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. 2022 Dec 22;23(1):1116.
doi: 10.1186/s12891-022-06032-y.

Variations in lower limb alignments indicate pelvic tilt after total hip arthroplasty

Kangming Chen #  1 , Jinyan Wu #  2 , Gangyong Huang  1 , Changquan Liu  1   3   4 , Chao Shen  2 , Junfeng Zhu  2 , Yang Li  2 , Tao Li  2 , Fei Xiao  2 , Jianping Peng  2 , Xiuguo Han  2 , Xinhai Zhang  2 , Jun Xia  1 , Xiaodong Chen  5
Affiliations

Variations in lower limb alignments indicate pelvic tilt after total hip arthroplasty

Kangming Chen et al. BMC Musculoskelet Disord. .

Abstract

Objective: We sought to correlate various spinopelvic and lower limb alignments, and to examine the current spinopelvic theories on a Chinese cohort.

Methods: We retrospectively reviewed 166 patients undergoing THA. Among them, 138 patients with unilateral THA met the inclusion criteria. Sagittal alignments and cup orientations were measured on standing and sitting lateral EOS images. Patients were categorized into two groups with a scoring system for lumbar spine degeneration. Patients' demographics including age, sex, lumbar spine degeneration and radiographic measurements were studied.

Results: PT, SS, LL and TK differed significantly between standing and sitting within each group except for TK in degenerative group (32.8 ± 13.9 vs. 32.9 ± 14.2, p = 0.905). Compared with degenerative spine group, non-degenerative spine patients have great pelvic mobility (ΔPT, -24.4 ± 12.5° vs. -17.6 ± 10.7, p = 0.0008), greater lumbar mobility (ΔLL, -34.8 ± 15.2 vs. -21.7 ± 12.2, p = < 0.0001) and compensatory cup orientation changes (ΔRA, -15.5 ± 11.1 vs. -12.0 ± 8.4, p = 0.00920; ΔRI, -10.8 ± 11.5 vs. -5.6 ± 7.5, p = 0.0055). Standing PT and ankle dorsiflexion angle correlated positively (R2 = 0.236, p = 0.005).

Conclusion: THA patients in this cohort showed a spinopelvic motion paradigm similar to that from previous studies on Caucasians. Ankle dorsiflexion indicate greater posterior pelvic tilt on standing. Surgeons should beware of risks of instability in patients with lower limb compensations.

Advances in knowledge: This study provides new insights into the clinical relevance of lower limb alignments to spinopelvic motion after THA in a relatively young Chinese population.

Keywords: Instability; Lower limb alignment; Spinal sagittal balance; Spinopelvic mobility; Total hip arthroplasty.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart depicting the patient inclusion and exclusion process. One hundred and sixty-six THA patients were considered at the initial stage. Patients not suitable for this study were ruled out in a stepwise fashion. At the last stage, 138 patients with unilateral THA performed were finally included
Fig. 2
Fig. 2
The flow diagram illustrate that after the initial inclusion and exclusion stages, patients were further categorized into non-degenerative and degenerative lumbar spine groups. Intragroup analyses between two postures, and intergroup analyses were conducted, followed by correlation analyses
See this image and copyright information in PMC

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