European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025
Radiographic and systemic predictors of persistent low back pain following total hip arthroplasty: roles of relative pelvic version and osteosarcopenia.
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Okamoto Yoshinori, Wakama Hitoshi, Saika Takafumi, Tani Kengo, Otsuki Shuhei
Аннотация
PURPOSE: This study aimed to assess the association of preoperative relative pelvic version (RPV, individualised pelvic incidence (PI)-based proportional parameter) and osteosarcopenia (coexisting osteoporosis and sarcopenia) with persistent low back pain (LBP) after total hip arthroplasty (THA).
METHODS: We retrospectively reviewed 162 consecutive patients who underwent unilateral primary THA (mean follow-up, 24 months). Preoperative assessments included lateral standing radiographs for RPV (= sacral slope - [PI × 0.59 + 9]), lumbar dual-energy X-ray absorptiometry for bone density, and computed tomography-based cross-sectional area of the psoas muscle. The primary outcome was the achievement of the minimal clinically important difference (MCID) in the visual analogue scale score for LBP (VAS-LBP) at final follow-up. Multivariate logistic regression identified independent predictors. As a sensitivity analysis, a 1:1 propensity score-matched comparison (pelvic retroversion vs control) evaluated patient-reported outcomes.
RESULTS: RPV < - 7° (P = 0.025), sarcopenia (P = 0.028), and osteoporosis (P = 0.044) were independently associated with failure to achieve MCID in LBP. The matched cohort confirmed worse VAS-LBP, Oswestry Disability Index, and patient satisfaction in the retroverted group (P < 0.05). Osteosarcopenia was also more frequent among affected patients (P < 0.001).
CONCLUSIONS: Preoperative RPV, a simple radiographic parameter, independently predicts persistent LBP after THA. Combined evaluation of RPV and osteosarcopenia may improve preoperative risk stratification and guide targeted perioperative management.
METHODS: We retrospectively reviewed 162 consecutive patients who underwent unilateral primary THA (mean follow-up, 24 months). Preoperative assessments included lateral standing radiographs for RPV (= sacral slope - [PI × 0.59 + 9]), lumbar dual-energy X-ray absorptiometry for bone density, and computed tomography-based cross-sectional area of the psoas muscle. The primary outcome was the achievement of the minimal clinically important difference (MCID) in the visual analogue scale score for LBP (VAS-LBP) at final follow-up. Multivariate logistic regression identified independent predictors. As a sensitivity analysis, a 1:1 propensity score-matched comparison (pelvic retroversion vs control) evaluated patient-reported outcomes.
RESULTS: RPV < - 7° (P = 0.025), sarcopenia (P = 0.028), and osteoporosis (P = 0.044) were independently associated with failure to achieve MCID in LBP. The matched cohort confirmed worse VAS-LBP, Oswestry Disability Index, and patient satisfaction in the retroverted group (P < 0.05). Osteosarcopenia was also more frequent among affected patients (P < 0.001).
CONCLUSIONS: Preoperative RPV, a simple radiographic parameter, independently predicts persistent LBP after THA. Combined evaluation of RPV and osteosarcopenia may improve preoperative risk stratification and guide targeted perioperative management.