Spinopelvic Compensatory Mechanisms for Reduced Hip Motion (ROM) in the Setting of Hip Osteoarthritis

被引：39

作者：

Buckland, Aaron J. ^{[1
]}

Steinmetz, Leah ^{[1
]}

Zhou, Peter ^{[1
]}

Vasquez-Montes, Dennis ^{[1
]}

Kingery, Matthew ^{[1
]}

Stekas, Nicholas D. ^{[1
]}

Ayres, Ethan W. ^{[1
]}

Varlotta, Christopher G. ^{[1
]}

Lafage, Virginie ^{[2
]}

Lafage, Renaud ^{[2
]}

Errico, Thomas ^{[1
]}

Passias, Peter G. ^{[1
]}

Protopsaltis, Themistocles S. ^{[1
]}

Vigdorchik, Jonathan ^{[1
]}

机构：

[1] NYU Langone Orthoped Hosp, Dept Orthopaed, 301 East 17th St, New York, NY 10003 USA

[2] Hosp Special Surg, Dept Orthopaed, 535 E 70th St, New York, NY 10021 USA

来源：

SPINE DEFORMITY | 2019年 / 7卷 / 06期

关键词：

Hip; Osteoarthritis; Spine; Sagittal spinal balance; Spinopelvic alignment;

D O I：

10.1016/j.jspd.2019.03.007

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study DesignRetrospective review from a single institution.ObjectiveTo investigate the effect of hip osteoarthritis (OA) on spinopelvic compensatory mechanisms as a result of reduced hip range of motion (ROM) between sitting and standing.Summary of Background DataHip OA results in reduced hip ROM and contracture, causing pain during postural changes. Hip flexion contracture is known to reduce the ability to compensate for spinal deformity while standing; however, the effects of postural spinal alignment change between sitting and standing is not well understood.MethodsSit-stand radiographs of patients without prior spinal fusion or hip prosthesis were evaluated. Hip OA was graded by Kellgren-Lawrence grades and divided into low-grade (LOA; grade 0-2) and severe (SOA; grade 3 or 4) groups. Radiographic parameters evaluated were pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), SVA, T1-pelvic angle (TPA), T10-L2, proximal femoral shaft angle (PFSA), and hip flexion (PT change-PFSA change). Changes in sit-stand parameters were compared between LOA and SOA groups.Results548 patients were included (LOA = 311; SOA = 237). After propensity score matching for age, body mass index, and PI, 183 LOA and 183 SOA patients were analyzed. Standing analysis demonstrated that SOA had higher SVA (31.1 vs. 21.7), lower TK (-36.2 vs. -41.1), and larger PFSA (9.1 vs. 7.4) (all p < .05). Sitting analysis demonstrated that SOA had higher PT (29.7 vs. 23.3), higher PI-LL (21.6 vs. 12.4), less LL (31.7 vs. 41.6), less TK (-33.2 vs. -38.6), and greater TPA (27.9 vs. 22.5) (all p < .05). SOA had less hip ROM from standing to sitting versus LOA (71.5 vs. 81.6) (p < .05). Therefore, SOA had more change in PT (15.2 vs. 7.3), PI-LL (20.6 vs. 13.7), LL (-21.4 vs. -13.1), and T10-L2 (-4.9 vs. -1.1) (all p < .001), allowing the femurs to change position despite reduced hip ROM. SOA had greater TPA reduction (15.1 vs. 9.6) and less PFSA change (86.7 vs. 88.8) compared with LOA (both p < .001).ConclusionsSpinopelvic compensatory mechanisms are adapted for reduced hip joint motion associated with hip OA in standing and sitting.Level of EvidenceLevel III.

引用

页码：923 / 928

页数：6

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