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Purpose <p>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).</p> Methods <p>We retrospectively reviewed 162 consecutive patients who underwent unilateral primary THA (mean follow-up, 24&#xa0;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 <i>vs</i> control) evaluated patient-reported outcomes.</p> Results <p>RPV &lt;  − 7° (<i>P</i> = 0.025), sarcopenia (<i>P</i> = 0.028), and osteoporosis (<i>P</i> = 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 (<i>P</i> &lt; 0.05). Osteosarcopenia was also more frequent among affected patients (<i>P</i> &lt; 0.001).</p> Conclusions <p>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.</p>

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Radiographic and systemic predictors of persistent low back pain following total hip arthroplasty: roles of relative pelvic version and osteosarcopenia

  • 期刊论文

  • 发表日期：

    2025年11月10日

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  • Yoshinori Okamoto,
  • Hitoshi Wakama,
  • Takafumi Saika,
  • Kengo Tani,
  • Shuhei Otsuki

摘要

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.