FP14.1 Exploring the Role of Spinopelvic Orientation in Low Back Pain in Patients with Symptomatic Hip Pathologies

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ID: 330959
2026
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Abstract
Abstract ICLA14 - The Extra-Articular Masterclass: Endoscopic Repairs, Ischiofemoral Fixes, and Complex Alignment, Auditorium A (BMCC Level 1), October 9, 2026, 14:00 - 16:00 Purpose Low back pain (LBP) is highly prevalent in patients with hip pain and may be attributable to variations in pelvic orientation. This study aims to assess the relationship of pelvic orientation, hip morphology, and baseline symptoms with LBP. Methods This is a retrospective study of patients with symptomatic femoroacetabular impingement or instability. Demographics, self-reported LBP, and 3D CT radiographic measurements were collected from medical records. Three independent reviewers measured pubic symphysis to sacrococcygeal distance (PSSC) on standing and supine AP pelvis radiographs, and pelvic tilt (PT) and sacral slope (SS) on lateral pelvis radiographs. Pelvic incidence (PI) was calculated as the sum of PT and SS. Independent t-tests were used to compare measurements between patients with and without LBP. Inter-rater reliability was assessed using ICC3k for pelvic radiographic measurements. Results 24 hips in 18 patients met inclusion criteria. ICC3k indicated good-to-excellent reliability. The cohort was majority female (72%) with mean age 30±13 years, and BMI 24.4±5.9 kg/m^2 . Patients with LBP had significantly higher BMI (31.3±4.9 v 22.7±5.0, p=0.019) with no other demographic differences. Patients with LBP exhibited significantly lower acetabular version at 12:00 (3.8 v 12.2, p=0.04), FNSA (128.7 v 134.2, p = 0.043), and greater alpha angles at 12:00 (54.7 v 40.0, p=0.003), 1:00 (55.2 v 46.9, p=0.049), and 3:00 (44.7 v 38.3, p=0.011). Patients with LBP demonstrated mean standing/supine PSSC of 38.0±6.8°/55.0±6.7°, PT 9.5±3.8°, SS 37.4±4.3°, and PI 46.9±5.0°, compared to 43.0±9.1°/53.6±5.6°, 9.3±1.9°, 41.4±5.1°, and 50.7±6.6° in those without LBP, with no significant differences between groups observed (p>0.1). Conclusions Preliminary findings suggest patients with LBP have higher BMI, decreased acetabular version, features associated with coxa vara, and greater alpha angles compared to patients without LBP. Differences may reflect underlying hip pathomorphologies between patients with and without LBP. Cam-predominant FAI and relative acetabular retroversion with reduced posterior coverage may contribute to increased mechanical demand on the sacroiliac joint and lumbar spine, potentially causing and/or exacerbating symptoms of LBP. Future investigation in larger cohorts is warranted to characterize these relationships further.
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Authors Lauren Heylmun, Brianna Rowe, Elizabeth Greenwell, Matthew Hagos, Michael B. Ellman, James Genuario
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.105
URL
https://doi.org/10.1093/jhps/hnag043.105
Keywords Keywords not found

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