A case report of the usefulness of lumbar pelvic motionin the sagittal plane for perceptual leg length differenceafter total hip arthroplasty: a case discussion and hypothesis generation
[Objective] To investigate the usefulness of lumbar pelvic motion in the sagittal plane for perceptual leg length difference (PLLD) after total hip arthroplasty (THA) based on a case study. [Case presentation] A female patient in her 60s with end-stage left hip osteoarthritis who presented with pain...
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| Published in | Annual Report of The Miyagi Physical Therrapy Association(rigaku ryoho no ayumi) Vol. 36; no. 1; pp. 58 - 61 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Miyagi Chapter of Japanese Physical Therapy Association
2025
公益社団法人 日本理学療法士協会宮城県理学療法士会 |
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| Online Access | Get full text |
| ISSN | 0917-2688 1882-1464 |
| DOI | 10.11342/mpta.36.58 |
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| Abstract | [Objective] To investigate the usefulness of lumbar pelvic motion in the sagittal plane for perceptual leg length difference (PLLD) after total hip arthroplasty (THA) based on a case study. [Case presentation] A female patient in her 60s with end-stage left hip osteoarthritis who presented with pain and decreased gait function underwent left THA. Prominent PLLD, pain, and limited hip internal rotation range of motion were observed postoperatively on day 3. Thus, in addition to the usual physical therapy, intervention focused on trunk lateral flexion exercises was performed. Her pain and hip adduction range of motion improved postoperatively on day 8; however, her pelvic lateral tilt to the side of the surgery, lumbar kyphosis and posterior pelvic tilt range of motion in the sitting position were limited, and PLLD persisted. [Progress] The intervention method was changed to trunk flexion and extension exercises in the sagittal plane in addition to the usual physical therapy, on postoperative day 9. The patient’s pelvic lateral tilt and PLLD improved, and the mobility of herlumbar kyphosis and pelvic tilt in the sitting position increased postoperatively on day 14. [Conclusion] Lumbar pelvic motion in the sagittal plane may be useful in dealing with patients with PLLD post-THA. |
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| AbstractList | [Objective] To investigate the usefulness of lumbar pelvic motion in the sagittal plane for perceptual leg length difference (PLLD) after total hip arthroplasty (THA) based on a case study. [Case presentation] A female patient in her 60s with end-stage left hip osteoarthritis who presented with pain and decreased gait function underwent left THA. Prominent PLLD, pain, and limited hip internal rotation range of motion were observed postoperatively on day 3. Thus, in addition to the usual physical therapy, intervention focused on trunk lateral flexion exercises was performed. Her pain and hip adduction range of motion improved postoperatively on day 8; however, her pelvic lateral tilt to the side of the surgery, lumbar kyphosis and posterior pelvic tilt range of motion in the sitting position were limited, and PLLD persisted. [Progress] The intervention method was changed to trunk flexion and extension exercises in the sagittal plane in addition to the usual physical therapy, on postoperative day 9. The patient’s pelvic lateral tilt and PLLD improved, and the mobility of herlumbar kyphosis and pelvic tilt in the sitting position increased postoperatively on day 14. [Conclusion] Lumbar pelvic motion in the sagittal plane may be useful in dealing with patients with PLLD post-THA. [Objective] To investigate the usefulness of lumbar pelvic motion in the sagittal plane for perceptual leg length difference (PLLD) after total hip arthroplasty (THA) based on a case study. [Case presentation] A female patient in her 60s with end-stage left hip osteoarthritis who presented with pain and decreased gait function underwent left THA. Prominent PLLD, pain, and limited hip internal rotation range of motion were observed postoperatively on day 