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01-09-2018 | Original Article

Radiological severity of hip osteoarthritis in patients with adult spinal deformity: the effect on spinopelvic and lower extremity compensatory mechanisms

Authors: Louis M. Day, Edward M. DelSole, Bryan M. Beaubrun, Peter L. Zhou, John Y. Moon, Jared C. Tishelman, Jonathan M. Vigdorchik, Ran Schwarzkopf, Renaud Lafage, Virginie Lafage, Themistocles Protopsaltis, Aaron J. Buckland

Published in: European Spine Journal | Issue 9/2018

Abstract

Purpose

Sagittal spinal deformity (SSD) patients utilize pelvic tilt (PT) and their lower extremities in order to compensate for malalignment. This study examines the effect of hip osteoarthritis (OA) on compensatory mechanisms in SSD patients.

Methods

Patients ≥ 18 years with SSD were included for analysis. Spinopelvic, lower extremity, and cervical alignment were assessed on standing full-body stereoradiographs. Hip OA severity was graded by Kellgren–Lawrence scale (0–4). Patients were categorized as limited osteoarthritis (LOA: grade 0–2) and severe osteoarthritis (SOA: grade 3–4). Patients were matched for age and T1-pelvic angle (TPA). Spinopelvic [sagittal vertical axis (SVA), T1-pelvic angle, thoracic kyphosis (TK), pelvic tilt (PT), lumbar lordosis (LL), pelvic incidence minus lumbar lordosis (PI-LL), T1-spinopelvic inclination (T1SPi)] and lower extremity parameters [sacrofemoral angle, knee angle, ankle angle, posterior pelvic shift (P. Shift), global sagittal axis (GSA)] were compared between groups using independent sample t test.

Results

136 patients (LOA = 68, SOA = 68) were included in the study. SOA had less pelvic tilt (p = 0.011), thoracic kyphosis (p = 0.007), and higher SVA and T1Spi (p < 0.001) than LOA. SOA had lower sacrofemoral angle (p < 0.001) and ankle angle (p = 0.043), increased P. Shift (p < 0.001) and increased GSA (p < 0.001) compared to LOA. There were no differences in PI-LL, LL, knee angle, or cervical alignment (p > 0.05).

Conclusions

Patients with coexisting spinal malalignment and SOA compensate by pelvic shift and thoracic hypokyphosis rather than PT, likely as a result of limited hip extension secondary to SOA. As a result, SOA had worse global sagittal alignment than their LOA counterparts.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Title: Radiological severity of hip osteoarthritis in patients with adult spinal deformity: the effect on spinopelvic and lower extremity compensatory mechanisms
Authors: Louis M. Day
Edward M. DelSole
Bryan M. Beaubrun
Peter L. Zhou
John Y. Moon
Jared C. Tishelman
Jonathan M. Vigdorchik
Ran Schwarzkopf
Renaud Lafage
Virginie Lafage
Themistocles Protopsaltis
Aaron J. Buckland
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 9/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5509-0

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Radiological severity of hip osteoarthritis in patients with adult spinal deformity: the effect on spinopelvic and lower extremity compensatory mechanisms

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

At a glance: The ONWARDS insulin icodec trials

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Abstract

Purpose

Methods

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Conclusions

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