Spinopelvic parameter changes and low back pain improvement due to femoral neck anteversion in patients with severe unilateral primary hip osteoarthritis undergoing total hip replacement

Piazzolla, Andrea; Solarino, Giuseppe; Bizzoca, Davide; Montemurro, Viola; Berjano, Pedro; Lamartina, Claudio; Martini, Carlotta; Moretti, Biagio

doi:10.1007/s00586-017-5033-7

Cited by 54 publications

(70 citation statements)

References 32 publications

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“…In a prospective study, Weng reported a signi cantly larger SS and smaller PT in patients with hip OA [6]. Piazzolla reported that patients with hip OA and low back pain have signi cantly increased SS, LL, and forward inclination of the trunk [17]. Yoshimoto chose individuals with low back pain as controls and reported that patients with hip OA showed signi cantly higher PI, SS and LL [7].…”

Section: Discussionmentioning

confidence: 99%

Sagittal Spinal-pelvic Alignment in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Ren

Kong

Chai

et al. 2020

Preprint

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Background: The impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described. This study aims to evaluate compensatory spinal radiographic changes and presence of back pain in patients with Crowe type IV developmental dysplasia of the hip (DDH).Methods: An observational study was conducted from July 2016 to December 2017, and 49 consecutive patients with Crowe IV DDH were enrolled. Forty-nine sex- and age-matched asymptomatic healthy adults were recruited as the controls. The sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and sagittal vertical axis (SVA[C7]) were measured on lateral whole spine radiographs. The presence of low back pain (LBP) and visual analogue scale (VAS) scores were recorded. Results: The patients with Crowe IV DDH showed significantly greater SS (47.5±7.5° vs. 40.4±6.7°, p<0.05), LL (-63.7±9.2° vs. -53.3±11.5°, P<0.05), SSA (141.8°±7.2° vs. 130.6±7.9°, p<0.05), C7T (93.9±3.6° vs. 91.1±3.7°, P<0.05), and lower SVA(C7) (-16mm[-95-45] vs. 6.4mm[-52-47], p<0.05) compared to the controls. The patients with bilateral Crowe IV DDH also exhibited larger SS, LL, SSA, and C7T and a smaller SVA (C7) than those with unilateral Crowe IV DDH. Sixty-three percent of the patients with Crowe IV DDH reported LBP.Conclusion: The patients with Crowe IV DDH exhibited abnormal spinal-pelvic alignment characterized by anterior pelvic tilt, lumbar hyperlordosis, and a backward-leaning trunk. Bilateral Crowe IV DDH had a greater impact on spinal-pelvic alignment than unilateral Crowe IV DDH.

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Section: Discussionmentioning

confidence: 99%

Sagittal Spinal-pelvic Alignment in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Ren

Kong

Chai

et al. 2020

Preprint

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“…Second, we evaluated the surgical history of joints but not the joint lesions and lower extremity alignment. Several studies indicated that hip lesion and leg length alignment had played an important role in the occurrence of LBP in non-RA patients [35][36][37]. RA affects all synovial joints, causing painful swelling that can cause bone erosion, joint deformity, and malalignment.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of and factors associated with dysfunctional low back pain in patients with rheumatoid arthritis

et al. 2019

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Purpose To investigate the prevalence of and factors associated with dysfunctional low back pain (LBP) in patients with rheumatoid arthritis (RA). Methods This cross-sectional study included 1276 RA outpatients from two hospitals. The Roland-Morris Disability Questionnaire was used to address the functional-dysfunctional state criterion. Clinical variables, such as medical status, disease activity, bone mineral density, and spinopelvic alignment parameters, were compared between patients with and without dysfunctional LBP. Results Mean age and disease duration were 64.6 and 13.4 years, respectively; the prevalence of dysfunctional LBP was 32.8%. On univariate analysis, significant differences existed in many variables, except sex, body weight, C-reactive protein (CRP) level, and prevalence of biological agent users, between patients with and without dysfunctional LBP. Multivariate logistic regression analysis revealed body mass index (BMI; odds ratio [OR], 1.116; P < 0.001), onset age of RA (OR, 1.020; P = 0.020), disease duration of RA (OR, 1.043; P < 0.001), methotrexate (MTX) use (OR, 0.609; P = 0.007), vertebral fractures (OR, 2.189; P = 0.001), vertebral endplate and/or facet erosion (OR, 1.411; P = 0.043), disease activity score (DAS) in 28 joints-CRP (DAS-28CRP) (OR, 1.587; P = 0.001), pelvic tilt (PT; OR, 1.023; P = 0.019), and sagittal vertical axis (SVA; OR, 1.007; P = 0.043) as associated factors. Conclusion The factors associated with dysfunctional LBP in patients with RA were more vertebral fractures, higher DAS-28CRP, vertebral endplate and/or facet erosion, higher BMI, longer disease duration, greater PT, older onset age, greater SVA, and less MTX use. Strictly controlling patients' body weight and disease activity with MTX and avoiding spinopelvic malalignment through vertebral fracture prevention are important.

