Association between acetabular dysplasia and sagittal spino-pelvic alignment in a population-based cohort in Japan

Harada, Teiji; Hashizume, Hiroshi; Taniguchi, Takaya; Iidaka, Toshiko; Asai, Yoshiki; Oka, Hiroyuki; Muraki, Shigeyuki; Akune, Toru; Kawaguchi, Hiroshi; Nakamura, Kozo; Yoshida, Munehito; Tanaka, Sakae; Yoshimura, Nagahisa; Yamada, Hiroshi

doi:10.1038/s41598-022-16865-1

Cited by 7 publications

(5 citation statements)

References 20 publications

(17 reference statements)

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“…A close relationship between degenerative conditions of the hip and spine was already described by Offerski and MacNab as early as 1983 [24]. Harada et al recently conducted a study investigating spinopelvic alignment in patients with hip dysplasia and found that patients with this condition had a significantly higher pelvic incidence (PI) than patients without [25]. Abola et al showed, in a cadaver study, that a high PI was associated with changes in sacral anatomy, which subsequently also affected the sacroiliac joint [26].…”

Section: Discussionmentioning

confidence: 84%

Clustered Occurrence of Osteitis Condensans Ilii in Patients with Symptomatic Hip Dysplasia

et al. 2023

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Background: Osteitis condensans ilii (OCI) is a relatively rare benign disease of the lower anterior sacroiliac joint (SIJ) region that can cause symptoms such as low back pain (LBP), lateral hip pain and nonspecific hip or thigh pain. Its exact pathoetiology remains to be clarified. The aim of this study is to determine the prevalence of OCI in patients with symptomatic developmental dysplasia of the hip (DDH) undergoing periacetabular osteotomy (PAO) to identify potential clustering of OCI in a with altered biomechanics of hip and SIJs. Methods: A retrospective investigation of all patients who underwent periacetabular osteotomy in a tertiary reference hospital from January 2015 to December 2020. Clinical and demographic data were retrieved from the hospital’s internal medical records. Radiographs and magnetic resonance images (MRIs) were reviewed for the presence of OCI. A t-test for independent variables was conducted to identify differences between patients with and without OCI. A binary logistic regression model was established to determine the influence of age, sex and body mass index (BMI) on the presence of OCI. Results: The final analysis included 306 patients (81% female). In 21.2% of the patients (f: 22.6%; m: 15.5%), OCI was present. BMI was significantly higher in patients with OCI (23.7 kg/m2 vs. 25.0 kg/m2; p = 0.044). Binary logistic regression revealed that a higher BMI increased the likelihood of sclerosis in typical osteitis condensans locations, OR = 1.104 (95%-CI [1.024, 1.191]), as did female sex, OR = 2.832 (95%-CI [1.091, 7.352]. Conclusions: Our study revealed a considerably higher prevalence of OCI in patients with DDH than in the general population. Furthermore, BMI was shown to have an influence on the occurrence of OCI. These results support the theory that OCI is attributable to altered mechanical loading of the SIJs. Clinicians should be aware that OCI is common in patients with DDH and a potential cause of LBP, lateral hip pain and nonspecific hip or thigh pain.

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Section: Discussionmentioning

confidence: 84%

Clustered Occurrence of Osteitis Condensans Ilii in Patients with Symptomatic Hip Dysplasia

et al. 2023

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“…Although patients with a high PI may experience a similar pathophysiology as those with acetabular dysplasia, recent studies have found they are not significantly associated. 17 While outside the scope of the present study, the contributions of acetabular and/or femoral version are similarly becoming increasingly recognized as important factors in patients with FAI. 1,30 Cumulatively, these findings indicate that the hip should not be treated in isolation, but rather in conjunction with the entire spinopelvic complex.…”

Section: Discussionmentioning

confidence: 92%

The Effect of Pelvic Incidence on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears

