S2 alar-iliac screw loosening as a preventive factor for hip joint osteoarthritis after adult spinal deformity surgery: a case–control study

Kozaki, Takuhei; Hashizume, Hiroshi; Taniguchi, Takaya; Nishiyama, Daisuke; Iwasaki, Hiroshi; Tsutsui, Shunji; Takami, Masanari; Nagata, Keiji; Fukui, Daisuke; Yamanaka, Manabu D.; Tamai, Hidenobu; Taiji, Ryo; Murata, Shizumasa; Oka, Hiroyuki; Yamada, Hiroshi

doi:10.1007/s00586-022-07344-2

Cited by 9 publications

(13 citation statements)

References 25 publications

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“…This study revealed that the DSIF model increased stress and angular motion at the hip joint more than the other models. Previous radiographic 8,10 and biomechanical 9,16 studies have reported that adult spinal deformity surgery influences the hip joint. The results of our study support these previous findings and suggest that more rigid fixation of the pelvis induces additional stress on the hip joint, which may precipitate or accelerate adjacent joint disease.…”

Section: Discussionmentioning

confidence: 99%

“…The bone mineral density was 1039 (mg/cm 2 ), z -score was −1.1, and t -score was −1.1. The participant represented a healthy model to eliminate the influence of the other risk factors, for example, pre-existing hip OA, malalignment of the spine, and autofusion of the sacroiliac joint 10 …”

Section: Methodsmentioning

confidence: 99%

“…Although spinopelvic fixation may reduce the incidence of distal junctional problems, hip pathology is sometimes observed after spinal fusion surgery with sacroiliac joint fixation 8 . The causative mechanism was thought to be the progression of adjacent joint disease after spinopelvic fixation 8–10 . It is postulated that the risk for adjacent joint disease at the hip and progression of hip osteoarthritis (OA) increases with increasing rigidity of pelvic fixation.…”

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confidence: 99%

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Effect of Lumbar Fusion and Pelvic Fixation Rigidity on Hip Joint Stress

Kozaki

Mell

Samartzis

et al. 2023

Spine

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Study Design. This study compared hip stress among different types of lumbopelvic fusion based on finite element (FE) analysis. Objective. We believe that the number and placement of S2 AI screws, and whether the screws loosen likely influence hip joint stress in the finite element model. Summary of Background Data. Spinopelvic fixation hs been shown to increase the risk of progression for hip joint osteoarthritis. The biomechanical mechanism is not well understood. We hypothesize that the rigid pelvic fixation may induce stress at adjacent joints. Methods. A three-dimensional nonlinear FE model was constructed from the L4 vertebra to the femoral bone. From the intact model, we made four fusion models, each with different lower vertebrae instrumentation: 1) L4-S1 fusion; 2) L4-S2 AI screw fixation; 3) L4-S2 AI screw fixation with S2 AI screw loosening; and 4) L4-S1 and dual AI screw fixation (DSIF). A compressive load of 400 N was applied vertically to the L4 vertebra, followed by an additional 10 Nm bending moment about different axes to simulate either flexion, extension, left lateral bending, or right axial rotation. The distal femoral bone was completely restrained. von Mises stress and angular motion were analyzed across the hip joints within each fusion construct model. Results. Hip joint cartilage stress, and range of motion increased for all postures as pelvic fixation became more rigid. The DSIF model increased stress and angular motion at the hip joint more than SIF model. Our results suggest that more rigid fixation of the pelvis induces additional stress on the hip joint, which may precipitate or accelerate adjacent joint disease. Conclusion. Dual sacral AI fixation led to the highest stress, while loosening of S2 AI decreased stress on the hip joint. This study illustrates that more rigid fixation among lumbosacral fusion constructs increases biomechanical stress on the hip joints.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Lumbar Fusion and Pelvic Fixation Rigidity on Hip Joint Stress

Kozaki

Mell

Samartzis

et al. 2023

Spine

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“…Similarly, hip joint pain after spinal fusion surgery has been reported [ 13 ]. A radiological study reported that sacroiliac joint fixation in adult spinal long fusion surgery decreased the hip joint cartilage in one-year follow-up study [ 3 ] and the prevalence was 10.0% in mean 50 months of follow-up study [ 14 , 15 ]. The pathology was thoght to be the AJD.…”

Section: Discussionmentioning

confidence: 99%

Spinopelvic fusion surgery from lower thoracic spine to pelvis increased hip joint moment–motion analysis

et al. 2022

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Purpose Spinal fusion surgery is often performed with pelvic fixation to prevent distal junctional kyphosis. The inclusion of spinopelvic fixation has been reported to induce progression of hip joint arthropathy in a radiographic follow-up study. However, its biomechanical mechanism has not yet been elucidated. This study aimed to compare the changes in hip joint moment before and after spinal fusion surgery. Methods This study was an observational study and included nine patients (eight women and one man) who were scheduled to undergo spinopelvic fusion surgery. We calculated the three-dimensional external joint moments of the hip during gait, standing, and climbing stairs before and 1 year after surgery. Results During gait, the maximum extension moment was 0.51 ± 0.29 and 0.63 ± 0.40 before and after spinopelvic fusion surgery ( p = 0.011), and maximum abduction moment was 0.60 ± 0.33 and 0.83 ± 0.34 before and after surgery ( p = 0.004), respectively. During standing, maximum extension moment was 0.76 ± 0.32 and 1.04 ± 0.21 before and after spinopelvic fusion surgery ( p = 0.0026), and maximum abduction moment was 0.12 ± 0.20 and 0.36 ± 0.22 before and after surgery ( p = 0.0005), respectively. During climbing stairs, maximum extension moment was − 0.31 ± 0.30 and − 0.48 ± 0.15 before and after spinopelvic fusion surgery ( p = 0.040), and maximum abduction moment was 0.023 ± 0.18 and − 0.02 ± 0.13 before and after surgery ( p = 0.038), respectively. Conclusion This study revealed that hip joint flexion–extension and abduction–adduction moments increased after spinopelvic fixation surgery in the postures of standing, walking, and climbing stairs. The mechanism was considered to be adjacent joint disease after spinopelvic fusion surgery including sacroiliac joint fixation.

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“…Spinal fusion surgery has several issues. Recently, several studies reported that adjacent joint disease on hip joint is a complication after spinal fusion surgery [1][2][3] . We encountered two cases of hip osteoarthritis (HOA) with acetabular rim fractures after spinal fusion surgery.…”

mentioning

confidence: 99%