3. Thus, in addition to the usual physical therapy, intervention focused on trunk lateral flexion exercises was performed. Her pain and hip adduction range of motion improved postoperatively on day 8; however, her pelvic lateral tilt to the side of the surgery, lumbar kyphosis and posterior pelvic tilt range of motion in the sitting position were limited, and PLLD persisted. [Progress] The intervention method was changed to trunk flexion and extension exercises in the sagittal plane in addition to the usual physical therapy, on postoperative day 9. The patient’s pelvic lateral tilt and PLLD improved, and the mobility of herlumbar kyphosis and pelvic tilt in the sitting position increased postoperatively on day 14. [Conclusion] Lumbar pelvic motion in the sagittal plane may be useful in dealing with patients with PLLD post-THA. 【目的】人工股関節全置換術（以下，THA）後の自覚的脚長差（以下，PLLD）に対する矢状面上の腰椎骨盤運動の有用性ついて症例考察から仮説を生成する。【症例紹介】症例は末期左変形性股関節症にて，左THA を施行した60代女性である。術後3日目に股関節内転可動域制限と疼痛とともに，著明なPLLD を認めたために，通常理学療法に加え，体幹側屈運動中心に介入を実施した。術後8日目には，疼痛，股関節内転可動域制限は改善したものの，術側への骨盤側方傾斜，座位における腰椎後弯と骨盤後傾の可動域制限，そしてPLLD は残存したままであった。【経過】術後9日目より，通常理学療法に加え，矢状面上の体幹屈伸運動を開始した。術後14日目には骨盤側方傾斜の改善，座位における腰椎後弯と骨盤後傾の可動性拡大，そして，PLLD の改善が得られた。【結論】矢状面上の腰椎骨盤運動はPLLD を有するTHA 後の患者への対応として有用となる可能性がある。 |
| Author | Suzuki, Yusuke Ito, Kosuke Shiraishi, Ayaka Tsunematsu, Hiroshi |
| Author_FL | 伊東 宏佑 鈴木 佑介 白石 彩佳 常松 大志 |
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| DocumentTitle_FL | 人工股関節全置換術後の自覚的脚長差に対する矢状面上の腰椎骨盤運動の有用性について症例考察から仮説生成を行った1症例 |
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| References | 25) Schwab FJ, Blondel B, et al.: International Spine Study Group (ISSG). Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 2013; 38(13): E803-812. 26) Souza TR, Almeida RP, et al.: Pelvic sagittal torsion caused by induced leg length discrepancy: geometrical illusion may influence measures based on superior-iliac spines positions. J Manipulative Physiol Ther 2021; 44(2): 128-136. 27) Balci A, Kocahan T, et al.: The immediate effect of simulating leg-length discrepancy on spinal posture and pelvic position: a cross-over designedstudy. Res Sports Med 2022; 22: 1-11. 5) Hammett T, Simonian A, et al.: Changes in physical activity after total hip or knee arthroplasty: a systematic review and metaanalysis of six- and twelve-month outcomes. Arthritis Care Res (Hoboken) 2018; 70(6): 892-901. 4) 一般社団法人日本人工関節学会: 人工関節登録調査集計（2021年度報告書）．https://jsra.info/data/pdf/report-2021.pdf（2023 年11月29日参照） 22) Rothenfluh DA, Mueller DA, et al.: Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J 2015; 24(6): 1251-1258. 8) Alzahrani MM, Smith K, et al.: Primary total hip arthroplasty: equivalent outcomes in low and high functioning patients. J Am Acad Orthop Surg 2016; 24(11): 814-822. 19) Pheasant MS, Coulter JL, et al.: Lumbar spine fusion and symptoms of leg length discrepancy after hip arthroplasty. J Arthroplasty 2021; 36(9): 3241-3247. 21) Nakanowatari T, Suzukamo Y, et al.: The effectiveness of specific exercise approach or modifiable heel lift in the treatment of functional leg length discrepancy in early postsurgery inpatients after total hip arthroplasty: a randomized controlled trial with a PROBE design. Phys Ther Res 2016; 19(1): 39-49. 24) Ike H, Dorr LD, et al.: Spine-pelvis-hip relationship in the functioning of a total hip replacement. J Bone Joint Surg Am 2018; 100(18): 1606-1615. 1) Yoshimura N, Campbell L, et al.: Acetabular dysplasia and hip osteoarthritis in Britain and Japan. Br J Rheumatol 1998; 37(11): 1193-1197. 16) Kawabata Y, Kimura M: Relationship of early postoperative perceived leg length discrepancy to the progression of osteoarthritis in the contralateral hip after unilateral total hip arthroplasty-a retrospective cohort study using propensity score matching. J Phys Ther Sci 2023; 35(4): 300-305. 17) Koga D, Jinno T, et al.: The effect of preoperative lateral flexibility of the lumbar spine on perceived leg length discrepancy after total hip arthroplasty. J Med Dent Sci 2009; 56(1): 69-77. 15) Waibel FWA, Berndt K, et al.: Symptomatic leglength discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res 2021; 107(1): 102761. 