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This prospective study evaluated two-year changes in LBP (primary clinical endpoint) and radiographic alignment, with global sagittal alignment and spinopelvic alignment defined as primary radiographic endpoints, as well as their associations with postoperative pain and disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective observational cohort study included 197 patients undergoing primary unilateral THA. LBP was assessed using the Numeric Rating Scale (NRS) preoperatively and at two-year follow-up. Standing lateral radiographs evaluated global sagittal alignment (sagittal vertical axis [SVA]) and spinopelvic parameters at both timepoints. The Oswestry Disability Index (ODI) assessed postoperative functional disability. Associations between radiographic alignment parameters and clinical outcomes were examined using univariable and multivariable regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 197 patients enrolled, 144 (73.1%) completed clinical follow-up at a mean of 29.1 months, and 120 had complete clinical and radiographic data. LBP improved significantly from a median NRS score of 5 (IQR 1\u20138) preoperatively to 2 (0\u20134) at two years (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Both SVA and pelvic incidence\u2013lumbar lordosis (PI\u2013LL) difference improved significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038, respectively). In multivariable analysis, preoperative LBP was the strongest predictor of postoperative LBP (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002; \u03b7\u00b2=0.14). Postoperative PI\u2013LL difference (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009) was independently associated with functional disability, whereas SVA showed no significant association with either postoperative LBP (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.422) or functional disability (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.096).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Primary THA was associated with significant improvement in LBP, sagittal and spinopelvic alignment at two years. Preoperative LBP was the strongest predictor of postoperative pain, while postoperative PI-LL difference was independently associated with functional disability at two years. These findings support preoperative spinopelvic assessment for risk stratification and interdisciplinary management in patients with coexisting hip and spine symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-026-10171-4","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T02:01:40Z","timestamp":1783389700000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in low back pain, global sagittal alignment, and spinopelvic parameters following primary total hip arthroplasty: results of a prospective observational study with two-year follow-up"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6597-8348","authenticated-orcid":false,"given":"Tom","family":"Folkerts","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henryk","family":"Haffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abelina","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Muellner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Becker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Hardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Perka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Pumberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"issue":"3","key":"10171_CR1","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1097\/00007632-198304000-00014","volume":"8","author":"CM Offierski","year":"1983","unstructured":"Offierski CM, MacNab I (1983) Hip-spine syndrome. 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CP holds board or committee appointments with the DGOOC, the International Hip Society, the Arbeitsgemeinschaft Endoprothetik, and the AO Recon Steering Board.All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}