학술논문
Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity.
Document Type
Academic Journal
Author
Balmaceno-Criss M; Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI.; Lafage R; Department of Orthopedic Surgery, Northwell, New York, NY.; Alsoof D; Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI.; Daher M; Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI.; Hamilton DK; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.; Smith JS; University of Virginia Health System, Charlottesville, VA.; Eastlack RK; San Diego Spine, La Jolla, CA.; Fessler RG; Department of Neurological Surgery, Rush University Medical School, Chicago, IL.; Gum JL; Leatherman Spine Center, Louisville, KY.; Gupta MC; Washington University in St Louis, St. Louis, MO.; Hostin R; Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX.; Kebaish KM; Johns Hopkins University School of Medicine, Baltimore, MD.; Klineberg EO; Department of Orthopaedic Surgery, University of Texas Health, Houston, TX.; Lewis SJ; Division of Orthopaedics, Toronto Western Hospital, Toronto, Canada.; Line BG; Denver International Spine Center, Denver, CO.; Nunley PD; Spine Institute of Louisiana, Shreveport, LA.; Mundis GM; San Diego Spine, La Jolla, CA.; Passias PG; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.; Protopsaltis TS; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.; Buell T; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.; Scheer JK; Department of Neurosurgery, University of California, San Francisco, CA.; Mullin JP; Department of Neurosurgery, University of Buffalo, Buffalo, NY.; Soroceanu A; Department of Orthopedic Surgery, University of Calgary, Calgary, Canada.; Ames CP; Department of Neurosurgery, University of California, San Francisco, CA.; Lenke LG; Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY.; Bess S; Denver International Spine Center, Denver, CO.; Shaffrey CI; Department of Orthopedic Surgery, Duke University, Durham, NC.; Schwab FJ; Department of Orthopedic Surgery, Northwell, New York, NY.; Lafage V; Department of Orthopedic Surgery, Northwell, New York, NY.; Burton DC; Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS.; Diebo BG; Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI.; Daniels AH; Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 7610646 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1159 (Electronic) Linking ISSN: 03622436 NLM ISO Abbreviation: Spine (Phila Pa 1976) Subsets: MEDLINE
Subject
Language
English
Abstract
Study Design: Retrospective review of prospectively collected data.
Objective: To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD).
Background: Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD.
Patients and Methods: In total, 527 preoperative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full-body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation.
Results: The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, and 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment ( P <0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt ( P =0.001) and sacrofemoral angle ( P <0.001), but increased knee flexion ( P =0.012). Regression analysis revealed that with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis ( r2 =0.812). Hip osteoarthritis decreased compensation through sacrofemoral angle (β-coefficient=-0.206). Knee and hip osteoarthritis contributed to greater knee flexion (β-coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model (β-coefficient=0.100).
Conclusions: For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.
Competing Interests: The International Spine Study Group reports the following: grants to the foundation from Medtronic, Globus, Stryker, SI Bone, Carlsmed. The remaining authors report no conflicts of interest.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Objective: To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD).
Background: Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD.
Patients and Methods: In total, 527 preoperative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full-body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation.
Results: The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, and 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment ( P <0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt ( P =0.001) and sacrofemoral angle ( P <0.001), but increased knee flexion ( P =0.012). Regression analysis revealed that with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis ( r2 =0.812). Hip osteoarthritis decreased compensation through sacrofemoral angle (β-coefficient=-0.206). Knee and hip osteoarthritis contributed to greater knee flexion (β-coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model (β-coefficient=0.100).
Conclusions: For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.
Competing Interests: The International Spine Study Group reports the following: grants to the foundation from Medtronic, Globus, Stryker, SI Bone, Carlsmed. The remaining authors report no conflicts of interest.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)