1 Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran

2 Department of Orthopedics, Baqiyatallah University of Medical Sciences, Tehran, IR Iran


Background: Adult degenerative disorders of hip and spine are common. The recent studies inconsistently have
discussed about the influence of spinal disorders on total hip arthroplasty (THA). In this review, we discussed clearly
about these relationships and their effects on the most appropriate position of the acetabular component.
Methods: We searched on databases and evaluated the articles about spinopelvic parameters in patients with spinal
disorders who needed THA.
Results: The literature search showed a prevalence of 21.2 % to 60.4% of low back pain (LBP) in patients, who
are candidates for primary THA. The coexistence of degenerative disease of hip and spine or other diseases can
significantly alter spinopelvic alignment. Accordingly, pain management or any other treatment in these patients
requires proper understanding about the biomechanics of the hip and the spinal and their corresponding interactions.
In this review article, we discussed about these interactions and their effects on the most appropriate position of the
acetabular component.
Conclusion: We concluded that counseling sessions among patients, orthopedic surgeons and spine surgeons
can result in obtaining the best outcome for these individuals.
Level of evidence: I


Main Subjects

1. Sing DC, Barry JJ, Aguilar TU, Theologis AA, Patterson
JT, Tay B, et al. Prior lumbar spinal arthrodesis
increases risk of prosthetic-related complication
in total hip arthroplasty. J Arthroplasty. 2016; 31(9
2. Lawrence RC, Helmick CG, Arnett FC, Deyo RA,
Felson DT, Giannini EH, et al. Estimates of the
prevalence of arthritis and selected musculoskeletal
disorders in the United States. Arthritis Rheum.
1998; 41(5):778-99.
3. Yoshimura N, Muraki S, Oka H, Mabuchi A, En-Yo Y,
Yoshida M, et al. Prevalence of knee osteoarthritis,
lumbar spondylosis, and osteoporosis in Japanese
men and women: the research on osteoarthritis/
osteoporosis against disability study. J Bone Miner
Metab. 2009; 27(5):620-8.
4. Muraki S, Oka H, Akune T, Mabuchi A, En-Yo Y,
Yoshida M, et al. Prevalence of radiographic lumbar
spondylosis and its association with low back pain
in elderly subjects of population-based cohorts: the
ROAD study. Ann Rheum Dis. 2009; 68(9):1401-6.
5. Hsieh PH, Chang Y, Chen DW, Lee MS, Shih HN, Ueng
SW. Pain distribution and response to total hip
arthroplasty: a prospective observational study in
113 patients with end-stage hip disease. J Orthop Sci.
2012; 17(3):213-8.
6. Staibano P, Winemaker M, Petruccelli D, de Beer J.
Total joint arthroplasty and preoperative low back
pain. J Arthroplasty. 2014; 29(5):867-71.
7. Offierski CM, MacNab I. Hip-spine syndrome. Spine.
1976; 8(3):316-21.
8. Thomas JS, France CR. The relationship between

