Spinopelvic alignment’s role in preventing osteoarthritis

Femoroacetabular health and preventing osteoarthritis

IN RECENT RESEARCH PUBLISHED in the Journal of Clinical Medicine authored by Stepinski, et al., spinopelvic alignment and its relevance in the success of total hip replacement is reviewed.¹ This is an important piece of research not only because of its telescopic view of the causal relationships of the hip, pelvis and spine, but also because it seems evident that if optimal spinopelvic alignment is established before the degenerative process consumes the patient, perhaps degenerative processes in the hip can be prevented, delayed or diminished. 

Osteoarthritis and aging

Osteoarthritis (OA) affects one in three people over the age of 65.¹ This number is staggering.  

We do know that if we can improve joint function and decrease load and trauma to the region, we can delay or diminish the limiting effects of OA. With hip surgery on a steep climb over the past five years and total hip replacements currently being the No. 1 hip surgery performed to date,² it seems a piece of the puzzle is missing. That piece is prevention of hip pathology. If we look deeper into the outcomes of total hip replacement (THR) surgery we can evaluate the correlation between sacral inclination, lumbar lordosis and surgical outcome.¹ 

The pelvic incidence angle is:³  

• The angle that is formed from the sacral base angle to the femoral head. 
• This angle is equal to the sum of pelvic tilt and sacral slope. 
• The greater the pelvic tilt, the greater the lumbar lordosis. 
• This angle changes the acetabular position and in the instance of surgical intervention, and points to the considerations of the acetabular cup placement.  
• This is a consideration due to the incidence of femoral dislocation post-THR. 

Therefore, we understand that the position of the sacral incidence speaks to femoral stability.  

Femoral stability and misalignment

Femoral stability speaks to the health of the femoroacetabular joint.⁴ It is easily conceivable that if the femoral heads are misaligned due to a leg length difference, micro-instability, degenerative changes, hip dysplasia, trauma or organically gained hip compensatory patterns, this would promote or exacerbate a hip pathology.  

Fig. A shown below demonstrates unequal leg length. By looking at this visual representation of excessive unilateral stress to the femoroacetabular joint, we can appreciate the potential for accelerated degeneration of the femoroacetabular joint. In this instance it is inevitable that a hip pathology will present itself eventually.

As far as intervention goes, we can also appreciate the ease of the placement of a flexible three-arch custom orthotic to facilitate decreased aberrant force transmission to the hip and establish pelvic leveling. Figure B demonstrates that correction. If this correction is coupled with chiropractic care of the lumbar spine and sacral base alignment, the preventative ability of future hip pathology seems evident.   

Interventions that are instituted before the onset of symptoms speak to the prevention of future problems that may limit activities of daily living or inhibit optimal performance. One step in the direction of early detection is to look at the feet. Callouses do not lie. They tell the story of global kinetic chain compensation. Unequal leg length, hip instability, as well as a laundry list of pathologies are easily unpeeled by looking at the compensatory patterns visible on the evaluation of the foot.  

Assessing foot function with a casting kit or digital foot scan is a solid first step in the early detection of not only hip pathology but any joint above the subtalar joint extending as far as the cervical spine. The addition of a foot assessment on the day of initial exam provides enhanced data gathering in addition to the detection of what may be covert or future problematic pathology. Additionally, this initiates the corrective care plan of the patient from day one. This easily implemented procedure combined with a quality exam and care of the patient lends itself to optimal patient performance and outcomes under your care.

Do the research

Looking into the research on spinopelvic alignment and how it correlates to the health, stability and success of the postsurgical hip is an important step in not only the multidisciplinary approach to patient-centered care, but the early detection and corrective plan for patients. This comprehensive approach to care places the patient at the front of the care plan and provides optimal outcomes for patients at all ages and levels of activity.

CHRISTINE FOSS, DC, MS.Ed, ATC, DACBSP, DACRB, ICSC, has a master’s degree in sports medicine from Old Dominion University and is currently director and lead instructor of the New York Chiropractic College Certified Chiropractic Sports Physician program, and Education Chair for Federation Internationale de Chiropractique du Sport and Director of Education for Foot Levelers. She has worked with Team USA track and field, men’s gymnastics and at the World Games as a medical staff member. She can be reached at drcfoss@gmail.com or @drchristinefoss on Instagram. 

References

1.  Stępiński P, Stolarczyk A, Maciąg B, Modzelewski K, Szymczak J, Michalczyk W, Zdun J, Grzegorzewski S. Spinopelvic Alignment and Its Use in Total Hip Replacement Preoperative Planning—Decision Making Guide and Literature Review. Journal of Clinical Medicine. 2021; 10(16):3528. https://doi.org/10.3390/jcm10163528 
2. Callaghan, John J., Aaron G. Rosenberg, and Harry E. Rubash, eds. The adult hip. Vol. 1. Lippincott Williams & 64-571 Wilkins, 2007. 
3. J.C. LE Huec, S. Aunoble, Leijssen Phillippe, Pellet Nicolas Pelvic Parameters: origin and significance. Eur Spine Journal 2011 Sept;20 (Suppl 5) 5 
4. Bolla, Microinstabiilty of the hip; apreviously unrecognized pathology