Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Bethesda Physiocare, Bethesda, MD, USA.
BMC Musculoskelet Disord. 2022 Mar 15;23(1):250. doi: 10.1186/s12891-022-05154-7.
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.
We adhered to the established methodology for scoping reviews. Four electronic databases were systematically searched from inception-December 31, 2021.
We selected prospective or retrospective observational or intervention studies that included patients with THA.
Data extraction and levels of evidence were independently performed using standardized checklists.
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.
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.
骨盆矢状面参数被认为是维持正常或病理状态下个体能量高效姿势的重要因素。尽管先前的几项研究表明全髋关节置换术（THA）后矢状面骨盆-脊柱参数可能会发生变化，但目前尚无对这一领域的综述。因此，本研究旨在总结有关 THA 后脊柱-骨盆矢状面参数和下腰痛（LBP）变化的证据。
我们遵循了范围综述的既定方法。从建立到 2021 年 12 月 31 日，我们系统地检索了四个电子数据库。
我们选择了包含 THA 患者的前瞻性或回顾性观察性或干预性研究。
使用标准化清单独立进行数据提取和证据水平评估。
本范围综述共纳入 45 篇论文，涉及 5185 例 THA 患者。骨盆倾斜是纳入研究中最常见的测量参数（n=26）。但所有研究的结果并不一致；然而，研究表明 THA 后骨盆倾斜的分布范围为 20°前至 25°后。此外，THA 后骶骨倾斜度降低和骨盆入射角降低与 THA 患者脱位风险增加相关。双侧髋关节骨关节炎患者 THA 后腰椎脊柱侧凸无明显变化（5.50°（1.16°）vs. 3.73°（1.16°）；P 值=0.29）。最后，一项研究表明，LBP 改善与术后脊柱-骨盆矢状面参数变化无关。本研究还存在一些方法学问题，包括未进行样本量计算，且对结果多重性未进行Ⅰ型错误调整。
THA 后可能会发生脊柱-骨盆矢状面参数变化，且随着时间的推移可能会改善。THA 脱位患者通常与无 THA 脱位患者相比存在异常的脊柱-骨盆矢状面参数。THA 后 LBP 通常随时间显著改善。