pain-related fear and lumbar flexion during natural
recovery from low back pain. Eur Spine J. 2007;
9. Wong TK, Lee RY. Effects of low back pain on the
relationship between the movements of the lumbar
spine and hip. Hum Mov Sci. 2004; 23(1):21-34.
10. Barrey C, Darnis A. Current strategies for the
restoration of adequate lordosis during lumbar
fusion. World J Orthop. 2015; 6(1):117-26.
11. Raphael IJ, Rasouli MR, Kepler CK, Restrepo S, Albert
TJ, Radcliff KE. Pelvic incidence in patients with hip
osteoarthritis. Arch Bone Jt Surg. 2016; 4(2):132-6.
12. Berge C. Heterochronic processes in human evolution:
an ontogenetic analysis of the hominid pelvis. Am J
Phys Anthropol. 1998; 105(4):441-59.
13. Le Huec J, Aunoble S, Philippe L, Nicolas P. Pelvic
parameters: origin and significance. Eur Spine J. 2011;
20(Suppl 5):564-71.
14. Duval-Beaupère G, Schmidt C, Cosson P. A
barycentremetric study of the sagittal shape of spine
and pelvis: The conditions required for an economic
standing position. Ann Biomed Eng. 20(4):451-62.
15. Duval-Beaupère G, Robain G. Visualization on full
spine radiographs of the anatomical connections of
the centres of the segmental body mass supported by
each vertebra and measured in vivo. Int Orthop. 1987;
16. Legaye J, Duval-Beaupere G, Hecquet J, Marty C. Pelvic
incidence: a fundamental pelvic parameter for threedimensional
regulation of spinal sagittal curves. Eur
Spine J. 1998; 7(2):99-103.
17. 1Stagnara P, De Mauroy JC, Dran G, Gonon GP, Costanzo
G, Dimnet J, et al. Reciprocal angulation of vertebral
bodies in a sagittal plane: approach to references for
the evaluation of kyphosis and lordosis. Spine. 1982;
18. Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal
morphology and equilibrium of pelvis and spine. Eur
Spine J. 2002; 11(1):80-7.
19. Blizzard DJ, Nickel BT, Seyler TM, Bolognesi MP. The
impact of lumbar spine disease and deformity on total
hip arthroplasty outcomes. Orthop Clin North Am.
2016; 47(1):19-28.
20. Lazennec JY, Brusson A, Rousseau MA. Hip-spine
relations and sagittal balance clinical consequences.
Eur Spine J. 2011; 20(Suppl 5):686-98.
21. Sariali E, Lazennec JY, Khiami F, Gorin M, Catonne
Y. Modification of pelvic orientation after total hip
replacement in primary osteoarthritis. Hip Int. 2009;
22. Lazennec JY, Brusson A, Rousseau MA. Lumbarpelvic-
femoral balance on sitting and standing lateral
radiographs. Orthop Traumatolog Surg Res. 2013;
99(1 Suppl):S87-103.
23. Lazennec JY, Rousseau MA, Rangel A, Gorin M,
Belicourt C, Brusson A, et al. Pelvis and total hip
arthroplasty acetabular component orientations
in sitting and standing positions: measurements
reproductibility with EOS imaging system versus
conventional radiographies. Orthop Traumatol Surg
Res. 2011; 97(4):373-80.
24. Weng W, Wu H, Wu M, Zhu Y, Qiu Y, Wang W. The effect
of total hip arthroplasty on sagittal spinal–pelvic–leg
alignment and low back pain in patients with severe
hip osteoarthritis. Eur Spine J. 2016; 25(11):3608-14.
25. Charosky S, Guigui P, Blamoutier A, Roussouly P,
Chopin D; Study Group on Scoliosis. Complications
and risk factors of primary adult scoliosis surgery:
a multicenter study of 306 patients. Spine. 2012;
26. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy
JP. Pelvic tilt and truncal inclination: two key
radiographic parameters in the setting of adults with
spinal deformity. Spine. 2009; 34(17):E599-606.
27. Barrey C, Roussouly P, Le Huec JC, D’Acunzi G, Perrin
G. Compensatory mechanisms contributing to keep
the sagittal balance of the spine. Eur Spine J. 2013;
22(Suppl 6):S834-41.
28. Lafage V, Schwab F, Skalli W, Hawkinson N, Gagey PM,
Ondra S, et al. Standing balance and sagittal plane
spinal deformity: analysis of spinopelvic and gravity
line parameters. Spine. 2008; 33(14):1572-8.
29. Lazennec JY, Boyer P, Gorin M, Catonné Y, Rousseau
MA. Acetabular anteversion with CT in supine,
simulated standing, and sitting positions in a THA
patient population. Clin Orthop Relat Res. 2011;
30. Radcliff KE, Orozco F, Molby N, Delasotta L, Chen E,
Post Z, et al. Change in spinal alignment after total hip
arthroplasty. Orthop Surg. 2013; 5(4):261-5.
31. Kanawade V, Dorr LD, Wan Z. Predictability of
acetabular component angular change with postural
shift from standing to sitting position. J Bone Joint
Surg Am. 2014; 96(12):978-86.
32. Wan Z, Malik A, Jaramaz B, Chao L, Dorr LD.
Imaging and navigation measurement of acetabular
component position in THA. Clin Orthop Relat Res.
2009; 467(1):32-42.
33. Phan D, Bederman SS, Schwarzkopf R. The influence
of sagittal spinal deformity on anteversion of the
acetabular component in total hip arthroplasty. Bone
Joint J. 2015; 97-B(8):1017-23.
34. Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt
makes acetabular cup navigation inaccurate. Acta
Orthop. 2005; 76(4):517-23.
35. Prather H, Van Dillen LR, Kymes SM, Armbrecht MA,
Stwalley D, Clohisy JC, et al. Impact of coexistent lumbar
spine disorders on clinical outcomes and physician
charges associated with total hip arthroplasty. Spine
J. 2012; 12(5):363-9.
36. Tang WM, Chiu KY. Primary total hip arthroplasty in
patients with ankylosing spondylitis. J Arthroplasty.
2000; 15(1):52-8.
37. Zheng GQ, Zhang YG, Chen JY, Wang Y. Decision
making regarding spinal osteotomy and total hip
replacement for ankylosing spondylitis experience
with 28 patients. Bone Joint J. 2014; 96-B(3):360-5.
38. Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS.
Predictors of patient relevant outcome after total hip
replacement for osteoarthritis: a prospective study.
Ann Rheum Dis. 2003; 62(10):923-30.
39. Ben-Galim P, Ben-Galim T, Rand N, Haim A, Hipp J,

