TY - JOUR
T1 - Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity
AU - Balmaceno-Criss, Mariah
AU - Lafage, Renaud
AU - Alsoof, Daniel
AU - Daher, Mohammad
AU - Hamilton, David Kojo
AU - Smith, Justin S.
AU - Eastlack, Robert K.
AU - Fessler, Richard G.
AU - Gum, Jeffrey L.
AU - Gupta, Munish C.
AU - Hostin, Richard
AU - Kebaish, Khaled M.
AU - Klineberg, Eric O.
AU - Lewis, Stephen J.
AU - Line, Breton G.
AU - Nunley, Pierce D.
AU - Mundis, Gregory M.
AU - Passias, Peter G.
AU - Protopsaltis, Themistocles S.
AU - Buell, Thomas
AU - Scheer, Justin K.
AU - Mullin, Jeffrey P.
AU - Soroceanu, Alex
AU - Ames, Christopher P.
AU - Lenke, Lawrence G.
AU - Bess, Shay
AU - Shaffrey, Christopher I.
AU - Schwab, Frank J.
AU - Lafage, Virginie
AU - Burton, Douglas C.
AU - Diebo, Bassel G.
AU - Daniels, Alan H.
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/6/1
Y1 - 2024/6/1
N2 - Study Design. Retrospective review of prospectively collected data. Objective. To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD). Background. Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD. Patients and Methods. In total, 527 preoperative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full-body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation. Results. The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, and 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment (P<0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt (P=0.001) and sacrofemoral angle (P<0.001), but increased knee flexion (P=0.012). Regression analysis revealed that with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis (r 2=0.812). Hip osteoarthritis decreased compensation through sacrofemoral angle (β-coefficient=-0.206). Knee and hip osteoarthritis contributed to greater knee flexion (β-coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model (β-coefficient=0.100). Conclusions. For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.
AB - Study Design. Retrospective review of prospectively collected data. Objective. To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD). Background. Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD. Patients and Methods. In total, 527 preoperative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full-body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation. Results. The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, and 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment (P<0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt (P=0.001) and sacrofemoral angle (P<0.001), but increased knee flexion (P=0.012). Regression analysis revealed that with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis (r 2=0.812). Hip osteoarthritis decreased compensation through sacrofemoral angle (β-coefficient=-0.206). Knee and hip osteoarthritis contributed to greater knee flexion (β-coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model (β-coefficient=0.100). Conclusions. For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.
KW - adult spinal deformity
KW - compensation
KW - hip osteoarthritis
KW - knee osteoarthritis
UR - http://www.scopus.com/inward/record.url?scp=85192677271&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004957
DO - 10.1097/BRS.0000000000004957
M3 - Article
C2 - 38375611
AN - SCOPUS:85192677271
SN - 0362-2436
VL - 49
SP - 743
EP - 751
JO - Spine
JF - Spine
IS - 11
ER -