Ferdi DİRVAR, Hakan AKGÜN, Furkan YAPICI, Deniz KARGIN, Alper KÖKSAL, Osman ÇİMEN, Kadir ABUL

An investigation of the effects of total hip arthroplasty with femoral shortening in unilateral Crowe type-IV dysplastic hips on sagittal spinopelvic parameters

It has been reported that sagittal spinal alignment may become abnormal in patients with hip osteoarthritis. There is limited data in the literature on how spinopelvic parameters change after total hip arthroplasty (THA) with femoral shortening in unilateral Crowe type IV dysplastic hips. We aimed to investigate the effects of THA with femoral shortening in unilateral Crowe type IV dysplastic hips on sagittal spinopelvic parametres. Patients who underwent THA for Crowe type IV dysplastic hips at our institution between 2014-2019 were included in the study. Pre- and postsurgical standing anteroposterior and lateral spine X-Ray images of the each patient were uploaded to SURGIMAP© (Nemaris Inc.. USA) (https://www.surgimap.com/). The radiographic data of all patients were reviewed and measurements performed for each patient by two senior spinal surgeons. All of the parameters were retrieved from the SURGIMAP© measurement system. There were 18 patients aged 27-60 (mean, 45.5±7.9) years. The mean follow-up duration was 27.5 ± 8.9 (range, 13–42) months. There was no statistically difference between pre-and postoperative values of Sacral Slope (SS), Pelvic incidence (PI) Lumbar Lordosis (LL), PI-LL mismatch and Thoracic Kyphosis (TK), Global Tilt (GT), T1 Pelvic Angle (TPA), Cervical Lordosis (CL) and T1 slope (T1S). We also found no significant change between pre-and postsurgical values of global alignment and proportion (GAP) scores. The only significant change was in detected pre-and postsurgical values of PT, T1Spi, T9Spi ( p = 0.022, p = 0.035, and p = 0.033 respectively). THA with femoral shortening in unilateral Crowe type-IV dysplastic hips does not effect a change in sagittal spinopelvic parameters. Except for PT, T9SPi, and T1SPi do.

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1. Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res.1986;213:20-33.
2. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979;61:15-23.
3. Yoder SA, Brand RA, Pedersen DR, et.al. Total hip acetabular component position affects component loosening rates. Clin Orthop Relat Res 1988;228:79-87.
4. Pagnano MW, Hanssen AD, Lewallen DG, et.al. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg Am. 1996;78:1004-14.
5. Rivière C, Lazic S, Dagneaux L.et.al. Spine–hip relations in patients with hip osteoarthritis. EFORT Open Reviews, 2018;3:39-44.
6. Offierski CM, MacNab I (1983) Hip-spine syndrome. Spine (Phila Pa 1976) 1983;8:316-21.
7. Le Huec JC, Saddiki R, Franke J, et al. Equilibrium of the human body and the gravity line: the basics. Eur Spine J. 2011;20:558-63.
8. Chaleat-Valayer E, Mac-Thiong JM, Paquet J. Sagittal spino-pelvic alignment in chronic low back pain. Eur Spine J. 2011;20:634-40.
9. Funao H, Tsuji T, Hosogane N, et al. Comparative study of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J. 2012 ;21:2181–7.
10. Zhu F, Bao H, He S, et al. Lumbo-femoral angle: a novel sagittal parameter related to quality of life in patients with adult scoliosis. Eur Spine J. 2015;24:1244–50.
11. Weng WJ, Wang WJ, Wu MD, et al. Characteristics of sagittal spine– pelvis–leg alignment in patients with severe hip osteoarthritis. Eur Spine J. 2015;24:1228–36.
12. Yoshimoto H, Sato S, Masuda T, et al. Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine (Phila Pa 1976). 2005;30:1650–7.
13. Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am.2005;87:260-7
14. Roussoly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 2005;30:346-53.
15. Schwab FJ, Blondel B, Bess S, et al. International Spine Study Group (ISSG). Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976). 2013;38:803-12.
16. I Obeid, L Boissière, C Yilgor, et al. Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J. 2016;25:3644-9.
17. Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine. 2009;34:1828–33.
18. Protopsaltis T, Schwab F, Bronsard N, et al. International Spine Study Group. TheT1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am. 2014;96:1631-40.
19. Le Huec J C, Demezon H, Aunoble S. Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J. 2015;24:63-71.
20. Knott PT, Mardjetko SM, Techy F. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J. 2010;10:994-8.
21. Yilgor C, Sogunmez N, Boissiere L, et al. Global alignment and proportion (gap) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am. 2017;99:1661-72.
22. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37-46.
23. Fleiss JL, Slakter MJ, Fischman SL, et al. Inter-examiner reliability in caries trials. J Dent Res. 1979;58:604-9.
24. Landis JR, Koch GG. The measurement of observer agree-ment for categorical Biometrics. 1977;33:159–74.
25. Duval-Beaupere G, Schmidt C, Casson P. A Barycentremetric study of the human body and the gravity linet he basics. Eur Spine J. 2011;20:634-40.
26. Korkmaz MF, Sevimli R. Total hip artroplasty. J Clinical and Analytical Med. 2015;6:5.
27. Caglar O, Isik S, Kaymakoglu M, et al. Sagittal spinal alignment after total hip arthroplasty for neglected high hip dysplasia: does changing the distorted mechanics of the hip normalize spinal alignment? Spine Deform. 2021;9:221-9.
28. Can A, Erdogan F, Yontar NS, et al. Spinopelvic alignment does not change after bilateral total hip arthroplasty in patients with bilateral Crowe typeIV developmental dysplasia of the hip. Acta Orthop Traumatol Turc. 2020;54:583-6.
29. Radcliff KE, Orozco F, Molby N, et al. Change in spinal alignment after total hip arthroplasty. Orthop Surg. 2013;5:261-5.
30. Lafage V, Schwab F, Skalli W, et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine. 2008;33:1572–8.
31. Buckland JA, Fernandez L, Shimmin JA, et al. Effects of sagittal spinal alignment on postural pelvic mobility in total hip arthroplasty candidates. J Arthroplasty. 2019;34:2663-8.
32. Vrtovec T, Janssen MM, Pernuš F, et al. Analysis of pelvic incidence from 3-dimensional images of a normal population. Spine (Phila Pa 1976). 2012;37:479-85.