Associated Factors for Lumbar Degenerative Spondylolisthesis in Japanese Patients with Osteoarthritis of the Hip: A Radiographic Study

STUDY DESIGN: Retrospective study. PURPOSE: To determine the presence and frequency of factors for degenerative spondylolisthesis (DS) in patients with hip osteoarthritis (OA). OVERVIEW OF LITERATURE: OA of the hip joint (hip OA) in Japanese patients is associated with a high incidence of degenerative lumbar spondylolisthesis (DS). However the associated factors for DS in patients with hip OA are unclear. METHODS: The study included 518 patients (59 men and 459 women) with a mean age of 63.8 years who underwent total hip arthroplasty for hip OA at our hospital between January 2004 and May 2014. The presence of DS was assessed using preoperative standing lateral radiographs of the hip joint including the lower lumbar spine. To identify the associated factors for DS in patients with hip OA, multiple logistic regression analysis was conducted in which the presence or absence of DS was used as a dependent variable, and age, female sex, body mass index (BMI), sacral slope (SS), Crowe classification, and primary OA (P-OA) not associated with acetabular dysplasia were independent variables. RESULTS: Patients with DS accounted for 114 (22.0%) of 518 cases. In multiple logistic regression analysis to identify associated factors for DS in patients with hip OA, the odds ratio for age was 1.05 (95% confidence interval [CI], 1.02–1.08), female sex was 2.48 (95% CI, 1.11–5.54), BMI was 1.08 (95% CI, 1.02–1.14), SS was 1.07 (95% CI, 1.04–1.09), Crowe classification was 0.60 (95% CI, 0.40–0.91), and P-OA was 1.90 (95% CI, 1.20–3.75). CONCLUSIONS: Age, female sex, BMI, SS, low Crowe classification, and P-OA are independently associated factors for DS in patients with hip OA.

Femoral Osteotomy and Rehabilitation for Osteoarthritis of the Hip / The Japanese Journal of Rehabilitation Medicine

In Japan, most of the osteoarthritis of the hip is secondary due to congenital dislocation of the hip or acetabular dysplasia. Total hip arthroplasty is generally performed as the operative method for treating hip osteoarthritis, but conservative operative methods are recommended for younger patients. Joint congruity is judged good for the hip joint in which the joint surface of the femoral head is parallel to the acetabular joint surface. In the case of an incongruent hip joint, the load concentrates and becomes larger per unit area of the joint. Joint incongruence is found in the early or advanced stage of the hip osteoarthritis. The femoral osteotomy should be performed when joint congruity is improved in the hip abduction or adduction position. Walking exercise begins 2 or 3 days postoperatively, and passive motion exercise is performed as soon as possible. Weight bearing on the operated hip should be limited for the protection of the joint cartilage. In the case of preserving joint space preoperatively, walking with a single crutch is allowed 2 or 3 months after the operation. If there was no or only a narrow joint space before the operation, it is recommended that two crutches be retained for 6 months and that one crutch then be used for another 6 months. Good results in clinical and radiological findings are maintained in 80% or more 10 years after the operation.