Dekel S, et al. Hip-spine syndrome: the effect of total
hip replacement surgery on low back pain in severe
osteoarthritis of the hip. Spine. 2007; 32(19):2099-
40. Chimenti PC, Drinkwater CJ, Li W, Lemay CA,
Franklin PD, O’Keefe RJ. Factors associated with
early improvement in low back pain after total hip
arthroplasty: a multi-center prospective cohort
analyses. J Arthroplasty. 2016; 31(1):176-9.
41. Eksi MS, Yucekul A, Barry JJ, Theologis AA, Mizutani
J, Pekmezci M, et al. The effects of adult spinal
deformity surgery on total hip arthroplasty acetabular
component position. Spine J. 2015; 15(10):S260.
42. Meftah M, Yadav A, Wong AC, Ranawat AS, Ranawat
CS. A novel method for accurate and reproducible
functional cup positioning in total hip arthroplasty. J
Arthroplasty. 2013; 28(7):1200-5.
43. Lewinnek GE, Lewis JL, Tarr R, Compere CL,
Zimmerman JR. Dislocations after total hipreplacement
arthroplasties. J Bone Joint Surg Am.
1978; 60(2):217-20.
44. Tannast M, Langlotz U, Siebenrock KA, Wiese M,
Bernsmann K, Langlotz F. Anatomic referencing of cup
orientation in total hip arthroplasty. Clin Orthop Relat
Res. 2005; 436(1):144-50.
45. Zhu J, Wan Z, Dorr LD. Quantification of pelvic tilt in
total hip arthroplasty. Clin Orthop Relat Rese. 2010;
46. Maratt JD, Esposito CI, McLawhorn AS, Jerabek
SA, Padgett DE, Mayman DJ. Pelvic tilt in patients
undergoing total hip arthroplasty: when does it
matter? J Arthroplasty. 2015; 30(3):387-91.
47. Abdel MP, von Roth P, Jennings MT, Hanssen AD,
Pagnano MW. What safe zone? The vast majority of
dislocated THAs are within the Lewinnek safe zone
for acetabular component position. Clin Orthop Relat
Res. 2016; 474(2):386-91.
48. Esposito CI, Gladnick BP, Lee YY, Lyman S, Wright
TM, Mayman DJ, et al. Cup position alone does not
predict risk of dislocation after hip arthroplasty. J
Arthroplasty. 2015; 30(1):109-13.
49. Legaye J. Influence of the sagittal balance of the spine
on the anterior pelvic plane and on the acetabular
orientation. Int Orthop. 2009; 33(6):1695-700.
50. Tang WM, Chiu KY, Kwan MF, Ng TP. Sagittal pelvic malrotation
and positioning of the acetabular component
in total hip arthroplasty: three‐dimensional computer
model analysis. J Orthop Res. 2007; 25(6):766-71.
51. Babisch JW, Layher F, Amiot LP. The rationale for tiltadjusted
acetabular cup navigation. J Bone Joint Surg
Am. 2008; 90(2):357-65.
52. Biedermann R, Tonin A, Krismer M, Rachbauer F,
Eibl G, Stöckl B. Reducing the risk of dislocation after
total hip arthroplasty: the effect of orientation of the
acetabular component. J Bone Joint Surg Br. 2005;
53. Kosashvili Y, Omoto D, Backstein D, Safir O, Lakstein
D, Gross AE. Acetabular alignment and primary arc
of motion for minus, skirtless, and skirted 28-, 32-,
36-, and 40-mm femoral heads. J Arthroplasty. 2013;
54. D’lima DD, Urquhart AG, Buehler KO, Walker RH,
Colwell CW Jr. The effect of the orientation of the
acetabular and femoral components on the range of
motion of the hip at different head-neck ratios. J Bone
Joint Surg Am. 2000; 82(3):315-21.
55. Morrey B. Difficult complications after hip joint
replacement: dislocation. Clin Orthop Relat Res. 1997;
56. Woo RY, Morrey BF. Dislocations after total hip
arthroplasty. J Bone Joint Surg Am. 1982; 64(9):1295-