Yokoi Hiroyuki, Osawa Yusuke, Takegami Yasuhiko, Ozawa Yuto, Funahashi Hiroto, Imagama Shiro
Nagoya University Hospital, Nagoya, Japan.
Arch Orthop Trauma Surg. 2025 Mar 19;145(1):195. doi: 10.1007/s00402-025-05829-5.
Pelvic obliquity (PO) in dysplastic hip osteoarthritis (DHOA) can present as either upward or downward tilting of the affected side. This study investigated the influence of preoperative PO direction on postoperative clinical outcomes and hip-spine morphology in patients undergoing total hip arthroplasty (THA).
Data from 116 (21 men, 95 women) patients with unilateral DHOA, who underwent THA at a single institution between June 2018 and September 2023 and exhibited ≥ 2° of PO, were analyzed. Patients were categorized into two groups: upward PO (U-PO [≥ 2° upward tilt, n = 35]); and downward PO (D-PO [≥ 2° downward tilt, n = 81]). Patient demographic information, surgery-related factors, hip function scores, and radiographic parameters of the hip, lower limbs, and spine were compared between the groups.
Except for the duration of hip disorders, no significant differences were observed in patient background and surgical data between the groups. Preoperatively, the U-PO group exhibited a larger acetabular offset, greater hip adduction angle, longer functional leg length on the affected side, and greater ipsilateral convex lumbar scoliosis than the D-PO group (P = 0.034, P < 0.001, P < 0.001, and P < 0.001, respectively). Postoperatively, a greater hip adduction angle and longer functional leg length discrepancy persisted in the U-PO group compared to those in the D-PO group (P < 0.001 and P = 0.002, respectively). The median (interquartile range) residual PO was greater in the U-PO group (3° [0-4°]) than that in the D-PO group (1° [0-3°]) (P = 0.009). Compared with the D-PO group, the mean postoperative hip Japanese Orthopaedic Association scores were significantly lower in the U-PO group (85 [81-92] vs. 92 [85-96], P = 0.016).
The U-PO group exhibited greater residual hip adduction angles, longer functional leg lengths on the affected side, and less improvement in PO after THA than the D-PO group, resulting in poorer postoperative hip function.
发育性髋关节骨关节炎（DHOA）中的骨盆倾斜（PO）可表现为患侧向上或向下倾斜。本研究调查了术前PO方向对接受全髋关节置换术（THA）患者术后临床结局和髋部-脊柱形态的影响。
分析了2018年6月至2023年9月在单一机构接受THA且PO≥2°的116例（21例男性，95例女性）单侧DHOA患者的数据。患者分为两组：向上PO（U-PO[向上倾斜≥2°，n=35]）；和向下PO（D-PO[向下倾斜≥2°，n=81]）。比较两组患者的人口统计学信息、手术相关因素、髋关节功能评分以及髋部、下肢和脊柱的影像学参数。
除髋关节疾病持续时间外，两组患者的背景和手术数据无显著差异。术前，U-PO组比D-PO组表现出更大的髋臼偏移、更大的髋关节内收角度、患侧更长的功能腿长度以及更大的同侧腰椎凸侧脊柱侧弯（分别为P= 0.034、P<0.001、P<0.001和P<0.001）。术后，与D-PO组相比，U-PO组持续存在更大的髋关节内收角度和更长的功能腿长度差异（分别为P<0.001和P=0.002）。U-PO组的中位（四分位间距）残余PO（3°[0-4°]）大于D-PO组（1°[0-3°]）（P=0.009）。与D-PO组相比，U-PO组术后髋关节日本骨科协会平均评分显著更低（85[81-92]对92[85-96]，P=0.016）。
与D-PO组相比，U-PO组术后髋关节内收角度残余更大、患侧功能腿长度更长，且THA后PO改善较小，导致术后髋关节功能较差。
