title: 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.
abstract: The study of the interrelation between hip and spine disorders is gaining increasing importance in the last years, but the link between Hip Osteoarthritis (HOA) and Low Back Pain (LBP) remains still unclear. Aim of the study is to assess the relationship between Femoral Neck Anteversion (FNA), LBP, and spinopelvic parameters in patients undergoing Total Hip Replacement (THR) for unilateral severe primary HOA.
  
  
  
  91 patients were recruited. Inclusion criteria were: grade 5 or 6 unilateral HOA, according to Turmezei, and Harris Hip score (HHS) <60. Exclusion criteria were: secondary hip osteoarthritis (dysplasia of the hip, rheumatoid arthritis, and ankylosing spondylitis); previous surgery of the spine, hip or knee; scoliosis with a Cobb angle greater than 10°; spondylolisthesis; history of spine fractures; previous bone tuberculosis or any spine infections; any contraindications to CT; BMI >30. Patients were divided into two homogeneous Groups according to the presence (Group-A) or not of concomitant LBP (Group-B). All patients underwent preoperatively a hip CT scan to evaluate FNA, Acetabular Anteversion (AA), and Combined Anteversion (CA = FNA + AA). ΔFNA, ΔAA and ΔCA were calculated as the differences between the arthritic hip and the normal hip angles in each Group. Full spinal X-rays in upstanding position were performed before (baseline) and 6 months after THR (follow-up) to calculate spinopelvic parameters. The health-related quality of life (HRQoL) was evaluated at baseline and at follow-up using Visual Analogue Scale (VAS), HHS, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RM), and Short-Form Health Survey (SF-36). The intra-group and inter-group variability were assessed using, respectively, paired and unpaired t tests. At baseline, the association between HRQoL scores and ΔFNA, ΔAA, and ΔCA was analysed by the Pearson correlation test.
  
  
  
  At baseline, in Group-A, there was a significant difference between arthritic FNA and normal hip FNA, while no differences were found in AA between the two hips. A close correlation was observed between ΔFNA and Spine-VAS (r = 0.788), ODI (r = 0.824), and RM (r = 0.775). In Group-B, there was not a significant difference in FNA and AA between the two hips. At recruitment, in Group-A patients, we recorded a higher LL, SS, PI, SVA(C7), and a lower PT and T1-SPI compared with Group-B subjects. Six months after THR, in Group-A, an improvement of all clinical scores was recorded, as well as, a significant reduction of SS, LL, T1PA, and SVA(C7) and an increment of PT. In Group-B, at follow-up, an improvement of HHS, Hip-VAS, and SF-36 was recorded, while the changes in spinopelvic parameters were not significant.
  
  
  
  Patients with concomitant unilateral HOA and LBP showed a marked anteverted FNA in the arthritic hip and a spinopelvic misalignment. After THR, a relief of both hip and low back pain and a change in spinopelvic parameters is observed.
authors.affiliation: School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic, Trauma and Spine Unit, Piazza Giulio Cesare 11, 70100, Bari, Italy. dott.piazzolla@gmail.com.
authors.forename: Andrea
authors.identifier: 0000-0003-2319-2108
authors.initials: A
authors.lastname: Piazzolla
authors.affiliation: School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic, Trauma and Spine Unit, Piazza Giulio Cesare 11, 70100, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Solarino
authors.affiliation: School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic, Trauma and Spine Unit, Piazza Giulio Cesare 11, 70100, Bari, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Bizzoca
authors.affiliation: School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic, Trauma and Spine Unit, Piazza Giulio Cesare 11, 70100, Bari, Italy.
authors.forename: Viola
authors.initials: V
authors.lastname: Montemurro
authors.affiliation: GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
authors.forename: Pedro
authors.initials: P
authors.lastname: Berjano
authors.affiliation: GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Lamartina
authors.affiliation: GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Martini
authors.affiliation: School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic, Trauma and Spine Unit, Piazza Giulio Cesare 11, 70100, Bari, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Moretti
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D060750:Bone Anteversion / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005272:Femur Neck / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D017116:Low Back Pain / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications* / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D013131:Spine / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Acetabular anteversion; Hip flexion; Hip-spine syndrome; Low back pain; Spinopelvic alignment