Relationship between spinal sagittal alignment and acetabular coverage: a patient-matched control study

Fukushima, Kazuhiko; Miyagi, Masayuki; Inoue, Gen; Shirasawa, Eiki; Uchiyama, Katsufumi; Takahira, Naonobu; Takaso, Masashi

doi:10.1007/s00402-018-2992-z

Cited by 39 publications

(39 citation statements)

References 15 publications

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“…We know of no other studies that describe the reversible changes in the pelvis after bilateral PAO. Previous work by Fukushima et al [8] compared the sagittal vertical axis, pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis in patients with acetabular dysplasia (defined by LCEA < 20°) and patients with symptomatic labral tears. They found a higher sacral slope and lumbar lordosis in patients with dysplasia and no difference in pelvic tilt between the two study populations.…”

Section: Discussionmentioning

confidence: 99%

“…When the acetabulum is deficient anteriorly, we speculate that patients attempt to compensate for this anterior deficiency by involuntarily increasing their anterior pelvic tilt. Recently, Fukushima et al [8] evaluated radiographic parameters of sagittal alignment in patients with hip pathology and noted an increased lumbar lordosis and sacral slope in patients with acetabular dysplasia when compared with patients with symptomatic labral tears. Matsuyama et al [14] observed a similar pattern with an increase in anterior pelvic tilt and a compensatory hyperlumbar lordosis in patients with bilateral congenital hip dislocation secondary to dysplasia.…”

Section: Introductionmentioning

confidence: 99%

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Does Compensatory Anterior Pelvic Tilt Decrease After Bilateral Periacetabular Osteotomy?

Daley¹,

Nahm

Koueiter

et al. 2019

Clin Orthop Relat Res

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Background The kinetic link among the lumbar spine, pelvic tilt, and the hip has been hypothesized, but this relationship requires further study in acetabular dysplasia. Anecdotal reports suggest that patients may compensate for acetabular dysplasia with an involuntary increase in anterior pelvic tilt; it is not known if this relationship is affected by acetabular reorientation. Questions/purposes (1) Does compensatory pelvic tilt decrease on preoperatively obtained standing AP pelvis radiographs compared with those obtained at a minimum of 6 months after bilateral periacetabular osteotomy (PAO)? (2) Does a modified surrogate measurement of pelvic tilt, the pubic symphysis to sacroiliac (PS-SI) index, correlate with a physical synthetic bones model in which pelvic tilt can be directly measured? (3) Can the PS-SI index demonstrate high interrater reliability? Methods We assessed the surgical records of one surgeon, who participates in the longitudinally maintained Academic Network of Conservational Hip Outcomes Research (AN-CHOR) registry, for patients who had undergone the second side of a staged bilateral PAO between 2007 and 2016; there were 113 such patients. Of those, 70 (62%) were lost to followup within 6 months of the second PAO or did not have adequate imaging studies, and another three (3%) were excluded for prespecified reasons, leaving 40 (35%) for evaluation in this retrospective study. Standing preoperative and most recent postoperative AP pelvis radiographs were used to measure the Tönnis angle, anterior wall index, posterior wall index, lateral center-edge angle, pubis symphysis-tosacrococcygeal junction distance, and the PS-SI index. The most recent radiographs were obtained at a mean of 16 6 6 months after the second PAO. We chose 6 months as the minimum because at this time point, the majority of patients have reached their maximum clinical improvement and are no longer limited by postoperative muscle dysfunction. Statistical analysis was performed using the intraclass correlation coefficient (ICC) for interrater reliability and paired t-tests for assessing change in measurements from pre-to postoperative. Additionally, a model was created using a physical synthetic bones model in which pelvic tilt could be directly measured. This model was secured through bilateral acetabuli on a mount and rotated through 5°increases in One of the authors certifies that he (IZ) has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from OrthoPediatrics (Warsaw, IN, USA), outside this submitted work. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does Compensatory Anterior Pelvic Tilt Decrease After Bilateral Periacetabular Osteotomy?

Daley¹,

Nahm

Koueiter

et al. 2019

Clin Orthop Relat Res

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“…12,13 Theoretically, the acetabular morphology has less impact on the sagittal tilt of the pelvis, while some studies reported that DDH patients tilt the pelvis anteriorly in standing to compensate for insufficient femoral head coverage by the dysplastic acetabulum. [14][15][16] On the other hand, others found a posterior rotation of the pelvis occurring from the supine to the standing position. 17 Controversy remains regarding whether compensation due to insufficient femoral head coverage is accompanied by a postural change in DDH patients.…”

mentioning

confidence: 99%

“…As the dynamics of the spine–pelvis–hip construct, the pelvis is controlled by two hinges, posteriorly the lumbosacral joint and anteriorly the hip joint . Theoretically, the acetabular morphology has less impact on the sagittal tilt of the pelvis, while some studies reported that DDH patients tilt the pelvis anteriorly in standing to compensate for insufficient femoral head coverage by the dysplastic acetabulum . On the other hand, others found a posterior rotation of the pelvis occurring from the supine to the standing position .…”

