Can Abnormal Spinopelvic Relationships be Identified by Anteroposterior Pelvic Radiographs?

Abnormal spinopelvic relationships may place patients at an increased risk for instability after primary total hip arthroplasty. The purpose of this study was to determine if radiographic markers on a standing anteroposterior (AP) pelvis radiograph could identify patients with sagittal spinopelvic imbalance or spinal stiffness.

Patients undergoing primary total hip arthroplasty at a single institution from 2017 to 2020 with standing AP pelvis radiographs and sitting/standing lateral radiographs were identified. AP pelvis radiographs were assessed for the following: lumbosacral hardware, spine osteophytes, disc space narrowing, scoliosis>5°, pelvic obliquity>5°, and overlap of the sacrococcygeal junction/pubic symphysis. Patients with spinopelvic imbalance and/or spinopelvic stiffness were identified. Univariate and multivariate analyses were performed. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.

Four hundred eighty-six patients were included. Prevalence of isolated sagittal spinopelvic imbalance and isolated spinopelvic stiffness was 12% and 21%, respectively; 11% of patients had sagittal imbalance and stiffness. Overlap of the sacrococcygeal junction/pubic symphysis (OR = 10.2, 95% CI = 5.3-19.8) and presence of lumbosacral hardware (OR = 4.4, 95% CI = 2.0-9.4) were markers of an increased risk of combined sagittal imbalance and stiffness. Seventy-nine percent of patients with overlap of the sacrococcygeal junction and pubic symphysis and 82% of patients with lumbosacral hardware had an abnormal spinopelvic relationship.

Isolated sagittal imbalance and stiffness were difficult to predict on standing AP pelvis radiographs. Overlap of the sacrococcygeal junction/pubic symphysis and presence of lumbosacral hardware associated with a higher risk of combined sagittal imbalance/stiffness and were present in ≥79% of patients with an abnormal spinopelvic relationship.

IV; retrospective cohort study.