Greater anterior pelvic tilt and lumbar mobility in females compared to males undergoing periacetabular osteotomy: A matched cohort study

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-02-10 DOI:10.1002/jeo2.70167

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

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Abstract

Purpose

The functional hip–spine interaction is increasingly noted in hip preservation by periacetabular osteotomy (PAO), while potentially affecting the impingement-free acetabular reorientation. However, the clinically relevant sex-related differences in lumbopelvic alignment have been poorly studied. Thus, the purpose of this study was to evaluate a matched PAO patient cohort for sex-related differences in lumbopelvic alignment.

Methods

Out of 138 patients undergoing PAO between January 2024 and September 2024 at one high-volume centre, there were 68 data sets (34 male, 34 female) included. The data sets of this diagnostic cohort study were prospectively collected, and the patients were matched in a 1:1 ratio for sex, age and acetabular morphology (hip dysplasia, borderline hip dysplasia, acetabular retroversion). Lumbopelvic alignment was assessed with serial sagittal lumbopelvic radiographs in standing, relaxed-seated and deep-seated positions. Each radiograph was reviewed for pelvic tilt (PT), lumbar lordosis and sacral slope.

Results

Females showed a significantly lower PT in standing (7.8 vs. 14.3°, p < 0.001), relaxed-seated (28.1 vs. 34.9°, p = 0.012) and deep-seated (3.7 vs. 11.0°, p = 0.013) positions. Furthermore, females had a significantly increased lumbar mobility (Δ relaxed-seated − deep-seated position − 35.4° vs. 27.0°, p = 0.003), while there was no sex-related difference in sacral mobility (p > 0.05).

Conclusion

There are sex-related differences in functional lumbopelvic alignment across various positions of daily living in patients undergoing PAO. With a greater anterior PT, females are at risk of an anterior hip impingement. Thus, the intraoperative anterior and posterior wall reorientation by PAO should be adapted to the sex-related lumbopelvic alignment to ensure an impingement-free surgical outcome.

Level of Evidence

Level IV, case series.

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与接受髋臼周围截骨术的男性相比，女性骨盆前倾和腰椎活动度更大：一项匹配的队列研究

目的髋臼周围截骨术（PAO）在髋关节保护中越来越多地注意到功能性髋-脊柱相互作用，同时可能影响无撞击的髋臼重新定位。然而，临床相关的腰盆腔排列性别差异研究甚少。因此，本研究的目的是评估一个匹配的PAO患者队列，以了解腰盆腔排列的性别差异。方法于2024年1月至2024年9月在一个高容量中心接受PAO治疗的138例患者，共纳入68组数据集（男性34例，女性34例）。前瞻性收集本诊断队列研究的数据集，患者按性别、年龄和髋臼形态（髋发育不良、边缘性髋发育不良、髋臼后翻）1:1的比例进行匹配。在站立、放松坐位和深坐位时，通过连续矢状位腰骨盆x线片评估腰骨盆对齐。每张x线片检查骨盆倾斜（PT）、腰椎前凸和骶骨倾斜。结果女性在站立位（7.8°vs. 14.3°，p < 0.001）、放松坐姿（28.1°vs. 34.9°，p = 0.012）和深度坐姿（3.7°vs. 11.0°，p = 0.013）时的PT均显著降低。此外，女性的腰椎活动度显著增加（Δ放松坐姿-深坐姿- 35.4°vs. 27.0°，p = 0.003），而骶骨活动度没有性别差异（p > 0.05）。结论PAO患者在日常生活中不同体位的腰骨盆功能线存在性别差异。如果前路PT较大，女性就有髋前撞击的风险。因此，PAO术中前后壁重新定位应适应与性别相关的腰骨盆对准，以确保无碰撞的手术结果。证据等级4级，案例系列。

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