Finally, one study indicated that LBP improvement was not correlated with postoperative changes in spinopelvic alignment parameters. Several methodological issues were addressed in this study, including no sample size calculation and no type-I error adjustment for outcome multiplicity. Conclusions Changes in spinopelvic alignment may occur after THA and may improve with time. Patients with a THA dislocation usually show abnormal spinopelvic alignment compared to patients without a THA dislocation. LBP usually improves markedly over time following THA.

Changes in spinal alignment one month post abdominal surgery: A prospective cohort study

“…[21,22] Furthermore, hip surgery has also been reported to affect the lumbar spine and pelvic mobility. [25,26] Although changes in spinal alignment, particularly those in the lumbar spine, were observed, no association was found with wound pain. Postoperative wound pain is experienced by many patients and has been reported to be associated with various postoperative complications.…”

“…[21,22] Furthermore, hip surgery has also been reported to affect the lumbar spine and pelvic mobility. [25,26]…”

Mid-term low back pain improvement after total hip arthroplasty in 306 patients with developmental dysplasia of the hip

“…The LBP improvement after THA in patients with bilateral asymmetry and symmetrical DDH hips were limited. Spinopelvic alignment is an essential factor for maintaining an energy-efficient posture in individuals [6]. Various spinopelvic alignment parameters have been evaluated before or after THA in studies, including pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis, lumbar lordotic angle, thoracic kyphosis angle, and coronal lumbar angles, problems from which exist in patients with bilateral DDH hips.…”

“…Moreover, there was a lack of an assessment of LBP to take into account hip and spinal disorders as a whole, and no specific scale for LBP. Patients with a hip dislocation usually showed abnormal spinopelvic alignment [6]. And it took a long time for DDH patients after THA to gradually establish new walking habits and adapt to new hip relationships.…”

“…The Back Pain Function Scale (BPFS) is a developed 12-item scale that introduces a new aspect of healthrelated quality of life, the patient's difficulty in completing daily activities [6]. It can take into account hip and spinal disorders as a whole, through completing daily activities, for quantitative assessment.…”