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Purpose <p>To determine whether large supine-to-standing posterior pelvic tilt is associated with standing-to-sitting spinopelvic stiffness in candidates for total hip arthroplasty (THA) and whether this postural change can serve as a preoperative alert sign for spinopelvic stiffness.</p> Methods <p>This retrospective study included 657 patients undergoing primary THA with preoperative lateral spinopelvic radiographs in the supine, standing, and sitting positions. Sacral slope (SS) was measured in each position. Large supine-to-standing posterior pelvic tilt was defined as ΔSSsup-stand &gt; 10° (supine SS minus standing SS). Spinopelvic stiffness was defined as ΔSSstand-sit ≤ 10° (standing SS minus sitting SS). Multivariable logistic regression was used to determine whether ΔSSsup-stand &gt; 10° was independently associated with spinopelvic stiffness, and receiver operating characteristic analysis assessed discriminative ability.</p> Results <p>Ninety-two patients (14%) had large supine-to-standing posterior pelvic tilt. Spinopelvic stiffness was more frequent in the posterior tilt group than in the normal tilt group (59% vs. 13%, <i>p</i> &lt; 0.001). ΔSSsup-stand &gt; 10° was independently associated with spinopelvic stiffness (odds ratio 8.23, 95% confidence interval 4.98–13.60, <i>p</i> &lt; 0.001). Older age and posterior spinal fusion were also associated with stiffness. The optimal cutoff was 11° with an area under the curve of 0.73, and the predefined ΔSSsup-stand &gt; 10° threshold showed 42% sensitivity, 93% specificity, and 83% accuracy.</p> Conclusions <p>Large supine-to-standing posterior pelvic tilt was associated with standing-to-sitting spinopelvic stiffness in candidates for THA. A ΔSSsup-stand threshold of &gt; 10° may serve as a high-specificity preoperative alert sign for careful assessment of standing-to-sitting spinopelvic motion.</p>

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Large supine-to-standing posterior pelvic tilt is associated with spinopelvic stiffness in candidates for total hip arthroplasty

  • 期刊论文

  • 发表日期：

    2026年6月17日

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  • Tomoyuki Ashizawa,
  • Masanori Fujii,
  • Yuki Nakao,
  • Kenji Kitamura,
  • Shinya Kawahara,
  • Satoshi Hamai,
  • Goro Motomura,
  • Yasuharu Nakashima

摘要

Purpose

To determine whether large supine-to-standing posterior pelvic tilt is associated with standing-to-sitting spinopelvic stiffness in candidates for total hip arthroplasty (THA) and whether this postural change can serve as a preoperative alert sign for spinopelvic stiffness.

Methods

This retrospective study included 657 patients undergoing primary THA with preoperative lateral spinopelvic radiographs in the supine, standing, and sitting positions. Sacral slope (SS) was measured in each position. Large supine-to-standing posterior pelvic tilt was defined as ΔSSsup-stand > 10° (supine SS minus standing SS). Spinopelvic stiffness was defined as ΔSSstand-sit ≤ 10° (standing SS minus sitting SS). Multivariable logistic regression was used to determine whether ΔSSsup-stand > 10° was independently associated with spinopelvic stiffness, and receiver operating characteristic analysis assessed discriminative ability.

Results

Ninety-two patients (14%) had large supine-to-standing posterior pelvic tilt. Spinopelvic stiffness was more frequent in the posterior tilt group than in the normal tilt group (59% vs. 13%, p < 0.001). ΔSSsup-stand > 10° was independently associated with spinopelvic stiffness (odds ratio 8.23, 95% confidence interval 4.98–13.60, p < 0.001). Older age and posterior spinal fusion were also associated with stiffness. The optimal cutoff was 11° with an area under the curve of 0.73, and the predefined ΔSSsup-stand > 10° threshold showed 42% sensitivity, 93% specificity, and 83% accuracy.

Conclusions

Large supine-to-standing posterior pelvic tilt was associated with standing-to-sitting spinopelvic stiffness in candidates for THA. A ΔSSsup-stand threshold of > 10° may serve as a high-specificity preoperative alert sign for careful assessment of standing-to-sitting spinopelvic motion.