A study of low back pain and changes in spinal sagittal parameters after total hip arthroplasty in patients with unilateral Crowe type <b>Ⅳ</b> developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Mingyang ^1,2,3 , LIU Yubo ^2,3,4 ^△ , YANG Minzhi ^1,2,3,4 ,  KONG Xiangpeng ^2,3 ,  CHAI Wei ^2,3

1. Chinese PLA Medicine School, Beijing, 100853, P.R.China;
2. Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R.China;
3. National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China;
4. School of Medicine, Nankai University, Tianjin, 300071, P.R.China;

Corresponding author：

KONG Xiangpeng, Email: chaiwei301@163.com; CHAI Wei, Email: chaiwei301@163.com

Keywords：

Developmental dysplasia of the hip; Crowe type Ⅳ; spinal sagittal parameters; total hip arthroplasty; low back pain

DOI：

10.7507/1002-1892.202107120

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the changes of low back pain (LBP) and spinal sagittal parameters in patients with unilateral Crowe type Ⅳ developmental dysplasia of the hip (DDH) after total hip arthroplasty (THA). Methods The clinical data of 30 patients who met the selection criteria between October 2018 and March 2020 were retrospectively analyzed. Patients were divided into LBP group (16 cases) and control group (14 cases) according to whether there was LBP before operation. There was no significant difference between the two groups of patients in gender, age, body mass index, affected sides, preoperative Harris score (P>0.05). Full-length lateral X-ray films of the spine were taken within 1 week before operation and at 1 year after operation, and the following imaging indicators were measured: sacral slope (SS), lumbar lordosis (LL ), spinal tilt (ST), spine-sacral angle (SSA), sagittal vertebral axis (SVA). The visual analogue scale (VAS) score, lumbar Oswestry disability index (ODI), the Harris score of the hip joint before operation and at 1 year after operation, and the occurrence of postoperative complications were collected and analysed. Results In the LBP group, LBP was relieved to varying degrees at 1 year after operation, of which 13 patients (81.3%) had complete LBP remission; VAS score decreased from 4.9±2.3 preoperatively to 0.3±0.8, ODI decreased from 33.5±22.6 preoperatively to 1.3±2.9, the differences were all significant (t=7.372, P=0.000; t=5.499, P=0.000). There was no new chronic LBP in the control group during follow-up. The Harris scores of the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between the two groups at 1 year after operation (t=0.421, P=0.677). There was no significant difference in imaging indexes between the two groups before operation and the difference between pre- and post-operation (P>0.05). At 1 year after operation, ST and SVA in the LBP group, SSA in the control group, and SS in the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference in the other indexes between the two groups before and after operation (P>0.05). Conclusion Unilateral Crowe type Ⅳ DDH patients with LBP before operation were all relieved of LBP after THA. The relief of LBP may be related to the improvement of spinal balance, but not to lumbar lordosis and its changes.

Citation： MA Mingyang, LIU Yubo, YANG Minzhi, KONG Xiangpeng, CHAI Wei. A study of low back pain and changes in spinal sagittal parameters after total hip arthroplasty in patients with unilateral Crowe type Ⅳ developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1543-1548. doi: 10.7507/1002-1892.202107120 Copy

1.	Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
2.	Matsuyama Y, Hasegawa Y, Yoshihara H, et al. Hip-spine syndrome: total sagittal alignment of the spine and clinical symptoms in patients with bilateral congenital hip dislocation. Spine (Phila Pa 1976), 2004, 29(21): 2432-2437.
3.	Ren P, Kong X, Chai W, et al. Sagittal spinal-pelvic alignment in patients with Crowe type Ⅳdevelopmental dysplasia of the hip. BMC Musculoskelet Disord, 2020, 21(1): 688. doi: 10.1186/s12891-020-03717-0.
4.	Offierski CM, MacNab I. Hip-spine syndrome. Spine (Phila Pa 1976), 1983, 8(3): 316-321. doi: 10.1097/00007632-198304000-00014.
5.	Khoury AN, Hatem M, Bowler J, et al. Hip-spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain. J Hip Preserv Surg, 2020, 7(3): 390-400.
6.	Bredow J, Katinakis F, Schlüter-Brust K, et al. Influence of hip replacement on sagittal alignment of the lumbar spine: An EOS study. Technol Health Care, 2015, 23(6): 847-854.
7.	Can A, Erdoğan F, Yontar NS, et al. Spinopelvic alignment does not change after bilateral total hip arthroplasty in patients with bilateral Crowe type-Ⅳ developmental dysplasia of the hip. Acta Orthop Traumatol Turc, 2020, 54(6): 583-586.
8.	Eyvazov K, Eyvazov B, Basar S, et al. Effects of total hip arthroplasty on spinal sagittal alignment and static balance: a prospective study on 28 patients. Eur Spine J, 2016, 25(11): 3615-3621.
9.	Piazzolla A, Solarino G, Bizzoca D, et al. Spinopelvic parameter changes and low back pain improvement due to femoral neck anteversion in patients with severe unilateral primary hip osteoarthritis undergoing total hip replacement. Eur Spine J, 2018, 27(1): 125-134.
10.	Radcliff KE, Orozco F, Molby N, et al. Change in spinal alignment after total hip arthroplasty. Orthop Surg, 2013, 5(4): 261-265.
11.	Weng W, Wu H, Wu M, et al. The effect of total hip arthroplasty on sagittal spinal-pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis. Eur Spine J, 2016, 25(11): 3608-3614.
12.	Fairbank JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
13.	Okuda T, Fujita T, Kaneuji A, et al. Stage-specific sagittal spinopelvic alignment changes in osteoarthritis of the hip secondary to developmental hip dysplasia. Spine (Phila Pa 1976), 2007, 32(26): E816-819.
14.	Kim SH, Kwon OY, Yi CH, et al. Lumbopelvic motion during seated hip flexion in subjects with low-back pain accompanying limited hip flexion. Eur Spine J, 2014, 23(1): 142-148.
15.	Rajnics P, Templier A, Skalli W, et al. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech, 2002, 15(1): 24-30.
16.	Kong X, Chai W, Chen J, et al. Intraoperative monitoring of the femoral and sciatic nerves in total hip arthroplasty with high-riding developmental dysplasia. Bone Joint J, 2019, 101-B(11): 1438-1446.
17.	Gallagher KM, Callaghan JP. Standing on a declining surface reduces transient prolonged standing induced low back pain development. Appl Ergon, 2016, 56: 76-83.
18.	Steer KJD, Bostick GP, Woodhouse LJ, et al. Low back pain and radiographic severity as predictors in hip osteoarthritis patients receiving steroid injection therapy. Hip Int, 2020, 30(2): 187-194.
19.	Stupar M, Côté P, French MR, et al. The association between low back pain and osteoarthritis of the hip and knee: a population-based cohort study. J Manipulative Physiol Ther, 2010, 33(5): 349-354.
20.	Tanaka S, Matsumoto S, Fujii K, et al. Factors related to low back pain in patients with hip osteoarthritis. J Back Musculoskelet Rehabil, 2015, 28(2): 409-414.

1. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
2. Matsuyama Y, Hasegawa Y, Yoshihara H, et al. Hip-spine syndrome: total sagittal alignment of the spine and clinical symptoms in patients with bilateral congenital hip dislocation. Spine (Phila Pa 1976), 2004, 29(21): 2432-2437.
3. Ren P, Kong X, Chai W, et al. Sagittal spinal-pelvic alignment in patients with Crowe type Ⅳdevelopmental dysplasia of the hip. BMC Musculoskelet Disord, 2020, 21(1): 688. doi: 10.1186/s12891-020-03717-0.
4. Offierski CM, MacNab I. Hip-spine syndrome. Spine (Phila Pa 1976), 1983, 8(3): 316-321. doi: 10.1097/00007632-198304000-00014.
5. Khoury AN, Hatem M, Bowler J, et al. Hip-spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain. J Hip Preserv Surg, 2020, 7(3): 390-400.
6. Bredow J, Katinakis F, Schlüter-Brust K, et al. Influence of hip replacement on sagittal alignment of the lumbar spine: An EOS study. Technol Health Care, 2015, 23(6): 847-854.
7. Can A, Erdoğan F, Yontar NS, et al. Spinopelvic alignment does not change after bilateral total hip arthroplasty in patients with bilateral Crowe type-Ⅳ developmental dysplasia of the hip. Acta Orthop Traumatol Turc, 2020, 54(6): 583-586.
8. Eyvazov K, Eyvazov B, Basar S, et al. Effects of total hip arthroplasty on spinal sagittal alignment and static balance: a prospective study on 28 patients. Eur Spine J, 2016, 25(11): 3615-3621.
9. Piazzolla A, Solarino G, Bizzoca D, et al. Spinopelvic parameter changes and low back pain improvement due to femoral neck anteversion in patients with severe unilateral primary hip osteoarthritis undergoing total hip replacement. Eur Spine J, 2018, 27(1): 125-134.
10. Radcliff KE, Orozco F, Molby N, et al. Change in spinal alignment after total hip arthroplasty. Orthop Surg, 2013, 5(4): 261-265.
11. Weng W, Wu H, Wu M, et al. The effect of total hip arthroplasty on sagittal spinal-pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis. Eur Spine J, 2016, 25(11): 3608-3614.
12. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
13. Okuda T, Fujita T, Kaneuji A, et al. Stage-specific sagittal spinopelvic alignment changes in osteoarthritis of the hip secondary to developmental hip dysplasia. Spine (Phila Pa 1976), 2007, 32(26): E816-819.
14. Kim SH, Kwon OY, Yi CH, et al. Lumbopelvic motion during seated hip flexion in subjects with low-back pain accompanying limited hip flexion. Eur Spine J, 2014, 23(1): 142-148.
15. Rajnics P, Templier A, Skalli W, et al. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech, 2002, 15(1): 24-30.
16. Kong X, Chai W, Chen J, et al. Intraoperative monitoring of the femoral and sciatic nerves in total hip arthroplasty with high-riding developmental dysplasia. Bone Joint J, 2019, 101-B(11): 1438-1446.
17. Gallagher KM, Callaghan JP. Standing on a declining surface reduces transient prolonged standing induced low back pain development. Appl Ergon, 2016, 56: 76-83.
18. Steer KJD, Bostick GP, Woodhouse LJ, et al. Low back pain and radiographic severity as predictors in hip osteoarthritis patients receiving steroid injection therapy. Hip Int, 2020, 30(2): 187-194.
19. Stupar M, Côté P, French MR, et al. The association between low back pain and osteoarthritis of the hip and knee: a population-based cohort study. J Manipulative Physiol Ther, 2010, 33(5): 349-354.
20. Tanaka S, Matsumoto S, Fujii K, et al. Factors related to low back pain in patients with hip osteoarthritis. J Back Musculoskelet Rehabil, 2015, 28(2): 409-414.

Chinese Journal of Reparative and Reconstructive Surgery

A study of low back pain and changes in spinal sagittal parameters after total hip arthroplasty in patients with unilateral Crowe type Ⅳ developmental dysplasia of the hip

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content