Study Design: The effect of Total Hip Replacement surgery (THR) upon spinal sagittal alignment and low back pain was assessed in patients with severe hip osteoarthritis.

Summary of Background Data: Osteoarthritis in the hip joint is associated with abnormal posture and gait due to hip flexion contracture and hip pain. This in turn may cause abnormal spinal sagittal alignment and secondarily induce low back and leg pain. However, there have been no reports regarding the corrective effect of Total Hip Replacement surgery upon spinal sagittal alignment in patients with osteoarthritis of the hip.

Methods: This study prospectively analyzed the results of 25 patients (15 females and 10 males, average age 67.4 years (32–84)) undergoing THR for severe osteoarthritis of the hip. Pre and post-surgical assessment included; sagittal measurement of Sacral Inclination (SI) and total Lumbar Lordosis (L1-S1) on standing lateral radiographs. Functional clinical outcomes for hip as well as low back were also evaluated using the Oswestry back Questionnaire, the Modified Harris Hip Score and Visual Analog Scale for lower back pain and hip pain accordingly.

All the radiographic and clinical evaluations were completed both before THR surgery and 3 months following the surgery during routine follow up.

Results: Mean Lumbar Lordosis before the surgery and in the follow up was 50.36 and 50.32 respectively. Mean sacral inclination before and after surgery were 39.06 and 38.16 respectively. Mean Functional outcomes as assessed by the HHS score before and after the surgery were 45.74 and 81.8 respectively. Mean Oswestry Questionnaire scores before and after the surgery were 36.72 and 24.08 respectively. Mean VAS scores for hip pain before and after the surgery were 7.08 and 2.52 respectively. Mean VAS scores for lower back pain before and after the surgery were 5.04 and 3.68 respectively.

Discussion: No Significant difference was found between the sagittal alignment of the spine before THR and 3 months following it. Interestingly, total hip replacement surgery significantly improved spinal functional outcome as well as relieved low back and hip pain.

We report a prospective study of 783 male Israeli recruits aged from 17 to 26 years. The risk of stress fracture was inversely proportional to age on both univariate and multivariate analysis. Each year of increase of age above 17 years reduced the risk of stress fracture by 28%.

Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndromes to which this disease can give rise. Extensive surgical drainage and antibiotic treatment led to recovery in all cases.

A prospective study of 295 infantry recruits has shown that the mediolateral width of the tibia measured radiographically at each of three different levels in the bone had a statistically significant correlation with the total incidence of stress fractures as well as with those in the tibia alone or the femur alone. A narrow tibial width was shown to be a risk factor, but cortical thickness was not found to be significant.