14) Iversen MD, Chudasama N, et al.: Influence of selfreported limb length discrepancy on function and satisfaction 6 years after total hip replacement. J Geriatr Phys Ther 2011; 34(3): 148-152. 6) Fujita K, Makimoto K, et al.: Three-year followup study of health related QOL and lifestyle indicators for Japanese patients after total hip arthroplasty. J Orthop Sci 2016; 21(2): 191-198. 7) Mills K, Falchi B, et al.: Minimal change in physical activity after lower limb joint arthroplasty, but the outcome measure may be contributing to the problem: a systematic review and meta-analysis. Physiotherapy 2019; 105(1): 35-45. 12) Iwakiri K, Ohta Y, et al.: Changes in patientperceivedleg length discrepancy following total hip arthroplasty. Eur J Orthop Surg Traumatol 2021; 31(7): 1355-1361. 3) Hasegawa M, Morikawa M, et al.: Population-based prevalence of femoroacetabular impingement in Japan. Mod Rheumatol 2021; 31(4): 899-903. 20) Nakashima H, Yukawa Y, et al.: Extension CT scan: its suitability for assessing fusion after posterior lumbar interbody fusion. Eur Spine J 2011; 20(9): 1496-1502. 11) Wylde V, Whitehouse SL, et al.: Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop 2009; 33(4): 905-909. 23) Kim Y, Vergari C, et al.: The Impact of Hip Mobility on Lumbar and Pelvic Mobility before and after Total Hip Arthroplasty. J Clin Med 2022; 12(1): 331. 13) Mahmood SS, Mukka SS, et al.: The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty 2015; 30(9): 1638-1642. 9) Grzesiak A, Aminian K, et al.: Total hipreplacement with a collarless polished cemented anatomic stem: clinical and gait analysis results at ten years follow-up. Int Orthop 2014; 38(4): 717-724. 10) Konyves A, Bannister GC: The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg Br 2005; 87(2): 155-157. 28) Brandl A, Egner C, et al.: Practical measurement of changes in leg length discrepancy after a myofascial release on the thoracolumbar fascia in patients with acute low back pain: a pilot study. Cureus 2022; 14(9): e29084. 2) Iidaka T, Muraki S, et al.: Prevalence of radiographic hip osteoarthritis and its association with hip pain in Japanese men and women: the ROAD study. Osteoarthritis Cartilage 2016; 24(1):117-123. 18) Omichi Y, Goto T, et al.: Impact of the hipspinerelationship and patient-perceived leg length discrepancy after total hip arthroplasty: a retrospective study. J Orthop Sci 2023; 11: S0949-2658(23)00088-X. |
| References_xml | – reference: 14) Iversen MD, Chudasama N, et al.: Influence of selfreported limb length discrepancy on function and satisfaction 6 years after total hip replacement. J Geriatr Phys Ther 2011; 34(3): 148-152. – reference: 27) Balci A, Kocahan T, et al.: The immediate effect of simulating leg-length discrepancy on spinal posture and pelvic position: a cross-over designedstudy. Res Sports Med 2022; 22: 1-11. – reference: 10) Konyves A, Bannister GC: The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg Br 2005; 87(2): 155-157. – reference: 20) Nakashima H, Yukawa Y, et al.: Extension CT scan: its suitability for assessing fusion after posterior lumbar interbody fusion. Eur Spine J 2011; 20(9): 1496-1502. – reference: 4) 一般社団法人日本人工関節学会: 人工関節登録調査集計（2021年度報告書）．https://jsra.info/data/pdf/report-2021.pdf（2023 年11月29日参照） – reference: 1) Yoshimura N, Campbell L, et al.: Acetabular dysplasia and hip osteoarthritis in Britain and Japan. Br J Rheumatol 1998; 37(11): 1193-1197. – reference: 17) Koga D, Jinno T, et al.: The effect of preoperative lateral flexibility of the lumbar spine on perceived leg length discrepancy after total hip arthroplasty. J Med Dent Sci 2009; 56(1): 69-77. – reference: 26) Souza TR, Almeida RP, et al.: Pelvic sagittal torsion caused by induced leg length discrepancy: geometrical illusion may influence measures based on superior-iliac spines positions. J Manipulative Physiol Ther 2021; 44(2): 128-136. – reference: 6) Fujita K, Makimoto K, et al.: Three-year followup study of health related QOL and lifestyle indicators for Japanese patients after total hip arthroplasty. J Orthop Sci 2016; 21(2): 191-198. – reference: 7) Mills K, Falchi B, et