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Background <p>Osteonecrosis of the femoral head (ONFH) involves femoral head collapse, leading to hip joint pain, low back pain (LBP), and reduced quality of life. While compensatory spinopelvic alignment (SPA) changes are well-documented in hip osteoarthritis, their relationship with ONFH progression remains poorly understood. This study aimed to investigate SPA changes across different ONFH stages and evaluate the effects of total hip arthroplasty (THA) on SPA and patient-reported outcome measures (PROMs), including LBP, in patients undergoing THA at early and late stages of ONFH.</p> Methods <p>This retrospective study included 82 patients with ONFH who underwent THA. Patients were classified into three groups based on ONFH stage using the Japanese Investigation Committee classification: stage 2 and 3A, stage 3B, and stage 4. Preoperative and postoperative SPA parameters (pelvic incidence, lumbar lordosis [LL], sacral slope [SS], pelvic tilt [PT], thoracic kyphosis, and sagittal vertical axis [SVA]) and PROMs (Japan Hip Disease Evaluation Questionnaire [JHEQ] and LBP Visual Analog Scale [VAS] scores) were compared across stages. SPA and PROMs were investigated preoperatively and 2&#xa0;years postoperatively.</p> Results <p>Preoperative SPA analysis revealed increased SS and SVA as ONFH progressed. Postoperatively, THA significantly reduced LL, SS, and SVA while increasing PT, with similar trends across all stages. Notably, stage 4 patients exhibited significantly greater increases in posterior PT. PROMs, including JHEQ and LBP VAS scores, improved significantly across all stages postoperatively, with no significant differences in the degree of improvement.</p> Conclusion <p>THA improves compensatory SPA changes and PROMs in ONFH cases, regardless of the disease stage. However, patients with advanced-stage ONFH may experience further progression of the posterior PT postoperatively, highlighting the importance of preoperative SPA evaluation in late-stage cases.</p>

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Changes in spinopelvic alignment and patient-reported outcomes after total hip arthroplasty in osteonecrosis of the femoral head

  • 期刊论文

  • 发表日期：

    2025年11月10日

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  • Hiroaki Ido,
  • Yusuke Osawa,
  • Yasuhiko Takegami,
  • Hiroto Funahashi,
  • Hiroki Iida,
  • Shiro Imagama

摘要

Background

Osteonecrosis of the femoral head (ONFH) involves femoral head collapse, leading to hip joint pain, low back pain (LBP), and reduced quality of life. While compensatory spinopelvic alignment (SPA) changes are well-documented in hip osteoarthritis, their relationship with ONFH progression remains poorly understood. This study aimed to investigate SPA changes across different ONFH stages and evaluate the effects of total hip arthroplasty (THA) on SPA and patient-reported outcome measures (PROMs), including LBP, in patients undergoing THA at early and late stages of ONFH.

Methods

This retrospective study included 82 patients with ONFH who underwent THA. Patients were classified into three groups based on ONFH stage using the Japanese Investigation Committee classification: stage 2 and 3A, stage 3B, and stage 4. Preoperative and postoperative SPA parameters (pelvic incidence, lumbar lordosis [LL], sacral slope [SS], pelvic tilt [PT], thoracic kyphosis, and sagittal vertical axis [SVA]) and PROMs (Japan Hip Disease Evaluation Questionnaire [JHEQ] and LBP Visual Analog Scale [VAS] scores) were compared across stages. SPA and PROMs were investigated preoperatively and 2 years postoperatively.

Results

Preoperative SPA analysis revealed increased SS and SVA as ONFH progressed. Postoperatively, THA significantly reduced LL, SS, and SVA while increasing PT, with similar trends across all stages. Notably, stage 4 patients exhibited significantly greater increases in posterior PT. PROMs, including JHEQ and LBP VAS scores, improved significantly across all stages postoperatively, with no significant differences in the degree of improvement.

Conclusion

THA improves compensatory SPA changes and PROMs in ONFH cases, regardless of the disease stage. However, patients with advanced-stage ONFH may experience further progression of the posterior PT postoperatively, highlighting the importance of preoperative SPA evaluation in late-stage cases.