Sunagawa Takuya, Okuzu Yaichiro, Kuroda Yutaka, Kawai Toshiyuki, Morita Yugo, Goto Koji, Matsuda Shuichi
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan.
Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osakasayama City, Osaka, 589-8511, Japan.
Arch Orthop Trauma Surg. 2025 Apr 28;145(1):275. doi: 10.1007/s00402-025-05876-y.
Degenerative lumbar spondylolisthesis (DLS) is sometimes found in preoperative spine radiographs before total hip arthroplasty (THA). However, whether DLS affects the clinical outcomes of THA and whether the slip is improved by THA remain unclear. This study investigated the clinical outcomes of THA in patients with DLS and change in the slip percentage of DLS after THA.
We included 369 patients who underwent primary THA due to hip osteoarthritis between December 2015 and February 2022. The patients were classified into the DLS or non-DLS group by evaluating preoperative whole-spine radiographs in the standing position. Preoperative sagittal spinal parameters, preoperative and 1-year postoperative Harris hip score, Oxford hip score, and slip percentage of DLS were evaluated. Multiple regression analysis was performed to identify the factors associated with DLS.
Of the 369 patients, 101 (27.4%) were classified into the DLS group. Multivariate analysis revealed that age (odds ratio (OR) per unit: 1.04, p < 0.01) and pelvic incidence (PI) (OR per unit: 1.04, p < 0.01) were significantly associated with DLS. Preoperative and postoperative clinical outcomes between the DLS and non-DLS groups were not significantly different. The preoperative and postoperative percentages of slip in the DLS group did not change significantly from 16.9% ± 6.2% to 16.7% ± 6.7% (p = 0.47). Patients with slip progression ≥ 2.5% of slip percentage were 19 (18.8%), who were younger (p = 0.02) and had higher PI (p = 0.01) and sacral slope (p = 0.03) than those with slip improvement.
Age and PI were significantly associated factors for DLS. The slip was not improved after THA. The clinical outcomes of THA in the DLS group were not affected. Longer-term follow-up studies are essential to elucidate the hip-spine relationship.
退行性腰椎滑脱（DLS）有时会在全髋关节置换术（THA）术前的脊柱X光片中被发现。然而，DLS是否会影响THA的临床疗效以及THA是否能改善滑脱情况仍不明确。本研究调查了DLS患者THA的临床疗效以及THA术后DLS滑脱百分比的变化。
我们纳入了2015年12月至2022年2月期间因髋骨关节炎接受初次THA的369例患者。通过评估术前站立位全脊柱X光片，将患者分为DLS组或非DLS组。评估术前矢状面脊柱参数、术前及术后1年的Harris髋关节评分、牛津髋关节评分以及DLS的滑脱百分比。进行多元回归分析以确定与DLS相关的因素。
在369例患者中，101例（27.4%）被归入DLS组。多变量分析显示，年龄（每单位比值比（OR）：1.04，p < 0.01）和骨盆入射角（PI）（每单位OR：1.04，p < 0.01）与DLS显著相关。DLS组和非DLS组术前及术后的临床疗效无显著差异。DLS组术前和术后的滑脱百分比从16.9%±6.2%至16.7%±6.7%无显著变化（p = 0.47）。滑脱进展≥滑脱百分比2.5%的患者有19例（18.8%），这些患者比滑脱改善的患者更年轻（p = 0.02），PI更高（p = 0.01），骶骨斜率更高（p = 0.03）。
年龄和PI是DLS的显著相关因素。THA术后滑脱情况未得到改善。DLS组THA的临床疗效未受影响。长期随访研究对于阐明髋-脊柱关系至关重要。
