Influence of sagittal degenerative spondylolisthesis on anteversion of the acetabular component in total hip arthroplasty

Einfluss der sagittalen degenerativen Spondylolisthesis auf die Anteversion der Azetabulum-Komponente bei Hüfttotalendoprothese



Degenerative lumbar spondylolisthesis (DSPL), as opposed to other degenerative spinal conditions, is disregarded in the assessment of hip stability after total hip arthroplasty (THA). This study aimed to determine whether patients with DSPL have different acetabular anteversion compared to patients with normal spine before and following THA.


Preoperative and postoperative 6‑month lateral pelvic radiographs in standing and sitting positions from 91 patients who underwent primary THA were retrospectively compared for spinopelvic parameters between patients with DSPL (n = 31) and with normal spine (n = 34).


Compared to control patients in the standing position, patients with DSPL had significantly increased preoperative pelvic tilt (24° in DSPL vs. 8° in controls; p < 0.01), pelvic–femoral angle (194° in DSPL vs. 174° in controls; p < 0.05), decreased lumbar lordosis (35° in DSPL vs. 43° in controls; p < 0.05), increased postoperative pelvic tilt (22° in DSPL vs. 7° in controls; p < 0.01), pelvic–femoral angle (187° in DSPL vs. 179° in controls; p < 0.05), and acetabular anteversion (31° in DSPL vs. 23° in controls; p < 0.05). Preoperative (p = 0.181) and postoperative (p = 0.201) sitting pelvic tilt did not differ. There were positive correlations between preoperative standing pelvic tilt and postoperative standing acetabular anteversion, pelvic–femoral angle, and combined sagittal index (CSI) in DSPL (R2 = 0.8416; R2 = 0.9180; R2 = 0.9459, respectively, p < 0.01) and in controls (R2 = 0.6872; R2 = 0.6176; R2 = 0.7129, respectively, p < 0.01).


While the imbalance of seated sagittal plane is usually insignificant and compensable, the mechanism by which DSPL patients achieve a standing posture is different from control patients, with more hip extension and posterior tilt of the pelvis. Special attention should be paid to the risk of impingement caused by the increase of acetabular anteversion in the postoperative standing position.



Die degenerative lumbale Spondylolisthesis (DSPL) wird im Gegensatz zu anderen degenerativen Wirbelsäulenerkrankungen bei der Beurteilung der Hüftstabilität nach Hüfttotalendoprothese (HTEP) vernachlässigt. Ziel dieser Studie war es, festzustellen, ob Patienten mit DSPL im Vergleich zu Patienten mit normaler Wirbelsäule vor und nach der HTEP eine andere azetabuläre Anteversion aufweisen.


Präoperative und postoperative 6‑Monats-Röntgenaufnahmen des lateralen Beckens in stehender und sitzender Position von 91 Patienten, die sich einer primären HTEP unterzogen, wurden retrospektiv hinsichtlich spinopelviner Parameter zwischen Patienten mit DSPL (n = 31) und normaler Wirbelsäule (n = 34) verglichen.


Im Vergleich zu den Kontrollpatienten in stehender Position wiesen Patienten mit DSPL eine signifikant erhöhte präoperative Beckenkippung (24° bei DSPL vs. 8° bei der Kontrollgruppe; p < 0,01), einen Becken-Oberschenkel-Winkel (194° bei DSPL vs. 174° bei der Kontrollgruppe; p < 0,05), eine verringerte Lendenlordose (35° bei DSPL vs. 43° bei der Kontrollgruppe; p < 0,05) sowie eine erhöhte postoperative Beckenkippung (22° bei DSPL vs. 7° bei der Kontrollgruppe; p < 0,01), Becken-Oberschenkel-Winkel (187° bei DSPL vs. 179° bei der Kontrollgruppe; p < 0,05) und Azetabulum-Anteversion (31° bei DSPL vs. 23° bei der Kontrollgruppe; p < 0,05). Die präoperative (p = 0,181) und postoperative (p = 0,201) Beckenkippung im Sitzen unterschied sich nicht. Es gab positive Korrelationen zwischen der präoperativen Beckenkippung im Stehen und der postoperativen Azetabulum-Anteversion im Stehen, dem Becken-Oberschenkel-Winkel und dem kombinierten Sagittal-Index (CSI) bei DSPL (R2 = 0,8416; R2 = 0,9180; R2 = 0,9459; jeweils p < 0,01) und bei der Kontrollgruppe (R2 = 0,6872; R2 = 0,6176; R2 = 0,7129; jeweils p < 0,01).


Während die Dysbalance der Sagittalebene im Sitzen in der Regel unbedeutend und kompensierbar ist, unterscheidet sich der Mechanismus, durch den DSPL-Patienten eine stehende Haltung erreichen, von Kontrollpatienten, durch mehr Hüftextension und eine posteriorere Kippung des Beckens. Besonderes Augenmerk sollte auf das Impingement-Risiko gelegt werden, das durch die Zunahme der azetabulären Anteversion in der postoperativen Stehposition entsteht.

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Acetabular anteversion




Body mass index


Combined sagittal index


Degenerative lumbar spondylolisthesis


Intraclass correlation coefficient


Institutional review board


Lumbar lordosis


Pelvic-femoral angle


Pelvic incidence


Pelvic tilt


Sacral slope


Total hip arthroplasty


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Author information




All co-authors actively participated in this study and have read and approved the final manuscript.

Corresponding author

Correspondence to Eryou Feng MD, PhD.

Ethics declarations

Conflict of interest

K. Shen, L. Lin, E. Feng, Y. Zhang, L. Xiao, F. Lin and Z. Li declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of Fuzhou Second Hospital affiliated to Xiamen University. Written informed consent was obtained from all patients enrolled in the investigation.

Additional information

Kaiwei Shen and Liqiong Lin are first co-authors, they contributed equally to the work.

Study design

Retrospective comparative case series (nonrandomized clinical study design).

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request; please contact the corresponding author Dr. Feng. Administrative permission was received from Fuzhou Second Hospital affiliated to Xiamen University (No. 47, Shangteng Road, Cangshan District, Fuzhou, China) to access the medical records.

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Shen, K., Lin, L., Feng, E. et al. Influence of sagittal degenerative spondylolisthesis on anteversion of the acetabular component in total hip arthroplasty. Orthopäde (2021).

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  • Retrospective study
  • Spinopelvic alignment
  • Imbalance
  • Sitting position
  • Standing position


  • Retrospektive Studie
  • Spinopelvines Alignment
  • Ungleichgewicht
  • Sitzende Position
  • Stehende Position