The presence of hip osteoarthritis is associated with abnormal spinopelvic characteristics. This study aims to determine whether the pre-operative, pathological spinopelvic characteristics “normalize” at 1-year post-THA.

This is a prospective, longitudinal, case-control matched cohort study. Forty-seven patients underwent pre- and post- (at one-year) THA assessments. This group was matched (age, sex, BMI) with 47 controls/volunteers with well-functioning hips. All participants underwent clinical and radiographic assessments including lateral radiographs in standing, upright-seated and deep-flexed-seated positions. Spinopelvic characteristics included change in lumbar lordosis (ΔLL), pelvic tilt (ΔPT) and hip flexion (pelvic-femoral angle, ΔPFA) when moving from the standing to each of the seated positions. Spinopelvic hypermobility was defined as ΔPT>30° between standing and upright-seated positions.

Pre-THA, patients illustrated less hip flexion (ΔPFA −54.8°±17.1° vs. −68.5°± 9.5°, p<0.001), greater pelvic tilt (ΔPT 22.0°±13.5° vs. 12.7°±8.1°, p<0.001) and greater lumbar movements (ΔLL −22.7°±15.5° vs. −15.4°±10.9°, p=0.015) transitioning from standing to upright-seated. Post-THA, these differences were no longer present (ΔPFApost −65.8°±12.5°, p=0.256; ΔPTpost 14.3°±9.5°, p=0.429; ΔLLpost −15.3°±10.6°, p=0.966). The higher prevalence of pre-operative spinopelvic hypermobility in patients compared to controls (21.3% vs. 0.0%; p=0.009), was not longer present post-THA (6.4% vs. 0.0%; p=0.194). Similar results were found moving from standing to deep-seated position post-THA.

Pre-operative, spinopelvic characteristics that contribute to abnormal mechanics can normalize post-THA following improvement in hip flexion. This leads to patients having the expected hip-, pelvic- and spinal flexion as per demographically-matched controls, thus potentially eliminating abnormal mechanics that contribute to the development/exacerbation of hip-spine syndrome.