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How Is Lumbar Fusion Associated With Compensatory Hip Motion After THA?

Hiroyuki Tokuyasu1,2, Eiki Tsushima2, Mitsuru Takemoto3

  • 1Department of Rehabilitation, Kyoto City Hospital, Kyoto, Japan.

Clinical Orthopaedics and Related Research
|March 6, 2026
PubMed
Summary
This summary is machine-generated.

Lumbar fusion after total hip arthroplasty (THA) increases compensatory hip flexion, with more fused levels leading to greater hip motion. Preoperative imaging can help predict this increased risk of dislocation.

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Area of Science:

  • Orthopedic Surgery
  • Spine Surgery
  • Hip Arthroplasty

Background:

  • Patients with total hip arthroplasty (THA) may compensate for reduced spinal motion after lumbar fusion by increasing hip flexion.
  • The relationship between the number of fused spinal levels and compensatory hip motion post-lumbar fusion is not well understood.
  • Predicting postoperative compensatory hip motion changes before lumbar fusion is challenging.

Purpose of the Study:

  • To determine if lumbar fusion after THA is associated with resting spinopelvic alignment or compensatory hip changes.
  • To assess if the number of fused spinal segments correlates with increased compensatory hip motion.
  • To evaluate if this increase in hip compensatory motion can be predicted preoperatively.

Main Methods:

  • Retrospective analysis of 109 patients with lumbar fusion after THA.
  • Functional lateral radiographs in standing, relaxed-seated, and flexed-seated postures before and after surgery.
  • Measurement of spinopelvic alignment parameters (e.g., pelvic incidence, lumbar lordosis, pelvic tilt) and hip angle (pelvic-femoral angle).
  • Multivariable regression analysis to associate fused levels with changes in pelvic-femoral angle (PFA) in the flexed-seated position.

Main Results:

  • Lumbar fusion led to improved Oswestry Disability Index scores and reduced back pain.
  • Post-lumbar fusion, increased lumbar lordosis and pelvic-femoral angle (PFA) were observed in the flexed-seated position, indicating greater compensatory hip flexion.
  • The number of fused spinal levels significantly correlated with the increase in PFA in the flexed-seated position (standardized β = 0.39, p = 0.002).
  • A regression model predicted the increase in PFA based on the number of fused levels and preoperative hip angle (R² = 0.43, p < 0.001).

Conclusions:

  • Preoperative flexed-seated radiographs in THA patients undergoing lumbar fusion are valuable.
  • This data aids spine surgeons in discussing dislocation risks with patients and hip surgeons, supporting shared decision-making.
  • Future research using 3D imaging is needed to explore multiplanar hip motion and dislocation risk during functional activities.