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Sagittal alignment in patients with flexion contracture of the hip before and after total hip arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

In hip osteoarthritis, hip flexion contracture can severely alter the patient’s alignment, and, therefore, affect the patient’s quality of life (QOL). Hip contracture is not well-studied, partly because of the difficulties of its diagnosis. The aim of this study was to propose a quantitative definition of hip flexion contracture, and to analyse sagittal alignment in these patients compared to non-contracture ones, before and 12 months after total hip arthroplasty (THA).

Materials and methods

Consecutive patients with hip arthrosis and an indication for THA were included (N = 123). Sagittal full-body radiographs were acquired in free standing position and in extension. QOL questionnaires were administered before and after surgery. Spinopelvic parameters were measured, including the pelvic–femur angle (PFA). Patients with low pelvic incidence (< 45°) were included in the hip contracture group if PFA > 5°, or PFA > -5° when pelvic incidence ≥ 45°.

Results

29% of patients were in the hip flexion contracture group, and they showed lower pelvic tilt than the no-contracture group (p < 0.001), larger lumbar lordosis (LL) and smaller PI-LL (p < 0.001), as well as a forward position of the head. 16% of patients still had hip contracture 12-months postop. Contracture patients showed higher QOL scores after surgery.

Conclusions

The proposed method to diagnose hip contracture group allowed to define a group of patients who showed a specific pattern of sagittal spinopelvic alignment. These patients improved their alignment and quality of life postoperatively, but their hip mobility was not always restored. Diagnosing these patients is a first step toward the development of more specific surgical approaches, aiming to improve their surgical outcome.

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Availability of data and materials

Data are available on an as-requested basis.

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Acknowledgements

The authors are grateful to the Japan Society for the Promotion of Science for funding, and to Ms. Yasuda Hisayo for her technical support.

Funding

The study was funded by the Japan Society for the Promotion of Science trough an invitational fellowship grant (S21026). The study sponsor had no role in study design, collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, 151 Bd de l’Hôpital, 75013, Paris, France

    Claudio Vergari

  2. International Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan

    Claudio Vergari

  3. Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan

    Youngwoo Kim, Mitsuru Takemoto, Yu Shimizu & Shunya Fukae

  4. Department of Orthopaedic Surgery, Gakkentoshi Hospital, Kyoto, Japan

    Chiaki Tanaka

  5. Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan

    Shunsuke Fujibayashi & Shuichi Matsuda

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Contributions

CV: concept and design, obtaining of funding, analysis and interpretation of the data, drafting of the article, and final approval of the article. CV was the main investigator of this study, and performed all of the measurements. YK: provision of study patients, obtaining of funding, collection, analysis and interpretation of data, participation in the reproducibility study, critical revision of the article for important intellectual content and final approval of the article. MT: concept and design, analysis and interpretation of data, critical revision of the article for important intellectual content, and final approval of the article. YS: provision of study patients, analysis and interpretation of data, critical revision of the article for important intellectual content, and final approval of the article. CT: provision of study patients, analysis and interpretation of data, critical revision of the article for important intellectual content, and final approval of the article. SF: provision of study patients, analysis and interpretation of data, critical revision of the article for important intellectual content, and final approval of the article. SF: provision of study patients, analysis and interpretation of data, critical revision of the article for important intellectual content, and final approval of the article. SM: concept and design, obtaining of funding, analysis and interpretation of data, critical revision of the article for important intellectual content, and final approval of the article.

Corresponding author

Correspondence to Claudio Vergari.

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Research involving Human Participants

Institutional review board approved the data collection (authorization N. 621).

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Vergari, C., Kim, Y., Takemoto, M. et al. Sagittal alignment in patients with flexion contracture of the hip before and after total hip arthroplasty. Arch Orthop Trauma Surg 143, 3587–3596 (2023). https://doi.org/10.1007/s00402-022-04606-y

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  • DOI: https://doi.org/10.1007/s00402-022-04606-y

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