The variability of sagittal spino-pelvic mobility in Indian population


  • Sukesh A. N. Department of Orthopaedics, V. P. S. Lakeshore Hospital, Kochi, Kerala, India
  • Jacob Varughese Department of Orthopaedics, V. P. S. Lakeshore Hospital, Kochi, Kerala, India
  • Appu B. Thomas Department of Orthopaedics, V. P. S. Lakeshore Hospital, Kochi, Kerala, India
  • Bipin Theruvil Department of Orthopaedics, V. P. S. Lakeshore Hospital, Kochi, Kerala, India



Spino-pelvic mobility, Stuck sitting, Stuck standing, Sagittal plane, Hip arthroplasty, Hip instability


Background: Abnormal spino-pelvic mobility is increasingly recognized as a leading cause for hip instability following arthroplasty.

Methods: We studied the lateral spino-pelvic radiographs of 90 patients, with no spine/hip pathology in standing and sitting positions. We measured the change in sacral slope and grouped them into three spino-pelvic patterns.

Results: We found that 50% of study subjects had normal spino-pelvic mobility. The remaining 50% were either hypermobile (24%) or stiff (26%). The stiff spines were either fixed (11%) or hypomobile (15%).

Conclusions: Our study shows that in a normal population without any prior hip/spine pathology a significant percentage (50%) have abnormal spino-pelvic mobility. The significance of spinal stiffness in younger age group need to be looked further to make any changes in acetabular cup placement during hip replacement.


Buckland AJ, Vigdorchik J, Schwab FJ, Errico TJ, Lafage R, Ames C, et al. Acetabular anteversion changes due to spinal deformity correction: bridging the gap between hip and spine surgeons. JBJS. 2015;97(23):1913-20.

Lazennec JY, Brusson A, Rousseau MA. Hip–spine relations and sagittal balance clinical consequences. Eur Spine J. 2011;20(5):686.

Buckland AJ, Puvanesarajah V, Jain A, Klineberg EO, Vigdorchik J, Schwarzkopf R, Shaffrey CI, Smith JS, Hart RA, Ames CP, Hassanzadeh H. Dislocation of Primary Total Hip Arthroplasty is More Common in Patients with Lumbar Spinal Fusion. Spine J. 2016;16(10):263-4.

Bedard NA, Martin CT, Slaven SE, Pugely AJ, Mendoza-Lattes SA, Callaghan JJ. Abnormally high dislocation rates of total hip arthroplasty after spinal deformity surgery. J Arthroplast. 2016;31(12):2884-5.

Sing DC, Barry JJ, Aguilar TU, Theologis AA, Patterson JT, Tay BK, Vail TP, Hansen EN. Prior lumbar spinal arthrodesis increases risk of prosthetic-related complication in total hip arthroplasty. J Arthroplast. 2016;31(9):227-32.

Buckland AJ, Hart RA, Mundis GM, Sciubba DM, Lafage R, Errico TJ, et al. Risk of total hip arthroplasty dislocation after adult spinal deformity correction. Spine J. 2016;16(10):180.

Tang WM, Chiu KY. Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplast. 2000;15(1):52-8.

Liu N, Goodman SB, Lachiewicz PF, Wood KB. Hip or spine surgery first? A survey of treatment order for patients with concurrent degenerative hip and spinal disorders. Bone Joint J. 2019;101(6):37-44.

Mudrick CA, Melvin JS, Springer BD. Late posterior hip instability after lumbar spinopelvic fusion. Arthroplast Today. 2015;1(2):25-9.

Esposito CI, Miller TT, Kim HJ, Barlow BT, Wright TM, Padgett DE, Jerabek SA, Mayman DJ. Does degenerative lumbar spine disease influence femoroacetabular flexion in patients undergoing total hip arthroplasty? Clin Orthopaed Relat Res. 2016;474(8):1788-97.

An VV, Sivakumar BS, Levy YD, Pierrepont J, Bruce WJ. Practical implications of the lumbar spine and its function on total hip arthroplasty. J Spine Surg. 2016;2(4):334.

Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine. 2005;30(3):346-53.

Pierrepont J, Hawdon G, Miles BP, Connor BO, Baré J, Walter LR, et al. Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. Bone Joint J. 2017;99(2):184-91.

Stefl M, Lundergan W, Heckmann N, McKnight B, Ike H, Murgai R, Dorr LD. Spinopelvic mobility and acetabular component position for total hip arthroplasty. Bone Joint J. 2017;99(1):37-45.

Philippot R, Wegrzyn J, Farizon F, Fessy MH. Pelvic balance in sagittal and Lewinnek reference planes in the standing, supine and sitting positions. Orthopaed Traumatol Surg Res. 2009;95(1):70-6.

Ike H, Dorr LD, Trasolini N, Stefl M, McKnight B, Heckmann N. Spine-pelvis-hip relationship in the functioning of a total hip replacement. JBJS. 2018;100(18):1606-15.

Lewinnek GE, Lewis JL, Tarr RI, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg. 1978;60(2):217-20.

Tsuda K, Miki H, Kitada M, Nakamura N, Nishii T, Sakai T, et al. Anterior pelvic plane may mislead cup orientation in a case with sagittal tilting of the pelvis. In Orthopaedic Proceedings. Br Edit Soc Bone Joint Surg. 2010;92(1):110.

Pinoit Y, May O, Girard J, Laffargue P, Ala TE, Migaud H. Low accuracy of the anterior pelvic plane to guide the position of the cup with imageless computer assistance: variation of position in 106 patients. Revue de chirurgieorthopedique et reparatrice de l'appareilmoteur. 2007;93(5):455-60.

Blondel B, Parratte S, Tropiano P, Pauly V, Aubaniac JM, Argenson JN. Pelvic tilt measurement before and after total hip arthroplasty. Orthopaed Traumatol Surg Res. 2009;95(8):568-72.

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 Arthroplast. 2015;30(3):387-91.

Luthringer TA, Vigdorchik JM. A preoperative workup of a “hip-spine” total hip arthroplasty patient: a simplified approach to a complex problem. J Arthroplast. 2019;34(7):57-70.

Endo K, Suzuki H, Nishimura H, Tanaka H, Shishido T, Yamamoto K. Sagittal lumbar and pelvic alignment in the standing and sitting positions. J Orthopaed Sci. 2012;17(6):682-6.

Tezuka T, Heckmann ND, Bodner RJ, Dorr LD. Functional safe zone is superior to the Lewinnek safe zone for total hip arthroplasty: why the Lewinnek safe zone is not always predictive of stability. J Arthroplast. 2019;34(1):3-8.

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(8):1017-23.

Chanplakorn P, Wongsak S, Woratanarat P, Wajanavisit W, Laohacharoensombat W. Lumbopelvic alignment on standing lateral radiograph of adult volunteers and the classification in the sagittal alignment of lumbar spine. Eur Spine J. 2011;20(5):706-12.

Legaye J, Duval-Beaupere G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99-103.

Tang WM, Chiu PK. Sagittal pelvic mal-rotation and positioning of the acetabular component. In The Triennial Congress of Asia Pacific Orthopaedic Association. Asia Pacific Orthopaedic Association. 2007.

Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Actaorthopaedica. 2005;76(4):517-23.

Wan Z, Malik A, Jaramaz B, Chao L, Dorr LD. Imaging and navigation measurement of acetabular component position in THA. Clin Orthopaed Relat Res. 2009;467(1):32-42.






Original Research Articles