Department of Orthopedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique- Hopitaux de Paris, Sorbonne Universite Medecine, Paris, France.
Department of Orthopedic Surgery, Yale University, New Haven, CT, USA.
Int Orthop. 2024 Oct;48(10):2545-2552. doi: 10.1007/s00264-024-06270-w. Epub 2024 Aug 20.
Patients frequently complain of low back pain and sacroiliac joint pain (SIP) following total hip arthroplasty (THA). We hypothesized that patients with SIP would display different pelvic incidence (PI) values between standing and relaxed sitting positions, indicative of increased motion in the sacroiliac joints.
In this retrospective case-control study, 94 patients who underwent unilateral THA and experienced SIP were compared with 94 control patients without SIP. SIP was confirmed through clinical tests and investigated using biplanar imaging in both standing and sitting positions. The key parameters analyzed included PI, sacral slope (SS), lumbar lordosis (LL), and limb length discrepancy (LLD).
Patients without SIP showed a mean difference in PI of -1.5° (-8°-5°) between standing-to-sitting positions, whereas those with SIP showed a difference of -3.3° (-12°-0°)(P < 0.0001), indicating more motion in the sacroiliac joint during daily activities in the latter group. Patients with SIP showed smaller change in LL between standing-to-sitting positions (mean:6.3°; range:-8°-27°) compared with those without SIP (mean:9.5°; range:-12°-28°)(P = 0.006). No significant differences were noted in functional leg length between patients with (mean:7 mm; range:0-12 mm) and without SIP (mean:7 mm; range:0-11 mm)(P = 0.973).
This study revealed significant sacroiliac joint motion in patients with SIP post-THA, as indicated by PI changes, increased posterior pelvic tilt, and reduced change in the LL. Contrary to common belief, SIP did not correlate with LLD.
全髋关节置换术后（THA）患者常诉腰痛和骶髂关节痛（SIP）。我们假设 SIP 患者在站立位和放松坐姿之间会表现出不同的骨盆入射角（PI）值，表明骶髂关节活动度增加。
在这项回顾性病例对照研究中，我们比较了 94 例接受单侧 THA 并出现 SIP 的患者与 94 例无 SIP 的对照组患者。通过临床检查和站立位及坐姿下的双平面成像来确认 SIP。分析的关键参数包括 PI、骶骨倾斜度（SS）、腰椎前凸（LL）和肢体长度差异（LLD）。
无 SIP 的患者在站立位到坐姿位之间 PI 的平均差值为-1.5°（-8°至 5°），而 SIP 的患者差值为-3.3°（-12°至 0°）（P<0.0001），表明后者在日常活动中骶髂关节活动度更大。与无 SIP 的患者相比（平均：9.5°；范围：-12°至 28°），SIP 的患者在站立位到坐姿位之间 LL 的变化更小（平均：6.3°；范围：-8°至 27°）（P=0.006）。SIP 的患者与无 SIP 的患者在功能性腿长方面无显著差异（平均：7mm；范围：0 至 12mm）（平均：7mm；范围：0 至 11mm）（P=0.973）。
本研究表明，THA 后 SIP 患者的骶髂关节活动度显著，表现为 PI 变化、骨盆后倾增加和 LL 变化减少。与普遍看法相反，SIP 与 LLD 无关。