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confidence: 99%

Posterior Pelvic Tilt From Supine to Standing in Patients With Symptomatic Developmental Dysplasia of the Hip

Tani

Takao

Uemura

et al. 2019

Journal Orthopaedic Research

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Pelvic sagittal inclination (PSI) significantly affects the femoral head coverage by the acetabulum in patients with developmental dysplasia of the hip (DDH), while no reports have quantified PSI in DDH patients in the supine and standing positions. Furthermore, little is known about how PSI changes after periacetabular osteotomies. Herein, PSI in the supine and standing positions was quantified in DDH patients preoperatively and postoperatively. Twenty‐five patients with DDH who had undergone periacetabular osteotomies were analyzed. The preoperative PSI and the PSI 2 years after surgery were measured in the supine and standing positions using the image registration technique between radiographs and computed tomographic images. The percentage of patients who showed PSI changes of more than 10° from the supine to the standing position was quantified. PSI changed 8.2 ± 5.0° posteriorly from the supine to the standing position during the preoperative period. Posterior pelvic tilt of more than 10° was found in nine cases (36%). Two years after periacetabular osteotomies, the postural PSI change was 7.1 ± 3.9° posteriorly. When the preoperative and postoperative PSI values were compared, PSI in the standing position did not differ (p = 0.20). Similarly, the amount of PSI change from the supine to standing position was not significantly different (p = 0.26). In conclusion, posterior pelvic tilt in the standing position was found preoperatively in symptomatic DDH patients, and it remained for 2 years after periacetabular osteotomies. This postural change in PSI does not seem to influence the outcome of periacetabular osteotomy. However, during preoperative planning, surgeons should recognize that acetabular anteversion or anterior acetabular coverage differs between the supine and standing positions in some patients with DDH. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:578–587, 2020

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“…Therefore, DDH patients might develop a compensatory anterior inclination of the pelvis so that an approximation of the acetabular cup for the femoral head can be achieved. Fukushima et al showed that DDH patients with increased PI had higher sacral slope (SS), which was considered to compensate for increased anterior acetabular coverage [ 24 ]. Thus, to increase acetabular coverage, a increased PI may be overdeveloped to provide sufficient sagittal balance in DDH patients.…”

Section: Discussionmentioning

confidence: 99%

The severity of developmental dysplasia of the hip does not correlate with the abnormality in pelvic incidence

Cheng

Huang

Kernkamp

et al. 2020

BMC Musculoskelet Disord

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Background The purpose of this study was to investigate the association between the severity of Developmental dysplasia of the hip (DDH) and the abnormality in pelvic incidence (PI). Methods This was a retrospective study analyzing 53 DDH patients and 53 non-DDH age-matched controls. Computed tomography images were used to construct three-dimensional pelvic model. The Crowe classification was used to classify the severity of DDH. The midpoint of the femoral head centers and sacral endplates were projected to the sagittal plane of the pelvis. The PI was defined as the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting this point to the axis of the femoral heads. Independent sample t-tests were used to compare the differences between the PI of DDH group and the non-DDH controls group. Kendall’s coefficient of concordance was used to determine the correlation between the severity of DDH and PI. Results Patients with DDH had a significantly (p = 0.041) higher PI than the non-DDH controls (DDH 47.6 ± 8.2°, normal 44.2 ± 8.8°). Crowe type I patients had a significantly (p = 0.038) higher PI (48.2 ± 7.6°) than the non-DDH controls. No significant difference between the PI in Crowe type II or III patients and the PI in non-DDH controls were found (Crowe type II, 50.2 ± 9.6°, p = 0.073; Crowe type III, 43.8 ± 7.2°, p = 0.930). No correlation was found between the severity of DDH and the PI (r = 0.091, p = 0.222). Conclusions No correlation was found between the severity of DDH and the PI. The study confirmed that the PI in DDH (Crowe type I) group was higher than that of the non-DDH control group, while the PI does not correlate with the severity of DDH.

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Relationship between spinal sagittal alignment and acetabular coverage: a patient-matched control study

Abstract: The SS and LL were greater in patients with DDH than in patients with hip pain, but without DDH. Patients with DDH might show lumbar hyperlordosis to rotate the pelvis anteriorly, increasing the anterosuperior acetabular coverage.

Cited by 39 publications

References 15 publications

Does Compensatory Anterior Pelvic Tilt Decrease After Bilateral Periacetabular Osteotomy?

Does Compensatory Anterior Pelvic Tilt Decrease After Bilateral Periacetabular Osteotomy?

Posterior Pelvic Tilt From Supine to Standing in Patients With Symptomatic Developmental Dysplasia of the Hip

The severity of developmental dysplasia of the hip does not correlate with the abnormality in pelvic incidence

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