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- Yoshinori Okamoto, Hitoshi Wakama, Junya Matsuyama, Kaito Nakamura, Takafumi Saika, Shuhei Otsuki, and Masashi Neo.
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan. yoshinori.okamoto@ompu.ac.jp.
- Eur Spine J. 2023 Dec 1; 32 (12): 445244634452-4463.
PurposeTo evaluate the association between the preoperative global alignment and proportion (GAP) score and low back pain (LBP) after total hip arthroplasty (THA).MethodsThis was a retrospective case-control study of 200 patients who underwent primary unilateral THA for hip osteoarthritis. The following variables were compared between individuals with (n = 76) and without (n = 124) LBP after THA over a mean follow-up of 2 years: age, sex, GAP score, and patient-reported outcome measures. Logistic regression and receiver operating characteristic curve analyses were used to detect predictive factors.ResultsThe following parameters were predictive of post-THA LBP: relative pelvic version (RPV) <-7° (odds ratio, 1.43; 95% confidence interval, 1.10-1.72; P = 0.032) and relative lumbar lordosis <-15° (odds ratio, 1.13; 95% confidence interval, 1.04-2.13; P = 0.041) preoperatively. Using an RPV cutoff value of - 7° (specificity 61/64 = 0.953; sensitivity 121/136 = 0.890), there were significant between-group differences in LBP visual analog scale (P = 0.020), Oswestry Disability Index (ODI, P = 0.014), EuroQol 5-Dimension (P = 0.027), Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR, P = 0.012), patient satisfaction (P = 0.024). There was clinically meaningful improvement for LBP visual analog scale (P = 0.001), ODI (P = 0.004), and HOOS JR (P < 0.001). The RPV before THA was correlated with HOOS JR (r = 0.773, P = 0.012) and ODI (r = - 0.602, P = 0.032) postoperatively.ConclusionAmong the GAP score, a moderate-to-severe pelvic retroversion was significantly associated with LBP post-THA. The RPV measurement may be a useful predictor of THA outcome, which may influence patient satisfaction.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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