Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture

Abstract

Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum.

Inversion of the acetabular labrum causes increased localized contact pressure on the femoral head: a biomechanical study

“…Some researchers [33] have suggested that posterior pelvic tilt may contribute to SIF. However, our research suggests that a 20°posterior pelvic tilt is associated with a mean stress value approximately 1.3-fold higher than normal.…”

Cementless Hip Arthroplasty in Patients with Subchondral Insufficiency Fracture of the Femoral Head

“…Therefore, they might have more frequent complications: dislocation, periprosthetic fracture, and component loosening, and the results after THA might be inferior compared to osteoarthritic patients [34][35][36][37] or osteoporotic patients [43][44][45] . One more concern is late anterior dislocation because SIFFH patients might have progressive kyphosis and excessive posterior pelvic tilt 4,8,46 . Nevertheless, there has been no study reporting the results of THA in SIFFH patients.…”

Artrosis rápidamente progresiva de cadera secundaria a una fractura por insuficiencia subcondral del acetábulo. Reporte de un caso

“…16 No debe dejarse de lado la evaluación por imágenes de la columna, porque la cifosis lumbar degenerativa y otras alteraciones del balance espinopélvico podrían ser factores predisponentes. 17 Sin embargo, en el caso reportado, nuestra paciente no tenía alteraciones en el espinograma.…”