Aubert Thomas, Hallé Aurélien, Vorimore Camille, Lhotellier Luc
Orthopaedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France.
Orthopaedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France.
Orthop Traumatol Surg Res. 2025 Jun;111(4):104169. doi: 10.1016/j.otsr.2025.104169. Epub 2025 Jan 17.
Spinopelvic kinematics, reflected by the change in spinopelvic tilt (ΔSPT) from a standing position to a flexed seated position, has been associated with the risk of prosthetic impingement and hip dislocation. Some studies have suggested changes in spinopelvic mobility after total hip arthroplasty (THA), but none have explored changes in mobility in the first three months following THA using a direct anterior approach.
Our hypothesis was that changes in spinopelvic mobility occur in the first 3 months postoperatively, leading to increased hip mobility and increased spinopelvic kinematic abnormalities.
This retrospective analysis of a consecutive series included 109 patients treated with primary anterior THA by a single senior surgeon. Lateral radiographs taken in standing and flexed seated positions before and three months after surgery were examined to analyze ΔSPT, pelvic femoral angle (PFA), lumbar lordosis (LL), and abnormal spinopelvic mobility (ΔSPT ≥20 °). Secondary objectives included examining the relationship between changes in lumbar flexion and hip flexion, and then analyzing preoperative spinopelvic parameters involved in postoperative pelvic mobility changes.
Between the two periods of analysis, the ΔSPT increased on average by 9.53 ° (-34.4/50.3 °), the ΔPFA increased by 7.68 ° (-74/49 °), and lumbar flexion (ΔLL) decreased by 4.26 ° (-20.8/26 °). The rate of ΔSPT ≥20 ° was 22.9% before the operation and 47.7% after the operation (OR = 8.98; CI [2.82; 28.56]; p < 0.001). A strong positive correlation was found between changes in ΔSPT and ΔPFA (ρ = 0.76; r = 0.574; p < 0.001) and no correlation between changes in ΔSPT and ΔLL (ρ=-0.019; r = 0.005; p = 0.842). The multivariate analysis demonstrated independent predictors of change in ΔSPT were body mass index (BMI, β = -0.59, [-1.15; -0.03], p = 0.0386), ΔPFA (β = -0.46, [-0.59; -0.34], p < 0.001), and ΔLL (β = -0.36, [-0.53; -0.19], p < 0.001). No dislocation was observed.
Spinopelvic mobility changes occur early on, within 3 months, after anterior THA. Patients with preoperative lumbar stiffness, associated with a stiff hip and lower BMI, should prompt surgeons to the risk of worsening spinopelvic kinematic abnormalities postoperatively.
IV; retrospective study.
从站立位到屈曲坐位时，脊柱骨盆倾斜度（ΔSPT）的变化所反映出的脊柱骨盆运动学，与假体撞击和髋关节脱位风险相关。一些研究表明全髋关节置换术（THA）后脊柱骨盆活动度会发生改变，但尚无研究采用直接前路入路探讨THA后前三个月内的活动度变化。
我们的假设是，术后前3个月内脊柱骨盆活动度会发生变化，导致髋关节活动度增加以及脊柱骨盆运动学异常增加。
本项对连续病例系列的回顾性分析纳入了109例由同一位资深外科医生行初次前路THA治疗的患者。对术前及术后3个月站立位和屈曲坐位时拍摄的侧位X线片进行检查，以分析ΔSPT、骨盆股骨角（PFA）、腰椎前凸（LL）以及异常脊柱骨盆活动度（ΔSPT≥20°）。次要目标包括检查腰椎屈曲变化与髋关节屈曲之间的关系，然后分析参与术后骨盆活动度变化的术前脊柱骨盆参数。
在两个分析时间段之间，ΔSPT平均增加9.53°（-34.4/50.3°），ΔPFA增加7.68°（-74/49°），腰椎屈曲（ΔLL）减少4.26°（-20.8/26°）。ΔSPT≥20°的发生率术前为22.9%，术后为47.7%（OR=8.98；CI[2.82；28.56]；p<0.001）。发现ΔSPT变化与ΔPFA变化之间存在强正相关（ρ=0.76；r=0.574；p<0.001），而ΔSPT变化与ΔLL变化之间无相关性（ρ=-0.019；r=0.005；p=0.842）。多变量分析表明，ΔSPT变化的独立预测因素为体重指数（BMI，β=-0.59，[-1.15；-0.03]，p=0.0386）、ΔPFA（β=-0.46，[-0.59；-0.34]，p<0.001）和ΔLL（β=-0.36，[-0.53；-0.19]，p<0.001）。未观察到脱位情况。
前路THA后3个月内早期会出现脊柱骨盆活动度变化。术前腰椎僵硬且伴有髋关节僵硬和较低BMI的患者，应促使外科医生注意术后脊柱骨盆运动学异常恶化的风险。
IV级；回顾性研究。