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“…In a prospective study in which the comparison group consisted of normal controls, Weng et al reported a significantly larger SS, smaller PT, and comparable LL and PI in patients with hip OA [9]. Piazzolla et al [18]reported that patients with unilateral hip OA and low back pain have significantly increased SS, LL, and forward inclination of the trunk. In addition, the authors also found increased femoral neck anteversion in the arthritic hip when compared to the contralateral healthy hip.…”

Section: Discussionmentioning

confidence: 99%

“…Parvizi et al [24] reported that 49% of patients with end-stage hip arthritis had LBP. In a study of 91 primary hip OA patients who underwent THA, Piazzolla [18] Pelvic tilt has been and remains a concern for hip surgeons because anterior or posterior pelvic tilt has a substantial impact on the orientation of the acetabular cup. For every 1°of posterior pelvic tilt, there is a corresponding increase of 0.7°-0.8° of acetabular anteversion [6,25,26].…”

Section: Discussionmentioning

confidence: 99%

Sagittal Spinal-pelvic Alignment in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Ren

Kong

Chai

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The compensatory mechanisms of the spine, pelvis, and lower limbs are essential to maintaining an upright posture. The effect of a high dislocated dysplastic hip on spinal-pelvic alignment has not been well described. The aim of this study was to investigate the sagittal spinal-pelvic alignment in patients with Crowe type IV developmental dysplasia of the hip(DDH). Methods A prospective study was conducted from July 2016 to December 2017, and 49 consecutive patients with unilateral or bilateral high dislocated dysplastic hips were enrolled. Forty-nine sex- and age-matched asymptomatic healthy adults were also recruited as a control group. The sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and sagittal vertical axis (SVA[C7])were measured on lateral whole spine radiographs. The presence of low back pain and visual analogue scale (VAS) scores were recorded. Results Patients with high dislocated dysplastic hips showed significantly greater SS(47.5±7.5° vs. 40.4±6.7°, p<0.001), LL(-63.7±9.2° vs. -53.3±11.5°, P<0.001), SSA(141.8°±7.2° vs. 130.6±7.9°, p<0.001), C7T(93.9±3.6° vs. 91.1±3.7°, P<0.001), and lower SVA(C7) (-16mm[-95-45] vs. 6.4mm[-52-47], p<0.001) compared to normal controls. Patients with bilateral high dislocated dysplastic hips also exhibited larger SS, LL, SSA, and C7T and a smaller SVA(C7) than those of patients with unilateral hip dysplasia. 63.2% of the patients with high dislocated dysplastic hips reported low back pain. Conclusion Patients with Crowe type IV DDH exhibited abnormal spinal-pelvic alignment characterized by anterior pelvic tilt, lumbar hyperlordosis, and a backward-leaning trunk. Bilateral dislocated dysplastic hips had a greater impact on spinal-pelvic alignment than unilateral dislocated dysplastic hips.

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Spinopelvic parameter changes and low back pain improvement due to femoral neck anteversion in patients with severe unilateral primary hip osteoarthritis undergoing total hip replacement

Abstract: Patients with concomitant unilateral HOA and LBP showed a marked anteverted FNA in the arthritic hip and a spinopelvic misalignment. After THR, a relief of both hip and low back pain and a change in spinopelvic parameters is observed.

Cited by 54 publications

References 32 publications

Sagittal Spinal-pelvic Alignment in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Sagittal Spinal-pelvic Alignment in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Prevalence of and factors associated with dysfunctional low back pain in patients with rheumatoid arthritis

Sagittal Spinal-pelvic Alignment in Patients with Crowe Type IV Developmental Dysplasia of the Hip

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