Lumbopelvic hyperlordosis is linked to higher femoral head coverage, lower femoral anteversion and younger age at periacetabular osteotomy.

IF 3.3 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-01-16 DOI:10.1002/ksa.12587

Maximilian Fischer, Lars Nonnenmacher, Andreas Nitsch, Matthias R Mühler, Alexander Möller, Andre Hofer, Georgi I Wassilew

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Abstract

Purpose: The dynamic alignment of the lumbar spine, pelvis and femur is increasingly studied in hip preservation surgery. However, the interaction between lumbopelvic alignment, acetabular and femoral morphology and its influence on patients' preoperative symptom burden remains poorly understood. The aim of this study was to evaluate whether lumbopelvic malalignment affects osseous hip morphology and exacerbates preoperative patient-reported joint functionality in patients undergoing periacetabular osteotomy (PAO).

Methods: One hundred thirteen patients were prospectively enroled in this single-centre study. Sagittal lumbopelvic radiographs were used to divide the patients in accordance with their lumbopelvic alignment (pelvic incidence [PI]-lumbar lordosis [LL] mismatch) into a balanced (PI-LL: 10° and 10°/n = 60) and unbalanced alignment (PI-LL: <10° and >10°/n = 53) group. Intergroup analyses were performed for acetabular and femoral morphology as well as various patient-reported outcome measures (PROMs) scores (modified Harris-Hip, Hip Osteoarthritis Outcome, International Hip Outcome tool-12 and University of California Los Angeles activity scale).

Results: Patients with concomitant unbalanced lumbopelvic alignment due to hyperlordosis showed higher femoral head coverage and lower femoral anteversion (lateral centre-edge angle 20.2° vs. 15.8°, p = 0.012/anterior wall index 0.47 vs. 0.36, p = 0.001/acetabular inclination 10.2° vs. 13.6°, p = 0.008/Femoral anteversion 21.3° vs. 28.2°, p = 0.041). Furthermore, these patients were significantly younger at the time of PAO (28.7 vs. 32.4 years, p = 0.020), even when there were no intergroup differences in all analyzed PROMs.

Conclusion: Concomitant lumbopelvic deformity affecting the hip joint morphology could aggravate clinical symptoms leading to earlier presentation in patients undergoing PAO. Thus, the lumbopelvic balance needs to be carefully evaluated in clinical decision-making in PAO patients and future research should focus on long-term outcomes of patients with concomitant unbalanced lumbopelvic alignment.

Level of evidence: Level III, prognostic study.

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腰盂前凸与股骨头覆盖面积大、股骨前倾程度低和髋臼周围截骨年龄小有关。

目的：在髋关节保护手术中，腰椎、骨盆和股骨的动态对齐越来越多地被研究。然而，腰盆腔排列、髋臼和股骨形态之间的相互作用及其对患者术前症状负担的影响尚不清楚。本研究的目的是评估腰骨盆错位是否会影响髋臼周围截骨术（PAO）患者的骨性髋关节形态，并加剧患者术前报告的关节功能。方法：这项单中心研究前瞻性纳入了113例患者。采用矢状位腰盂x线片将患者根据腰盂排列（骨盆发生率[PI]-腰椎前凸[LL]不匹配）分为平衡组（PI-LL: 10°和10°/n = 60）和不平衡组（PI-LL: 10°/n = 53）。对髋臼和股骨形态以及各种患者报告的结果测量（PROMs）评分（改良Harris-Hip，髋关节骨关节炎结局，国际髋关节结局工具-12和加州大学洛杉矶分校活动量表）进行组间分析。结果：前凸过大导致腰盂对准不平衡的患者股骨头覆盖率较高，股前倾角较低（外侧中心边缘角20.2°比15.8°，p = 0.012/前壁指数0.47比0.36,p = 0.001/髋臼倾斜度10.2°比13.6°，p = 0.008/股前倾角21.3°比28.2°，p = 0.041）。此外，这些患者在PAO时明显更年轻（28.7岁vs. 32.4岁，p = 0.020），即使所有分析的PROMs没有组间差异。结论：PAO患者伴发影响髋关节形态的腰盂畸形可加重临床症状，导致早期出现。因此，在PAO患者的临床决策中需要仔细评估腰骨盆平衡，未来的研究应关注伴有腰骨盆不平衡的患者的长期预后。证据等级：III级，预后研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).