Changes of spino-pelvic characteristics post-THA are independent of surgical approach: a prospective study

TL;DR

This study found that changes in pelvic tilt after hip replacement surgery are mostly not affected by the surgical approach used.

Contribution

The study shows that surgical approach has minimal impact on pelvic tilt changes after THA, which is new for preoperative planning guidance.

Findings

Pelvic tilt increased slightly after THA, with most patients showing no clinically significant change.

Preoperative pelvic tilt was the strongest predictor of postoperative change.

Anterior approach resulted in the least change in pelvic tilt, but differences were too small for clinical relevance.

Abstract

Spinopelvic characteristics change after THA. Whether this change varies between approaches, is of interest for pre-op cup orientation planning. The aims of this study were to (1) Characterize changes in standing PT amongst patients with hip osteoarthritis treated with THA; (2) Test whether certain patient-related factors may predict PT change; and (3) Assess the association between surgical approach and PT change.

This was a prospective, two-center, radiographic outcome study including 424 hips, consisting of anterior approach for 171 (40.3%) hips, lateral approach for 181 hips (42.7%) and posterior approach for 72 hips (17.0%). Spinopelvic characteristics were determined from lateral radiographs (before and one year after THA). Parameters of interest included: Pelvic tilt (PT), lumbar lordosis, sacral slope, pelvic incidence. PT change of more than 7 ° was considered clinically relevant.

Pelvic tilt increased by 2 ° from 15.1 ° (± 8.9) to 17.1 ° (± 9.7) after THA (p < 0.001). 19 hips (4.5%) experienced a relevant PT decrease, 337 (79.5%) had no clinically significant change in pelvic tilt, and 68 (16.0%) showed a moderate increase. Age, female sex and preoperative spinopelvic parameters including PT, SS and PI were predictive of PT change more than 7 °. PT increased most with lateral approach (2.9 ± 6.2) and least with anterior approach (1.1 ± 6.2, p = 0.024).

Preoperative PT is the best predictor for PT change. PT is generally normalizing after THA and patients with low PT due to hip flexion contractures tend to increase PT after THA, few patients with high PT will decrease after THA. Anterior approach with capsulectomy was associated with the least change in PT post-THA. However, the approach-specific changes, although statistically significant, were too small to be considered during clinical practice, therefore no approach-specific prediction of PT change needs to be considered during preoperative planning for primary THA.

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