Article
How to screen for lumbar spine stiffness in patients awaiting total hip arthroplasty
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Authors
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Moritz Innmann
- Orthopädische Universitätsklinik Heidelberg, Heidelberg, Germany
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Jeroen Verhaegen
- Department of Orthopaedics and Trauma Surgery, The Ottawa Hospital, Ontario, Canada, University Hospital Antwerp, Edegem, Belgium, Ottawa, Canada
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Tobias Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Heidelberg, Germany
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Christian Merle
- Diakonie-Klinikum Stuttgart, Endoprothetikzentrum III (Orthopädische Klinik Paulinenhilfe), Stuttgart, Germany
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George Grammatopoulos
- Department of Orthopaedics and Trauma Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| Published: | October 23, 2023 |
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Outline
Text
Objectives: This study aims to (1) define the prevalence of spinopelvic abnormalities amongst patients with hip osteoarthritis (OA) and controls (asymptomatic volunteers); and (2) identify factors that reliably predict the presence of lumbar spine stiffness.
Methods: This is a prospective, cross-sectional, case-cohort study of patients with end-stage primary hip OA, who underwent primary THA between January 2019 and December 2021. Patients were compared with a cohort of asymptomatic volunteers, matched for age-, sex- and BMI, serving as a control group with a 2:1 ratio. Spinopelvic pathologies were defined as having a lumbar spine flatback deformity (PI-LL≥ 10°), a standing sagittal pelvic tilt of≥ 19° and lumbar spine stiffness (lumbar flexion <20° between both postures).
Results and conclusion: The prevalence of spinopelvic pathologies was similar between patients and controls (flatback deformity: 16% vs. 10%, p=0.209; standing pelvic tilt >19°: 17% vs. 24%, p=0.218; lumbar spine stiffness: 6% vs. 5%, p=0.827. Age over 65 years and a standing lumbar lordosis angle of less than 45°, were associated with a high sensitivity and specificity for identifying patients with lumbar spine stiffness (age >65 years: 82% and 66%; standing lumbar lordosis angle <45°: 85% and 73%) (ROC-curves).
The presence of end-stage hip osteoarthritis was not associated with an increased prevalence of abnormal or adverse spinopelvic characteristics compared to matched, asymptomatic volunteers. Age and LLstanding are the strongest predictors of lumbar spine flexion and can guide clinical practice on when to obtain additional radiographs for patients with hip OA prior to arthroplasty to identify at-risk patients.
Figure 1 [Fig. 1]
