Pelvic version and kinematics in patients with total hip arthroplasty: a scoping review of current classification systems and recommendations based on spinal alignment

Aims Total hip arthroplasty (THA) failure occurs more frequently in patients with abnormal pelvic version and kinematics, as these individuals are at greater risk of impingement and dislocation. This scoping review summarizes current classification systems for hip-spine and spine-hip issues in THA, defines specific patterns of pelvic version and kinematics, and integrates recommendations to optimize outcomes. Methods An extensive literature review was carried out in October 2024 on MEDLINE, Cochrane, ProQuest, and PubMed medical databases, reporting classification systems with specific diagnostic recommendations and treatment strategies. The search included articles published in English language from January 2016 until September 2024. Search keywords included ‘Total hip arthroplasty’ or ‘total hip arthroplasty’ in combination with ‘hip-spine’, ‘spine-hip’, ‘lumbopelvic’, ‘spinopelvic‘, ‘pelvic version’, ‘pelvic kinematic’, and ‘pelvic mobility’. Seven eligible articles were selected and analyzed. Results Current hip-spine classifications characterize groups of patients based on specific parameters. Available classifications were summarized in a nomogram illustrating all combinations of pelvic version and kinematics, and that provides recommendations to minimize the risk of complications following THA for each pattern. Specific recommendations are provided for patients with abnormal pelvic version and kinematics. Notably, for patients presenting stiff, stuck-standing, or stuck-standing pelvis, the surgeon should increase cup inclination and anteversion and also consider an anti-dislocation implant design and offset femoral component. Conversely, if lumbopelvic mismatch is present in stiff, stuck-sitting patients, cup anteversion must be reduced. Conclusion This review provides an integrated and comprehensive overview of the current literature on spinopelvic issues in THA patients. It highlights the complexity of the issue and the need for a unified understanding of the different classifications. The review also provides robust and consistent recommendations for managing patients with abnormal pelvic version and kinematics. Further studies are required to validate the efficacy of the recommendations proposed by current available classification systems.