Torabian,

Cherian,

Eberlin

et al. 2024

Am J Sports Med

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Background: In the setting of femoroacetabular impingement (FAI), decompression osteoplasties reconcile deleterious loading patterns caused by cam and pincer lesions. However, native variations of spinopelvic sagittal alignment may continue to perpetuate detrimental effects on the labrum, chondrolabral junction, and articular cartilage after hip arthroscopy. Purpose: To evaluate the effect of pelvic incidence (PI) on postoperative outcomes after hip arthroscopy for acetabular labral tears in the setting of FAI. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective query of prospectively collected data identified patients ≥18 years of age who underwent primary hip arthroscopy for FAI and acetabular labral tears between February 2014 and January 2022, with 3-, 6-, 12-, and 24-month follow-ups. Measurements for PI, pelvic tilt (PT), sacral slope (SS), and acetabular version were obtained via advanced diagnostic imaging. Patients were stratified into low-PI (<45°), moderate-PI (45°≤ PI ≤ 60°), and high-PI (>60°) cohorts. Patient-reported outcome measures (PROMs), clinically meaningful outcomes (ie, minimal clinically important difference, Patient Acceptable Symptom State, substantial clinical benefit, and maximal outcome improvement), visual analog scale (VAS) pain scores, and patient satisfaction were compared across cohorts. Results: A total of 74 patients met eligibility criteria and were stratified into low-PI (n = 28), moderate-PI (n = 31), and high-PI (n = 15) cohorts. Correspondingly, patients with high PI displayed significantly greater values for PT ( P = .001), SS ( P < .001), acetabular version ( P < .001), and acetabular inclination ( P = .049). By the 12- and 24-month follow-ups, the high-PI cohort was found to have significantly inferior PROMs, VAS pain scores, rates of clinically meaningful outcome achievement, and satisfaction relative to patients with moderate and/or low PI. No significant differences were found between cohorts regarding rates of revision arthroscopy, subsequent spine surgery, or conversion to total hip arthroplasty. Conclusion: After hip arthroscopy, patients with a high PI (>60°) exhibited inferior PROMs, rates of achieving clinically meaningful thresholds, and satisfaction at 12 and 24 months relative to patients with low or moderate PI. Conversely, the outcomes of patients with low PI (<45°) were found to match the trajectory of those with a neutral spinopelvic alignment (45°≤ PI ≤ 60°). These findings highlight the importance of analyzing spinopelvic parameters preoperatively to prognosticate outcomes before hip arthroscopy for acetabular labral tears and FAI.

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“…The effect of PT on acetabular orientation has recently received great attention [ 34–36 ]. Studies suggest that patients with dysplasia have increased lumbar lordosis and sacral slope, leading to an increase in anterior coverage [ 17 , 37 , 38 ]. Differences in PT affect joint contact pressure and may thereby influence joint degeneration [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Does pelvic tilt change with a peri-acetabular osteotomy?

Verhaegen,

Dedeoğulları,

Horton

et al. 2023

Journal of Hip Preservation Surgery

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Change in pelvic tilt (PT) during and after peri-acetabular osteotomy (PAO) is important for surgical planning. The aims of this study were to (i) determine how PT varies throughout the course of treatment in patients undergoing PAO, (ii) test what factors influence the change in PT and (iii) assess whether changes in PT influenced achieved correction. This is an retrospective, single-centre, consecutive case series of 111 patients treated with PAO for global (n = 79), posterior (n = 49) or anterior dysplasia (n = 6) (mean age: 27.3 ± 7.7 years; 85% females). PT was determined on supine, anteroposterior pelvic radiographs pre-, intra-, 1 day, 6 weeks and 1 year post-operatively, using the sacro-femoral-pubic (SFP) angle, a validated, surrogate marker of PT. An optimal acetabular correction was based on the lateral centre-edge angle (25°–40°), acetabular index (−5° to 10°) and cross-over ratio (<20%). There was a significant difference across pre- (70.1° ± 4.8°), 1-day (71.7° ± 4.3°; P < 0.001) and early post-operative SFP (70.6° ± 4.7°; P = 0.004). The difference in SPF between pre-operative and 1-year post-operative was −0.5° ± 3.1° (P = 0.043), with 9% of cases having a difference of >5°. The difference in SFP did not correlate with age, sex, body mass index, type of dysplasia or achievement of optimal acetabular correction (P = 0.1–0.9). In the early post-operative period, PT is reduced, leading to a relative appearance of acetabular retroversion, which gradually corrects and is restored by annual follow-up. The degree of change in PT during PAO did not adversely affect fragment orientation. PT does not significantly change in most patients undergoing PAO and therefore does not appear to be a compensatory mechanism.

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Association between acetabular dysplasia and sagittal spino-pelvic alignment in a population-based cohort in Japan

Cited by 7 publications

References 20 publications

Clustered Occurrence of Osteitis Condensans Ilii in Patients with Symptomatic Hip Dysplasia

Clustered Occurrence of Osteitis Condensans Ilii in Patients with Symptomatic Hip Dysplasia

The Effect of Pelvic Incidence on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears

Does pelvic tilt change with a peri-acetabular osteotomy?

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