al.: Minimal change in physical activity after lower limb joint arthroplasty, but the outcome measure may be contributing to the problem: a systematic review and meta-analysis. Physiotherapy 2019; 105(1): 35-45. – reference: 3) Hasegawa M, Morikawa M, et al.: Population-based prevalence of femoroacetabular impingement in Japan. Mod Rheumatol 2021; 31(4): 899-903. – reference: 18) Omichi Y, Goto T, et al.: Impact of the hipspinerelationship and patient-perceived leg length discrepancy after total hip arthroplasty: a retrospective study. J Orthop Sci 2023; 11: S0949-2658(23)00088-X. – reference: 25) Schwab FJ, Blondel B, et al.: International Spine Study Group (ISSG). Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 2013; 38(13): E803-812. – reference: 22) Rothenfluh DA, Mueller DA, et al.: Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J 2015; 24(6): 1251-1258. – reference: 24) Ike H, Dorr LD, et al.: Spine-pelvis-hip relationship in the functioning of a total hip replacement. J Bone Joint Surg Am 2018; 100(18): 1606-1615. – reference: 21) Nakanowatari T, Suzukamo Y, et al.: The effectiveness of specific exercise approach or modifiable heel lift in the treatment of functional leg length discrepancy in early postsurgery inpatients after total hip arthroplasty: a randomized controlled trial with a PROBE design. Phys Ther Res 2016; 19(1): 39-49. – reference: 16) Kawabata Y, Kimura M: Relationship of early postoperative perceived leg length discrepancy to the progression of osteoarthritis in the contralateral hip after unilateral total hip arthroplasty-a retrospective cohort study using propensity score matching. J Phys Ther Sci 2023; 35(4): 300-305. – reference: 13) Mahmood SS, Mukka SS, et al.: The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty 2015; 30(9): 1638-1642. – reference: 2) Iidaka T, Muraki S, et al.: Prevalence of radiographic hip osteoarthritis and its association with hip pain in Japanese men and women: the ROAD study. Osteoarthritis Cartilage 2016; 24(1):117-123. – reference: 12) Iwakiri K, Ohta Y, et al.: Changes in patientperceivedleg length discrepancy following total hip arthroplasty. Eur J Orthop Surg Traumatol 2021; 31(7): 1355-1361. – reference: 28) Brandl A, Egner C, et al.: Practical measurement of changes in leg length discrepancy after a myofascial release on the thoracolumbar fascia in patients with acute low back pain: a pilot study. Cureus 2022; 14(9): e29084. – reference: 8) Alzahrani MM, Smith K, et al.: Primary total hip arthroplasty: equivalent outcomes in low and high functioning patients. J Am Acad Orthop Surg 2016; 24(11): 814-822. – reference: 19) Pheasant MS, Coulter JL, et al.: Lumbar spine fusion and symptoms of leg length discrepancy after hip arthroplasty. J Arthroplasty 2021; 36(9): 3241-3247. – reference: 11) Wylde V, Whitehouse SL, et al.: Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop 2009; 33(4): 905-909. – reference: 5) Hammett T, Simonian A, et al.: Changes in physical activity after total hip or knee arthroplasty: a systematic review and metaanalysis of six- and twelve-month outcomes. Arthritis Care Res (Hoboken) 2018; 70(6): 892-901. – reference: 23) Kim Y, Vergari C, et al.: The Impact of Hip Mobility on Lumbar and Pelvic Mobility before and after Total Hip Arthroplasty. J Clin Med 2022; 12(1): 331. – reference: 9) Grzesiak A, Aminian K, et al.: Total hipreplacement with a collarless polished cemented anatomic stem: clinical and gait analysis results at ten years follow-up. Int Orthop 2014; 38(4): 717-724. – reference: 15) Waibel FWA, Berndt K, et al.: Symptomatic leglength discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res 2021; 107(1): 102761. |
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| SubjectTerms | Lumbar pelvic motion in the sagittal plane Perceptual Leg Length Discrepancy Total Hip Arthroplasty 人工股関節全置換術 矢状面上腰椎骨盤運動 自覚的脚長差 |
| Title | A case report of the usefulness of lumbar pelvic motionin the sagittal plane for perceptual leg length differenceafter total hip arthroplasty: a case discussion and hypothesis generation |
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